Expression of CDX2, Cytokeratins 7 and 20 in Sinonasal Intestinal-Type Adenocarcinoma

Abstract

CDX2 is a transcription factor expressed by intestinal epithelium. It is considered as a sensitive marker for a colorectal or-less frequently-gastric origin of adenocarcinomas. The pattern of coordinated expression of cytokeratin (CK) 7 and CK20 is also useful for the diagnosis of the origin of metastatic adenocarcinomas. Expression of CDX2, CK7 and CK20 was investigated in 14 cases of sinonasal intestinal-type adenocarcinoma (SIA), a particular tumor with an enteric-cell-type appearance. Formalin-fixed, paraffin embedded tissue sections were immunostained with monoclonal antibodies using the biotin-labeled streptavidin technique. All of the cases expressed CDX2, being stained 50 to 100% of the tumor cells (mean: 87.2%). CK7 positivity was detected in 8 cases (57.1%), with the staining of 10 to 100% of cells (mean: 65.6%), and CK20 was found in all the tumors (10 to 100% of cells; mean: 78.8%). The histologic resemblance between SIA and colorectal adenocarcinoma is reinforced by the expression of CDX2 and CK20, which are virtually constant in both neoplasms. CDX2 seems to be a marker for cellular phenotype better than an indicator of the origin of adenocarcinomas. CK7 is expressed in SIA less frequently than in colonic adenocarcinoma, but with a rate similar to the subset of rectal tumors, making the differential diagnosis between the two neoplasms difficult.

Among Sinonasal Tumors, CDX-2 Immunoexpression is not Restricted to Intestinal-Type Adenocarcinomas

“…We confirmed that CDX-2 and cytokeratin 20 are highly sensitive for sinonasal ITAC, as has been previously shown Intestinal-type adenocarcinoma 6/6 (100) 6/6 (100) [15][16][17][18][19][20]. It is worth noting that the immunostaining was not always diffuse in ITACs: focal positivity for CDX-2 and cytokeratin 20 was seen in 1 of 6 and 2 of 6 cases, respectively.…”

“…In addition, the two immunostains were complementary; in the 3 cases where one was only focally positive, the other was diffuse. Both markers were consistently negative in non-intestinal surface-type adenocarcinomas, as others have previously demonstrated [15][16][17][18][19][20].…”

“…While sinonasal ITAC shares the CDX-2 positive/cytokeratin 20 positive immunoprofile of its colorectal counterpart, low grade non-intestinal surfacetype adenocarcinomas are consistently negative [15][16][17][18][19][20]. To our knowledge, however, these immunostains have not been tested across a broad range of sinonasal neoplasms, so their specificities for ITAC are not known.…”

Biphasic Low-Grade Nasopharyngeal Papillary Adenocarcinoma with a Prominent Spindle Cell Component: Report of a Case Localized to the Posterior Nasal Septum

“…Regarding papillary variants of the intestinal type of adenocarcinoma, these tumors show more nuclear atypia than our tumor and commonly display mucinous differentiation. Immunohistochemically, ITACs are positive for CK20 and express cdx-2 [39] (negative in our case). Sinonasal low-grade tubulo-papillary adenocarcinoma (''terminal tubulus adenocarcinoma'' according to Kleinsasser) is a rare neoplasm characterized by Skalova et al [40].…”

Differential diagnostic and functional role of the multi-marker phenotype CDX2/CK20/CK7 in colorectal cancer stratified by mismatch repair status

“…19,[45][46][47][48][49][50] On the basis of this ubiquity, negative CDX2 expression in adenocarcinoma cannot systematically rule out a diagnosis of colorectal cancer. Especially, the immunohistochemical analysis of a mucinous adenocarcinoma with negative CK20 expression in addition to negative CDX2 expression, located on the right side of the colon of a female patient must be underlined as a potential pitfall of misdiagnosis, where a metastasis could be diagnosed without consideration of a possible microsatellite instability high colorectal cancer.…”