GATA3 immunohistochemistry as a diagnostic adjunct for differentiated vulvar intraepithelial neoplasia: utility and limitations

Abstract

Herein, the authors evaluate the diagnostic utility and limitations of GATA3 immunohistochemistry for the distinction of differentiated vulvar intraepithelial neoplasia (dVIN) from its potential mimics. Immunohistochemical studies for GATA3, p53 and p16 were performed on 124 pathologic vulvar tissues, inclusive of dVIN (n=21), vulvar aberrant maturation (VAM; n=10), HSIL (n=44), and 49 non-neoplastic vulvar dermatoses of various types. GATA3 expression was scored using a modification of previously proposed criteria: pattern 0 (no significant loss of basal layer staining, >75% staining), pattern 1 (25-75% staining) and pattern 2 (<25% staining). With the exception of lichen sclerosus, 8% of which showed pattern 1 or 2 staining, all other non-neoplastic lesions showed pattern 0 expression. Aberrant GATA3 expression (i.e. patterns 1 or 2) was present in 90% of dVIN cases [2 (9.5%), 3 (14.3%), 16 (76.2%) with patterns 0, 1, and 2 respectively], 90% of VAM cases [1 (10%),7 (70%), 2 (20%) with patterns 0, 1, 2 respectively], and 15.9% of HSIL cases [84.1% pattern 0; 2.3% pattern 1; 13.6% pattern 2]. All HSIL cases were p16 positive, including the 7 pattern 1 and 2 cases. All cases of dVIN-like HSIL were pattern 0, and all (n=2) cases of HSIL-like (basaloid) dVIN were pattern 2 (both of the latter cases displayed complete absence of epidermal staining). Only 1 dVIN case was both pattern 0 and p53 wild-type. We conclude that GATA3 is useful for the distinction of dVIN from non-neoplastic dermatoses and from HSIL, but is best used as part of a panel that includes p53 and p16 to mitigate its limitations.