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2009, Volume 25, Number 3, Page(s) 090-099
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DOI: 10.5146/tjpath.2009.01161 |
The Role of Immunohistochemistry in Differential Diagnosis of Follicular Patterned Lesions of Thyroid |
Gülçin YEĞEN1, Mehmet Akif DEMİR1, Yeşim ERTAN2, Olcay AKNALBANT3, Müge TUNÇYÜREK2 |
Department of Pathology, 1Celal Bayar University, Faculty of Medicine and 3M. H. Manisa State Hospital, MANİSA and2Ege University, Faculty of Medicine, İZMİR, TURKEY |
Keywords:
Thyroid follicular neoplasia, Galectin-3, CD44v6, Thyroid peroxidase, Cytokeratin 19 |
Objective: In the present study we aimed to assess the role of galectin-
3, cytokeratin 19, thyroid peroxidase and CD44v6 in distinguishing
benign from malignant follicular lesions.
Material and Method: Fifty-four malignant and 50 benign lesions
were evaluated and classified according to World Health Organization
2004 histological classification. Galectin-3, cytokeratin 19, thyroid
peroxidase and CD44v6 were performed immunohistochemically
and the slides were evaluated by two independent investigators.
Sensitivity, specificity and diagnostic accuracy were assessed for each
antibody tested.
Results: Sensitivity, specificity and diagnostic accuracy were as follows
respectively: Galectin-3: 59,25%, 84% and 71,15%; Cytokeratin 19:
70%, 82% and 75,4%; Thyroid peroxidase: 61%, 70% and 65,4%;
CD44v6: 20,4%, 88% and 52,9%.
Conclusion: The negativity for Galectin-3 and Cytokeratin 19
can not exclude malignancy but positivity can be thought as a
sign of malignant feature or potential for lesions in which there is
strong suspect of malignancy. Thyroid peroxidase immunostaining
failed to differantiate benign from malignant oxyphilic tumors but
decreased expression can be used as a malignancy marker together
with Galectin-3 and/or Cytokeratin19 positivity in suspicious cases.
CD44v6 does not seem to be reliable in distinguishing benign from
malignant follicular patterned thyroid lesions.
In conclusion, our approach is to take as much new samples or serial
sections as possible in cases without clear-cut evidence of malignancy
but with histological and immunohistochemical suspicion. Follicular
variant papillary carcinoma has different criteria for malignancy and
it should be always kept in mind while evaluating a benign-looking
lesion with immunohistochemical signs that favor malignancy.
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