滋养组织中转录因子GATA3的表达及意义

Expression of transcriptional factor GATA3 in trophoblastic tissues and its implications

目的探讨转录因子GATA3在滋养组织中的表达及其鉴别诊断价值。方法运用免疫组化EnVision法检测GATA3在91例滋养组织中的表达,包括30例正常胎盘组织、30例水泡状胎块、18例绒毛膜癌、3例胎盘部位滋养细胞肿瘤、5例胎盘部位结节及5例超常胎盘部位;同时检测30例子宫颈癌及30例子宫内膜癌中GATA3的表达。结果 GATA3在早期胎盘组织中呈弥漫强阳性,成熟绒毛中表达明显减弱,但在胎盘部位呈持续强阳性。61例滋养细胞疾病中,仅1例绒毛膜癌阴性,其余病例均为阳性;阳性细胞主要定位于细胞滋养细胞和中间型滋养细胞,合体滋养细胞基本不着色。子宫内膜癌中无GATA3阳性病例;3例子宫颈鳞状细胞癌呈弱至中等的局灶着色,子宫颈腺癌中GATA3均呈阴性。GATA3在滋养细胞病变中敏感性及特异性分别为98.36%及95.00%。结论 GATA3是滋养细胞较为敏感及特异的标志物,不能区分不同类型的滋养细胞疾病,但可鉴别滋养细胞疾病及苗勒管起源的恶性肿瘤。

Purpose To investigate the expression of GATA3 in trophoblast-related tissues and to explore the immunophenotypic value of GATA3 in their differential diagnosis. Methods GATA3 immunohistochemistry was performed in 91 cases of trophoblast-related tissues, including 30 placentas, 30 hydatidiform moles, 18 choriocarcinomas, 3 placental site trophoblastic tumors, 5 placental site nod- ules and 5 exaggerated placental sites. Thirty cervical cancers and thirty endometrial adenocarcinomas were also stained. Results Im- mature placentas showed strong, diffuse nuclear GATA3 staining, while mature placentas showed less expression. Intermediate tropho- blast in the placental implantation site was consistently positive for GATA3. Of the 61 cases of trophoblastic diseases, only one case of choriocarcinomas was negative for GATA3. Diffuse and strong expression was most commonly observed in cytotrophoblast and intermediate trophoblast, while heterogenous expression in syncytiotrophoblast. None of endometrial adenocarcinomas and cervical adenocarcinomas was GATA3-positive. Of the 20 cases of cervical squamous cell cancer, only 3 cases showed focal weak GATA3 staining. Conclusion GATA3 is a highly sensitive and specific marker for trophoblast cell and may help in distinguishing trophoblastic tumors from mullerian epithelial malignancies.