title: Detection of Cancer Stem Cells in Colorectal Cancer: Histopathological and Immunohistochemical Study.
abstract: BACKGROUND
  Growing evidence supports the notion that the onset of tumorigenesis could occur through cancer stem cells (CSCs). These tumour cells show low proliferative rates, high self-renewal capacity, propensity to differentiate into active proliferating tumour cells & resistance to chemoradiotherapy thus, possibly causing local recurrences & metastasis formation. CD44 has been used as a marker to isolate CSCs from colorectal carcinoma (CRC).
  
  
  OBJECTIVE
  To investigate the immunohistochemical expression of cancer stem cells marker (CD44) in CRC and correlate its expression with the clinicopathological aspects, TNM staging and modified Dukes' classification.
  
  
  METHODS
  Tumour biopsies from colectomy specimens of 60 patients with CRC were stained with hematoxylin-eosin for histological evaluation then immunostained with monoclonal antibodies against CD44 which was detected in term of negative or positive expression.
  
  
  RESULTS
  CD44 was demonstrated in 58.3% (35/60) of cases and showed statistically significant correlation with tumour site and histological type (p-value < 0.05). However, CD44 showed statistically insignificant inverse correlation with tumour invasiveness (T), lymph node status (N), grade, TNM stage grouping and modified Dukes' classification, while it was directly correlated with distant metastasis (M) (p-value > 0.05). Chi-square /Fisher exact test proportion independence and the p-value are set significant at 0.05 level.
  
  
  CONCLUSIONS
  the CD44 rate of expression is higher in the colon than rectum and in adenocarcinoma than mucinous and undifferentiated carcinoma. CD44 showed statistically insignificant relation with T, N, M, grade, TNM stage grouping and modified Dukes' classification.
authors.affiliation: Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Nour El Hoda S
authors.initials: NE
authors.lastname: Ismaiel
authors.affiliation: Pathology Department, National Research Centre, Dokki, Cairo, Egypt.
authors.forename: Walid M
authors.initials: WM
authors.lastname: Sharaf
authors.affiliation: Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Dina O
authors.initials: DO
authors.lastname: Helmy
authors.affiliation: Pathology Department, National Research Centre, Dokki, Cairo, Egypt.
authors.forename: Mona M
authors.initials: MM
authors.lastname: Zaki
authors.affiliation: Pathology Department, National Research Centre, Dokki, Cairo, Egypt.
authors.forename: Manal A
authors.initials: MA
authors.lastname: Badawi
authors.affiliation: Pathology Department, National Research Centre, Dokki, Cairo, Egypt.
authors.forename: Ahmed S A
authors.initials: AS
authors.lastname: Soliman
keywords: CD44; Cancer stem cells; Colorectal carcinoma; Metastasis