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Expression pattern of CK7, CK20, CDX-2, and villin in intestinal-type sinonasal adenocarcinoma
  1. M T Kennedy1,
  2. R C K Jordan2,
  3. K W Berean3,
  4. B Perez-Ordoñez1
  1. 1Department of Pathology, University Health Network, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto M4N 3M5, Ontario, Canada
  2. 2University of California, San Francisco, San Francisco, California 94143-0424, USA
  3. 3University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
  1. Correspondence to:
 Dr B Perez-Ordoñez
 Department of Pathology, University Health Network, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M4N 3M5, Canada;


Background: Intestinal-type sinonasal adenocarcinoma (ITAC) is an uncommon neoplasm, which resembles adenocarcinoma of the gastrointestinal tract. ITAC occurs sporadically or in association with occupational exposure to hardwood dust and other agents.

Aims: To investigate the phenotype and possible pathogenetic mechanisms of primary sinonasal and nasopharyngeal adenocarcinomas by staining for cytokeratin 7 (CK7), CK20, CDX-2, and villin.

Methods: Twelve sporadic sinonasal and nasopharyngeal adenocarcinomas were stained with monoclonal antibodies to CK7, CK20, CDX-2, and villin. The ITACs were classified as papillary, colonic, solid, mixed, or mucinous types.

Results: The diagnosis of ITAC was confirmed in 10 cases: five were colonic type and five were papillary. One was a sinonasal papillary low grade adenocarcinoma, and one a papillary nasopharyngeal adenocarcinoma, and these tumours were CK7 positive, but CK20, CDX-2, and villin negative. All ITACs were positive for CK20, CDX-2, and villin, and six were CK7 positive. One ITAC had a focus of intestinal metaplasia away from the invasive carcinoma.

Conclusions: Sinonasal ITACs have a distinctive phenotype, with all cases expressing CK20, CDX-2, and villin. Most ITACs also express CK7, although a proportion of tumours are CK7 negative. ITAC seems to be preceded by intestinal metaplasia of the respiratory mucosa, which is accompanied by a switch to an intestinal phenotype. Although ITACs are morphologically similar, differences in cytokeratin expression patterns suggest two distinct types. The expression pattern of CK7, CK20, CDX-2, and villin positive may be useful in separating these tumours from other non-ITAC adenocarcinomas of the sinonasal tract and nasopharynx.

  • CK, cytokeratin
  • ITAC, intestinal-type sinonasal adenocarcinoma
  • LGSA, low grade sinonasal papillary adenocarcinoma
  • nasal cavity
  • sinonasal tract
  • intestinal-type adenocarcinoma
  • nasal cavity
  • CDX-2
  • villin
  • keratin 7
  • keratin 20

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