Gastrointestinal stromal tumors (GIST) occur primarily in the wall of the intestine and are characterized by activating mutations in the receptor tyrosine kinases (RTK) genes KIT or PDGFRA. The diagnosis of GIST relies heavily on demonstration of KIT/CD117 protein expression by immunohistochemistry. However, KIT expression is absent in ~4-15% of GIST and this can complicate the diagnosis of GIST in patients who may benefit from treatment with RTK inhibitors. We previously identified DOG1/TMEM16A as a novel marker for GIST using a conventional rabbit anti-peptide antiserum and an in situ hybridization probe. Here, we describe two new monoclonal antibodies against DOG1 (DOG1.1 and DOG1.3) and compare their staining profiles with KIT and CD34 antibodies on 447 cases of GIST.  These included 306 cases with known mutational status for KIT and PDGFRA from a molecular consultation service.  In addition, 935 other mesenchymal tumors, and 432 non-sarcomatous tumors were studied. 

Both DOG1 antibodies showed high sensitivity and specifity for GIST, with DOG1.1 showing some advantages. This antibody yielded positive staining in 370 of 425 (87%) scorable GIST, while CD117 was positive in 317 of 428 (74%) GIST and CD34 in 254 of 430 (59%) GIST. In GIST with mutations in PDGFRA, 79% (23/29) showed DOG1.1 immunoreactivity while only 9% (3/32) and 27% (9/33) stained for CD117 and CD34, respectively. Only 1 of 326 (0.3%) leiomyosarcomas and 1 of 39 (2.5%) synovial sarcomas among the 935 soft tissue tumors examined showed positive immunostaining for DOG1.1. In addition, DOG1.1 immunoreactivity was seen in fewer cases of carcinoma, melanoma, and seminoma as compared to KIT.

Key words: GIST, DOG1, monoclonal antibody, immunohistochemistry.

Department of aPathology, Stanford University Medical Center, Stanford, California, USA; bDepartment of Pathology and OHSU Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA;  cDepartments of Anatomic Pathology and Molecular Genetics, Lerner Research Institute and Taussig Cancer Center, Cleveland Clinic, Cleveland, USA; d Department of Pathology, University of British Columbia, Vancouver, Canada; eApplied Genomics Inc, Burlingame, California, USA