Home > Antigens > Cytokeratins > Coordinate expression of cytokeratins 7 and 20
Specific cytokeratin expression gives valuable information as to the primary site of a carcinoma. Cytokeratins 7 and 20 are most useful in this respect.
(When we are trying to determine the line of differentiation of a tumour, we not uncommonly are forced to rely on very limited immunoreactivity as the best available evidence. This is not appropriate when evaluating specific cytokeratins. It is important to know the thresholds for positivity, which vary between papers, in some cases the threshold being set as low as 1% of cells1,7, often at 10% of cells, but at the most stringent requiring at least 50% of cells to show at least moderate staining2.)
Predominantly CK7+/CK20- |
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CK7+/CK20+ |
CK7+/CK20- |
CK7-/CK20+ |
CK7-/CK20- |
76% (39/541, 64/742, 12/155, 16/176, 41/438, 9/1010, 20/2122, 14/1623, 24/4224, 30/4025) |
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0/31, 8/288 |
3/31, 20/288 |
0/31 |
0/31 |
|
0/161, 0/1710 |
11/161, 11/1710 |
0/161, 0/1710 |
5/161, 6/1710 |
|
6/381, 0/2010 |
31/381, 19/2010, 6/622, 6/1225 |
1/381, 0/2010 |
0/381, 1/2010, 6/1225 |
|
1/111, 0/610 |
10/111, 6/610 |
0/111, 0/610 |
0/111, 0/610 |
|
0/5510 |
0/5510 |
|
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0/910, 0/ 15319, 6/8420 |
9/910, 153/15319, 78/8420 |
0/910, 0/15319, 0/8420 |
0/910, 0/15319, 0/8420 |
|
0/810, 0/3414 |
0/810, 28/3414 |
0/810, 0/3414 |
8/810, 6/3414 |
|
Oesophageal adenocarcinoma |
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Endometrial |
3/251, 0/1010 |
20/251, 10/1010 |
0/251, 0/1010 |
2/251, 0/1010 |
Cervix, squamous cell carcinoma |
0/1510 |
13/1510 |
0/1510 |
2/1510 |
Predominantly CK7-/CK20+ |
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|
CK7+/CK20+ |
CK7+/CK20- |
CK7-/CK20+ |
CK7-/CK20- |
Appendiceal adenocarcinoma |
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Appendiceal goblet cell carcinoid |
1/97, 4/67 |
0/97, 0/67 |
8/97, 2/67 |
0/97, 0/67 |
Colorectal adenocarcinoma (non-mucinous and mucinous): note that CK7 positivity may be more common in rectal carcinomas. |
5/511, 16/772, 4/297, 4/308, 1/2010, 12/22516, 0/1116, 1/2417, 3/2818, 1/1224, 1/1425 |
0/511, 0/772, 1/297, 1/308, 0/2010, 9/22516, 0/1116, 0/2818
|
40/511, 59/772, 23/297, 25/308, 19/2010, 3/315, 153/22516, 10/1116, 22/2417, 23/2818, 11/1224, 11/1425 |
6/511, 2/772, 1/297, 0/2010, 51/22516, 1/1116, 1/2417, 2/2818, 2/1425
|
0/910 |
0/910 |
7/910 |
2/910 |
|
|
CK7+/CK20+ |
CK7+/CK20- |
CK7-/CK20+ |
CK7-/CK20- |
16/2417 |
8/2417 |
0/2417 |
0/2417 |
|
14/151, 10/1818 |
1/151, 8/1818 |
0/151, 0/1818 |
0/151, 0/1818
|
|
Endocervical adenocarcinoma |
7/818 |
1/818 |
0/818 |
0/818 |
Bladder, transitional cell carcinoma |
17/191, 12/264, 17/289, 6/2410 |
2/191, 12/264, 6/289, 15/2410 |
0/191, 1/289, 1/2410 |
0/191, 4/289, 2/2410 |
31/4813, 6/1410, 3/418, 5/1421 |
15/4813, 7/1410, 0/418, 9/1421 |
2/4813, 0/1410, 1/418 |
0/4813, 1/1410, 0/418 |
|
Pancreatic adenocarcinoma |
15/231, 8/1310, 11/1418 |
6/231, 4/1310, 3/1418 |
2/231, 0/1310, 0/1418 |
0/231, 1/1310, 0/1418 |
