STAT6 Immunohistochemistry Is Helpful in the Diagnosis of... : The American Journal of Surgical Pathology (original) (raw)

Original Articles

STAT6 Immunohistochemistry Is Helpful in the Diagnosis of Solitary Fibrous Tumors

Yoshida, Akihiko MD, PhD*; Tsuta, Koji MD, PhD*; Ohno, Makoto MD, PhD†; Yoshida, Masayuki MD, PhD*; Narita, Yoshitaka MD, PhD†; Kawai, Akira MD, PhD‡; Asamura, Hisao MD, PhD§; Kushima, Ryoji MD, PhD*

Departments of *Pathology and Clinical Laboratory

†Neurosurgery and Neuro-Oncology

‡Musculoskeletal Oncology

§Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan

Conflicts of Interest and Source of Funding: Supported in part by the National Cancer Center Research and Development Fund (23-A-10). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Akihiko Yoshida, MD, PhD, Department of Pathology and Clinical Laboratory, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan (e-mail: [email protected]).

Abstract

Solitary fibrous tumor (SFT) is an uncommon fibroblastic neoplasm. Although histologic characteristics and frequent CD34 expression allow for an accurate diagnosis in the majority of SFT cases, a wide histologic spectrum and an occasional unexpected immunophenotype may pose diagnostic challenges. Molecular analyses have discovered that almost all SFTs harbor an NAB2-STAT6 fusion gene, which is considered specific to this tumor type. Recent studies have suggested that STAT6 immunohistochemistry is a reliable surrogate for detection of the fusion gene. Our aim was to validate these findings by examining a large number of SFT cases and a broad array of 30 different types of non-SFT tumors. A total of 49 SFTs with a range of histologic characteristics and 159 benign or malignant tumors that can mimic SFTs were retrieved and stained for STAT6. All 49 SFTs (100%) showed STAT6 expression that was restricted in the nucleus, mostly in a diffuse and strong manner, irrespective of the tumor sites and histologic patterns. The staining was uniform in most cases but was heterogenous in about 20% of the cases in which zonal staining attenuation was observed, likely reflecting variability in fixation or tissue ischemia. In contrast, only 4 non-SFT tumors (2.5%) exhibited weak nuclear STAT6 expression, whereas the remaining 155 cases showed no staining or often weak reactivity in both the cytoplasm and the nucleus. Therefore, nuclear STAT6 immunoreactivity is a highly sensitive and specific marker of SFTs and can be helpful when diagnosis is inconclusive by conventional methods.