Expression of Simple Mucin Type Antigens and Lewis Type 1 and Type 2 Chain Antigens in the Thyroid Gland: An Immunohistochemical Study of Normal Thyroid Tissues, Benign Lesions, and Malignant Tumors

Stage-Specific Embryonic Antigen-1 (SSEA-1) Expression in Thyroid Tissues

Stage-specific embryonic antigen-1 (SSEA-1), also known as CD15, is a member of a cluster of differentiation antigens that have been identified in various normal tissues and in different types of cancers including papillary and medullary thyroid carcinoma. SSEA-1 may be expressed in normal stem cells and cancer stem-like cells. To evaluate the potential diagnostic and prognostic utility of SSEA-1 in thyroid tumors, we analyzed the expression of SSEA-1 in normal and neoplastic thyroid tissues by immunohistochemistry (IHC) using a tissue microarray with 158 different tissue cores. To evaluate the potential utility of SSEA-1 as a surface marker, we also assessed the expression of SSEA-1 in thyroid cell lines by flow cytometric analysis. SSEA-1 immunoreactivity was identified in malignant thyroid follicular epithelial cancers but not in the benign thyroid tissues. Anaplastic thyroid (ATC) (80 %) and conventional papillary thyroid carcinoma (PTC) (60.7 %) showed significantly higher percentage of cases that were SSEA-1 immunoreactive than follicular variant of papillary thyroid carcinoma (FVPTC) (20.6 %) and follicular carcinoma (FCA) (32.1 %). Flow cytometric analysis of cultured thyroid cell lines showed that a small subpopulation of ATC and PTC thyroid tumor cells had SSEA-1 immunoreactivity which may represent thyroid cancer stem-like cells. The ATC cells expressed more SSEA-1 immunoreactive cells than the PTC cell lines. Our findings suggest that expression of SSEA-1 immunoreactivity in thyroid neoplasms was associated with more aggressive thyroid carcinomas. SSEA-1 is a marker that detects malignant thyroid neoplasms in formalin-fixed paraffin-embedded thyroid tissue sections and may be a useful marker for thyroid cancer stem-like cells.

Papillary Thyroid Carcinoma Overexpresses Fully and Underglycosylated Mucins Together with Native and Sialylated Simple Mucin Antigens and Histo-Blood Group Antigens

We studied the immunohistochemical expression of mucins (MUC1, underglycosylated MUC1, MUC2, MUC5AC, and MUC6), simple mucin antigens (Tn, sialyl Tn, and T), and histo-blood group antigens (type 1-Lewis(a) and sialyl Lewis(a) type 2-Lewis(x) and sialyl Lewis(x)) in a series of 26 papillary thyroid carcinomas (PTC), 6 follicular carcinomas, and a control group of 32 cases of "normal" thyroid parenchyma adjacent to the tumors. PTC expressed more often, more intensively, and more extensively every antigen but MUC6, which was not observed in any case. The expression of MUC5AC was also extremely rare. MUC1 expression was related to the expression of underglycosylated MUC1, MUC2, Lewis(a), and sialyl Lewis(a). A trend toward an association between the expression of MUC1 and that of type 2 histo-blood group antigens was also observed. Whenever there was a dissociation between the expression of type 1 and type 2 Lewis antigens, MUC1 appeared closely related to type 1 and independent from type 2 histo-blood group antigens. We conclude that MUC1 plays a pivotal, though not exclusive, role in the glycosylation features of well differentiated thyroid carcinomas. Despite the prominent expression of mucins and carbohydrate antigens in PTC, no significant differences were observed between PTC and follicular carcinoma thus ruling out the possibility of using the aforementioned antigens as diagnostic markers per se.

Clinicopathologic and Prognostic Significance of the Expression of Mucins, Simple Mucin Antigens and Histo-Blood Group Antigens in Papillary Thyroid Carcinoma

We have previously analyzed the expression of MUC1, underglycosylated MUC1, MUC2, MUC5AC, Tn, sialyl Tn, Lewis(a), sialyl Lewis(a), Lewis(x), and sialyl Lewis(x) in papillary thyroid carcinoma (PTC). The present study of 26 thoroughly scrutinized cases of PTC with "good" or "bad outcome" and a minimum of 10 yr of follow-up (or until death of the patients) was undertaken in an attempt to find if there is any relationship between the expression of the aforementioned antigens and the clinicopathologic and morphologic features of the cases and to evaluate the prognostic significance of the immunohistochemical pattern of PTC. We observed a significant or suggestive association between the expression of MUC1, underglycosylated MUC1, MUC2, Lewis(a), and Lewis(x) and the older age of the patients, and a suggestive association between Lewis(x) expression and lymph node metastasis and venous invasion. There was also a strong correlation between extrathyroid invasion, lymph node metastasis, intrathyroid dissemination, and venous invasion and patients outcome thus demonstrating, once more, the prominence of the classic clinicopathologic and morphologic features in the prognostic evaluation of PTC. The immunohistochemical study of mucins, simple mucin antigens, and histo-blood group antigens did not provide additional prognostic information, but for the significant association of Lewis(x) immunoreactivity to the group of "bad outcome."

Diagnosis of malignant epithelial thyroid lesions: fine needle aspiration and histopathologic correlation

Fine needle aspiration is a diagnostic tool useful as a guide to patient management. We believe that its role in solving the diagnostic dilemmas presented by thyroid nodules is still underappreciated. Current fiscal constraints in health care might bring about a wider use of this simple technique to select patients for surgery. Care in sampling a mass is essential to obtain aspirates that are representative of the lesion and adequate in quantity for interpretation. Several aspirates are needed from all but the smallest masses. Most thyroid carcinomas are well-differentiated with a low grade of malignancy. The majority of these are papillary carcinomas, which are easily diagnosed in good cytologic smears. With fine needle aspirates the goal is to diagnose a follicular neoplasm and to separate it from the adenomatoid nodule. The follicular neoplasm then can be classified as adenoma or carcinoma with the histologic sections. The minimally invasive carcinoma still can be challenging to recognize. We hope that the cytologic criteria and histopathologic correlations presented here will help general pathologists who interpret aspirates. We believe that in the near future additional immunohistochemical methods and genetic markers will be used increasingly to discriminate among the neoplasms and to provide prognostic information.

Carbohydrate Antigens as Oncofetal Antigens in Papillary Carcinoma of the Thyroid Gland

The expression of simple mucin-type antigens, Lewis type-1 antigens, and Lewis type-2-related antigens was evaluated by immunohistochemistry in a series of nine fetal thyroid glands. The aim of the study was to establish whether the previously reported expression of carbohydrate antigens in thyroid carcinomas represents a "de novo" expression or a form of the so-called oncofetal expression. We have detected simple mucin-type antigens and Lewis type-2-related antigens in fetal thyroid tissue. Lewis type-I antigens were not found. Taking the results of this study together with those previously reported, we conclude that the presence of Lewis type I antigens in thyroid carcinomas appears to be a "de novo" expression, whereas the constant and strong expression of simple mucin-type antigens and Lewis type-2-related antigens represents a re-expression (oncofetal expression) of antigens already present during fetal life.