Immunohistochemical Expression of Cytokeratin 19 in Patients with Papillary Thyroid Carcinoma and its Mimics in Erbil, Kurdistan Region, Iraq
Keywords:Papillary thyroid carcinoma, Benign thyroid lesions, Immunohistochemistry
Background and objective: Papillary thyroid carcinoma (PTC) is the most common primary thyroid cancer. PTC diagnosis is based on the presence of classic nuclear features in most cases. However, there are some mimics including both benign neoplastic and non-neoplastic lesions, therefore immune-histochemical stains are necessary for equivocal cases. This study aimed to evaluate the diagnostic expression of CK19 in different thyroid lesions and also to differentiate PTC from other mimicking thyroid lesions.
Methods: A retrospective study of 90 cases of different thyroid lesions (56 patients with benign neoplastic and non-neoplastic lesions and 34 PTC) was investigated from January 2018 to January 2020. Immunohistochemical staining with CK19 was performed.
Results: CK19 IHC expressed in about 94% of PTC cases as moderate and strong pattern of staining, while in benign neoplastic and non-neoplastic thyroid lesions only 7% expressed as moderate and non with strong pattern of staining, it showed a significant statistical difference (P <0.001).The sensitivity and specificity of CK19 total estimated score for diagnosis of PTC were 94.1% and 92.9%, respectively.
Conclusion: Although no single immunohistochemical marker is completely sensitive in differentiating benign from thyroid malignancy, this study found a significant and effective role of CK19 in distinguishing PTC from benign neoplastic and non-neoplastic mimickers’ lesions. In addition, lymph node metastatic tumor cells retained the same staining intensity of CK19.
Kamran CS, Marqusee E, Kim I M, Frates CM, Ritner J, Peters H, et al. Thyroid Nodule Size and Prediction of Cancer. J Clin Endocrinol Metab. 2013; 98(2):564–70. DOI: 10.1210/jc.2012-2968
Mathur A, Olson MT, Zeiger MA. Follicular lesions of the thyroid. Surg Clin North Am 2014; 94(3):499–513. DOI: 10.1016/j.suc.2014.02.005
Devi PC, Karri DM, Venugopal M, Akarsh PM. Nuclear Features in the Diagnosis of Follicular Variant of Papillary Thyroid Carcinoma—The Diagnostic Dilemma. JAMA Otolaryngol Head Neck Surg. 2015; 4(04):296–302. DOI: 10.4236/ijohns.2015.44051
Dunderovic D, Lipkovski MJ, Boricic I, Soldatovic I, Bozic V, Cvejic D, et al. Defining the value of CD56, CK19, Galectin 3 and HBME-1 in diagnosis of follicular cell derived lesions of thyroid with systematic review of literature. Diagn Pathol. 2015; 10:196. DOI: 10.1186/s13000-015-0428-4
El atti MR, Shash SL. Potential diagnostic utility of CD56 and claudin-1 in papillary thyroid carcinoma and solitary follicular thyroid nodules. J Egypt Natl CancInst. 2012; 24(4):175–84. DOI: 10.1016/j.jnci.2012.10.002
Mete O, Asa LS. Pitfalls in the diagnosis of the follicular epithelial proliferation of the thyroid. Adv Anat Pathol. 2012; 19(6):363–73. DOI: 10.1097/PAP.0b013e318271a5ac
Wu G, Wang J, Zhou Zh, Li T, Tang F. Combined staining for immunohistochemical markers in the diagnosis of papillary thyroid carcinoma: Improvement in the sensitivity or specificity?. J Int Med. 2013; 414(9):975–83. DOI: 10.1177/0300060513490617
Murtezaoglu R A, Gucer H. Diagnostic value of TROP-2 expression in papillary thyroid carcinoma and comparison with HBME-1, galectin-3 and cytokeratin 19. Pol J Pathol. 2017; DOI: 10.5114/pjp.2017.67610
Guhanandam H, Rajamani R, Noorunnisa N, Durairaj M. Expression of Cytokeratin-19 and Thyroperoxidase about Morphological Features in Non-Neoplastic and Neoplastic Lesions of Thyroid. J Clin Diagn Res. 2016; 10(6). DOI: 10.7860/JCDR/2016/18522.7919
Wong R, Farrell G S, Grossmann M. Thyroid nodules: diagnosis and management. Med J Aust. 2018; 209(2):92–8. DOI: 10.5694/mja17.01204
Sahin B S, Ogullar S, Ural M U, Ilkkilic K, Metin Y, Ayaz T. Alterations of thyroid volume and nodular size during and after pregnancy in a severe iodine-deficient area. Clin Endocrinol (Oxf). 2014; 81(5):762–8. DOI: 10.1111/cen.12490
Alexander K E, Pearce N E, Brent A G, Brown S R, Chen H, Dosiou C, et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017; 27(3):315–89. DOI: 10.1089/thy.2016.0457
Revathy VJ, Sarath K A. Expression of CK-19 in Papillary Thyroid Carcinoma and its Association with Prognostic Factors - A Cross-Sectional Study. J Evol Med Dent Sci. 2021; 10(11):813–8. DOI: 10.14260/jemds/2021/174
Mataraci EA, Ozguven BY, Kabukcuoglu F. Expression of cytokeratin 19, HBME-1 and galectin-3 in neoplastic and nonneoplastic thyroid lesions. Pol J Pathol. 2012; 63(1):58–64. PMID: 22535608
Dina A, Afra S, Mohamed A E, Fawaz A, Walid A, Gadelkarim HA. Expression of CK19, CD56, and galectin-3 tumor markers in different types of thyroid carcinoma. IJMRHS. 2019; 8:6.
Matos LL, Giglio DA, Matsubayashi OC, Farah LM, Giglio DA, Pinhal AM. Expression of ck-19, galectin-3 and hbme-1 in the differentiation of thyroid lesions: systematic review and diagnostic meta-analysis. Diagn Pathol. 2012; 7:97. DOI: 10.1186/1746-1596-7-97.
Abdu A, Shabaan M, Abdallah R, Nabil N. Diagnostic Value of TROP-2 and CK19 Expression in Papillary Thyroid Carcinoma in Both Surgical and Cytological Specimens. Clin Pathol. 2019; 12. DOI: 10.1177/2632010X19863047
Abouhashem N, Talaat S. Diagnostic utility of CK19 and CD56 in the differentiation of thyroid papillary carcinoma from its mimics. Pathol Res Pract. 2017; 213(5):509–17. DOI: 10.1016/j.prp.2017.01.017
How to Cite
Copyright (c) 2023 Tavga Hushair Dizeyi (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Zanco J Med Sci is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).