Combined immunohistochemistry of beta-catenin, cytokeratin 7, and cytokeratin 20 is useful in discriminating primary lung adenocarcinomas from metastatic colorectal cancer

Abstract

Background: It is important to discriminate between primary and secondary lung cancer. However, often, the discriminating diagnosis of primary lung acinar adenocarcinoma and lung metastasis of colorectal cancer based on morphological and pathological findings is difficult. The purpose of this study was to evaluate the clinical usefulness of immunohistochemistry of beta-catenin, cytokeratin (CK) 7, and CK20 for the discriminating diagnosis of lung cancer.

Methods: We performed immunohistochemistry of beta-catenin, CK7, and CK20 in 19 lung metastasis of colorectal cancer samples, 10 corresponding primary colorectal cancer samples and 11 primary lung acinar adenocarcinoma samples and compared the levels of accuracy of the discriminating diagnosis by using antibodies against these antigens.

Results: Positive staining of beta-catenin was observed in all the lung metastasis of colorectal cancer samples as well as in the primary colorectal cancer samples but in none of the primary lung acinar adenocarcinoma samples. Positive staining of CK7 was observed in 90.9% of the primary lung acinar adenocarcinoma samples and in 5.3% of the lung metastasis of colorectal cancer samples, but in none of the primary colorectal cancer samples. Positive staining of CK20 was observed in all the primary colorectal cancer samples and in 84.2% of the lung metastasis of colorectal cancer samples, but in none of the primary lung acinar adenocarcinoma samples.

Conclusion: Combined immunohistochemistry of beta-catenin, CK7, and CK20 is useful for making a discriminating diagnosis between lung metastasis of colorectal cancer and primary lung acinar adenocarcinoma. This method will enable accurate diagnosis of a lung tumor and will be useful for selecting appropriate therapeutic strategies, including chemotherapeutic agents and operation methods.

Figure 1

Immunohistochemical analysis of β-catenin, cytokeratin 7, and cytokeratin 20. (A) Positive nuclear staining of β-catenin in primary colorectal cancer. (B) Positive nuclear and cytoplasmic staining of β-catenin in lung metastasis of colorectal cancer. (C) Negative nuclear and cytoplasmic staining of β-catenin and positive membranous staining of β-catenin in primary lung acinar adenocarcinoma. (D and E) Negative staining of cytokeratin 7 in primary colorectal cancer and in lung metastasis of colorectal cancer. (F) Positive cytoplasmic staining of cytokeratin 7 in primary lung acinar adenocarcinoma. (G and H) Positive cytoplasmic staining of cytokeratin 20 in primary colorectal cancer and in lung metastasis of colorectal cancer. (I) Negative staining of cytokeratin 7 in primary lung acinar adenocarcinoma. Bar 50 μm