Cytokeratin 7-positive/cytokeratin 20-negative cecal adenocarcinoma metastatic to the uterine cervix: a case report

Abstract

BackgroundThe vast majority of uterine cervical malignancies are primary carcinomas, and secondary neoplasms that metastasize to the uterine cervix from a distant organ are uncommon. Although relatively rare, metastases to the uterine cervix from a primary colon cancer have been reported. We report a rare case of metastatic carcinoma originating from a cecal adenocarcinoma with an unusual cytokeratin 7/cytokeratin 20 immunophenotype.Case presentationA 74-year-old postmenopausal Japanese woman was referred to our hospital for the evaluation of a uterine tumor. She had a past medical history of cecal cancer and had undergone laparoscopically assisted right hemicolectomy at the age of 69 years. During follow-up, she was found to have elevated levels of the tumor markers carbohydrate antigen 19-9 (179.7 IU/mL) and carcinoembryonic antigen (26.9 μg/L). Positron emission tomography/computed tomography showed a focus of high 18F-fluorodeoxyglucose uptake in her uterus. Examination of a cervical biopsy found a poorly differentiated adenocarcinoma that was immunopositive for cytokeratin (CK)7 and caudal-related homeobox 2 (CDX2) expression and immunonegative for cytokeratin 20 expression. The patient underwent radical hysterectomy and bilateral salpingo-oophorectomy. Histopathological examination found invasive growth of irregular and atypical ductal hyperplasia. Immunohistochemical staining of the tumor specimen revealed the same immunophenotype as the biopsy specimen. The cecal cancer specimen from her previous surgery was also examined and found to have the same immunophenotype. The histopathological diagnosis was cecal adenocarcinoma metastatic to the uterine cervix. The patient is currently receiving adjuvant chemotherapy and to date is without evidence of recurrent disease.ConclusionsOur report illustrates the importance of immunohistochemistry for the correct diagnosis of the origin of a uterine cervical adenocarcinoma in a patient with a medical history of colorectal cancer. Re-examination of a previous oncological specimen is critical for cases with a uterine lesion that is difficult to identify as primary or metastatic cancer.

Engineered colorectal cancer tissue recapitulates key attributes of a patient-derived xenograft tumor line

“…This result is consistent with immunohistochemical findings that 78% of stage II colon cancer patients had partial positivity for CK20 [92]. Importantly the CK20 protein is linked to metastasis and invasiveness, microsatellite instability, differentiation, and stage of CRC [82][83][84][85].…”

“…To examine temporal changes in cancer cell subpopulations in the CRC-PDX tumor, 3D-eCRC-PDX tissues, and 2D-CRC-PDX cultures, CK20 was used to examine a CRC positive (CK20 + ) cell subpopulation. Even though CK20 is a CRC marker, not all CRC cells express the CK20 protein; the CK20 negative cell subpopulation may include other CRC cells [82][83][84][85][86]. As expected, the CK20 + cells were a subpopulation of the B2M + cells while all mouse cells were negative for B2M as well as CK20 (supplementary figure 5).…”

Endometrioid adenocarcinoma of the rectovaginal septum with invasion of the rectum: a case report and review of literature

“…On the other hand, CDX2 (a homeobox transcription factor) is expressed during normal intestinal development [27]. Thus, CDX2 expression may be positive in colorectal cancers and has high sensitivity for the differential diagnosis of colorectal adenocarcinoma [28]. Our patient had positive IHC staining for CK7, ER, and PAX-8, and negative staining for CK20 and CDX-2, compatible with our diagnosis of endometrioid adenocarcinoma.…”

Identification of proteins associated with paclitaxel resistance of epithelial ovarian cancer using iTRAQ‑based proteomics

“…They are maintained during carcinogenesis ( 40 , 41 ). CK7 is expressed by a number of ductal and glandular epithelial cells (mainly gallbladder, hepatic ducts, and pancreatic ducts), by female genital tract tissues (ovary, endometrium, fallopian tube, and cervix) and by breast, lung, and urinary tract tissues ( 42 ). Chu et al ( 43 ) conducted immunohistochemistry to assess CK7 and cytokeratin 20 expression in 435 epithelial malignancy specimens, and 5% stained cells was considered to be positive.…”