The tissue expression pattern of CA 19.9 is associated with oncological features in medullary thyroid carcinoma

• Published in: Endocrine 2020-12, Vol.70 (3), p.544-551
• Main Authors: Vargas, Carla Vaz Ferreira, Ceolin, Lucieli, Scheffel, Rafael Selbach, Benini, Antônio Felippe, Graudenz, Márcia Silveira, Maia, Ana Luiza
• Format: Article
• Language: English
• Subjects: Biomarkers, Tumor; Carcinoma, Neuroendocrine - genetics; Diabetes; Endocrinology; Female; Humanities and Social Sciences; Humans; Immunohistochemistry; Internal Medicine; Male; Medicine; Medicine & Public Health; multidisciplinary; Neck; Original Article; Science; Thyroid Neoplasms - genetics
• ISSN: 1355-008X; 1559-0100; 1559-0100
• DOI: 10.1007/s12020-020-02377-3

Purpose Elevated serum levels of carbohydrate antigen 19.9 (CA19.9), a well-established tumor marker in pancreatic neoplasms, has been proposed as a prognostic marker of tumor aggressiveness in medullary thyroid carcinoma (MTC). A hypothesis of C-cell dedifferentiation has been raised. Here, we evaluated the expression of CA19.9 and CD133, a stem cell marker, in MTC tissues. Methods MTC samples from patients attending a university-based hospital were evaluated for CA19.9 and CD133 expression by immunohistochemistry. Clinical data were retrieved from medical records. Results Tumor specimens from 70 MTC patients (57.1% hereditary) were evaluated. The age at diagnosis was 36.1 ± 16.3 years, and 58.6% were female; 53% of patients had cervical and 20% distant metastases. CA19.9 staining was detected in 87% of the samples, but no association was observed with biochemical markers, tumor size, local or distant metastases (All P  > 0.05). Remarkable, CA19.9 expression was higher in the metastasis than in primary tumor samples ( P  = 0.0002). CD133 was expressed in 90.5% samples, but no correlation was found with CA19.9. Interestingly, we identified three distinct expression patterns to CA19.9: individual, focal, and diffuse cells. Sporadic MTC was associated with the individual cell pattern (70.6%), while the hereditary form with the focal expression pattern (63.9%; P  = 0.04). Remarkably, the diffuse pattern was associated with larger tumor size and distant metastases ( P  = 0.032). Conclusions The majority of samples stained for CA19.9, suggesting it is an MTC cell-intrinsic feature. Three distinct expression patterns were identified, which were associated with the hereditary or sporadic form, larger tumor size, and presence of metastases.