면역조직화학염색을 이용한 구강내 전이성 암종과타액선 암종의 감별 진단 = Differential Diagnosis Using Immunohistochemistry between Metastatic Cancers to Oral Cavity and Salivary Cancers

다국어 초록 (Multilingual Abstract)

Metastatic tumors in oral cavity are rare, where their prognoses are considered to be extremely poor. Unless recognizing its primary origin, pathologic diagnoses for metastatic cancer have been troublesome for oral pathologists. This retrograde analysis was aimed at providing practical suggestion for the diagnoses of metastatic cancers to oral and maxillofacial region. We reviewed 20 patients diagnosed as metastatic cancers to oral cavity from 1991 to 2007. The patients were classified according to their clinical and histologic findings. We also reviewed 19 patients of mucoepidermoid carcinoma and 16 patients of adenoid cystic carcinoma to compare with those of metastatic cancers. Immunohistochemical staining for CK 5/6, CK 17, TTF-1, CEA was performed for differential diagnosis. Histologically, 20 cases compromised 11 cases of adenocarcinoma, 5 cases of undifferentiated carcinoma, 3 cases of squamous cell carcinoma, and one papillary carcinoma. The lung was the most common site for primary site (5/20), followed by the breast (2/20). In metastatic adenocarcinoma, TTF-1 positive cases were one lung cancer and a rectal cancer, and carcinomas from breast and rectum showed CK5/6 positive reaction. CEA was expressed in gastric and rectal carcinomas. In 19 cases of mucoepidermoid carcinoma, 13 cases (68.4%) are CK5/6 (+). In 16 cases of adenoid cystic carcinoma, 11 cases (68.8%) showed the positive reaction for CK5/6. TTF-1 is an antibody to show high sensitivity and specificity for lung adenocarcinoma, therefore, TTF-1 is helpful to make a diagnosis of metastatic adenocarcinomas from lung. Adenocarcinomas originated from salivary glands show high CK5/6 expression, but metastatic adenocarcinomas, except of those from breast and rectum, show no CK5/6 expression, lending support that CK5/6 may be useful to differentiate metastatic adenocarcinomas from carcinomas of salivary gland origin.

참고문헌 (Reference)

1 김규식, "구강내 전이성 암종에 대한 증례보고 및 문헌 고찰" 22 : 461-467, 1996

2 Ordones NG, "Value of cytokeratin 5/6 immunostaining in distinguishing epithelial mesothelioma of the pleura from lung adenocarcinoma" 22 : 1215-1221, 1998

3 Oliveira AM, "Thyroid Transcription Factor-1 Distinguishes Metastatic Pulmonary From well-Differentiated Neuroendocrine Tumors of Other Sites" 25 : 815-819, 2001

4 Moll R, "The catalog of human cytokeratins: patterns of expression in normal epithelia, tumors and cultured cells" 31 : 11-24, 1982

5 Troyanovsky SM, "Patterns of keratin 17 in human epithelia: dependency on cell position" 93 : 4119-426, 1989

6 Park SY, "Panels of immunohistochemical markers help determine primary sites of metastatic adenocarcinoma" 131 : 1561-1567, 2007

7 Zachariades N, "Neoplasms metastatic to the mouth, jaws and surrounding tissues" 17 : 283-290, 1989

8 Nishimura YH, "Nakajima. Metastatic tumors of the mouth and jaws" 10 : 253-258, 1982

9 Lim SY, "Metastatic tumours to the jaws and oral soft tissues: a retrospective analysis of 41 Korean patients" 35 : 412-415, 2006

10 Hirshberg A, "Metastatic tumors to the oral region" 31B : 355-360, 1995

11 Batsakis JG, "Metastatic neoplasms to the head and neck" 133 : 673-677, 1971

12 Hirshberg A, "Metastases to the oral mucosa: analysis of 157 cases" 22 : 385-390, 1993

13 Curtin J, "Mandibular metastasis from a primary adenocarcinoma of the fallopian tube" 43 : 636-638, 1985

14 Chu PG, "Keratin expression in human tissues and neoplasms" 40 : 403-439, 2002

15 DeYoung BR, "Immunohistologic evaluation of metastatic carcinomas of unknown origin: an algorithmic approach" 17 : 184-193, 2000

16 Brown RW, "Immunohistochemical identification of tumor markers in metastatic adenocarcinoma. in: A diagnostic adjunct in the determination of primary site" 107 : 12-19, 1997

17 Xiong Q, "Female patients with breast carcinoma age 30 years and younger have a poor prognosis: the M. D. Anderson Cancer Center experience" 92 : 2523-2528, 2001

18 Stahlman M, "Expression of thyroid transcription factor-1 (TTF-1) in fetal and neonatal human lung" 44 : 673-678, 1996

19 Kim JK, "Do very young Korean breast cancer patients have worse outcomes?" 14 : 3385-3391, 2007

20 Reis-Filho JS, "Distribution of p63, cytokeratins 5/6 and cytokeratin 14 in 51 normal and 400 neoplastic human tissue samples using TARP-4 multi-tumor tissue microarray" 443 : 122-132, 2003

21 Sarbia M, "Differentiation between pancreaticobiliary and upper gastrointestinal adenocarcinomas: is analysis of cytokeratin 17 expression helpful?" 128 : 255-259, 2007

22 Shankar S, "Dental pulp metastasis and pan-osseous mandibular involvement with mammary adenocarcinoma" 22 : 455-461, 1984

23 Duffy MJ, "Carcinoembryonic antigen as a marker for colorectal cancer: is it clinically useful?" 47 : 624-630, 2001

24 Dykes PW, "Carcinoembryonic antigen (CEA)" 13 : 1000-1013, 1972

25 Kothari AS, "Breast carcinoma in women age 25 years or less" 94 : 606-614, 2002

26 Goveia G, "Asymptomatic hepatocellular carcinoma metastatic to the mandible" 45 : 424-430, 1978

27 Fantasia JE, "A testicular tumor with gingival metastasis" 48 : 64-68, 1979