Cytokeratin 7 and 20 expression in epithelioid sarcoma

University of South Alabama, Mobile, Alabama, United States
Journal of Cutaneous Pathology (Impact Factor: 1.58). 05/2003; 30(4):242-6. DOI: 10.1046/j.0303-6987.2003.047.x
Source: PubMed


Epithelioid sarcoma (ES) is a rare malignant soft tissue tumor of uncertain histogenesis that arises predominantly in the extremities of young adults. Immunohistochemically, the neoplastic cells are typically positive for vimentin, low molecular weight cytokeratin (CAM5.2) and epithelial membrane antigen (EMA).
We examined eight cases of ES from seven different patients. All cases were studied with immunohistochemistry for EMA, CAM5.2 (keratin 8 and 18), 34BE12 (keratins 1, 5, 10 and 14/15), cytokeratins 7 and 20 (CK7, CK20), and CD34.
The average patient age was 53 (range 43-76) and the male:female ratio was 5:2. The location was the upper extremity in five tumors, the lower extremity, the perineum, and the paraspinal soft tissue in one tumor each. All cases contained predominantly epithelioid cells, but spindle cells were also present in three cases. All cases contained areas of geographic necrosis. CAM5.2 was strongly positive in seven tumors and focally positive in one (8/8). EMA was diffusely positive in two cases and focally positive in five cases (7/8). CD34 was diffusely positive in 3/8 cases. 34BE12 was diffusely positive in one case and focally positive in two others (3/8). CK7 was diffusely positive in one case and focally positive in another (2/8). CK20 was negative in all cases (0/8). All cases tested were positive for vimentin (6/6), 2 cases were focally positive for HHF35 (2/5), and all cases tested were negative for S-100 protein (0/7).
In addition to the known immunoreactivity for CAM5.2 and EMA, there is positivity for CK7 and 34BE12 in a small proportion of cases. None of the cases expressed CK20. This immunophenotypic profile suggests that ES is more similar to carcinoma and synovial sarcoma than to other soft tissue tumors, and may be of diagnostic utility.

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    • "Abbreviations: BAC, bronchioloalveolar adenocarcinoma; PAED, pulmonary adenocarcinoma with enteric differentiation; ITAC, intestinal-type adenocarcinoma; AdCC, adenoid cystic carcinoma; PLGA, polymorphous low-grade adenocarcinoma; ACC, acinic cell carcinoma; Ca-ex-MT, carcinoma ex mixed tumor; CCC, clear cell carcinoma; BCAC, basal cell adenocarcinoma; MPNST, malignant peripheral nerve sheath tumor; MFH, malignant fibrous histiocytoma. Table 2. Distribution of CK7/CK20 phenotype in different types of tumors of different organs (based on references: Bassily et al., 2000; Cambell & Harrington, 2001; Chu et al., 2000; Duval et al., 2000; Hatanaka et al., 2011; Humble et al., 2003; Kummar et al., 2002;Lam et al., 2001; Nikitakis et al., 2004; Rekhi et al., 2008; Saeb-Lima et al., 2008; Sawan, 2009; Simsir et al., 2004; Stopyra et al., 2001; Tatsumi et al., 2005; Tot, 2002; Wauter at al., 1995) "

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    ABSTRACT: We studied a case of epithelioid sarcoma that had developed on the right sole of a 27-year-old Japanese man. The lesion, which had a history of 6 months, presented as indurated erythematous plaque of 4 × 7 cm scattered with several irregular scars. Microscopically, the majority of the proliferated tumor cells were large, plump epithelioid-like cells with eosinophilic cytoplasm and an oval nucleus. The remainder were fibroblast-like, bearing spindle-shaped cell bodies. Immunohistochemistry indicated that the epithelioid-like cells were positive for Vimentin and AE1/AE3, but that the fibroblast-like cells were negative. Electron microscopy revealed that the former cells were characterized by an abundant and monotonous cytoplasm being filled with intermediate filaments densely arranged throughout the cell bodies. Small mitochondria were the only organelles around the nucleus. On the other hand, the fibroblast-like cells were characterized by prominent cytoplasmic organelles, including mitochondria, rough endoplasmic reticulum, Golgi apparatus and free ribosomes, and by abundant glycogen within the cytoplasm. Regardless of such different features, both cells were partially surrounded by basal lamina and exhibited close contact with juxta cells with gap junctions. These findings support the belief that the tumor was related etiologically to synovial sarcoma.
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