Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010, USA.
Am J Surg Pathol. 2011 Dec;35(12):1830-6. doi: 10.1097/PAS.0b013e3182299c25.
Mucinous adenocarcinomas (MAs) of various origins may have a similar histologic appearance and frequently metastasize to distant sites, which often causes diagnostic problems in surgical pathology practice. The immunohistochemical profiles of MAs of various origins have not been well studied. We investigated the expression of 10 immunohistochemical markers (CK7, CK20, CDX-2, β-catenin, MUC-1, MUC-2, MUC-6, ER, WT-1, and PAX-8) in 175 cases of MA, including 69 cases from the lower gastrointestinal (GI) tract, 41 from the upper GI tract, 27 from gynecologic organs, 4 from the urinary bladder, 18 from the breast, and 16 from the lung. We found that lower GI MAs (colon, rectum, and anus) frequently expressed CDX-2 (42 of 42, 100%; 33 of 42 with homogenous positivity, 79%), MUC-2 (42 of 42; 100%), CK20 (41 of 42; 98%), and β-catenin (nuclear) (27 of 42; 64%) and rarely expressed MUC-6 (2 of 42; 5%) and CK7 (8 of 42; 19%). Most of the CK7-positive cases were from the rectum and anus (7 of 8; 88%). The expression of these markers in appendiceal MAs was similar to that of low GI tract MAs, except for a lower percentage of homogenous CDX-2 (3 of 27; 11%) and nuclear β-catenin (3 of 27; 11%) expression. Unlike their lower GI tract counterparts, the upper GI tract MAs (ampulla, pancreas/biliary tree, and stomach/esophagus) frequently expressed CK7 (38 of 41; 93%) and MUC-6 (31 of 41; 76%) and were rarely homogenously positive for CDX-2 (4 of 41; 10%) and nuclear positive for β-catenin (8 of 41; 19%). Breast MAs were frequently positive for CK7 (18 of 18; 100%), MUC-1 (18 of 18; 100%), MUC-2 (18 of 18; 100%), ER (16 of 18; 89%), MUC-6 (9 of 18; 50%), and WT-1 (9 of 18; 50%). Lung MAs were frequently positive for CK7 (16 of 16; 100%) and MUC-1 (15 of 16; 94%). Gynecologic MAs were positive for CK7 (25 of 27; 93%) and PAX-8 (13 of 27; 48%). We conclude that homogenous CDX-2 and nuclear β-catenin expressions are commonly seen in lower GI tract MAs. In contrast, appendiceal MAs are usually heterogenously positive for CDX-2 and show cytoplasmic positivity for β-catenin. Unlike lower GI tract MAs, upper GI tract MAs are frequently positive for CK7 and MUC-6. As is the case in appendiceal MAs, the upper GI tract MAs may also be heterogenously positive for CDX-2. Breast MAs are positive for ER and WT-1, whereas gynecologic MAs are positive for PAX-8 and negative for WT-1.
黏液性腺癌（MAs）源于不同的组织器官，其组织学形态相似，且常发生远处转移，这常常给外科病理诊断带来问题。目前，人们对源于不同组织器官的 MAs 的免疫组织化学表型尚未进行充分研究。本研究旨在探讨 10 种免疫组织化学标志物（CK7、CK20、CDX-2、β-catenin、MUC-1、MUC-2、MUC-6、ER、WT-1 和 PAX-8）在 175 例 MAs 中的表达情况，这些 MAs 分别来自于 69 例下消化道（GI）、41 例上消化道、27 例妇科器官、4 例膀胱、18 例乳腺和 16 例肺。我们发现，下消化道 MA（结肠、直肠和肛门）常表达 CDX-2（42/42，100%；33/42 呈均一阳性，79%）、MUC-2（42/42；100%）、CK20（42/42；98%）和β-catenin（核）（27/42；64%），很少表达 MUC-6（2/42；5%）和 CK7（8/42；19%）。大多数 CK7 阳性病例来自直肠和肛门（7/8；88%）。阑尾 MA 的表达与下消化道 MA 相似，只是 CDX-2（3/27；11%）和核 β-catenin（3/27；11%）的均一阳性率较低。与下消化道 MA 不同的是，上消化道 MA（壶腹、胰腺/胆道和胃/食管）常表达 CK7（38/41；93%）和 MUC-6（31/41；76%），CDX-2 （4/41；10%）和核 β-catenin（8/41；19%）的均一阳性率较低。乳腺 MA 常表达 CK7（18/18；100%）、MUC-1（18/18；100%）、MUC-2（18/18；100%）、ER（16/18；89%）、MUC-6（9/18；50%）和 WT-1（9/18；50%）。肺 MA 常表达 CK7（16/16；100%）和 MUC-1（15/16；94%）。妇科 MA 表达 CK7（25/27；93%）和 PAX-8（13/27；48%）。我们的研究结果表明，下消化道 MA 常表达均一的 CDX-2 和核 β-catenin。相反，阑尾 MA 常呈异质性 CDX-2 阳性，且细胞质内 β-catenin 阳性。与下消化道 MA 不同的是，上消化道 MA 常表达 CK7 和 MUC-6。与阑尾 MA 相似，上消化道 MA 也可能呈异质性 CDX-2 阳性。乳腺 MA 表达 ER 和 WT-1，而妇科 MA 表达 PAX-8，不表达 WT-1。
