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SOX11, SOX10 and MITF Gene Interaction: a Possible Diagnostic Tool in Malignant Melanoma

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SOX11, SOX10 and MITF Gene Interaction: a Possible Diagnostic Tool in Malignant Melanoma life Article SOX11, SOX10 and MITF Gene Interaction: A Possible Diagnostic Tool in Malignant Melanoma Marius-Alexandru Beleaua 1,2, Ioan Jung 2, Cornelia Braicu 3,4 , Doina Milutin 1 and Simona Gurzu 1,2,4,* 1 Department of Pathology, Clinical County Emergency Hospital, Targu-Mures, Romania, 540139 Targu Mures, Romania; [email protected] (M.-A.B.); [email protected] (D.M.) 2 Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania; [email protected] 3 Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; [email protected] 4 Research Center (CCAMF), George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania * Correspondence: [email protected]; Tel.: +40-745-673550; Fax: +40-265-210407 Abstract: Malignant melanoma (MM) is a highly heterogenic tumor whose histological diagnosis might be difficult. This study aimed to investigate the diagnostic and prognostic utility of the con- ventional pan-melanoma cocktail members (HMB-45, melan-A and tyrosinase), in conjunction with SOX10 and SOX11 immunohistochemical (IHC) expression. In 105 consecutive cases of MMs and 44 of naevi, the IHC examination was performed using the five-abovementioned markers, along with microphthalmia transcription factor (MITF), S100, and Ki67. Correlation with the clinicopathological factors and a long-term follow-up was also done. Survival analysis was performed with Kaplan– Meier curves and compared with TCGA public datasets. None of the 44 naevi expressed SOX11, but its positivity was seen in 52 MMs (49.52%), being directly correlated with lymphovascular invasion, Citation: Beleaua, M.-A.; Jung, I.; the Ki67 index, and SOX10 expression. HMB-45, SOX10, and tyrosinase, but not melan-A, proved Braicu, C.; Milutin, D.; Gurzu, S. to differentiate the naevi from MMs successfully, with high specificity. Triple MITF/SOX10/SOX11 SOX11, SOX10 and MITF Gene co-expression was seen in 9 out of 15 negative conventional pan-melanoma-cocktail cases. The Interaction: A Possible Diagnostic independent prognostic value was proved for the conventional pan-melanoma cocktail (triple pos- Tool in Malignant Melanoma. Life 2021, 11, 281. https://doi.org/ itivity for HMB-45, melan-A, and tyrosinase) and, independently for HMB-45 and tyrosinase, but 10.3390/life11040281 not for melan-A, SOX10, or SOX11. As consequence, to differentiate MMs from benign naevi, melan-A should be substituted by SOX10 in the conventional cocktail. Although the conventional Academic Editor: Paola Nieri pan-melanoma cocktail, along with S100 can be used for the identification of melanocytic origin of tumor cells and predicting prognosis of MMs, the conventional-adapted cocktail (triple positivity for Received: 11 March 2021 HMB-45, SOX10, and tyrosinase) has a slightly higher diagnostic specificity. SOX11 can be added to Accepted: 24 March 2021 identify the aggressive MMs with risk for lymphatic dissemination and the presence of circulating Published: 27 March 2021 tumor cells. Publisher’s Note: MDPI stays neutral Keywords: melanoma cocktail; immunohistochemistry; SOX11; SOX10; MITF; survival with regard to jurisdictional claims in published maps and institutional affil- iations. 1. Introduction Malignant melanoma (MM) is the twenty-first most frequently diagnosed malignant tumor worldwide, presenting almost a doubled mortality in the last two decades [1–5]. Due Copyright: © 2021 by the authors. to its highly heterogeneous aspect, the histopathological diagnosis needs to be confirmed Licensee MDPI, Basel, Switzerland. by immunohistochemical (IHC) markers. In daily practice, the IHC-panel usually includes This article is an open access article S100 protein and at least one of the three members of the conventional pan-melanoma distributed under the terms and cocktail: Human melanoma black 45 (HMB45), MART1/melan-A, and tyrosinase [6–8]. conditions of the Creative Commons In conventional pan-melanoma-cocktail-negative cases, it is recommended to add, for an Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ appropriate differential diagnosis, other markers such as the microphthalmia transcrip- 4.0/). tion factor (MITF) [9] and the SRY-related high-mobility group box transcription factor Life 2021, 11, 281. https://doi.org/10.3390/life11040281 https://www.mdpi.com/journal/life Life 2021, 11, 281 2 of 15 10 (SOX10) [10]. The proliferation grade is estimated based on the mitotic rate and the Ki67 percentage [11]. Except in the above-mentioned markers used for diagnosis, there are cases with uncertain differentiation in which the IHC panel needs to be enlarged. One of these antibodies is known as SOX11. It is a nuclear transcription factor belonging to the SOX-C proteins group, along with SOX4 and SOX12 [12–14]. This paper aimed to examine the possible role of SOX11 in the diagnosis and evolution of MM, in conjunction with clinicopathological factors, MITF, SOX10, and conventional pan-melanoma cocktail. 