Herawi Mehsati, De Marzo Angelo M, Kristiansen Glen, Epstein Jonathan I
Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA.
Hum Pathol. 2007 Jan;38(1):72-8. doi: 10.1016/j.humpath.2006.06.015. Epub 2006 Aug 10.
Numerous studies have claimed that CDX2 is relatively specific and sensitive in establishing a gastrointestinal origin in metastatic tumors of unknown origin. We have recently seen 2 cases of prostatic adenocarcinoma (PCa) on needle biopsies with diffuse strong nuclear staining for CDX2 sent for consultation. One case was a prostatic duct adenocarcinoma in a man with a prostate-specific antigen (PSA) value of 327 ng/mL, and the other was a PCa with a Gleason score (GS) of 4 + 4 = 8 in a man with a PSA value of 15 ng/mL. An adenocarcinoma with GS 3 + 3 = 6 from the contralateral side did not express CDX2. Because documented examples of this phenomenon are rare, we investigated the immunoexpression of CDX2, using tissue microarrays (TMAs). Three slides of TMAs were used to stain 708 tissue samples (0.6 mm in diameter) containing either benign or malignant prostate tissue, as well as control tissues from various anatomical sites including colon. In total, 195 samples of primary PCa with GS of 6 (n = 41), 7 (n = 21), and 8 (n = 8); 195 samples of benign prostate tissue; and 185 samples of metastatic PCa were studied. Of 70 radical prostatectomy specimens examined for PCa in TMAs, 4 (5.7%) were positive for CDX2, showing Gleason score of 6 (n = 3) and Gleason score of 7 (n = 1). Focal moderate positive staining was seen in benign prostate tissue in 7 (11.7%) of 60 radical prostatectomy specimens. None of the metastatic PCa expressed CDX2. CDX2 may uncommonly be focally expressed in benign prostatic glands. Staining in PCa is less common and appears independent of GS and is usually patchy and focal and of lesser intensity than in colonic tissue. However, rarely strong and diffuse staining may be seen. Positive CDX2 staining in high-grade prostate cancer (ductal, cribriform, and solid) may be confused with secondary carcinoma of colonic origin. Routine histopathology, positive PSA immunostaining, and clinical findings can help confirm the correct diagnosis.
众多研究表明，在确定不明原发转移瘤的胃肠道起源方面，CDX2相对具有特异性且敏感度较高。我们最近会诊了2例针吸活检显示前列腺腺癌（PCa）伴有弥漫性强核CDX2染色的病例。1例为前列腺导管腺癌，患者前列腺特异性抗原（PSA）值为327 ng/mL；另1例为Gleason评分（GS）4 + 4 = 8的PCa，患者PSA值为15 ng/mL。对侧GS 3 + 3 = 6的腺癌未表达CDX2。由于这种现象的文献记载实例很少，我们使用组织芯片（TMA）研究了CDX2的免疫表达。用3张TMA玻片对708个组织样本（直径0.6 mm）进行染色，这些样本包含良性或恶性前列腺组织以及来自包括结肠在内的各个解剖部位的对照组织。总共研究了195例GS为6（n = 41）、7（n = 21）和8（n = 8）的原发性PCa样本；195例良性前列腺组织样本；以及185例转移性PCa样本。在TMA中检查的70例前列腺癌根治术标本中，4例（5.7%）CDX2呈阳性，Gleason评分为6（n = 3）和Gleason评分为7（n = 1）。在60例前列腺癌根治术标本中的7例（11.7%）良性前列腺组织中可见局灶性中度阳性染色。转移性PCa均未表达CDX2。CDX2可能罕见地在良性前列腺腺体内局灶性表达。在PCa中的染色较少见，且似乎与GS无关，通常呈斑片状和局灶性，强度低于结肠组织。然而，罕见情况下可见强弥漫性染色。高级别前列腺癌（导管、筛状和实性）中CDX2阳性染色可能会与结肠起源的继发性癌混淆。常规组织病理学、PSA免疫染色阳性以及临床发现有助于确诊。
