CD44 Expression in Intraoral Salivary Ductal Papillomas and Oral Papillary Squamous Cell Carcinoma

Abstract

CD44 is a transmembrane adhesion molecule which has been previously shown to be useful in the differentiation of benign papillary lesions from invasive carcinoma in several different areas including sinonasal mucosa and breast tissue. CD44 expression has previously been shown to be lost in invasive carcinoma and retained in benign papillary lesions in both of the above locations. In addition, studies have evaluated oral mucosal lesions for CD44 expression and found a loss with invasive squamous cell carcinoma when compared to normal epithelium, hyperplasia, and squamous papillomas, which stained particularly strongly. To the best of our knowledge, no study has evaluated CD44 expression when comparing salivary ductal papillomas in comparison to oral papillary SCCA. In this study 18 cases of intraductal papilloma were compared to 19 cases of oral papillary SCCA. Within the ductal papilloma group, all cases stained either absent (6 %), weakly (33 %), or moderately (61 %) with 76 % expressing the stain diffusely and 24 % focally. In comparison, the papillary squamous cell carcinoma cases expressed the CD44 moderately (26 %) or strongly (74 %) with 100 % showing diffuse staining. Thus, the CD44 expression was contrary to expectation based on previous studies, which we hypothesize is due to the extremely well differentiated nature of papillary SCCA which expressed CD44 staining compatible with levels previously reported with oral squamous papillomas than invasive carcinoma.

Expression of cell adhesion molecule CD44 in mucoepidermoid carcinoma and its association with the tumor behavior

“…Classical CD44 molecules are intimately involved in the pathogenesis of malignancies such as esophageal cancer, breast cancer, gastric cancer, and prostate cancer [ 4 , 5 , 7 ] CD44 has also been reported as a marker of CSCs in prostate, breast, and head and neck cancer and its expression in these tumors is associated with poor prognosis and aggressive behavior [ 4 , 10 , 11 ]. CSCs are stem-like cells that have the potential to regenerate a tumor mass and maintain their renewal ability.…”

Buccal mass excreting pus-like material

“…19 We, also, found a limited basal and suprabasal expression of p63 that could be helpful in differentiation IDP from MEC, as in the latter tumor, epidermoid or intermediate cells are diffusely positive for p63. 25 In a recent report 26 immunohistochemical reaction for the transmembrane adhesion molecule CD44 was found to be helpful in discriminating between salivary papillomas and papillary squamous cell carcinomas invading adjacent salivary glands. Although this was not a diagnostic consideration in our case, the immunoreaction pattern seen herein was similar to that described for salivary duct papillomas.…”

“…Although this was not a diagnostic consideration in our case, the immunoreaction pattern seen herein was similar to that described for salivary duct papillomas. 26 The pathogenesis of IDP is unknown. Infection from the human papillomavirus (HPV) has been considered as a possible factor 15,17 and HPV6/11 DNA has been detected in 3 out of 6 cases of IDP by in situ hybridization (ISH), 28 while HPV11 DNA was found in a case arising in an HIV-positive patient by polymerase chain reaction (PCR).…”