Elsevier

Human Pathology

Volume 42, Issue 4, April 2011, Pages 594-601
Human Pathology

Case study
Differences of immunophenotypic markers and signaling molecules between adenocarcinomas of gastric cardia and distal stomach

https://doi.org/10.1016/j.humpath.2010.06.015Get rights and content

Summary

During the past decades, the subsites of gastric carcinoma underwent significant changes. The incidence of the adenocarcinoma at distal stomach has been decreased, whereas cardiac adenocarcinoma remained increasing in many countries. The aim of this study was to investigate the differences between gastric cardiac and distal adenocarcinomas. We detected expressions of cytokeratins (cytokeratins 7, 14, 19, and 20) and mucins (mucins 1, 2, and 5AC) by immunohistochemistry and signaling molecules (p38, mitogen-activated protein kinase-interacting kinase 1 (MNK1), extracellular signal-regulated kinase, Jun N-terminal kinase, and phosphoinositide 3 kinase) by reverse transcription–polymerase chain reaction in both groups. The incidence of mucin 2 expression was lower in total (50.0%) and advanced-stage cases (52.0%) with cardiac adenocarcinomas than those in distal cases with total (70.2%) and advanced stage (71.4%), respectively. However, the staining for cytokeratin 14 was also significantly higher in total or advanced-stage tumors from the cardia. Our data showed no significant difference of cytokeratin 7/cytokeratin 20 pattern between 2 groups, but cytokeratin 20 expression was significantly higher in advanced-stage carcinomas of the cardia (58.7%) than in distal ones with advanced stage (38.3%). A multivariate analysis demonstrated different relationships between immunophenotypic markers and pathologic parameters in adenocarcinomas of the cardia and distal stomach. Moreover, significantly lower expressions of MNK1 and p38 in cardiac tumors were also detected. In summary, we found significant differences in patterns of immunophenotypic markers and expressions of signaling molecules between the 2 groups. It is indicated that adenocarcinoma of the cardia was different in histotype and histologic origin from distal adenocarcinoma. The cardiac adenocarcinoma might be a special subtype or an independent entity of gastric carcinoma in China.

Section snippets

Patients

Ninety-nine patients with gastric cardiac and distal adenocarcinomas consecutively operated on at Cixian County Hospital and Zanhuang County Hospital in Hebei Province from January 2005 to December 2009 were included in the study. All patients underwent preoperative upper gastrointestinal endoscopies (with biopsy specimens routinely performed). Fifty patients with cardiac carcinoma attended in this study were chosen carefully according to the definition of Siewert II AEG, whose tumors' centers

Expressions of CK and MUC in adenocarcinomas of gastric cardia and distal stomach

Tumor tissues derived from 2 subsites were characterized by immunohistochemistry, and the malignant cells of carcinomas showed reactivity for the antigens under study (Fig. 2). In all cases, 93.9% of tumors had CK19-positive staining, whereas CK14-positive reactivity was observed in only 20 cases (20.2%). Among 99 cases with cardiac and distal cancers, the positive expressions of CK7, CK20, MUC1, MUC2, and MUC5AC were detected in 82 (82.8%), 48 (48.5%), 59 (59.6%), 61 (61.6%), and 69 (69.7%)

Discussion

The reason for the increasing incidence of cardiac adenocarcinomas is obscure. Ambiguous definition of these tumors regarding origin or etiology hampers largely diagnosis and treatment for patients. Special immunophenotypic markers may be helpful to comprehend cardiac tumors. Therefore, we detected the expressions of certain CKs and MUCs in adenocarcinomas of gastric cardia and distal stomach. Different immunoreactivity of the antigens in 2 groups may provide us a better understanding about

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    This work was supported by Key R & D Project of Hebei Province (No. 07276102D for Xianghong Zhang), Scientific Foundation of Hebei Province Educational Commission (No. ZH200801 for Xianghong Zhang), and the Natural Science Foundation of Hebei Province for Youths (No. 2009001098 for Liying Xue).

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