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DOG1 Antibody in the Differential Diagnosis of Gastrointestinal Stromal Tumors: A Study of 1840 Cases

Miettinen, Markku MD*; Wang, Zeng-Feng PhD; Lasota, Jerzy MD*

The American Journal of Surgical Pathology: September 2009 - Volume 33 - Issue 9 - p 1401-1408
doi: 10.1097/PAS.0b013e3181a90e1a
Original Articles

Gastrointestinal stromal tumors (GISTs), KIT or platelet derived growth factor receptor α (PDGFRA) signaling driven mesenchymal tumors of the gastrointestinal (GI)-tract and abdomen, require a precise diagnosis so that the patients may benefit from the newly introduced tyrosine kinase inhibitor drugs. The limitations of the current main tools, KIT immunohistochemistry and KIT/PDGFRA mutation analysis, include lack of KIT expression and mutations in some GISTs. In this study we examined 1168 GISTs of different sites and histologic subtypes, and 672 other tumors and normal tissues for discovered on GIST-1 (DOG1) clone K9, a newly introduced immunohistochemical marker, a chloride channel protein. All GISTs and selected non-GISTs were independently evaluated for KIT. In the GI tract, Cajal cells and gastric surface epithelia were DOG1-positive. The overall sensitivity of DOG1 and KIT in GISTs was nearly identical: 94.4% and 94.7%, and results in GISTs were generally concordant. Gastric spindle cell GISTs was nearly uniformly positive for both markers, whereas DOG1 performed slightly better in gastric epithelioid GISTs that included PDGFRA mutant GISTs. In the intestinal GISTs, KIT was slightly more sensitive than DOG1. Negativity for both DOG1 and KIT was observed in 2.6% of GISTs of GI tract. KIT or PDGFRA mutations were detected in 11/24 DOG1-negative GISTs supporting the diagnosis of GIST. DOG1 expression was also generally present in extragastrointestinal and metastatic GISTs. DOG1 was highly specific for GIST, but exceptional DOG1-positive other mesenchymal tumors included uterine type retroperitoneal leiomyomas, peritoneal leiomyomatosis, and synovial sarcomas (positive in 5/42, 4/17, and 6/37 cases). Leiomyomas colonized by DOG1-positive Cajal cells should not be confused with GISTs. DOG1 positivity was relatively common in esophageal squamous cell and gastric carcinomas, whereas it was rare in colorectal carcinomas. DOG1 should be added into the diagnostic panel evaluating GI and other abdominal tumors, but limitations in its sensitivity and specificity should be recognized.

Departments of *Soft Tissue Pathology

Scientific Laboratories, Armed Forces Institute of Pathology, Washington, DC

Correspondence: Markku Miettinen, MD, Department of Soft Tissue Pathology, Armed Forces Institute of Pathology, 6825 16th Street, NW, Building 54, Room G090, Washington, DC 20306-6000 (e-mail:

The opinions and assertions contained herein are the expressed views of the authors and are not to be construed as official or reflecting the views of the Departments of the Army or Defense.

© 2009 Lippincott Williams & Wilkins, Inc.