Morules in endometrioid proliferations of the uterus and ovary consistently express the intestinal transcription factor CDX2

106

Context Immunohistochemistry has become an indispensable ancillary study in the identification and classification of undifferentiated neoplasms/tumors of uncertain origin. The diagnostic accuracy has significantly improved because of the continuous discoveries of tissue-specific biomarkers and the development of effective immunohistochemical panels. Objectives To identify and classify undifferentiated neoplasms/tumors of uncertain origin by immunohistochemistry. Data Sources Literature review and authors' research data and personal practice experience were used. Conclusions To better guide therapeutic decisions and predict prognostic outcomes, it is crucial to differentiate the specific lineage of an undifferentiated neoplasm. Application of appropriate immunohistochemical panels enables the accurate classification of most undifferentiated neoplasms. Knowing the utilities and pitfalls of each tissue-specific biomarker is essential for avoiding potential diagnostic errors because an absolutely tissue-specific biomarker is exceptionally rare. We review frequently used tissue-specific biomarkers, provide effective panels, and recommend diagnostic algorithms as a standard approach to undifferentiated neoplasms.

Section: Review Of Selected Antibodiesmentioning

confidence: 99%

Immunohistochemistry in Undifferentiated Neoplasm/Tumor of Uncertain Origin

Lin

Liu

2014

106

“…95,96 Furthermore, a curious pattern of CDX2 expression has been documented in the ''squamous'' morules of endometrioid hyperplasia and carcinoma. 97,98 Adenocarcinomas arising within germ cell tumors often show intestinal differentiation, as evidenced by CDX2 expression. 83,84 Villin.-Villin is an actin-binding protein, found preferentially in microvilli, expression of which is largely (but not entirely) restricted to glandular epithelium and corresponding adenocarcinomas of the GI tract.…”

mentioning

confidence: 99%

Practical Applications in Immunohistochemistry: Carcinomas of Unknown Primary Site

Kandalaft

Gown

2015

Context.-Identification of the site of origin of carcinoma of unknown primary using immunohistochemistry is a frequent requirement of anatomic pathologists. Diagnostic accuracy is crucial, particularly in the current era of targeted therapies and smaller sample sizes.Objectives.-To provide practical guidance and suggestions for classifying carcinoma of unknown primary using both proven and new antibodies, as well as targeting panels based on integration of morphologic and clinical features.Data Sources.-Literature review, the authors' practice experience, and authors' research.Conclusions.-With well-performed and interpreted immunohistochemistry panels, anatomic pathologists can successfully identify the site of origin of carcinoma of unknown primary. It is crucial to understand not only the diagnostic uses of the many available antibodies but also the potential limits and pitfalls.

“…It has been well established that caudal type homeobox 2 (CDX2) is a highly sensitive immunomarker for gastrointestinal (GI) adenocarcinomas but may also be expressed in tumors from other organs, such as the pancreas, bile ducts, bladder, uterine cervix, endometrium, and ovary. [10][11][12][13][14][15] Marked reduction or loss of expression of cytokeratin 20 (CK20) and CDX2 is frequently seen in MC. 9,[16][17][18][19] Wick and colleagues 20 reported that multifocal positivity of neuroendocrine markers (synaptophysin and chromogranin A) and focal p53 positivity were observed in 32% and 53% of MC cases, respectively.…”

mentioning

confidence: 99%

Cadherin-17 and SATB2 Are Sensitive and Specific Immunomarkers for Medullary Carcinoma of the Large Intestine

Lin

Shi

Zhu

et al. 2014

113

117

Context.-Distinction of medullary carcinoma of the large intestine from other cytokeratin (CK) 7 À /CK20 À carcinomas can be challenging when working on a tumor of unknown primary because the majority of medullary carcinomas are negative for CK7, CK20, and CDX2.Objective.-To investigate the expression of cadherin-17 and SATB-2 and other markers in medullary carcinomas of the large intestine and cadherin-17 and SATB2 in a large number of carcinomas and normal tissues from various organs to further test their diagnostic specificity.Design.-This study evaluated cadherin-17 and SATB2 expression in 18 medullary carcinoma cases and 1941 tumors and 358 normal tissues from various organs. Other immunomarkers, including MLH1, PMS2, MSH2, MSH6, CDX2, CK7, CK20, TFF3, MUC4, calretinin, p504S, villin, and synaptophysin, were also tested on the 18 medullary carcinoma cases.Results.-The results demonstrated (1) loss of MLH1 and PMS2 in more than 80% of medullary carcinomas; (2) expression of cadherin-17 and SATB2 in 89% of medullary carcinomas; (3) focal expression of TFF3, MUC4, calretinin, CDX2, CK20, and synaptophysin in 72%, 72%, 67%, 67%, 28%, and 17% of 18 medullary carcinoma cases, respectively; and (4) expression of SATB2 and cadherin-17 in 97% and 98% of the colorectal adenocarcinomas, respectively, whereas their expression was seen in 3.6% and 3.3% of nongastrointestinal tumors, respectively.Conclusions.-We concluded that SATB2 and cadherin-17 were highly sensitive and specific markers for colorectal carcinomas and propose including MLH1, cadherin-17, and SATB2 in a routine immunostaining panel when working on a tumor of unknown primary, especially in an elderly patient with a CK7 À /CK20À carcinoma.