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CDX2 and LEF‐1 expression in pilomatrical tumors and their utility in the diagnosis of pilomatrical carcinoma
Author(s) -
Tumminello Katherine,
Hosler Gregory A.
Publication year - 2018
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/cup.13113
Subject(s) - wnt signaling pathway , carcinogenesis , biology , cdx2 , cancer research , immunohistochemistry , transcription factor , catenin , pathology , signal transduction , medicine , cancer , homeobox , microbiology and biotechnology , immunology , genetics , gene
Background The Wnt signaling pathway has been implicated in the pathogenesis of pilomatrical tumors. Lymphoid enhancer‐binding factor 1 (LEF‐1) is a downstream component of this pathway, and Caudal‐related homeobox transcription factor 2 (CDX2) has been postulated to regulate it, but little is known about expression of these transcription factors in pilomatrical tumors. Methods Immunohistochemistry for CDX2, β‐catenin, LEF‐1, CK19, CK5, Special AT‐rich sequence‐ binding protein 2 (SATB2), cadherin 17 and androgen receptor was performed on pilomatricomas (PMs) ( N = 12), pilomatrical carcinomas (PMCAs) ( N = 12) and non‐pilomatrical cutaneous tumors ( N = 18). Results PMs and PMCAs were positive for CDX2 (9/12 PMs, sensitivity = 75%, specificity = 100%; 11/12 PMCAs, sensitivity = 92%, specificity = 100%; P < 0.01), β‐catenin (12/12 PMs, sensitivity = 100%, specificity = 94%; 10/12 PMCAs, sensitivity = 83%, specificity = 94%; P < 0.01) and LEF‐1 (12/12 PMs, sensitivity = 100%, specificity = 56%; 12/12 PMCAs, sensitivity = 100%, specificity = 56%; P < 0.01). CDX2 expression was commonly focal, within a discrete subpopulation of squamoid cells. The LEF‐1 expression pattern was different and discernable between pilomatrical tumors (strong, diffuse) and non‐pilomatrical tumors (weak, patchy). Conclusion This study reaffirms the importance of the Wnt signaling pathway in the tumorigenesis of pilomatrical tumors, and this introduces CDX2 as a possible regulator and marker of pilomatrical tumorigenesis. LEF‐1 and CDX2 performed at least as well as β‐catenin, if not better when taking into account expression pattern, as a diagnostic marker for PMCA, and should be considered in the workup of ambiguous primitive‐appearing cutaneous tumors.