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CDX-2 Expression in Primary Lung Adenocarcinoma.

Morgan L Cowan1, Qing K Li, Peter B Illei

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

Applied Immunohistochemistry & Molecular Morphology : AIMM
|October 16, 2015
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Summary

CDX-2 positivity is found in 12% of lung adenocarcinomas without enteric features. These tumors typically express CK7, TTF-1, and napsin A, aiding in lung cancer diagnosis.

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Area of Science:

  • Oncology
  • Pathology
  • Molecular Diagnostics

Background:

  • Adenocarcinoma with enteric differentiation is a rare lung adenocarcinoma variant.
  • CDX-2 expression is variable in known enteric-type lung adenocarcinomas.
  • Limited data exists on CDX-2 in lung adenocarcinomas lacking enteric features.

Purpose of the Study:

  • To determine the rate of CDX-2 positivity in non-enteric-type lung adenocarcinomas.
  • To characterize the immunohistochemical profile of CDX-2 positive non-enteric lung adenocarcinomas.

Main Methods:

  • Immunohistochemistry for CDX-2, CK7, CK20, TTF-1, napsin A, and p40 was performed.
  • A tissue microarray of 93 primary lung adenocarcinomas lacking enteric differentiation was analyzed.
  • Mutation analysis for EGFR, K-ras, and ALK was conducted on a subset of CDX-2 positive tumors.

Main Results:

  • 12% (11/93) of non-enteric lung adenocarcinomas showed CDX-2 positivity.
  • All CDX-2 positive tumors were positive for CK7, TTF-1, and napsin A, and negative for p40.
  • Focal CK20 staining was observed in one CDX-2 positive case; a K-ras mutation was found in one of four tested CDX-2 positive tumors.

Conclusions:

  • CDX-2 positivity occurs in a subset of lung adenocarcinomas lacking enteric differentiation.
  • The immunophenotype (CK7+, TTF-1+, napsin A+, p40-) of these tumors is consistent with lung origin.
  • CDX-2 positivity alone should not rule out a lung primary in adenocarcinoma diagnosis.