CDX-2 Protein Expression in Premalignant and Malignant Lesions of Gallbladder

Abstract

Introduction: CDX2 is a caudal type homeobox gene encoding a transcription factor that play important role in regulating proliferation and differentiation of the intestinal epithelium. Recent studies demonstrated CDX2 expression in metaplasia and carcinoma of oesophagus, stomach, ampulla of Vater, gallbladder and cholangiocarcinoma. Clinical and pathological significance of CDX2 in gallbladder carcinoma is not well established. Aim: To evaluate CDX2 expression in premalignant and malignant lesions of gallbladder and its correlation with histological grades and clinicopathological features. Materials and Methods: A total 93 cases of gallbladder lesions including 57 cases of adenocarcinoma, 27 cases of premalignant condition and 9 cases of chronic cholecystitis were selected both prospectively and retrospectively. Histological grading and typing was done. Immunohistochemical staining was performed using mouse monoclonal anti-human CDX2 as per manufacturer’s protocol. Statistical analysis was done using SPSS software (version 21.0). Results: CDX2 expression was strongly associated with well and moderately differentiated adenocarcinoma as compared to poorly differentiated (100% 77.3% and 35.3% respectively, p<0.001). Papillary and intestinal type showed strong expression of CDX2 (100%). There was low CDX2 expression with cases of lymph node metastasis and cases with surrounding tissue invasion. Positive or increased CDX2 expression was associated with increased overall survival rate. Conclusion: CDX2 expression has inverse relation with tumour grade and is an independent marker of clinical outcome in gallbladder adenocarcinoma.

Keywords

• carcinoma
• dysplasia
• metaplasia