ABSTRACT
SUMMARY OBJECTIVE: Thyroid neoplasm incidence has increased worldwide, mostly due to the advancements in medical imaging and screening rates. The aberrant Wnt/β-catenin pathway has been identified as a key mechanism, and it has also been related to the metastatic activity of differentiated thyroid cancer. We aimed to verify the difference in the expression of Wnt3a, a canonical activator of the β-catenin signaling, and CDX-2, a transcription factor upregulated by Wnt/β-catenin pathway, in multinodular goiter and differentiated thyroid cancer and to determine their prognostic value. METHODS: We included 194 thyroid tissue surgical specimen and their clinicopathological data: study group (differentiated thyroid cancer, n=154) and control group (multinodular goiter, n=40). Immunohistochemistry (IHC) was performed on formalin-fixed, paraffin-embedded tissue by the primary antibodies Wnt3a and CDX-2. RESULTS: High Wnt3a expression was significantly associated with differentiated thyroid cancer (p=0.031). CDX-2 was negative in all differentiated thyroid cancer cases (100%) and also in multinodular goiter. Wnt3a expression was significantly associated with tumors ≤20 mm (p=0.044) and with the absence of capsule invasion (p=0.031). The multivariate analyses suggested that older age (≥55), independent of capsular invasion and tumor size, was an independent prognostic factor for Wnt3a expression (p=0.058). CONCLUSIONS: Wnt3a expression but not CDX-2 is correlated with differentiated thyroid cancer samples in comparison to multinodular goiter. Although its prognostic value was limited to tumor size and capsule invasion, a combined model in a panel of immune markers can add accuracy in the classification of challenging thyroid follicular-derived lesions.
ABSTRACT
Objective To explore the expression of caudal type homeobox transcription factor 2 (Cdx2) and liver intestinal cadherin (LI-CD) in intestinal metaplasia ( IM ) of gastric mucosa and gastric adenocarcinoma of the intestinal type (GAIT). Methods By using immunohistochemical method, the ex-pressions of Cdx2 and LI-CD were detected in biopsy sample including 30 cases of GAIT, 30 IM and 30 nor-mal controls. Results The positive rate of Cdx2 expression was 0, 93.3% and 46.7% in normal stomach mucosa, IM and GAIT, respectively. The positive rates of Cdx2 expression in IM and GAIT were significant-ly higher than that in normal stomach mucosa ( P < 0. 005 ), and the expression of Cdx2 in IM was signifi-cantly higher than that in GAIT (P<0. 005). Similarly, LI-CD was also negative in normal stomach muco-sa, and positive rates were 96. 7% and 73. 3% in IM and GAIT group, which were significantly higher than that in normal stomach mucasa (P < 0. 005 ), and LI-CD expression was also significantly higher in IM than in GAIT (P < 0. 05 ). In addition, the staining intensity of Cdx2 and LI-CD expressions in IM exhibited sig-nificant correlation (r=0. 827, P<0.01), but those in GAIT did not (r =0.438, P=0. 117). Conclu-sion Ectopic expression of Cdx2 and LI-CD can be found in IM and GAIT tissues, which could be an early marker in the disease progression. There is correlation between Cdx2 and LI-CD expression in IM tissue of human, and presumably, Cdx2 regulates LI-CD in IM development.
ABSTRACT
Low-grade adenocarcinomas that primarily arise within the sinonasal tract are uncommon tumors. We report here on three cases of primary sinonasal low-grade adenocarcinomas. The patients were 2 females and 1 male with ages of 48, 57 and 64, respectively. Microscopically, the tumors had a well developed tubulopapillary growth pattern that consisted of columnar or pseudostratified cells with eosinophilic cytoplasm, round to oval nuclei and rare mitotic activity. On immunohistochemistry, the tumor cells were strongly positive for cytokeratin 7, but they were negative for cytokeratin 20, CDX-2 and p53. The Ki-67 labeling index was very low (mean: 1.9%). Two patients developed recurrent tumors at the primary site after the initial surgery, but all the patients are presently alive without metastasis 6 years 8 months, 8 years 8 months, and 11 months after the initial diagnosis. When considering the progress of these tumors, we think that it's important to understand the pathology of this entity to avoid underdiagnosis because a complete excision is required for effective treatment.