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

BACKGROUND/AIMS: As the relationship between gastrointestinal stromal tumors (GIST) and interstitial cells of Cajal had become clear, GIST is defined as CD117 positive mesenchymal tumors, and recognized as a new distinct entity among mesenchymal tumors presenting as gastrointestinal submucosal tumors (SMT). To evaluate GISTs in the category of SMTs, we analyzed mesenchymal SMTs immunohistochemically and clinicopathologically. METHODS: Forty-five patients with mesenchymal SMTs, who received surgical or endoscopic resection were retrospectively analyzed for clinical parameters. Immunohistochemical staining for CD117, CD34, NSE, SMA, and S-100 was also performed. RESULTS: Among 45 tumors, 41 (91.1%) expressed CD117 and were diagnosed as GIST. The most frequent location was the gastric body. Except esophageal location (73.3%), GISTs accounted for 100% of SMTs in the gastrointestinal tract. The mixed myoid-neural differentiated type and the spindle cell shape were most common. Metastasis was observed in 5 patients (11%). All of them had tumors larger than 5 cm and died. Their mean survival was 4.6 months. CONCLUSIONS: GIST accounted for majority (91.1%) of SMTs. The presence of metastasis and tumor size at the time of diagnosis indicate poor prognostic factors. Immunohistochemical study is necessary for exact diagnosis of GIST.
Adult ; Aged ; Female ; Gastrointestinal Neoplasms/*chemistry/diagnosis/pathology ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Prognosis ; Proto-Oncogene Proteins c-kit/analysis

OBJECTIVETo study the histogenesis and pathological characteristics of gastrointestinal stromal tumors (GIST) and GIST type stromal tumor (ST) beyond the gastrointestinal tract.

METHODSA retrospective study was carried out on leiomyoma, leiomyosarcoma and neurilemoma (46 cases in gastrointestinal tract and l3 cases in urinary tract and perineal area). 4 antibodies (CD117, CD34, SMA, S-100) were used for immunohistochemical staining.

RESULTSAmong 45 cases of GIST, the positive rate of CD117 and CD34 was 93.3% and 88.9% respectively. Among 12 cases of GIST type ST beyond the gastrointestinal tract, the positive rate of CD117 and CD34 was 83.3% and 75.0% respectively. In 2 cases (1 in gastrointestinal tract) of leiomyomas, both CD117 and CD 34 were negative in tumor cells, while SMA was extensively positive.

CONCLUSIONSCD117 and CD34 positivity are the most valuable factors in diagnosing ST. Both GIST and GIST type ST beyond the gastrointestinal tract are considered originating from a proto-interstitial stem cell with disoriented differentiation.

Actins ; analysis ; Adult ; Aged ; Aged, 80 and over ; Antigens, CD34 ; analysis ; Biomarkers, Tumor ; analysis ; Female ; Gastrointestinal Stromal Tumors ; chemistry ; pathology ; Humans ; Immunohistochemistry ; Leiomyoma ; chemistry ; pathology ; Leiomyosarcoma ; chemistry ; pathology ; Male ; Middle Aged ; Neurilemmoma ; chemistry ; pathology ; Pelvic Neoplasms ; chemistry ; pathology ; Perineum ; Proto-Oncogene Proteins c-kit ; analysis ; Retrospective Studies ; S100 Proteins ; analysis ; Urologic Neoplasms ; chemistry ; pathology

OBJECTIVETo study the expression of CDX2 in normal and tumor tissues, and to evaluate the value of CDX2 immunostaining in the diagnosis of gastrointestinal adenocarcinoma.

METHODSeventy-six samples of normal tissue and 612 samples of tumor tissue were studied by tissue microarray technology and immunohistochemistry for CDX2.

RESULTSCDX2 was strongly expressed in surface epithelium of 13 samples of normal intestine and in ductal epithelium of 8 samples of normal pancreas, as well as in 47 samples (92.2%) of colonic adenocarcinoma and 58 samples (66.9%) of gastric adenocarcinoma. As for other tumor types, there was only weak or patchy CDX2 positivity. The positivity rates were as follows: ovarian mucinous adenocarcinoma 15.6% (10/64), pancreatic cancer 33.3% (3/9), thyroid cancer 27.3% (3/11) and extrahepatic biliary cancer 25% (4/16). On the other hand, primary tumors of breast, prostate, kidney, adrenal and liver were negative for CDX2.

CONCLUSIONSCDX2 is expressed mainly in normal epithelium of intestinal tract and small pancreatic ducts, as well as in primary adenocarcinoma of gastrointestinal tract. CDX2 may thus play an important role in distinguishing primary non-intestinal adenocarcinoma from metastatic adenocarcinoma of gastric or colorectal primary.

