TTF-1 in pulmonary adenocarcinoma

	Peripheral parenchymal type	33/37(Staining was generally intense.)3
	Indeterminate group (between peripheral and central types)	56/773
	Central bronchial type	7/14(Staining was generally only moderate.)3

	Atypical alveolar hyperplasia	5/53

	By tumour subtype:
	mixed pattern	55/653
	non-mucinous bronchoalveolar carcinoma	9/9(Staining was generally intense.)3, 24/265, 30/32(strong in 28 cases)6
	acinar, papillary or tubular	10/143
	solid with mucin	14/253
	mucinous, other than mucinous bronchoalveolar carcinoma and signet ring cell	8/112, 2/43
	mucinous bronchoalveolar carcinoma	3/102, 1/23, 3/145, 4/186
	signet ring cell	14/171, 2/22, 1/13
	Clear cell	1/23
	Pleomorphic / sarcomatoid with adenocarcinoma	3/63, 17/214

	When examining by areas of tumour with a particular pattern, some tumours being mixed:
	non-mucinous bronchoalveolar-like	32/333
	mucinous bronchoalveolar-like	1/43
	papillary	11/113
	inseparable papillary/tubular	15/183
	tubular	40/483
	solid	42/583
	Poorly differentiated adenocarcinoma	4/103
	mucinous	2/63

Reference 7	components	TTF-1
Reference 7	components	total	1-10% of nuclei	11-50% of nuclei	51-90% of nuclei	>90% of nuclei
Group A: adenocarcinomas with Clara/type II (with or without a bronchial surface epithelial component), in addition to other components	Clara/Type II	87/87	1	5	4	77
	mixed Clara/type II and bronchial surface epithelial component	39/39	1	7	9	22
	bronchial surface epithelial component	5/5	1	2	1	1
	goblet cell component	0/1	0	0	0	0
	poorly differentiated component	41/44	6	9	14	12
	Total	105/105	1	10	29	65
Group B: adenocarcinomas with components including bronchial surface epithelial component and/or goblet cell component, but lacking a Clara/type II component	bronchial surface epithelial component	6/15	3	2	0	1
	mixed bronchial surface epithelial and goblet cell component	1/10	1	0	0	0
	poorly differentiated component	4/15	2	1	0	1
	Total	7/33	4	2	0	1
Group C: adenocarcinomas with only a poorly differentiated component		8/10	1	2	3	2

Although TTF-1 is extremely useful in identifying primary pulmonary carcinomas, it is commonly negative in mucinous bronchoalveolar carcinomas5, which may also be positive for CDX-2 and CK20, but are also positive for CK7 and retain negativity for villin.

References

1 Merchant, S. H., Amin, M. B., Tamboli, P., Ro, J., Ordonez, N. G., Ayala, A. G., Czerniak, B. A., Ro, J. Y. Primary signet-ring cell carcinoma of lung: immunohistochemical study and comparison with non-pulmonary signet-ring cell carcinomas. Am J Surg Pathol 2001;25:1515-1519

2 Rossi, G., B. Murer, et al. (2004). "Primary mucinous (so-called colloid) carcinomas of the lung: a clinicopathologic and immunohistochemical study with special reference to CDX-2 homeobox gene and MUC2 expression." Am J Surg Pathol 28(4): 442-52.

3 Stenhouse, G., N. Fyfe, et al. (2004). "Thyroid transcription factor 1 in pulmonary adenocarcinoma." J Clin Pathol 57(4): 383-7. (with clarification from author)

4 Rossi, G., Cavazza, A., Sturm, N., Migaldi, M., Facciolongo, N., Longo, L., Maiorana, A. and Brambilla, E. Pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements: a clinicopathologic and immunohistochemical study of 75 cases. Am J Surg Pathol 2003;27:311-24.

5 Goldstein, N. S. and M. Thomas (2001). "Mucinous and nonmucinous bronchioloalveolar adenocarcinomas have distinct staining patterns with thyroid transcription factor and cytokeratin 20 antibodies." Am J Clin Pathol 116(3): 319-25.

6 Saad, R. S., Y. L. Liu, et al. (2004). "Prognostic significance of thyroid transcription factor-1 expression in both early-stage conventional adenocarcinoma and bronchioloalveolar carcinoma of the lung." Hum Pathol 35(1): 3-7.

7 Maeshima AM, Omatsu M, Tsuta K, et al. Immunohistochemical expression of TTF-1 in various cytological subtypes of primary lung adenocarcinoma, with special reference to intratumoral heterogeneity. Pathol Int 2008; 58:31-7

This page last revised 27.11.2008.