J Korean Med Sci.  2005 Aug;20(4):643-648. 10.3346/jkms.2005.20.4.643.

The Usefulness of CDX-2 for Differentiating Primary and Metastatic Ovarian Carcinoma: An Immunohistochemical Study Using a Tissue Microarray

• Kim MJ

• KMID: 1712747
• DOI: http://doi.org/10.3346/jkms.2005.20.4.643

Abstract

Distinguishing primary ovarian carcinoma from metastatic carcinoma to the ovary is often difficult by histologic examination alone. Recently an immunohistochemical marker CDX-2 was found to be of considerable diagnostic value in establishing the gastrointestinal origin of metastatic tumors. The aim of this study was to determine whether CDX-2 can distinguish between these malignancies. Paraffin-embedded tissue sections from 57 primary ovarian tumors and 40 metastatic tumors to the ovary were immunostained for CDX-2, and results were compared to the ancillary immunohistochemical results for CK7/CK20, CEA, CA125, and her-2/neu. CDX-2 immunoreactivity was observed in most of metastatic carcinomas with colorectal (91%) and appendiceal (100%) origin, however CDX-2 was negative in all primary ovarian carcinomas, except for the mucinous subtype. Almost all primary ovarian carcinomas including the mucinous subtype showed diffuse and strong immunoexpression for CK7. CEA and CA125 were mainly found in metastatic and primary ovarian carcinoma, respectively. Her-2/neu overexpression was only noted in a small proportion of primary and metastatic ovarian carcinomas. These results suggest that CDX-2 is very useful immunohistochemical marker for distinguishing metastatic colorectal carcinoma to the ovary from primary ovarian carcinoma, including the mucinous subtype. Furthermore, combination with CDX-2 and CK7 strengthen the differential diagnosis between these tumors.

Keyword

Cdx-2-3 protein; Ovarian Neoplasms; Adenocarcinoma; Neoplasm Metastasis; Immunohistochemistry

MeSH Terms

CA-125 Antigen/analysis
Carcinoembryonic Antigen/analysis
Colorectal Neoplasms/metabolism/pathology
Diagnosis, Differential
Female
Homeodomain Proteins/*analysis
Humans
Immunohistochemistry
Keratin/analysis
Neoplasm Metastasis
Ovarian Neoplasms/metabolism/*pathology
Receptor, erbB-2/analysis
Research Support, Non-U.S. Gov't
Tissue Array Analysis/*methods
Trans-Activators/*analysis

Figure

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  Fig. 1 Representative sections of diffuse CDX-2 immunoreactivity in primary ovarian mucinous adenocarcinoma (A) and in metastatic carcinoma from colorectum (B), stomach (C) and appendix (D) (×40).

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  Fig. 2 Almost all primary ovarian mucinous carcinomas are diffusely positive for CK7 (A), and variably positive for CK20, often showing patchy rather than diffuse staining (B). Conversely, metastatic colorectal carcinoma had a focal CK7 (C) and diffuse CK20 (D) immunoprofile (×40).

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  Fig. 3 Diffuse strong cytoplasmic staining for CA125 is observed in ovarian serous carcinoma (A). Her-2/neu expression is evident in a small group of the ovarian mucinous (B) and clear cell carcinomas (C) and unexpectidly in metastatic carcinomas from the stomach (D) (×40).

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