Predominantly CK7-/CK20- |
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CK7+/CK20+ |
CK7+/CK20- |
CK7-/CK20+ |
CK7-/CK20- |
Head and neck, squamous cell carcinoma |
0/3010 |
8/3010 |
2/3010 |
20/3010 |
0/121, 0/1510 |
1/121, 0/1510 |
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0/111, 0/710 |
2/111, 3/710, 4/523 |
0/111, 0/710 |
9/111, 4/710, 1/523 |
|
0/910, 0/1611 |
2/910, 9/1611 |
0/910, 0/1611 |
7/910, 7/1611 |
|
Oesophagus, squamous cell carcinoma |
0/1410 |
3/1410 |
0/1410 |
11/1410 |
0/1510 |
2/1510 |
1/1510 |
12/1510 |
|
Colonic high grade neuroendocrine carcinoma |
0/57 |
0/57 |
0/57 |
5/57 |
2/301, 0/1110 |
5/301, 1/1110 |
0/301, 1/1110 |
23/301, 9/1110 |
|
0/171, 0/1910 |
4/171, 2/1910 |
1/171, 0/1910 |
12/171, 17/1910 |
|
1/131, 1/599, 0/1810 |
1/131, 5/599, 0/1810 |
3/131, 5/599, 0/1810 |
8/131, 48/599, 18/1810 |
|
Germ cell tumour |
0/1410 |
1/1410 |
0/1410 |
13/1410 |
0/1210 |
0/1210 |
0/1210 |
12/1210 |
|
0/1010 |
0/1010 |
0/1010 |
10/1010 |
|
Variable |
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CK7+/CK20+ |
CK7+/CK20- |
CK7-/CK20+ |
CK7-/CK20- |
Gastric adenocarcinoma |
5/291, 3/143, 8/387, 2/810, 132/28916, 18/4316, 0/518
|
10/291, 3/143, 3/387, 3/810, 42/28916, 8/4316, 1/518
|
3/291, 3/143, 0/387, 2/810, 40/28916, 1/4316, 0/518
|
One must note that the cut-off percentage of staining for a positive result is varies in different studies from 1%1 to 5%10, which in part may contribute to differences in the results in some groups of carcinomas between studies. In addition, the CK 20 monoclonal antibody that was used varied (American Research Products [APR], Inc., Belmont, MA10, DAKO1).
Neither CK7 nor CK20 alone reliably differentiated pulmonary from colonic carcinomas: however, the combination is reliable, with tumours that are CK7+/CK20+ or CK7-/CK20- being of indeterminate origin. If an adenocarcinoma within the lung is being examined, TTF-1 will also be informative in combination with these cytokeratins.
Only one paper has analysed the effect of the grade on expression: aberrant cytokeratin expression is more common in poorly differentiated adenocarcinomas7.
References
1 Coordinate expression of cytokeratins 7 and 20 defines unique subsets of carcinomas. NP Wang et al. Applied Immunohistochemistry 1995; 3:99-107.
15 Jimenez-Linan M et al. Cytokeratin immunostaining differentiates endometrioid carcinoma of ovary from metastatic colorectal carcinoma. Pathological Society July 2004, abstract 78.
20 Nikitakis NG, Tosios KI, Papanikolaou VS, et al. Immunohistochemical expression of cytokeratins 7 and 20 in malignant salivary gland tumors. Mod Pathol 2004; 17:407-15 FULL TEXT
23 Chhieng DC, Cangiarella JF, Zakowski MF, et al. Use of thyroid transcription factor 1, PE-10, and cytokeratins 7 and 20 in discriminating between primary lung carcinomas and metastatic lesions in fine-needle aspiration biopsy specimens. Cancer 2001; 93:330-6 FULL TEXT
25 Su YC, Hsu YC,Chai CY Role of TTF-1, CK20, and CK7 immunohistochemistry for diagnosis of primary and secondary lung adenocarcinoma. Kaohsiung J Med Sci 2006; 22:14-9 FULL TEXT
This page last revised 17.11.2008.
©SMUHT/PW Bishop