RNA-binding protein LIN28 is a marker for primary extragonadal germ cell tumors: An immunohistochemical study of 131 cases

LIN28 has been shown to have an important role in primordial germ cell development and malignant transformation of germ cells in mouse. In this study, we examined the immunohistochemical profile of LIN28 in 131 primary human extragonadal germ cell tumors (central nervous system (CNS) 76, mediastinum 17, sacrococcygeal region 30, pelvis 3, vagina 2, liver 1, omentum 1, and retroperitoneum 1), including the following tumors and/or components: 57 seminomas/germinomas, 10 embryonal carcinomas, 74 yolk sac tumors, 6 choriocarcinomas, 15 mature, and 13 immature teratomas. We compared LIN28 with SALL4 to assess its diagnostic value. To determine its specificity, we examined LIN28 in 406 extragonadal-non-germ cell tumors (103 carcinomas, 91 sarcomas, 9 melanomas, 12 mesotheliomas, 83 lymphomas, 9 plasmacytomas, 82 CNS tumors, and 17 thymic epithelial tumors). The staining was semi-quantitatively scored as 0 (no cell stained), 1 (0-30%), 2 (31-60%), 3 (61-90%), and 4 (>90%). LIN28 staining was seen in all seminomas/germinomas (3 in 1 and 4 in 56), embryonal carcinomas (4 in all 10), and yolk sac tumors (3 in 3 and 4 in 71). Variable LIN28 staining was seen in 5 of 6 choriocarcinomas (1 to 4), 8 of 13 immature teratomas (1 to 2 in immature elements), and in 1 of 15 mature teratomas (1). Only 11 of 406 non-germ cell tumors showed 1 LIN28 staining. Therefore, LIN28 is a sensitive (100% sensitivity) marker for primary extragonadal seminomas/germinomas, embryonal carcinomas, and yolk sac tumors with high specificity. Compared with SALL4, LIN28 demonstrated a similar level of diagnostic sensitivity for seminomas/germinomas and embryonal carcinomas. For primary extragonadal yolk sac tumors, although SALL4 stained all tumors (1 in 1, 2 in 2, 3 in 10, and 4 in 61), LIN28 stained more tumor cells (mean 95 vs 90%, P0.03) and was therefore more sensitive. For primary extragonadal yolk sac tumors, combining LIN28 and SALL4 can achieve a higher diagnostic sensitivity than either alone.