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Intestinal metaplasia of the sinonasal mucosa adjacent to intestinal-type adenocarcinoma. A morphologic, immunohistochemical, and molecular study

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Abstract

It has been hypothesized that the development of sinonasal intestinal-type adenocarcinoma (ITAC) occurs through intestinal metaplasia (IM) of the respiratory and/or glandular epithelium. The aim of this study was to characterize the histological, immunohistochemical, and molecular features of sinonasal IM. Histologic slides from 29 consecutive surgical specimens of ITAC were retrieved. Sections were stained for CDX2, cytokeratin 20 (CK20), MUC2, and p53. The status of TP53 gene exons 4–9 was assessed separately in areas of IM and in ITAC. Foci of IM were detected in eight cases (27.5 %). They were all positive for CK20 and CDX2, while MUC2 was detected in six cases (75 %). In six cases (75 %), the metaplastic foci showed signs of dysplasia, including nuclear enlargement with increased nucleus to cytoplasm ratio, nuclear hyperchromasia, loss of nuclear polarity, and presence of prominent nucleoli. P53 nuclear immunoreactivity was observed in four cases. TP53 gene sequencing was successfully performed in six cases and revealed the same mutation in both IM and ITAC in two cases (c.832C > T and c.215G > C), while another ITAC showed a mutation that was not present in the adjacent IM (c.536A > G). In conclusion, our study suggests a possible clonal relationship between areas of sinonasal IM and ITAC, indicating that IM may represent a precursor lesion of ITAC. Improving the knowledge on the morphological and molecular features of IM is a key step to identify reliable biomarkers to determine the risk of sinonasal ITAC development.

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Acknowledgments

This paper was supported in part by a grant from Istituto Toscano Tumori (ITT).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Section of Anatomic Pathology, Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy

    Alessandro Franchi, Antonella Simoni, Monica Pepi & Marco Santucci

  2. Section of Histopathology, Department of Biomedicine, Azienda Ospedaliera Universitaria Careggi, Florence, Italy

    Annarita Palomba

  3. Unit of Environmental and Occupational Epidemiology, ISPO—Cancer Prevention and Research Institute, Florence, Italy

    Lucia Miligi

  4. Department of Anatomic Pathology, Catholic University, Rome, Italy

    Valentina Ranucci

  5. Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy

    Duccio Rossi Degli Innocenti

Authors
  1. Alessandro Franchi
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  2. Annarita Palomba
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  3. Lucia Miligi
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  4. Valentina Ranucci
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  5. Duccio Rossi Degli Innocenti
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  6. Antonella Simoni
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  7. Monica Pepi
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  8. Marco Santucci
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Correspondence to Alessandro Franchi.

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Franchi, A., Palomba, A., Miligi, L. et al. Intestinal metaplasia of the sinonasal mucosa adjacent to intestinal-type adenocarcinoma. A morphologic, immunohistochemical, and molecular study. Virchows Arch 466, 161–168 (2015). https://doi.org/10.1007/s00428-014-1696-1

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  • DOI: https://doi.org/10.1007/s00428-014-1696-1

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