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Stains

ERG

Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 18 November 2011, last major update November 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

General
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● v-ets erythroblastosis virus E26 oncogen homologue; ETS family transcription factor present at 22q12
● EWSR1-ERG fusion protein, associated with t(21;22)(q22;q12), is common in Ewing sarcoma/PNET
● Component of fusion protein in acute myeloid leukemia (J Clin Oncol 2009;27:5031)
● TMPRSS2-ERG fusion appears to be an early event in prostate cancer (Arch Pathol Lab Med 2009;133:1033)
● TMPRSS2-ERG fusion is 50% sensitive and highly specific for prostate adenocarcinoma, usually by FISH (Am J Surg Pathol 2007;31:882); lower frequency (28%) in Japanese patients (Mod Pathol 2010;23:1492)
● ERG immunohistochemistry accurately assesses presence of TMPRSS2-ERG fusion protein; simpler and less costly than FISH (Am J Surg Pathol 2011;35:1014)
● ERG does not appear to have prognostic value in prostate adenocarcinoma after radical prostatectomy (Mod Pathol 2011 Nov 11 [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)

Interpretation
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● Nuclear stain

Uses for pathologists
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● Currently the subject of many research studies but no clear indication
● (1) TMPRSS2-ERG fusion for prostatic adenocarcinoma is one of most common translocations for any malignancy
● (2) ERG by immunohistochemistry is being investigated as a prostatic adenocarcinoma marker

Micro images
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Prostatic adenocarcinoma

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

Positive staining - tumors
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● Prostatic adenocarcinoma (40-50%), 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)
● Prostatic small cell carcinoma but not small cell carcinoma from lung or bladder (Hum Pathol 2011;42:11, Mod Pathol 2011;24:820)
● >90%: angiosarcoma, epithelioid hemangioendothelioma, hemangioma, Kaposi sarcoma, lymphangioma (Am J Surg Pathol 2011;35:432)
● Rarely Ewing sarcoma

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

Molecular images
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Prostatic adenocarcinoma: FISH

End of Stains > ERG

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