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Lucas NC, Neal C, Hsu B, Wright P. Erythroblastosis Transformation-Specific Regulated Gene 1 (ERG) Immunohistochemistry in the Diagnosis of Acute Myeloid Leukemia. Cureus 2024; 16:e61168. [PMID: 38933637 PMCID: PMC11202094 DOI: 10.7759/cureus.61168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION The erythroblastosis transformation-specific regulated gene 1 (ERG) is a transcription factor that can be used as an immunohistochemical (IHC) marker in the diagnosis and prognostication of malignancy. ERG was initially used in prostate cancer; however, it is a useful marker in extramedullary myeloid disease. Patients with acute myeloid leukemia (AML), dry bone marrow aspirate, and CD34, CD117-negative blast cells can be in a diagnostic dilemma. This audit aimed to (a) validate ERG IHC in bone marrow trephine samples, (b) quantify ERG IHC positivity in an AML cohort, and correlate concordance with CD34 and CD117 IHC, when available, and (c) to see whether ERG is a useful adjunct in the diagnosis of cases of AML. METHODS A retrospective audit was completed of all new and relapsed cases of AML over one year at a single center. For inclusion, patients needed a trephine specimen at presentation, and all had a hematoxylin and eosin(H&E) specimen, ERG IHC, and at least one or both of CD34 and CD117 IHC. Four pathologists independently assessed the stains quantitatively and qualitatively in comparison to the morphology seen on the H&E sample. The kappa value was used to assess agreement. RESULTS Seventeen patients with AML met the inclusion criteria. All specimens had H&E, CD34, and ERG stains; 9/17 (53%) had CD117 IHC. ERG demonstrated high concordance with blast cells on H&E morphology, with a high agreement among pathologists. Qualitatively, pathologists recognized that ERG spared lymphoid nodules; however, it also stained granulocytes at various maturation stages. CONCLUSION ERG is a sensitive marker for the diagnosis of AML. ERG can help visualize blast cells that have been confirmed by ancillary tests. More research into the utility of ERG in AML diagnostics is recommended.
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Affiliation(s)
- Nathanael C Lucas
- Department of Haematology, Christchurch Hospital, Te Whatu Ora/Health New Zealand, Christchurch, NZL
| | - Catherine Neal
- Department of Haematology, Christchurch Hospital, Te Whatu Ora/Health New Zealand, Christchurch, NZL
| | - Blake Hsu
- Department of Haematology, Christchurch Hospital, Te Whatu Ora/Health New Zealand, Christchurch, NZL
| | - Penny Wright
- Department of Anatomical Pathology, Christchurch Hospital, Te Whatu Ora/Health New Zealand, Christchurch, NZL
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Mullen D, Nowak K, Chetty R. Gene of the month: ERG. J Clin Pathol 2022; 75:577-580. [PMID: 35738886 DOI: 10.1136/jcp-2022-208350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/04/2022]
Abstract
The ERG gene belongs to the erythroblastosis transformation specific family of transcription factors and encodes for the transcription regulator protein ERG. It is located on chromosome 22q22 and is a nuclear transcription factor. In normal physiology, ERG protein is expressed in endothelial cells and is involved in processes including, but not limited to, angiogenesis and haematopoiesis. Of diagnostic value in clinical practice, ERG immunohistochemistry is a useful marker of endothelial differentiation for both benign and malignant vascular lesions. It is also reliable for identifying ERG gene translocated malignancies such as EWS/FUS::ERG Ewing's sarcoma and TMPSSR2::ERG prostatic carcinoma.
