TTF-1 and napsin A do not differentiate metastatic lung adenocarcinomas from primary esophageal adenocarcinomas: proposal of a novel staining panel.

Abstract

CONTEXT:

When adenocarcinomas arise within the esophagus, particularly when located away from the gastroesophageal junction, it may be important in some patients to differentiate between a primary esophageal adenocarcinoma and metastasis from another site. Lung adenocarcinoma is one tumor that has been reported to frequently metastasize to the esophagus.

OBJECTIVES:

To create a panel of immunohistochemical markers that can reliably distinguish between an esophageal and pulmonary primary; within the gastrointestinal pathology literature, including published articles and textbooks, common lung immunohistochemical markers, such as TTF-1, are assumed to be negative in esophageal adenocarcinoma, yet, to our knowledge, no study has yet investigated the veracity of that presumption.

DESIGN:

In this study, 24 cases each of pulmonary and esophageal adenocarcinomas were stained with TTF-1, napsin A, CDX2, 34βE12, N-cadherin, and IMP3 in an attempt to define an optimal panel for differentiation. Esophageal adenocarcinomas occurring at the gastroesophageal junction were excluded in this study because a gastric primary tumor cannot be excluded in those cases.

RESULTS:

Surprisingly, TTF-1 and napsin A were positive in similar proportions of tumors from both sites. Those markers that differentiated statistically between esophageal and pulmonary adenocarcinoma were IMP3, CDX2, and N-cadherin.

CONCLUSIONS:

When differentiating the origin of a tumor as either esophageal or pulmonary, an immunohistochemical panel consisting of IMP3, CDX2, and N-cadherin is superior to either TTF-1 or napsin A.

• Authors: Kanwaijit S Aulakh, Cary D Chisholm, Daniel A Smith, V O Speights
• Journal: Archives of pathology & laboratory medicine (Arch Pathol Lab Med) Vol. 137 Issue 8 Pg. 1094-8 (Aug 2013) ISSN: 1543-2165 [Electronic] United States
• PMID: 23899066 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antigens, CD
• Biomarkers, Tumor
• CDH2 protein, human
• CDX2 Transcription Factor
• CDX2 protein, human
• CK-34 beta E12
• Cadherins
• Homeodomain Proteins
• IGF2BP3 protein, human
• NKX2-1 protein, human
• Nuclear Proteins
• RNA-Binding Proteins
• Thyroid Nuclear Factor 1
• Transcription Factors
• Keratins
• Aspartic Acid Endopeptidases
• NAPSA protein, human

Topics

• Adenocarcinoma (metabolism, pathology, secondary)
• Antigens, CD (metabolism)
• Aspartic Acid Endopeptidases (metabolism)
• Biomarkers, Tumor (metabolism)
• CDX2 Transcription Factor
• Cadherins (metabolism)
• Diagnosis, Differential
• Esophageal Neoplasms (metabolism, pathology, secondary)
• Homeodomain Proteins (metabolism)
• Humans
• Immunohistochemistry (methods)
• Keratins (metabolism)
• Lung Neoplasms (metabolism, pathology)
• Nuclear Proteins (metabolism)
• RNA-Binding Proteins (metabolism)
• Staining and Labeling (methods)
• Thyroid Nuclear Factor 1
• Transcription Factors (metabolism)