2. Materials and Methods 2.1. Selection Criteria The study was done based on 105 consecutive patients with MM who underwent surgical excision between 2012 and 2018 (Table1). Only patients who survived at least four months following surgery, with no neoadjuvant chemotherapy before excision, were included in this observational study. We did not examine cases of MMs in situ as well as cases with distant metastasis or those in whom follow-up data were not avail- able. The patients’ follow-up ranged from 5 to 112 months, with a median time of 50.04 ± 4.89 months. Table 1. Clinicopathological parameters of patients with malignant melanoma. Variable N = 105 (%) Age (years) 63.63 ± 14.48 (range 30–90) Gender: Male: Female 52:53 (1:1.01) Histological type Nodular 76 (72.37) Superficial 18 (17.15) Lentiginous 11 (10.48) Thickness (Breslow) (Median: 6.73 ± 8.25, range 0.4–60) ≤1 mm 20 (19.05) >1 to ≤2 mm 15 (14.29) >2 to ≤4 mm 14 (13.33) >4 mm 56 (53.33) Ulceration 74 (70.47) Microsatellites 19 (18.09) Mitotic Rate (mm2) (Median: 10.09 ± 11.9, range 0–57) <5 42 (40) ≥5 63 (60) TILs (Tumor-Infiltrating Lymphocytes) Not identified 30 (28.58) Brisk 19 (18.09) Non-Brisk 56 (53.33) Lymphovascular Invasion 23 (21.9) Neurotropism 9 (8.57) Tumor regression 36 (34.28) Anatomic Level (Clark) I 1 (0.95) II 11 (10.48) III 13 (12.38) IV 58 (55.24) V 22 (20.95) Life 2021, 11, 281 3 of 15 Table 1. Cont. Variable N = 105 (%) Tumor location Anterior Trunk 18 (17.15) Posterior Trunk 29 (27.61) Head and Neck 17 (16.19) Superior Limb 16 (15.24) Inferior Limb 25 (23.81) Tumor satellites 12 (11.42) Tumor size (mm) 23.45 ± 15.78 (range 6–110) Tumor stage pT1 20 (19.05) pT2 17 (16.19) pT3 14 (13.33) pT4 54 (51.43) Deep Margin distance (mm) 8.41 ± 5.21 (range 6–22.8) Peripheral Margins distance (mm) 7.67 ± 5.9 (range 1–35) Growth Phase Radial 20 (19.05) Vertical 85 (80.95) This retrospective study was conducted under the approval of the Ethical Committee of the “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technologies of Targu Mures, Romania. 2.2. Histological Assessment and Tissue Microarray Construction The first step was the histological re-evaluation of the MM cases. All the 105 MMs were re-staged based on the American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th edition [15] and the WHO Classification of Skin Tumors 4th edition [16]. Then, representative areas were marked, on Hematoxylin-Eosin (HE) sections, for the construction of the tissue microarray (TMA) blocks. Areas with necrosis, hemorrhage, or rich inflammatory infiltrate were avoided. The TMA blocks were generated from formalin- fixed paraffin-embedded tissue blocks (FFPE). For the control group, to test the sensitivity and specificity of the examined markers, we included 44 cases of naevi. For both naevi and MMs, 10 cores-TMA blocks were constructed, using one tissue-core per case (4 mm diameter). 2.3. Immunohistochemistry—Technical Data The IHC stains were performed to check the expression of the following antibodies: S100 protein (polyclonal; dilution 1:400; Dako, Agilent Technologies Inc., Glostrup, Den- mark); Ki67 (clone MIB-1; dilution 1:100; Agilent, Santa Clara, CA, USA); SOX10 (clone A-2; dilution 1:100; Santa Cruz Biotechnology, Dallas, TX, USA); MITF (clone 34CA5; dilution 1:10; Leica Biosystems, Newcastle Ltd., Newcastle, UK); SOX11 (polyclonal; dilution 1:100; Sigma-Aldrich, St. Louis, MO, USA), and markers of the conventional pan-melanoma cocktail: HMB-45 (monoclonal; dilution 1:100; Cell Marque, Rocklin, CA, USA), melan-A (clone A103; dilution 1:100; Cell Marque, Rocklin, CA, USA), and tyrosinase (clone T311; ready to use (RTU); Leica Biosystems, Wetzlar, Germany). The immunostains were performed for most of the markers (except for tyrosinase and MITF), using the semi-automated method and the detection system EnVisionTM FLEX (Agilent, Santa Clara, CA, USA). After deparaffinization and rehydration of the TMA sections, the activity of endogenous peroxidase was blocked by the EnVisionTM FLEX Peroxidase-Blocking reagent, for 10 min at room temperature. The antigen retrieval consisted of boiling in Tris/EDTA, pH 9 solution for 40 min at 95 ◦C using the PT Link Life 2021, 11, 281 4 of 15 200 Pre-Treatment Module (Agilent, Santa Clara, CA, USA). Then, primary and secondary antibodies were incubated for 60 and 30 min, respectively, at room temperature (Dako EnVision™ FLEX/HRP detection reagent). The development was performed using the EnVision™ FLEX HRP Magenta Substrate Chromogen System (Agilent, Santa Clara, CA, USA) and the counterstain was done with Mayer’s Hematoxylin. For tyrosinase and MITF, we used the BOND-MAX Fully Automated Immunostainer and the BOND Polymer Refine Red Detection kit (Leica Biosystems, Wetzlar, Germany) with ethylenediaminetetraacetic acid- (EDTA) based pH 9.0 epitope retrieval solution.
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