Document Detail

Thyroid transcription factor-1, but not p53, is helpful in distinguishing moderately differentiated neuroendocrine carcinoma of the larynx from medullary carcinoma of the thyroid.
MedLine Citation:
PMID:  15098009     Owner:  NLM     Status:  MEDLINE    
Moderately differentiated neuroendocrine carcinoma/atypical carcinoid tumor is the most common nonsquamous malignancy in the larynx; however, due to morphologic overlap and calcitonin immunoreactivity, it can be difficult to distinguish from thyroid medullary carcinoma. Currently, low serum calcitonin is the most reliable means for distinguishing primary laryngeal moderately differentiated neuroendocrine carcinoma from metastatic medullary carcinoma. Thyroid transcription factor-1 (TTF-1) is positive in at least 80% of medullary carcinomas, but has not been evaluated in laryngeal moderately differentiated neuroendocrine carcinomas. Additionally, it has been suggested that p53 is positive in laryngeal moderately differentiated neuroendocrine carcinomas and negative in other neuroendocrine tumors, but this has not been validated. The purpose of this study was to determine if the immunohistochemical markers TTF-1 and p53 could be used to discriminate between laryngeal moderately differentiated neuroendocrine carcinomas and thyroid medullary carcinomas. Eight laryngeal moderately differentiated neuroendocrine carcinomas and 10 thyroid medullary carcinomas were identified from the archival files of the BWH and MGH Pathology Departments. Hematoxylin and eosin slides were reviewed, and immunohistochemistry was performed using antibodies to calcitonin, TTF-1, and p53. Calcitonin immunohistochemistry demonstrated immunoreactivity in 100% of laryngeal moderately differentiated neuroendocrine carcinomas (N=8) and 100% of thyroid medullary carcinomas (N=10). There was weak, focal immunoreactivity with TTF-1 in one of eight (13%) laryngeal moderately differentiated neuroendocrine carcinomas, whereas nine of ten (90%) medullary carcinomas were positive for TTF-1, with strong diffuse staining in seven of these cases (78%). p53 was positive in three of six (50%) laryngeal moderately differentiated neuroendocrine carcinomas, and three of ten (30%) medullary carcinomas. Our data demonstrate that immunoreactivity for TTF-1, but not calcitonin or p53, may be helpful in distinguishing laryngeal moderately differentiated neuroendocrine carcinoma and thyroid medullary carcinoma. In particular, diffuse and/or strong TTF-1 immunoreactivity favors a diagnosis of primary thyroid medullary carcinoma over laryngeal moderately differentiated neuroendocrine carcinoma.
Michelle S Hirsch; William C Faquin; Jeffrey F Krane
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc     Volume:  17     ISSN:  0893-3952     ISO Abbreviation:  Mod. Pathol.     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-18     Completed Date:  2004-10-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8806605     Medline TA:  Mod Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  631-6     Citation Subset:  IM    
Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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MeSH Terms
Calcitonin / analysis
Carcinoma, Medullary / metabolism,  pathology*
Carcinoma, Neuroendocrine / metabolism,  pathology*
Diagnosis, Differential
Laryngeal Neoplasms / metabolism,  pathology*
Middle Aged
Nuclear Proteins / analysis*
Thyroid Gland / metabolism,  pathology*
Transcription Factors / analysis*
Tumor Suppressor Protein p53 / analysis*
Reg. No./Substance:
0/Nuclear Proteins; 0/Transcription Factors; 0/Tumor Suppressor Protein p53; 0/thyroid nuclear factor 1; 9007-12-9/Calcitonin

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