Guanylyl cyclase C, a receptor for bacterial diarrheagenic
enterotoxins, is expressed selectively by intestinal epithelium and is an endogenous downstream target of CDX2. The expression of
Guanylyl cyclase C is preserved throughout the
adenoma/
carcinoma sequence in the colorectum. Detection of
Guanylyl cyclase C expression by
reverse transcriptase-polymerase chain reaction is currently being validated as a technique to identify occult
lymph node metastases in patients with
colorectal cancer and for circulating cells in the blood for postoperative surveillance. Although
Guanylyl cyclase C is widely expressed by well-differentiated
colorectal cancer, its expression in poorly differentiated
colorectal cancer has not been evaluated. A tissue microarray was created from 69 archival specimens including 44 poorly differentiated, 15 undifferentiated or medullary, and 10 signet ring cell
colorectal carcinomas. Matched normal colonic mucosa was used as a positive control. Immunohistochemical staining for
Guanylyl cyclase C and CDX2 was evaluated as positive or negative based on at least
a 10% extent of staining. Of the 69
tumor samples, 75%, 47%, and 90% of the poorly differentiated, medullary, and signet ring cell
tumors were positive for
Guanylyl cyclase C and 75%, 40% and 90% of these subsets were positive for CDX2, respectively. There was excellent correlation between
Guanylyl cyclase C and CDX2 expression on a case-per-case basis (P < .0001). There was also a statistically significant difference in the
Guanylyl cyclase C staining pattern between
medullary carcinomas and poorly differentiated, not otherwise specified (P = .05). Immunopositivity for
Guanylyl cyclase C was greater than 95% in a separately stained microarray series of well/moderately differentiated
colorectal carcinomas. In conclusion,
Guanylyl cyclase C expression is lost in a quarter of poorly differentiated and half of undifferentiated
colorectal carcinomas. Therefore, the utility of
Guanylyl cyclase C expression as a diagnostic marker for
colorectal carcinoma may be questionable in poorly differentiated
colorectal neoplasms.