Raspollini Maria Rosaria, Baroni Gianna, Taddei Antonio, Taddei Gian Luigi
Department of Human Pathology and Oncology, University of Florence, Florence, Italy.
Arch Pathol Lab Med. 2003 Dec;127(12):1586-90. doi: 10.5858/2003-127-1586-PCAWID.
Cdx-2 is expressed in normal colonic epithelia and in most colorectal adenocarcinomas. No data exist on Cdx-2 expression in primary cervical adenocarcinoma with colonic differentiation.
To ascertain the utility of Cdx-2 and a limited immunohistochemical panel in differentiating between primary cervical adenocarcinoma with intestinal differentiation and secondary (colonic) cervical adenocarcinoma, which call for different surgical and chemotherapeutic treatment protocols.
We examined cervical tract adenocarcinomas in women with previously negative medical histories for neoplastic disease and in women with colonic carcinoma. An immunohistochemical panel consisting of cytokeratin 7, cytokeratin 20, carcinoembryonic antigen, and a new marker, Cdx-2, was evaluated in all cases. The clinical data, the morphologic features, and the immunohistochemical staining patterns were compared.
Of the tumors diagnosed as metastatic intestinal adenocarcinoma of the cervix, based on clinical data and hematoxylin-eosin-stained sections, all were Cdx-2 positive, whereas Cdx-2 was not expressed in any of our cases of primary cervical adenocarcinoma with colonic differentiation. Carcinoembryonic antigen was expressed both in primary cervical tumor and in secondary (intestinal) cervical adenocarcinoma. Cytokeratin 20 was not expressed in our cases of cervical adenocarcinoma, and it was not expressed in 7.15% of cervical metastases from intestinal carcinoma. Immunostaining with cytokeratin 7 was positive in cervical adenocarcinoma, but was negative in secondary (intestinal) cervical adenocarcinoma.
Our immunohistochemical analysis shows that Cdx-2 has good specificity and would be a good marker to use in a limited panel of immunohistochemical markers, such as cytokeratin 7, cytokeratin 20, and carcinoembryonic antigen, to distinguish primary cervical adenocarcinoma from intestinal metastases to the cervix.
Cdx-2在正常结肠上皮及大多数结直肠癌中表达。关于具有结肠分化的原发性宫颈腺癌中Cdx-2的表达情况尚无数据。
确定Cdx-2及一组有限的免疫组化指标在鉴别具有肠化生的原发性宫颈腺癌与继发性（结肠）宫颈腺癌中的作用，这两种腺癌需要不同的手术及化疗方案。
我们检查了既往无肿瘤病史女性的宫颈腺癌以及结肠癌女性患者的宫颈腺癌。对所有病例评估了由细胞角蛋白7、细胞角蛋白20、癌胚抗原及一种新标志物Cdx-2组成的免疫组化指标。比较了临床数据、形态学特征及免疫组化染色模式。
根据临床数据及苏木精-伊红染色切片诊断为宫颈转移性肠腺癌的所有肿瘤均Cdx-2阳性，而我们所有具有结肠分化的原发性宫颈腺癌病例中Cdx-2均未表达。癌胚抗原在原发性宫颈肿瘤及继发性（肠型）宫颈腺癌中均有表达。细胞角蛋白20在我们的宫颈腺癌病例中未表达，在7.15%的肠型宫颈癌转移灶中也未表达。细胞角蛋白7免疫染色在宫颈腺癌中呈阳性，但在继发性（肠型）宫颈腺癌中呈阴性。
我们的免疫组化分析表明，Cdx-2具有良好的特异性，在由细胞角蛋白7、细胞角蛋白20及癌胚抗原等组成的有限免疫组化指标中，是区分原发性宫颈腺癌与宫颈肠转移癌的良好标志物。
