A Triple Stain of Reticulin, Glypican-3, and Glutamine Synthetase Is Useful for the Diagnosis of Liver Lesions
Benjamin J Swanson, William L Marsh, Jr., Wendy L Frankel. Ohio State University Wexner Medical Center, Columbus, OH
Background: The histologic diagnosis of mass lesions of the liver can be difficult, especially when there is limited material in a biopsy. Here, we evaluated the usefulness of a triple stain of reticulin, glypican-3 (Gly3) and glutamine synthetase (GS) in whole tissue slides (WTS) and tissue microarrays (TMA) of hepatocellular carcinoma (HCC), hepatic adenoma (HA), non-neoplastic liver tissue adjacent to hepatocellular carcinoma (Liv), and focal nodular hyperplasia (FNH).
Design: WTS of liver masses were retrieved from the archives including HCC (n=16), HA (n=10) and FNH (n=13). In addition, TMA were constructed to mimic a small biopsy of HCC (n=19), HA (n=16), Liv (n=20) and FNH (n=13). A triple stain of reticulin followed sequentially by immunostains for Gly3 (alkaline phosphatase red chromogen) and GS (diaminobenzidine chromogen) was performed on all WTS and TMA. Cases were evaluated for reticulin (intact, lost), Gly3 (positive if >10% or negative) and GS (perivenular, map-like, diffuse if >50% or negative). Sensitivity and specificity in TMA cases were determined using known diagnoses from the resection specimen.
Results: Expression of reticulin, Gly3 and GS in both WTS and TMA cases is shown.
|WTS HA||10/10 (100%)||0||0||10/10 (100%)||7/10 (70%)||0||1/10 (10%)|
|TMA HA||15/16 (94%)||1/16 (6%)||0||16/16 (100%)||8/16 (50%)||0||1/16 (6%)|
|WTS FNH||13/13 (100%)||0||0||13/13 (100%)||0||13/13 (100%)||0|
|TMA FNH||13/13 (100%)||0||0||13/13 (100%)||0||11/13 (85%)||2/13 (15%)|
|WTS HCC||1/16 (6%)||15/16 (94%)||8/16 (50%)||8/16 (50%)||1/16 (6%)||0||9/16 (56%)|
|TMA HCC||2/19 (10%)||17/19 (90%)||11/19 (58%)||8/19 (42%)||0||0||15/19 (79%)|
|TMA Liv||20/20 (100%)||0||0||20/20 (100%)||15/20 (75%)||0||0|