WT1 expression in the female genital tract

Our plain-English summary of WT1 expression in the female genital tract, by C. Bárcena, E. Oliva (Advances in Anatomic Pathology, 2011).

The study

• Authors: C. Bárcena, E. Oliva
• Journal: Advances in Anatomic Pathology
• Published: 2011;18(6):454-65
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The Wilms tumor gene 1 (WT1) has been reported in normal tissues and many neoplasms of the female genital tract. This review discusses WT1 expression in the female genital tract and its potential utility in the differential diagnosis of neoplasms that occur at this location. WT1 is of value in the differential diagnosis of synchronous serous carcinomas arising in the ovary/fallopian tube/peritoneum and endometrium, as strong WT1 positivity in both tumors points toward an extrauterine origin. In addition, WT1 can be used to distinguish sex cord stromal tumors (WT1 positive) from endometrioid carcinomas (OECs). WT1 expression is not helpful in the differential diagnosis of ovarian serous carcinomas (OSCs) and transitional carcinomas, as both are typically positive and has limited value in the distinction of serous tumors arising in the ovary/fallopian tube/peritoneum from mesotheliomas. WT1 is also not helpful to differentiate small cell carcinoma of hypercalcemic type from juvenile granulosa cell tumor, a common diagnostic problem. Intra-abdominal desmoplastic round cell tumor reacts to WT1 (C-terminal) in contrast to all other tumors discussed which helps to separate this rare tumor from most other small round cell tumors that may involve, primarily or secondarily, the ovary with the exception of small cell carcinoma of hypercalcemic type that typically reacts with the N-terminal of WT1.

In plain English

This article was a review of published research on WT1, a protein that pathologists stain for in tissue samples, in normal tissues and tumors of the female genital tract. It did not study asbestos or any exposure, and it reported no new patients. Its mesothelioma section summarized earlier studies. WT1, calretinin, CK5/6 and D2-40 were positive in more than 90% of mesotheliomas, but could also be expressed in approximately 90%, 10%, 25% and 65% of ovarian serous carcinomas, respectively. WT1 positivity in mesothelioma had been reported at 43% to 90%. In one cited study (Laury et al), only 2 of 23 (9%) peritoneal malignant mesotheliomas showed focal or weak staining for another marker, PAX8, and all pleural malignant mesotheliomas were negative. The authors judged strong PAX8 staining a better discriminator than WT1. Another cited study (Goldstein and Uzieblo) found WT1 in 29 of 30 ovarian serous carcinomas but in none of 18 uterine serous carcinomas. The authors concluded that WT1 staining is often not diagnostic and should be combined with other markers and microscopic features.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of published literature (review article on a pathology staining marker)
• Who was studied: No original study population. The review covered published studies of normal tissues and tumors of the female genital tract, including ovarian, uterine, mesothelial, sex cord stromal and small round cell tumors. The authors were from the Pathology Department, Massachusetts General Hospital, Boston.
• Exposure: Not applicable. The review concerns staining for the WT1 protein in tissue samples. It does not discuss asbestos, fibers or any occupational or environmental exposure.
• Main results:
  • Cited studies: WT1, calretinin, CK5/6 and D2-40 were positive in more than 90% of mesotheliomas. They may also be expressed in approximately 90%, 10%, 25% and 65% of ovarian serous carcinomas, respectively.
  • Cited studies: WT1 positivity in mesothelioma has been reported to range from 43% to 90%.
  • Cited study by Laury et al: only 2 of 23 (9%) peritoneal malignant mesotheliomas showed focal and/or weak PAX8 staining, and all pleural malignant mesotheliomas were negative. The review authors considered strong PAX8 staining a better discriminator than WT1 between serous carcinoma and malignant mesothelioma.
  • Cited study by Goldstein and Uzieblo: 29 of 30 (97%) ovarian serous carcinomas were WT1 positive, while all 18 of 18 uterine (endometrial) serous carcinomas were WT1 negative.
  • Cited study by Al-Hussaini et al: 36 of 38 (94.7%) ovarian serous carcinomas were WT1 positive.
  • Adenomatoid tumor is a benign mesothelial growth. WT1 did not help separate it from uterine smooth muscle tumors, because WT1 also stains uterine smooth muscle.
• The authors' conclusion: The authors concluded that WT1 staining is often not diagnostic on its own and should be integrated with other immunohistochemical markers and morphologic features.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Ovarian cancer.

Medical terms in this study, explained in our Lexicon: Neoplasm, Differential Diagnosis, Carcinoma, Peritoneum, Ovarian Serous Carcinoma, Mesothelioma, Desmoplastic Mesothelioma.

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