title: Intestinal metaplasia of the sinonasal mucosa adjacent to intestinal-type adenocarcinoma. A morphologic, immunohistochemical, and molecular study.
abstract: It has been hypothesized that the development of sinonasal intestinal-type adenocarcinoma (ITAC) occurs through intestinal metaplasia (IM) of the respiratory and/or glandular epithelium. The aim of this study was to characterize the histological, immunohistochemical, and molecular features of sinonasal IM. Histologic slides from 29 consecutive surgical specimens of ITAC were retrieved. Sections were stained for CDX2, cytokeratin 20 (CK20), MUC2, and p53. The status of TP53 gene exons 4-9 was assessed separately in areas of IM and in ITAC. Foci of IM were detected in eight cases (27.5%). They were all positive for CK20 and CDX2, while MUC2 was detected in six cases (75%). In six cases (75%), the metaplastic foci showed signs of dysplasia, including nuclear enlargement with increased nucleus to cytoplasm ratio, nuclear hyperchromasia, loss of nuclear polarity, and presence of prominent nucleoli. P53 nuclear immunoreactivity was observed in four cases. TP53 gene sequencing was successfully performed in six cases and revealed the same mutation in both IM and ITAC in two cases (c.832C > T and c.215G > C), while another ITAC showed a mutation that was not present in the adjacent IM (c.536A > G). In conclusion, our study suggests a possible clonal relationship between areas of sinonasal IM and ITAC, indicating that IM may represent a precursor lesion of ITAC. Improving the knowledge on the morphological and molecular features of IM is a key step to identify reliable biomarkers to determine the risk of sinonasal ITAC development.
authors.affiliation: Section of Anatomic Pathology, Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy, franchi@unifi.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Franchi
authors.forename: Annarita
authors.initials: A
authors.lastname: Palomba
authors.forename: Lucia
authors.initials: L
authors.lastname: Miligi
authors.forename: Valentina
authors.initials: V
authors.lastname: Ranucci
authors.forename: Duccio Rossi Degli
authors.initials: DR
authors.lastname: Innocenti
authors.forename: Antonella
authors.initials: A
authors.lastname: Simoni
authors.forename: Monica
authors.initials: M
authors.lastname: Pepi
authors.forename: Marco
authors.initials: M
authors.lastname: Santucci
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D007422:Intestines / Q000473:pathology; D008297:Male; D008679:Metaplasia / Q000473:pathology*; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology*; D010255:Paranasal Sinus Neoplasms / Q000473:pathology*; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D014408:Biomarkers, Tumor