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Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 23 November 2012, last major update November 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.
PubMed Search: erg[title] prostate
Broken links/comments: click here or email CopyrightPathOut@gmail.com, subject=Stains chapter-ERG


● Transcription factor highly specific and 50% sensitive for prostatic adenocarcinoma; detect via FISH or immunohistochemistry


● v-ets erythroblastosis virus E26 oncogen homologue; ETS family transcription factor present at 22q12

Uses by pathologists

● TMPRSS2-ERG fusion is one of most common translocations for any malignancy; 50% sensitive and highly specific for prostate adenocarcinoma, usually by FISH (Am J Surg Pathol 2007;31:882); lower frequency (28%) in patients from Japan (Mod Pathol 2010;23:1492) and Korea (Korean J Pathol 2012;46:423)
● ERG immunohistochemistry (nuclear stain) accurately assesses presence of TMPRSS2-ERG fusion protein; simpler and less costly than FISH (Am J Surg Pathol 2011;35:1014)
● IHC is more specific for prostatic adenocarcinoma than AMACR; staining of atypical focus is specific for carcinoma if high-grade PIN can be excluded (Arch Pathol Lab Med 2012;136:935, Hum Pathol 2012 Nov 14 [Epub ahead of print])
● Differentiate small cell carcinoma of prostate (positive) from bladder (negative, Mod Pathol 2011;24:1120)
● Strong nuclear ERG immunoreactivity is specific for Ewing sarcoma / PNET with EWSR1-ERG rearrangement / t(21;22)(q22;q12) (Mod Pathol 2012;25:1378)
● Component of fusion protein in acute myeloid leukemia (J Clin Oncol 2009;27:5031)

Clinical features

● TMPRSS2-ERG fusion may be an early event in prostate cancer (Arch Pathol Lab Med 2009;133:1033), although marked intrafocal heterogeneity exists (Mod Pathol 2012 Aug 17 [Epub ahead of print])
● ERG does not appear to have prognostic value in prostate adenocarcinoma after radical prostatectomy (Mod Pathol 2012;25:471) or in high grade PIN (BJU Int 2012 Oct 9 [Epub ahead of print])
● ERG rearrangement is more common in peripheral zone prostatic adenocarcinomas, but also present in 12% of transition zone cancers (Mod Pathol 2010;23:1499)
● Similar TMPRSS2-ERG gene fusion status between primary and metastatic prostate cancers (Hum Pathol 2012;43:644)
● Quantification of T2:ERG in postdigital rectal examination urine is specific for prostate cancer (Am J Clin Pathol 2012;138:685)

Micro images

Prostate: adenocarcinoma

Prostate: adenocarcinoma from Korean patients

Prostate: high grade PIN

Prostate: small cell carcinoma

Prostate: needle biopsies with benign, atypical and malignant diagnoses

Positive staining - normal

● Endothelial cells, some bone marrow precursors
● Also early fetal mesenchyme and subpopulations of fetal cartilage (Am J Surg Pathol 2011;35:432)

Positive staining - disease

● Prostatic adenocarcinoma (40-60%), 20-30% of HGPIN or benign glands adjacent to prostatic adenocarcinoma (Am J Surg Pathol 2011;35:1062) and other HGPIN or benign glands (Am J Surg Pathol 2011;35:608, Mod Pathol 2011;24:1128)
● Prostatic small cell carcinoma, but not small cell carcinoma from lung or bladder (Hum Pathol 2011;42:11, Mod Pathol 2011;24:820)
● Vascular tumors (> 90%): angiosarcoma, epithelioid hemangioendothelioma, hemangioma, Kaposi sarcoma and lymphangioma (Am J Surg Pathol 2011;35:432)
● Ewing sarcoma associated with EWSR1-ERG rearrangement (strong nuclear staining)

Negative staining

● Benign prostatic glands distant from adenocarcinoma
● Most other carcinomas and epitheliod tumors (Mod Pathol 2010;23:1061)

Molecular images


Prostatic adenocarcinoma (FISH)

Prostatic small cell carcinoma: FISH for ERG

End of Stains > ERG

Ref Updated: 11/21/12

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