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Affiliation(s)
- Dorinda Mullen
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Klaudia Nowak
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
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Vargas AC, Turner J, Burchett I, Ho LL, Zumbo R, Gill AJ, Maclean FM. Myeloid sarcoma and extramedullary hematopoiesis expand the spectrum of ERG-positive proliferations; an ancillary tool in the diagnosis. Hum Pathol 2022; 124:1-13. [DOI: 10.1016/j.humpath.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/20/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
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ERG Immunoreactivity in Blastic Hematolymphoid Neoplasms: Diagnostic Pitfall in the Workup of Undifferentiated Malignant Neoplasms. Appl Immunohistochem Mol Morphol 2021; 30:42-48. [PMID: 34261976 DOI: 10.1097/pai.0000000000000958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
Undifferentiated malignant neoplasms pose diagnostic challenges, and reliable immunohistochemical markers with well-characterized staining profiles are desirable when characterizing them. Our initial observation of erythroblast transformation specific regulated gene-1 (ERG) reactivity in myeloid sarcomas led us to broadly explore the utility of ERG as a marker of immature hematolymphoid neoplasms presenting in extramedullary sites. We stained 207 immature and mature hematolymphoid lesions as well as 39 benign hematolymphoid tissues and found weak-to-moderate ERG immunopositivity in 15 of 16 (94%) acute myeloid leukemias/myeloid sarcomas, including 4 of 5 (80%) CD34-negative/CD117-negative acute myeloid leukemias/myeloid sarcomas. ERG positivity was also seen in all 9 cases of B-lymphoblastic and T-lymphoblastic leukemia/lymphoma, all 3 cases of hematogone hyperplasia, and all 4 cases of systemic mastocytosis. ERG was negative in 148 mature B-cell and T-cell lymphomas, including 2 high-grade B-cell lymphomas and 2 blastoid variant mantle cell lymphomas; 23 histiocytic/dendritic cell neoplasms; 2 indolent T-lymphoblastic proliferations; and 2 blastic plasmacytoid dendritic cell neoplasms. We conclude that ERG immunoreactivity may pose a significant diagnostic pitfall in the workup of undifferentiated malignant neoplasms, particularly those presenting in extramedullary sites.
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Esmaeili M, Fischer AS, Khurana M, Gru AA, Yan AC, Rubin AI. Shapiro xanthogranuloma: An essential diagnosis for dermatologists and dermatopathologists to recognize to avoid misdiagnosis of a hematopoietic malignancy in infants and neonates. J Cutan Pathol 2020; 48:558-562. [PMID: 32713034 DOI: 10.1111/cup.13823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/28/2020] [Accepted: 07/22/2020] [Indexed: 01/19/2023]
Abstract
The Shapiro xanthogranuloma is a histopathologic form of xanthogranuloma that shows closely packed monomorphous cells, which can extend into the subcutaneous fat; it usually lacks routine diagnostic features of xanthogranuloma. Herein we describe two cases of Shapiro xanthogranuloma occurring in a neonate and in an infant, which were initially thought to be hematologic malignancies. One patient's presentation as a "blueberry muffin baby" added to the diagnostic confusion. Pediatric dermatologists, dermatologists, and dermatopathologists need to be aware of the Shapiro xanthogranuloma and its clinicopathologic features to avoid misdiagnosis of a hematopoietic malignancy in neonates and infants.
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Affiliation(s)
- Melody Esmaeili
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew S Fischer
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michele Khurana
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Albert C Yan
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Olson NJ, Ornstein DL, Linos K. Survey of ERG expression in normal bone marrow and myeloid neoplasms. J Hematop 2019. [DOI: 10.1007/s12308-019-00378-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Zhang S, Wang L, Cheng L. Aberrant ERG expression associates with downregulation of miR-4638-5p and selected genomic alterations in a subset of diffuse large B-cell lymphoma. Mol Carcinog 2019; 58:1846-1854. [PMID: 31237044 DOI: 10.1002/mc.23074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/22/2019] [Accepted: 05/31/2019] [Indexed: 12/19/2022]
Abstract
ERG (avian v-ets erythroblastosis virus E26 oncogene homolog), an oncoprotein in prostate carcinoma and Ewing's sarcoma is associated with poor prognosis in patients with acute myeloid leukemia and T lymphoblastic leukemia. However little is known about ERG in lymphoma. Here we studied ERG in diffuse large B-cell lymphoma (DLBCL) by immunohistochemistry, fluorescence in situ hybridization (FISH), genome-wide microRNA (miRNA) expression profiling, real-time reverse-transcriptase polymerase chain reaction (RT-PCR) and whole exome sequencing (WES). Approximately 30% of de novo DLBCLs (37 of 118) expressed ERG (ERG+). ERG expression showed no significant correlation with DLBCL cell-of-origin classification, patient's age, sex, nodal, or extranodal disease status, tumor expression of p53 or p63. There was no ERG rearrangement in 10 randomly selected ERG+ DLBCLs by FISH. Forty-three miRNAs showed significant differential expression between ERG+ and ERG- DLBCLs. Downregulation of miR-4638-5p was confirmed by real-time RT-PCR. WES not only confirmed known gene mutations in DLBCLs but also revealed multiple novel gene mutations in POLA1, E2F1, PSMD8, AXIN1, GAB2, and GNB2L1, which occur more frequently in ERG+ DLBCLs. In conclusion, our studies demonstrated aberrant ERG expression in a subset of DLBCL, which is associated with downregulation of miR-4638-5p. In comparison with ERG-negative DLBCL, ERG+ DLBCL more likely harbors mutations in genes important in cell cycle control, B-cell receptor-mediated signaling and degradation of β-catenin. Further clinicopathological correlation and functional studies of ERG-related miRNAs and pathways may provide new insight into the pathogenesis of DLBCL and reveal novel targets for better management of patients with DLBCL.
