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Among Sinonasal Tumors, CDX-2 Immunoexpression is not Restricted to Intestinal-Type Adenocarcinomas

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Abstract

Intestinal-type adenocarcinoma (ITAC) is a rare form of sinonasal cancer characterized by an association with exposure to industrial dusts, aggressive clinical behavior, and histologic/immunophenotypic similarity to tumors of the gastrointestinal tract. ITAC is sometimes very poorly differentiated and difficult to distinguish from other sinonasal neoplasms, particularly in a limited biopsy. CDX-2 and cytokeratin 20 are consistently immunoreactive in ITAC and as a result, these immunostains are often used to support the diagnosis. However, CDX-2 and cytokeratin 20 have not been tested on a broad range of sinonasal tumors, so their specificities remain unknown. Immunohistochemistry for CDX-2 and cytokeratin 20 was performed on 6 sinonasal ITACs as well as 176 non-intestinal-type sinonasal neoplasms. CDX-2 and cytokeratin 20 were positive in all 6 cases of ITAC. CDX-2 immunoexpression was also observed in 17 of 176 (10 %) non-intestinal-type tumors including 6 of 16 (38 %) sinonasal undifferentiated carcinomas, 8 of 81 (10 %) squamous cell carcinomas (including 5 of 39 non-keratinizing variants), 2 of 20 (10 %) salivary-type adenocarcinomas, and 1 of 2 (50 %) small cell carcinomas. In contrast, among non-intestinal types of sinonasal tumors, cytokeratin 20 was only focally observed in 1 of 176 non-intestinal tumors (a non-keratinizing squamous cell carcinoma). All cases of non-intestinal surface-derived adenocarcinoma and esthesioneuroblastoma were negative for both markers. Both CDX-2 and cytokeratin 20 are highly sensitive for the diagnosis of sinonasal ITAC, but cytokeratin 20 is more specific. CDX-2 staining may be observed in other high grade tumor types, especially sinonasal undifferentiated carcinoma and non-keratinizing squamous cell carcinoma. As a result, in the setting of a poorly differentiated sinonasal carcinoma the diagnosis of ITAC should not be based on CDX-2 immunoexpression alone. Clear-cut glandular differentiation and cytokeratin 20 immunoexpression are more reliable features.

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Authors and Affiliations

  1. Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Matthew P. Tilson & Justin A. Bishop

  2. Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Gary L. Gallia

  3. Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Gary L. Gallia

  4. Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg 2249, Baltimore, MD, 21231, USA

    Justin A. Bishop

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  1. Matthew P. Tilson
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  2. Gary L. Gallia
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Correspondence to Justin A. Bishop.

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Tilson, M.P., Gallia, G.L. & Bishop, J.A. Among Sinonasal Tumors, CDX-2 Immunoexpression is not Restricted to Intestinal-Type Adenocarcinomas. Head and Neck Pathol 8, 59–65 (2014). https://doi.org/10.1007/s12105-013-0475-7

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