Background: Cyclo-oxygenase (COX)-2 overexpression is observed in various neoplasms and COX-2 inhibition has been attempted as prevention and/or therapy in these neoplasms. Carcinoid tumors are thought to arise from neuroendocrine cells and originate mainly in the gastrointestinal tract. Cyclo-oxygenase-2 is reportedly expressed in neuroendocrine cells of normal colorectal mucosa. The role of COX in carcinoids has not previously been investigated. The aim of the present paper was to clarify the expression of COX-1 and -2, and their role in human gastrointestinal carcinoids. Methods: Expression of COX-1 and -2 was studied immunohistochemically in 38 gastrointestinal carcinoids. Five bronchopulmonary and seven metastatic carcinoids were also examined, for comparison with gastrointestinal carcinoids. The immunohistochemical score (IHS) was calculated from staining intensity and immunoreactive cell population, and ranked according to four grades (negative to strong). Results: Cyclo-oxygenase-2 was expressed in all gastrointestinal carcinoids (weak, 1; moderate, 13; strong, 24) and bronchopulmonary carcinoids (weak, 1; moderate, 4), as well as their metastases (moderate, 3; strong, 4). The IHS of COX-2 in larger tumors was significantly lower than that in smaller tumors. However, the IHS of COX-2 at the advancing tumor edge was significantly higher than that at the centers of tumors ≥ 10 mm in size. Faint COX-1 expression was detected in only one duodenal, one rectal and four bronchopulmonary carcinoids. Conclusions: Enhanced COX-2 expression was observed in gastrointestinal as well as bronchopulmonary carcinoids and their metastases, especially at the advancing edges of the tumors. Cyclo-oxygenase-2 may play a role in carcinoid progression.Weak to moderate COX-2 immunoreactivity was observed in all bronchopulmonary carcinoid tumors (Table 2). In contrast to GI carcinoid tumors, four of five bronchopulmonary tumors exhibited COX-1 staining. However, immunoreactivity was weak and was seen only in limited areas of the tumor in all four cases (Table 2).
COX-1 and -2 expression in metastatic carcinoid tumorsMetastatic LN tumors, from one gastric, one colonic, one rectal and one bronchopulmonary carcinoid tumor, were examined. All LN tumors expressed moderate to strong COX-2 immunoreactivity (Table 2, Fig. 1f), whereas no COX-1 staining was observed. In non-tumor LN tissues, weak COX-1 and -2 staining was detected in fibroblasts and mononuclear cells.Two cases with metastatic liver tumors from the rectum, one multiple and one single, were examined. The COX-2 staining was detected in all liver tumors examined (Table 2, Fig. 1g) and was moderate in non-tumor hepatocytes, which is consistent with previous reports. 22,23 Cyclo-oxygenase-1 staining was not observed in either liver tumors or non-tumor hepatic tissues.A metastatic bone tumor from the rectum also expressed COX-2 (Table 2, Fig. 1h) but not COX-1.