Article

ERG Transcription Factor as an Immunohistochemical Marker for Vascular Endothelial Tumors and Prostatic Carcinoma

Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
The American journal of surgical pathology (Impact Factor: 5.15). 03/2011; 35(3):432-41. DOI: 10.1097/PAS.0b013e318206b67b
Source: PubMed

ABSTRACT

ERG, an ETS family transcription factor, is known to be expressed in endothelial cells, and oncogenic ERG gene fusions occur in subsets of prostatic carcinoma, acute myeloid leukemia, and Ewing sarcoma. In this study, we immunohistochemically investigated nuclear ERG expression using a new monoclonal antibody, CPDR ERG-MAb, that is highly specific for detecting ERG protein and ERG-expressing prostate carcinomas. A broad range of vascular endothelial (n = 250), other mesenchymal (n = 973), and epithelial tumors (n = 657) was examined to determine the use of ERG immunohistochemistry in surgical pathology. Only immunostains with ERG-positive normal endothelia (internal control) were considered valid, and only nuclear staining was considered to be positive. In adult tissues, ERG was restricted to endothelial cells and to a subset of bone marrow precursors, but early fetal mesenchyme and subpopulations of fetal cartilage were also positive. In vascular tumors, ERG was expressed in endothelia of all hemangiomas and lymphangiomas, and typically extensively expressed in 96 of 100 angiosarcomas, 42 of 43 epithelioid hemangioendotheliomas, and all 26 Kaposi sarcomas. Among nonvascular mesenchymal tumors, only blastic extramedullary myeloid tumors (7 of 10) and rare Ewing sarcomas (2 of 29) were positive. Among epithelial tumors, 30 of 66 prostatic adenocarcinomas showed focal-to-extensive ERG positivity, with no immunoreactivity in the normal prostate. Other carcinomas and epithelial tumors (n = 643) were ERG negative, with the exception of 1 of 42 large cell undifferentiated pulmonary carcinomas and 1 of 27 mesotheliomas, each of which showed focal nuclear ERG positivity. On the basis of the above observations, ERG is a highly specific new marker for benign and malignant vascular tumors. Among epithelial tumors, ERG shows a great promise as a marker to identify prostatic carcinoma in both primary and metastatic settings.

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    • "The landmark study by Tomlins et al. (2005) discovered gene fusion of the 5′ untranslated region of TMPRSS2 (which encodes transmembrane protease, serine 2) to the ETS family members ERG or ETV1 in the majority of the prostate cancer cases studied. These findings have now been independently corroborated by a number of researchers, with increased ERG protein expression thought to be reflective of ERG gene rearrangement in prostate cancer (Chaux et al. 2011; Miettinen et al. 2011; van Leenders et al. 2011; Furusato et al. 2010; Lotan et al. 2011; Park et al. 2010). Of note, the prevalence of Prostate cancer shows a great difference between western and Asian patients (Siegel et al. 2013). "
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    Full-text · Article · Dec 2015 · Journal of Cancer Research and Clinical Oncology
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    • "Furthermore, a striking positional conservation of those genes was also found. Both the location and the direction of the genes are maintained within the genetic locus in Xenopus, including transcriptional regulator ERG and Beta-1,3-galactosyltrans- ferase 5, both known vascular and ovarian tumor markers, respectively (Miettinen, et al., 2011; Seko et al., 2009). These data indicate that DSCAM maintained synteny as well as sequence conservation throughout vertebrate evolution, likely reflecting a functionally conserved role of DSCAM in vertebrate development. "
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    • "However, some AS fail to show this feature, presenting instead as poorly differentiated epithelioid or spindled lesions that may mimic a wide variety of other mesenchymal and nonmesenchymal tumors, including carcinomas and various spindle cell sarcomas [1]. In these settings, immunohistochemistry (IHC) has proven to be extremely valuable in establishing the diagnosis of AS using endothelium-associated markers such as von Willebrand factor (factor 8–related antigen) [4]; CD31 [5]; CD34 [6]; and, more recently, FLI/ERG proteins [7] [8] and claudin-5 [9]. With increased reliance upon IHC for the diagnosis of AS, however, has come awareness of potential immunohistochemical pitfalls, including aberrant expression by AS of various antigens including cytokeratins [10], CD30 [11], and CD117 (c-kit) [12]. "
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    ABSTRACT: Angiosarcomas (AS) are uncommon endothelial malignancies, usually arising from sun-damaged skin in older adults. Although most AS are readily diagnosed by light microscopy alone, immunohistochemistry (IHC) for endothelial markers such as CD31, CD34, FLI1 and ERG plays a valuable adjunctive role. However, IHC studies of AS must be interpreted with caution, as aberrant expression of markers such as cytokeratins, CD30 and CD117 may be seen. We report 3 cases of AS showing aberrant expression of the neuroendocrine markers synaptophysin and/or chromogranin A, previously unreported phenomena. Cases presented as metastatic lesions in the lung of a 48-year-old woman and as primary tumors of the kidney and neck in 29-year-old and 51-year-old women, respectively. All cases expressed synaptophysin and/or chromogranin A, and various neuroendocrine/endocrine neoplasms were strongly considered as diagnoses by the initial evaluating pathologists. Additional morphological study and confirmatory IHC for CD31, FLI1 and ERG established the diagnosis of AS in all cases. Co-expression of synaptophysin and chromogranin A in one case suggests at least some AS show true neuroendocrine differentiation. Awareness of this potential diagnostic pitfall is important for correct diagnosis and treatment of this rare subset of AS.
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