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Affiliation(s)
- Shanxiang Zhang
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lin Wang
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Liang Cheng
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Abstract
Inflammatory skin diseases encompass a vast array of conditions. The field continues to expand and evolve with resurgence of conditions, through newly recognized medication adverse effects, and via more detailed descriptions of known dermatoses. The importance of clinicopathologic correlation and an up to date knowledge of dermatologic conditions cannot be overstated. This review focuses on an array of recent important developments in the histologic diagnosis of inflammatory conditions that affect the skin.
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Abstract
This article focuses on cutaneous hematopoietic neoplasms that are more likely to be encountered in the pediatric age-group and includes both lymphoproliferative and histiocytic disorders. The cutaneous hematologic disorders in children have a different epidemiologic profile to what is seen during adulthood. Although mycosis fungoides is the most frequent form of cutaneous lymphoma in adults, it is very rare in children. Because lymphoblastic leukemias and lymphomas are more frequent in the pediatric setting, cutaneous leukemic infiltrates are relatively common in this age-group. Similarly, histiocytic disorders are more common in children, particularly Langerhans cell histiocytosis and juvenile xanthogranuloma. Notably, the histiocytic disorders have undergone significant modifications on their nomenclature in the basis of the molecular characteristics that are present in them. A summary of the most frequent cutaneous hematopoietic disorders in children will be discussed further in this review.
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Affiliation(s)
- Alejandro A Gru
- 1 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 2 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital and Dermatopathology, Washington University Medical Center, St. Louis, Missouri
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Kristiansen I, Stephan C, Jung K, Dietel M, Rieger A, Tolkach Y, Kristiansen G. Sensitivity of HOXB13 as a Diagnostic Immunohistochemical Marker of Prostatic Origin in Prostate Cancer Metastases: Comparison to PSA, Prostein, Androgen Receptor, ERG, NKX3.1, PSAP, and PSMA. Int J Mol Sci 2017; 18:ijms18061151. [PMID: 28555048 PMCID: PMC5485975 DOI: 10.3390/ijms18061151] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 12/21/2022] Open
Abstract
Aims: Determining the origin of metastases is an important task of pathologists to allow for the initiation of a tumor-specific therapy. Recently, homeobox protein Hox-B13 (HOXB13) has been suggested as a new marker for the detection of prostatic origin. The aim of this study was to evaluate the diagnostic sensitivity of HOXB13 in comparison to commonly used immunohistochemical markers for prostate cancer. Materials and methods: Histologically confirmed prostate cancer lymph node metastases from 64 cases were used to test the diagnostic value of immunohistochemical markers: prostate specific antigen (PSA), Prostatic acid phosphatase (PSAP), prostate specific membrane antigen (PSMA), homeobox gene NKX3.1, prostein, androgen receptor (AR), HOXB13, and ETS-related gene (ERG). All markers were evaluated semi-quantitatively using Remmele’s immune reactive score. Results: The detection rate of prostate origin of metastasis for single markers was 100% for NKX3.1, 98.1% for AR, 84.3% for PSMA, 80.8% for PSA, 66% for PSAP, 60.4% for HOXB13, 59.6% for prostein, and 50.0% for ERG. Conclusions: Our data suggest that HOXB13 on its own lacks sensitivity for the detection of prostatic origin. Therefore, this marker should be only used in conjunction with other markers, preferably the highly specific PSA. The combination of PSA with NKX3.1 shows a higher sensitivity and thus appears preferable in this setting.
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Affiliation(s)
- Ilka Kristiansen
- Institute of Pathology, University Hospital Bonn, 53127 Bonn, Germany.
| | - Carsten Stephan
- Department of Urology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Klaus Jung
- Berlin Institute of Urologic Research, Berlin, Germany.
| | - Manfred Dietel
- Institute of Pathology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Anja Rieger
- Institute of Pathology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Yuri Tolkach
- Institute of Pathology, University Hospital Bonn, 53127 Bonn, Germany.
| | - Glen Kristiansen
- Institute of Pathology, University Hospital Bonn, 53127 Bonn, Germany.
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