Adenocarcinoma ; diagnosis ; metabolism ; CDX2 Transcription Factor ; Colonic Neoplasms ; diagnosis ; metabolism ; Female ; Gastrointestinal Neoplasms ; diagnosis ; metabolism ; Gastrointestinal Tract ; chemistry ; pathology ; Homeodomain Proteins ; metabolism ; Humans ; Immunohistochemistry ; Male ; Stomach Neoplasms ; diagnosis ; metabolism ; Tissue Array Analysis

Actins ; metabolism ; Child, Preschool ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Gastrointestinal Stromal Tumors ; pathology ; Humans ; Immunohistochemistry ; Myofibroma ; metabolism ; pathology ; surgery ; Stomach ; chemistry ; pathology ; surgery ; Stomach Neoplasms ; metabolism ; pathology ; surgery

No abstract available.
Acanthosis Nigricans/diagnosis/*etiology ; Biopsy ; Gastrointestinal Stromal Tumors/chemistry/*complications/pathology ; Humans ; Immunohistochemistry ; Laparoscopy ; Male ; Middle Aged ; Paraneoplastic Syndromes/diagnosis/*etiology ; Peritoneal Neoplasms/chemistry/*complications/pathology ; Proto-Oncogene Proteins c-kit/analysis ; Tomography, X-Ray Computed ; Tumor Markers, Biological/analysis

BACKGROUND: CD44 is a cell surface adhesion molecule which has been implicated in various biologic functions as lymphocyte homing and activation, cellular migration and extracellular matrix adhesion. Over-expression of CD44v8- 10 has been found in several cancers and is considered to be associated with tumor progression and metastasis. Recently, a novel molecular method, CD44v8- 10/CD44v10 competitive reverse transcription-polymerase chain reaction(RT-PCR) has been developed for detecting cancer cells over-expressing CD44v8-10. METHODS: We analyzed from benign and malignant pleural effusion and ascites by CD44 competitive RT-PCR and compared to the conventional cytology. RESULTS: The CD44 competitive RT-PCR analysis showed that all the 24 samples associated with benign disease presented a predominant expression of the CD44v10 transcript (v8-10/v10 ratio: 0.126-0.948), whereas 6 of 7 malignant pleural samples associated with cytology positive cancer expressed the CD44v8-10 transcript (v8-10/v10 ratio > 1.00). CONCLUSION: These results indicate that CD44 competitive RT-PCR assay is a useful and adjunct to cytological examination in cancer diagnosis, especially in detecting exfoliated cancer cells in pleural effusion.
Adult ; Aged ; Aged, 80 and over ; Antigens, CD44/analysis* ; Ascites/pathology* ; Ascites/immunology* ; Base Sequence ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/immunology ; Comparative Study ; Female ; Gastrointestinal Neoplasms/pathology ; Gastrointestinal Neoplasms/immunology ; Human ; Lung Neoplasms/pathology ; Lung Neoplasms/chemistry ; Male ; Middle Age ; Molecular Sequence Data ; Pleural Effusion, Malignant/pathology* ; Pleural Effusion, Malignant/chemistry* ; Reverse Transcriptase Polymerase Chain Reaction* ; Sensitivity and Specificity ; Support, Non-U.S. Gov't

Recently the origin of gastrointestinal stromal tumors (GISTs) is thought be the interstitial cells of Cajal or primitive stem cells. This study was performed to evaluate the roles of fine needle aspiration cytology (FNAC), cell block preparation, and immunohistochemistry in the diagnosis of GISTs. Nine cases of GIST in which FNAC was performed were included in this study. Cytologically, the tumor cells characteristically occurred in closely packed cohesive tissue fragments with high cellular density often in bloody background. The tumor cells often formed fascicles with parallel, side-by-side arrangements of the nuclei. Histologically, GISTs were highly cellular spindle or epithelioid tumor with basophilic appearance. Immunohistochemically, GISTs were c-kit positive in all of nine cases, CD34 positive in seven, focally SMA positive in two, and S-100 and GFAP negative in all. Both histologic and cell block sections showed the same histologic and immunohistochemical features. Cytomorphologically GISTs show a broad morphologic spectrum but rarely a significant nuclear pleomorphism and the assessment of malignant potential is difficult based on cytology alone. However, in the appropriate clinical and radiologic setting, a confident diagnosis of primary or metastatic GIST can be established by FNAC, cell block, and immunohistochemistry.
Actins/analysis ; Adult ; Antigens, CD34/analysis ; Biopsy, Needle ; Female ; Gastrointestinal Neoplasms/chemistry/*pathology ; Glial Fibrillary Acidic Protein/analysis ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Paraffin Embedding ; Proto-Oncogene Proteins c-kit/analysis ; S100 Proteins/analysis ; Stromal Cells/*pathology

Transcatheter arterial radioembolization (TARE) with Yttrium-90 (90Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.
Aged ; Carcinoma, Hepatocellular/*diagnosis/radiotherapy ; Embolization, Therapeutic/*adverse effects ; Gastrectomy ; Gastrointestinal Hemorrhage/etiology ; Gastroscopy ; Humans ; Liver Neoplasms/*diagnosis/radiotherapy ; Magnetic Resonance Imaging ; Male ; *Microspheres ; Radiopharmaceuticals/therapeutic use ; Stomach/pathology ; Stomach Ulcer/*etiology/surgery ; Yttrium Radioisotopes/chemistry