The alterations of cytokeratin and vimentin protein expressions in primary esophageal spindle cell carcinoma

Abstract

BackgroundThe accumulated evidence has indicated the diagnostic role of cytokeratin (CK) and vimentin protein immunoassay in primary esophageal spindle cell carcinoma (PESC), which is a rare malignant tumor with epithelial and spindle components. However, it is largely unknown for the expression of CK and vimentin in pathological changes and prognosis of PESC.MethodsEighty-two PESC patients were identified from the esophageal and gastric cardia cancer database established by Henan Key Laboratory for Esophageal Cancer Research of Zhengzhou University. We retrospectively evaluated CK and vimentin protein expressions in PESC. Clinicopathological features were examined by means of univariate and multivariate survival analyses. Furthermore, the co-expression value of cytokeratin and vimentin was analyzed by receiver operating characteristic (ROC) curve.ResultsThe positive pan-cytokeratins AE1/AE3 (AE1/AE3 for short) staining was chiefly observed in cytoplasm of epithelial component tumor cells, with a positive detection rate of 85.4% (70/82). Interestingly, 19 cases showed AE1/AE3 positive staining both in epithelial and spindle components (23.2%). However, AE1/AE3 expression was not observed with any significant association with age, gender, tumor location, gross appearance, lymph node metastasis and TNM stage. Furthermore, AE1/AE3 protein expression does not show any effect on survival. Similar results were observed for vimentin immunoassay. However, in comparison with a single protein, the predictive power of AE1/AE3 and vimentin proteins signature was increased apparently than with single signature [0.75 (95% CI = 0.68–0.82) with single protein v.s. 0.89 (95% CI = 0.85–0.94) with AE1/AE3 and vimentin proteins]. The 1-, 3-, 5- and 7-year survival rates for PESC patients in this study were 79.3%, 46.3%, 28.0% and 15.9%, respectively. Multivariate analysis demonstrated age and TNM stage were independent prognostic factors for overall survival (P = 0.036 and 0.003, respectively). It is noteworthy that only 17.1% patients had a PESC accurate diagnosis by biopsy pathology before surgery (14/82). 72.4% PESC patients with biopsy pathology before surgery had been diagnosed as squamous cell carcinoma.ConclusionThe present study demonstrates that cytokeratin and vimentin protein immunoassay is a useful biomarker for PESC accurate diagnosis, but not prognosis. The co-expression of cytokeratin and vimentin in both epithelial and spindle components suggest the possibility of single clone origination for PESC.

Unusual case of a protruding mass in the esophagus successfully treated by endoscopic submucosal dissection

“…Immunohistochemistry showed the squamous cells stained positively for cytokeratin and the stromal cells for vimentin. These findings are consistent with the general features of esophageal pseudosarcoma, which is a rare subtype of spindle cell carcinoma (SpCC) [1]. SpCC is characteristically a polypoid mass with intermingled spindle cell and squamous cell components [2].…”

Myocardial metastasis from ZEB1- and TWIST-positive spindle cell carcinoma of the esophagus: A case report

“…SCC often shows positivity for vimentin and p53 on immunohistochemistry, whereas the epithelial component is frequently positive for pan cytokeratin (AE1/AE3). Li et al [ 8 ] reported that, in 23.2% of cases of primary esophageal SCC, both the spindle cells and the epithelial cells were positive for AE1/AE3, and in 8.5% of cases, both components were also positive for vimentin. In the present case, AE1/AE3 expression was limited to only a small portion, with loss of epithelial characteristics in the majority, suggesting difficulty in making a definitive diagnosis on biopsy.…”

Esophageal Carcinosarcoma with Basaloid Squamous Cell Carcinoma: A Case Report and Review of the Literature

“…Sarcomatous spindle cells demonstrated very weak immunoreactivity of epithelial markers in our present case. However, Li et al (2018) reported that AE1/AE3 were positive in sarcomatous components in only 23% of cases. Therefore, the absences of immunoreactivity of epithelial markers in sarcomatous components could not exclude the possibility of a concept of monoclonal origin.…”