Vang Russell, Gown Allen M, Wu Lee-Shu-Fune, Barry Todd S, Wheeler Darren T, Yemelyanova Anna, Seidman Jeffrey D, Ronnett Brigitte M
Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
Mod Pathol. 2006 Nov;19(11):1421-8. doi: 10.1038/modpathol.3800698. Epub 2006 Sep 15.
Recent studies have demonstrated conflicting results regarding the value of CDX2 for distinguishing primary ovarian mucinous tumors from metastatic mucinous carcinomas in the ovary. Utility of coordinate expression of cytokeratins 7 and 20 is restricted to distinction of ovarian mucinous tumors from lower gastrointestinal tract metastases and data comparing coordinate expression of all three markers is limited. Immunohistochemical studies were performed to compare expression of CDX2 and cytokeratin 20, both markers of intestinal differentiation, in conjunction with coordinate expression of cytokeratin 7, in 90 mucinous tumors involving the ovary: 42 primary ovarian mucinous tumors (31 atypical proliferative (borderline) mucinous tumors (gastrointestinal type), 11 mucinous carcinomas) and 48 metastatic mucinous carcinomas of upper (pancreaticobiliary tract: 14; stomach: five) and lower (colon and rectum: 25; appendix: four) gastrointestinal tract origin. Primary ovarian tumors expressed CDX2 (40%) less frequently than cytokeratin 20 (83%) (P<0.0001). CDX2 expression in primary ovarian tumors (40%) was lower than CDX2 expression in metastatic carcinomas of both upper (74%; P=0.016) and lower gastrointestinal tract origin (90%; P<0.0001). Cytokeratin 20 expression was similar in primary ovarian tumors (83%) and metastases of upper (89%; P=0.071) and lower gastrointestinal tract origin (93%; P=0.29). Thus, as a single marker CDX2 offers some advantage over cytokeratin 20 because it is less frequently positive in primary ovarian tumors. In the almost universally cytokeratin 7-positive primary ovarian tumors and metastases of upper gastrointestinal tract origin, CDX2 coordinate expression was less common in primary ovarian tumors (36%) than in metastases of upper gastrointestinal tract origin (63%) (P=0.022) whereas cytokeratin 20 coordinate expression was identical in both tumor types (79%). In the almost universally cytokeratin 7-negative metastases of lower gastrointestinal tract origin, coordinate expression of CDX2 (83%) and cytokeratin 20 (86%) were equivalent (P=1.00). CDX2 was comparable to cytokeratin 20 in distinguishing metastases of lower gastrointestinal tract origin (usually cytokeratin 7-negative and CDX2/cytokeratin 20 positive) from primary ovarian tumors and metastases of upper gastrointestinal tract origin (usually cytokeratin 7-positive and CDX2/cytokeratin 20 variable). CDX2 provided some advantage over cytokeratin 20 for distinguishing primary ovarian mucinous tumors from metastases of upper but not lower gastrointestinal tract origin; however, the advantage in the former was limited due to the occurrence of shared coordinate expression profiles in both tumor types. Cytokeratin 7 provides the predominant discriminatory value among these markers yet is limited to distinction of primary ovarian tumors from metastases of lower gastrointestinal tract origin.
近期研究表明，在鉴别原发性卵巢黏液性肿瘤与卵巢转移性黏液癌时，CDX2的价值存在相互矛盾的结果。细胞角蛋白7和20的协同表达仅用于鉴别卵巢黏液性肿瘤与下消化道转移瘤，且比较这三种标志物协同表达情况的数据有限。我们进行了免疫组化研究，以比较CDX2和细胞角蛋白20（二者均为肠化生标志物）的表达，并结合细胞角蛋白7的协同表达情况，研究对象为90例累及卵巢的黏液性肿瘤，其中包括42例原发性卵巢黏液性肿瘤（31例非典型增生性（交界性）黏液性肿瘤（胃肠道型），11例黏液癌）以及48例上消化道（胰胆管：14例；胃：5例）和下消化道（结肠和直肠：25例；阑尾：4例）来源的转移性黏液癌。原发性卵巢肿瘤中CDX2的表达频率（40%）低于细胞角蛋白20（83%）（P<0.0001）。原发性卵巢肿瘤中CDX2的表达（40%）低于上消化道来源转移性癌（74%；P=0.016）和下消化道来源转移性癌（90%；P<0.0001）。细胞角蛋白20在原发性卵巢肿瘤（83%）以及上消化道（89%；P=0.071）和下消化道来源转移瘤（93%；P=0.29）中的表达相似。因此，作为单一标志物，CDX2比细胞角蛋白20具有一定优势，因为它在原发性卵巢肿瘤中的阳性频率较低。在几乎普遍呈细胞角蛋白7阳性的原发性卵巢肿瘤及上消化道来源转移瘤中，CDX2的协同表达在原发性卵巢肿瘤（36%）中比在上消化道来源转移瘤（63%）中少见（P=0.022），而细胞角蛋白20的协同表达在两种肿瘤类型中相同（79%）。在几乎普遍呈细胞角蛋白7阴性的下消化道来源转移瘤中，CDX2（83%）和细胞角蛋白20（86%）的协同表达相当（P=1.00）。在鉴别下消化道来源转移瘤（通常细胞角蛋白7阴性且CDX2/细胞角蛋白20阳性）与原发性卵巢肿瘤及上消化道来源转移瘤（通常细胞角蛋白7阳性且CDX2/细胞角蛋白20情况不定）方面，CDX2与细胞角蛋白20相当。在鉴别原发性卵巢黏液性肿瘤与上消化道而非下消化道来源转移瘤时，CDX
