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GATA-3 Immunohistochemistry in the Differential Diagnosis of Adenocarcinoma of the Urinary Bladder

Ellis, Carla L. MD, MS*; Chang, Alex G. MD*; Cimino-Mathews, Ashley MD*; Argani, Pedram MD*; Youssef, Ramy F. MD; Kapur, Payal MD; Montgomery, Elizabeth A. MD*; Epstein, Jonathan I. MD*

The American Journal of Surgical Pathology: November 2013 - Volume 37 - Issue 11 - p 1756–1760
doi: 10.1097/PAS.0b013e31829cdba7
Original Articles

GATA-3 is a newly described marker that labels urothelial and breast carcinoma. However, no prior study has evaluated the expression of GATA-3 in primary bladder adenocarcinoma. Tissue microarrays (TMAs) containing 46 primary bladder adenocarcinomas were constructed. They contained 19 signet ring cell (SRC) and 27 conventional adenocarcinomas. Three additional cases of SRC using routine sections were included resulting in a total of 22 SRCs. In addition, TMAs containing 32 primary gastric signet ring adenocarcinomas and 36 primary lobular breast carcinomas were evaluated. The TMAs were subjected to immunohistochemical analysis for GATA-3, with nuclear labeling scored by intensity and percentage labeling. Breast and urothelial TMAs were also labeled for estrogen receptor, progesterone receptor, and gross cystic duct fluid protein. Diffuse nuclear GATA-3 labeling was seen in 9/22 (41.0%) SRCs and in 2/27 (7.0%) conventional adenocarcinomas (P=0.01). Extracellular mucin production was seen in 12 SRCs. One of 12 (8.0%) SRCs with extracellular mucin was GATA-3 positive, and 8/10 SRCs without extracellular mucin was GATA-3 positive (P=0.005). No nuclear GATA-3 labeling was seen in any gastric signet ring carcinoma. Diffuse, moderate to strong nuclear GATA-3 labeling was seen in 36/36 (100%) primary lobular breast carcinomas. Nuclear GATA-3 labeling is a useful marker for primary adenocarcinomas of the urinary bladder with signet ring features and can be helpful in distinguishing primary signet ring carcinomas of the urinary bladder from gastric signet ring carcinomas. GATA-3 is rarely positive in bladder adenocarcinomas that lack signet ring features and in SRCs displaying extracellular mucin production.

*Department of Pathology, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD

Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX

Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Jonathan I. Epstein, MD, Department of Pathology, The Johns Hopkins Hospital, Weinberg Building, Rm 2242, 401N. Broadway Street, Baltimore, MD 21231 (e-mail:

© 2013 by Lippincott Williams & Wilkins.