Proteomic analysis identifies argininosuccinate synthetase 1 and special AT‐rich sequence binding protein 1 as reliable markers for the immunohistochemical distinction between WHO types A and B3 thymomas

Aims The reliable classification of type A versus type B3 thymomas has prognostic and therapeutic relevance, but can be problematic due to considerably overlapping morphology. No immunohistochemical markers aiding in this distinction have been published so far. Methods and results We identified and quantified numerous differentially expressed proteins using an unbiased proteomic screen by mass spectrometry in pooled protein lysates from three type A and three type B3 thymomas. From these, candidates were validated in a larger series of paraffin‐embedded type A and B3 thymomas. We identified argininosuccinate synthetase 1 (ASS1) and special AT‐rich sequence binding protein 1 (SATB1) as highly discriminatory between 34 type A and 20 type B3 thymomas (94% sensitivity, 98% specificity and 96% accuracy). Although not the focus of this study, the same markers also proved helpful in the diagnosis of type AB ( n = 14), B1 ( n = 4) and B2 thymomas ( n = 10). Conclusions Mutually exclusive epithelial expression of ASS1 in 100% of type B3 thymomas and ectopic nuclear expression of SATB1 in 92% of type A thymomas support the distinction between type A and type B3 thymomas with 94% sensitivity, 98% specificity and 96% accuracy.