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Aberrant CDX2 expression in hepatocellular carcinomas: an important diagnostic pitfall.

Sejal S Shah1, Tsung-Teh Wu1, Michael S Torbenson1

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Human Pathology
|January 17, 2017
PubMed
Summary

CDX2, a marker for intestinal tumors, was unexpectedly found in a small subset of hepatocellular carcinomas (HCCs). This finding is crucial for pathologists diagnosing liver cancer, as CDX2 positivity does not rule out HCC.

Keywords:
CDX2Fibrolamellar carcinomaHepatocellular carcinomaLiverMetastasis

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Area of Science:

  • Gastroenterology
  • Oncology
  • Pathology

Background:

  • CDX2 is a well-established marker for intestinal differentiation, aiding in tumor origin diagnosis.
  • Occasional CDX2-positive hepatocellular carcinomas (HCCs) have been anecdotally observed but not systematically studied.

Purpose of the Study:

  • To investigate the prevalence and characteristics of CDX2 expression in a large cohort of resected HCCs.
  • To determine the diagnostic implications of CDX2 positivity in liver tumors.

Main Methods:

  • Immunohistochemical staining for CDX2 was performed on 172 resected HCCs and 6 fibrolamellar carcinomas (FLCs).
  • Tumor differentiation and CDX2 expression levels were analyzed.
  • Statistical correlations between CDX2 expression and clinicopathological features were assessed.

Main Results:

  • CDX2 expression was detected in 5.2% (9/172) of HCCs, while all FLCs were negative.
  • CDX2 positivity was significantly more common in poorly differentiated HCCs (31%) compared to well/moderately differentiated tumors (2.5%).
  • No other significant clinicopathological correlations were identified.

Conclusions:

  • A small subset of HCCs can exhibit CDX2 expression.
  • CDX2 positivity in a liver tumor does not exclude the diagnosis of HCC, necessitating careful pathological evaluation.
  • Awareness of this phenomenon is important for accurate cancer diagnosis and subtyping.