Utility of Nestin immunohistochemistry in the diagnosis of granular cell tumor

Abstract

Aim: Granular cell tumors (GCTs) show neuroectodermal differentiation. Morphologically, a wide variety of mesencymal tumors may have granular cell appearance. Nestin, which is an intermediate filament protein expressed in undifferentiated cells during central nerves system development and its tumors. We aim to determine the diagnostic utility of Nestin in diagnosis of GCTs. 

Methods:  Nestin immunohistochemistry applied to GCT cases and other mesenchymal tumors which may have granular cytoplasm and the major differential diagnostic consideration of GCT.  A total of 21 GCT from different tissues (including 7 in the esophagus, 8 originating from skin tissues, 4 in the tongue, 2 in the vocal cord), 17 gastrointestinal stromal tumor  in the gastrointestinal tract, 8 leiomyoma (5 in the esophagus and 3 originating from skin tissues), 4 schwannoma (1 in the esophagus and 3 originating from skin tissues),  subcutaneous mesenchymal tumors ( including 7 neurofibroma, 5 fibroma, 15 dermatofibroma), 20 melanocytic nevi, 15 gastric xanthomas and 15 xanthalesma of the skin were included the study.

Results: Nestin positivity was detected in all GCTs. Additionally, strong Nestin positivity was seen in all gastrointestinal stromal tumors, schwannoma and neurofibroma cases. However, Nestin was negative in all leiomyoma, fibroma, dermatofibroma, melanocytic nevi, gastric xanthoma and xanthalesma cases. 

Conclusion:  The study showed that Nestin immunohistochemistry has limitation in distinction of GCT from tumors arising from neural cell lineage such as gastrointestinal stromal tumor, schwannoma and neurofibroma; however, Nestin as a neural marker provides an evidence to neural origin of GCT and could be useful in distinction GCT from other mesenchymal tumors with granular cytoplasm such as leiomyoma, dermatofibroma and melanocytic nevi.

Keywords

• Nestin,granular cell tumor,neural origin

Granüler hücreli tümör tanısında Nestin immunhistokimyasının kullanımı

Öz

Amaç: Granüler hücreli tümorler (GCTs) nöroektodermal diferansiasyon gösterirler. Morfolojik olarak pek çok mezenkimal tümor, granüler hücreli görünüme sahip olabilir. Nestin, santral sinir sistemi gelişimi boyunca undiferansiye hücrelerde ve santral sinir sistemi tümörlerinde eksprese edilen bir intermediate filament proteindir. Çalışmamızda Nestin proteininin granüler hücreli tümör ayırıcı tanısında kullanılabilirliğinin belirlenmesi amaçlanmıştır.

Yöntemler: Çalışmamızda GCT tümör olguları ve granüler sitoplazmaya sahip olabilecek ve granüler hücreli tümör ayırıcı tanısında başlıca ele alınan mezenkimal tümörlere immunhistokimyasal olarak Nestin antikoru uygulanmıştır.  Farklı dokulardan köken alan 21 GCT (7’si özofagus, 8’i deri,  4’ü dil,  2’si vokal korddan gelişen ) , 17 GIST (gastrointestinal stromal tumor- gastrointestinal kanaldan gelişen) , 8 leiomyoma ( 5’i özofagus,  3’ü deriden gelişen), 4 schwannoma  (1’i özofagus, 3’ü deri yerleşimli) ve subkutan yerleşimli mesenkimal tümörler (7 nörofibroma, 5 fibroma, 15 dermatofibroma)  ile 20 melanositik nevüs,  15 gastrik ksantom ve 15 ksantalezma olgusu çalışmamıza dahil edilmiştir.

Bulgular: GCT’lerin tamamında Nestin pozitifliği görüldü. Ayrıca tüm GIST’ler,  schwannoma ve nörofibromada Nestin pozitif olarak izlendi.   Bununla birlikte tüm leiomyoma, fibroma,  dermatofibroma,  melanositik nevüs, gastrik ksantom ve  ksantalezmada  olgularında  Nestin ekspresyonu görülmedi.

Sonuç: Çalışmamız Nestin immunhistokimyasının GCT’ün ayırıcı tanısında özellikle GIST, Schwannoma ve nörofibroma gibi nöral orijinli tümörlerde sınırlı olduğunu göstermektedir. Bununla birlikte nöral bir marker olan Nestin GCT’ün nöral kökenine dair bir kanıt sunmaktadır.  Nestin, GCT ‘ün granüler sitoplazmaya sahip leiomyoma, dermatofibroma gibi diğer mezenkimal tümörler ve melanositik nevüsden ayırımında kullanılabilir.

Anahtar Kelimeler

• nestin,granüler hücreli tümör,nöral orijin

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