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, 24/26 (26-50% of tumour in one case, 51-75% in one case, >75% in 22 cases)5, 30/32 (strong in 28 cases)6
	acinar, papillary or tubular	10/14 (Staining was generally intense in papillary tumours.)3
	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, 3/14 (<5% of tumour in one case, 5-25% in two cases)5, 4/18 (in 4 cases, staining was focal but strong)6
	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

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

¹Merchant, 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

²Rossi, 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.

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

⁴Rossi, 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.

⁵Goldstein, 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.

⁶Saad, 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.

This page last revised 1.8.2004.

©SMUHT/PW Bishop