Pattern-based interpretation of SOX2 expression in ovarian teratomas: avoiding diagnostic pitfalls in the distinction between immature and mature neuroectodermal elements.

Authors

Agnese Orsatti, Caterina Ravaioli, Marco Grillini, Eugenia Franchini, João Lobo, Andres M Acosta, Veronica Mollica, Claudio Zamagni, Pierandrea De Iaco, Anna Myriam Perrone, Michelangelo Fiorentino, Giovanni Tallini, W Glenn McCluggage, Costantino Ricci, Antonio De Leo

Published in

Histopathology. Aug 21, 2026. Epub Aug 21, 2026.

Abstract

The distinction between ovarian immature teratoma (IT) and mature teratoma (MT) relies on the identification of immature neuroectodermal tissue in the former, a task that may be challenging in some tumours and carries significant prognostic and therapeutic implications. SRY-box transcription factor 2 (SOX2) has been proposed as a marker of immature neuroepithelium, although its expression in mature components of ovarian teratomas has not been systematically investigated. We aimed to assess the diagnostic value and limitations of SOX2, in comparison with SALL4, in differentiating immature from mature neuroectodermal elements.
We retrospectively analysed a multicentric cohort of 61 ovarian teratomas (52 MTs and 9 ITs). SOX2 and SALL4 immunohistochemical expression was evaluated across all tissue components with correlation to detailed morphological assessment. SOX2 showed diffuse expression in both immature neuroepithelium and mature neuroectodermal tissues, including glia and ependymal structures, as well as a characteristic layer-restricted pattern in retinal tissue, while cerebellar tissue was consistently negative; some non-neural mature epithelial tissues were also positive. SALL4 expression was variably positive in immature neuroectodermal components (specifically in neuroectodermal rosettes) and was absent in all mature components. Notably, heterogeneous SOX2 expression in rosette-like structures prompted systematic morphological reassessment, leading to reclassification of 5/9 (55.6%) cases initially diagnosed as IT into MT. These findings highlight that SOX2 expression alone may represent a significant diagnostic pitfall, particularly in distinguishing immature neuroepithelium from mature ependymal rosettes.
SOX2 is a sensitive marker of neuroectodermal lineage but does not discriminate between immature and mature elements. Its interpretation requires integration with morphology and SALL4 expression to avoid overdiagnosis and inappropriate tumour classification and grading of ITs. A pattern-based approach to SOX2 staining may improve diagnostic accuracy in ovarian teratomas.

PMID:
42628947
Bibliographic data and abstract were imported from PubMed on 22 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.