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Expression of REG4 in ovarian mucinous tumors
Qiong Huang1, Xiaoduan Chen, Weiguo Lu
1Departments of *Pathology & Pathophysiology †Surgical Pathology ‡Gynecologic Oncology, The Affiliated Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province, P.R. China.
Abstract:
Regenerating islet-deprived gene family, number 4 (REG4), is a novel marker for intestinal differentiation. We performed immunohistochemical studies on REG4, cytokeratin (CK)7, CK20, and caudal type homeobox 2 (CDX2) in 291 ovarian mucinous tumors. There were 226 primary tumors and 65 metastatic tumors. The primary tumors comprised 69/226 mucinous cystadenomas, 79/226 mucinous borderline tumors (64/79 intestinal-type and 15/79 endocervical-like tumors), and 78/226 mucinous carcinomas. We found that REG4 expression was significantly higher in mucinous borderline tumors (30/79, 38.0%) and primary mucinous carcinomas (26/78, 33.3%) than in mucinous cystadenomas (4/69, 5.8%; P<0.05). However, REG4 expression was more commonly associated with intestinal-type, borderline, mucinous tumors rather than the endocervical-like type (30/64 vs. 0/15, P<0.001). There was a significant correlation between the REG4 and CDX2 expression profiles in primary ovarian mucinous tumors (r=0.772, P<0.001). REG4, CDX2, and diffuse CK20 had higher expression frequencies in metastatic lower gastrointestinal adenocarcinoma than in primary mucinous tumors (P<0.01). The CK7/REG4 coordinate expression profile was comparable in diagnostic value to CK7/CK20 or CK7/CDX2 profile. We conclude that REG4 expression is common in mucinous borderline tumors of the intestinal type as it is absent in the endocervical-like form in this series. Expression of CK7/REG4 may contribute to the differential diagnosis between primary and metastatic ovarian mucinous tumors.
Insights
Regenerating islet-deprived gene family, number 4 (REG4) is a novel marker for intestinal differentiation. REG4 expression is common in intestinal-type ovarian mucinous borderline tumors and may aid in distinguishing primary from metastatic ovarian tumors.
Area of Science:
- Gynecologic Pathology
- Tumor Markers
- Gastrointestinal Differentiation
Background:
- Regenerating islet-deprived gene family, number 4 (REG4) is a novel marker associated with intestinal differentiation.
- Ovarian mucinous tumors exhibit diverse histological subtypes, necessitating accurate diagnostic markers.
Purpose of the Study:
- To investigate the expression patterns of REG4, cytokeratin (CK)7, CK20, and caudal type homeobox 2 (CDX2) in ovarian mucinous tumors.
- To evaluate the diagnostic utility of REG4 in differentiating ovarian mucinous tumor subtypes and primary versus metastatic lesions.
Main Methods:
- Immunohistochemical analysis of REG4, CK7, CK20, and CDX2 in 291 ovarian mucinous tumors (226 primary, 65 metastatic).
- Statistical analysis to correlate marker expression with tumor type, grade, and origin.
Main Results:
- REG4 expression was significantly higher in mucinous borderline tumors and primary mucinous carcinomas compared to cystadenomas.
- REG4 expression was strongly associated with intestinal-type mucinous tumors, but absent in endocervical-like tumors.
- REG4, CDX2, and diffuse CK20 showed higher expression in metastatic lower gastrointestinal adenocarcinoma than in primary ovarian mucinous tumors.
- The CK7/REG4 expression profile showed comparable diagnostic value to CK7/CK20 or CK7/CDX2.
Conclusions:
- REG4 is a valuable marker for intestinal-type mucinous borderline tumors of the ovary.
- The CK7/REG4 expression profile can aid in the differential diagnosis between primary and metastatic ovarian mucinous tumors.
