The proliferation potentials and the level of apoptosis were compared in paired primary colorectal adenocarcinomas and their liver metastases within each individual. From a total of 22 patients 44 specimens of paired primary and metastatic tumors were obtained for analysis. The levels of spontaneous apoptosis (a spontaneous apoptosis index, SAI: % apoptotic nuclei among a total of 1000 nuclei) and of proliferation (KI-67 index: % positively stained cells for KI-67 among a total of 1000 cells) were analyzed between primary and metastatic tumors. Survival rates and its relationship with the clinical parameters were also analyzed. The overall survival rate at 5 years was 16.9% with the median survival time of 45 months. T-stage (p=0.005) and time to liver metastasis (synchronous versus metachronous, p=0.03) showed statistical significance in relation to survival. The mean SAI of primary tumors was 1.35 +/- 0.25, which was not statistically different from the 1.58 +/- 0.18 of metastatic tumors (p=0.33). The mean KI-67 indices in primary and metastatic tumors were 23.9 +/- 3.4 and 16.4 +/- 2.5, respectively, and this difference was statistically significant (p=0.016). Subset analysis showed significant difference in the KI-67 index in the synchronous group but not in the metachronous group. No significant difference was shown in the relative ratios of apoptosis to proliferation between the primary tumor and the metastasis within each individual. The results in this study may partly explain the indolent behavior of liver metastasis from colorectal cancer and provides a rationale for the active treatment of metastatic tumors as well as of primary disease.
Adenocarcinoma/chemistry/*secondary ; Adult ; Aged ; *Apoptosis ; Cell Division ; Colorectal Neoplasms/chemistry/*pathology ; Female ; Human ; Liver Neoplasms/chemistry/*secondary ; Male ; Middle Aged ; Support, Non-U.S. Gov't

The identification of primary location of a metastatic tumor is a difficult diagnostic problem and sometimes can be facilitated by the use of immunohistochemical markers. Thyroid transcription factor-1 (TTF-1) is a 38-kDa nuclear homeodomain transcription factor that is expressed specifically in lung or thyroid neoplasms. Cytokeratin 20 (CK20) is a 46-kDa low-molecular-weight cytokeratin that shows restricted expression in adenocarcinomas of the gastrointestinal tract (GIT) and transitional cell carcinomas of the urinary tract. We studied the immunohistochemical expression of TTF-1 and CK20 in 68 metastatic carcinomas in cervical lymph nodes. The primary sites were the lung in 29 cases, stomach in 13, colorectum in 3, and other sites in 23. TTF-1 expression was detected in 69.0% of metastatic lung carcinomas and none in metastatic GIT carcinomas, whereas CK20 expression was detected in 68.8% of metastatic GIT carcinomas and none of metastatic lung carcinomas. TTF-1 had a specificity of 0.95 and a sensitivity of 0.69 for metastatic lung carcinoma, whereas CK20 had a specificity of 1.00 and a sensitivity of 0.69 for metastatic GIT carcinoma. These results indicate that TTF-1 and CK20 should be the first choice as a component of antibody panel to prove or to exclude the lung and GIT origin, respectively, especially in patients presenting with metastatic carcinomas of unknown primary site.
Adenocarcinoma/chemistry/pathology/secondary ; Carcinoma/chemistry/pathology/*secondary ; Gastrointestinal Neoplasms/chemistry/pathology ; Homeodomain Proteins/analysis ; Humans ; Intermediate Filament Proteins/*analysis/immunology ; Keratin-20 ; Lung Neoplasms/chemistry/pathology ; Lymph Nodes/chemistry/pathology ; Lymphatic Metastasis/*diagnosis/pathology ; Neck ; Neoplasms, Unknown Primary/chemistry/pathology ; Nuclear Proteins/*analysis/immunology ; Sensitivity and Specificity ; Transcription Factors/*analysis/immunology ; Tumor Markers, Biological/analysis

No abstract available.
Adenocarcinoma/chemistry/*drug therapy/secondary ; Adult ; Antineoplastic Agents/*therapeutic use ; Biopsy ; Carcinoma, Large Cell/chemistry/*pathology ; Carcinoma, Neuroendocrine/chemistry/*pathology ; Carcinoma, Non-Small-Cell Lung/chemistry/*drug therapy/secondary ; *Drug Resistance, Neoplasm ; Humans ; Lung Neoplasms/chemistry/*drug therapy/pathology ; Magnetic Resonance Imaging ; Male ; Protein Kinase Inhibitors/*therapeutic use ; Quinazolines/*therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Markers, Biological/analysis

Clinically evident metastases of carcinomas to the thyroid gland are rare, particularly from a colorectal primary tumor. We present a case of colonic adenocarcinoma metastatic to the thyroid gland with histopathologic and immunohistochemical findings. A 68-year-old woman with a history of Dukes' stage B colon carcinoma presented a mass in the thyroid gland. The tumor was confirmed to be metastatic adenocarcinoma from the colon. The immunohistochemical findings demonstrated positive staining for cytokeratin 20, low-molecular-weight cytokeratin, villin and carcinoembryonic antigen, but stains were negative for cytokeratin 7 and thyroglobulin.
Adenocarcinoma/secondary* ; Adenocarcinoma/radiography ; Aged ; Carcinoembryonic Antigen/analysis ; Carrier Proteins/analysis ; Case Report ; Colonic Neoplasms/pathology* ; Female ; Human ; Immunoenzyme Techniques ; Intermediate Filament Proteins/analysis ; Keratin/analysis ; Microfilament Proteins/analysis ; Thyroid Neoplasms/secondary* ; Thyroid Neoplasms/radiography ; Thyroid Nodule/radiography ; Thyroid Nodule/chemistry ; Tomography, X-Ray Computed ; Tumor Markers, Biological

Adenocarcinoma ; metabolism ; secondary ; surgery ; Anal Canal ; chemistry ; pathology ; surgery ; Anus Neoplasms ; metabolism ; pathology ; surgery ; Carcinoembryonic Antigen ; analysis ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Keratin-20 ; analysis ; Male ; Middle Aged ; Mucin-1 ; analysis ; Paget Disease, Extramammary ; metabolism ; secretion ; surgery ; Skin Neoplasms ; metabolism ; secretion ; surgery