Tma ttf-2

1. Expression of Thyroid Transcription
Factor-1 (TTF-1) in Endometrial
Carcinoma
Prof. Jaudah Al-Maghrabi, MD, MSc, FRCPC, FCAP
Nisrin Anfinan, Khalid Sait, Hesham Sait, Mahmou Al-Ahwal,
Abdullah Basalamah.
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2. Introduction
 Thyroid transcription factor-1 (TTF-1) is DNAbinding
protein that is encoded by a gene located on
chromosome 14q13.
 TTF-1 regulates transcription of genes specific for
the thyroid and lung and selectively expressed in these
organs.
 In anatomic pathology, it is used as a marker to
determine if a tumor arises from the lung or thyroid, to
distinguish between primary and secondary carcinomas.
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3. Lung adenocarcinoma Thyroid papillary carcinoma

4. Introduction
 Some studies showed that TTF-1 also can be
expressed in extrapulmonary & extrathyroid
adenocarcinomas.
 The data on TTF-1 expression in endometrial
cancer is limited and conflicting (range: 1-26%)
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5. Aim
 The aim of this study is to evaluate the
immunoexpression of TTF-1 in primary
endometrial adenocarcinoma.
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6. Material and methods
 A total of 116 endometrial carcinomas were retrieved
from Department of Pathology, KAUH.
 The categories of endometrial adenocarcinoma
include:
 78 grade I endometrioid
 17 grade II endometrioid
 12 grade III endometrioid
 7 serous
 2 clear cell.
 Tissue microarray (TMA) was prepared
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7. Tissue Array

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Tissue Array

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Tissue Array

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13. Material and methods
 Tissue sections were immunostained using monoclonal
antibodies to TTF-1 clones 8G7G3/1 (dilution 1:100, Dako)
 The immunohistochemical stains were scored
semiquantitativly from 0 to 5+.
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15. Tissue Array

16. Results
 TTF-1 immunoexpression was detected only in 2
carcinomas (1 serous and one endometrioid type)
and in both cases the staining score was 1+.
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20. Discussion
 Bejarano et al, Mod Pathol 1996; 9(4):445-452.
TTF-1 has been reported in 1 of 8 endometrial adenocarcinomas.
 At M. D. Anderson, Deavers et al. Arch Pathol Lab Med
2008; 132(2):175-180.
 Studied TTF-1 expression in 31 endometrial endometrioid
adenocarcinomas (11 grade I, 8 grade II, and 12 grade III).
 TTF-1, immunoreactivity was identified in 5 cases (16%), and
ranged from focal to diffuse in distribution.
 There was no correlation between TTF-1 expression and the
degree of differentiation,
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21. Discussion
 Zhang et al. (Int J Gynecol Pathol 2012; 28(1):10-18).
• TTF-1 positivity was identified in 26% (SPT24/Vision)
• TTF-1 positivity was identified in 1%-6.4%. 8G7G3/1/Dako
• TTF-1 is frequently detected in uterine malignant mixed
Mullerian tumor (82%), more common in uterine
tumors than ovarian tumors.
 Turner et al. Arch Pathol Lab Med 2012; 136(2):163-171.
TTF-1 positivity was identified in 1 out of 48 endometrial
adenocarcinoma.
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22. Discussion
 Ervine et al. Histopathology. 2014 May;64(6):840-6.
Demonstrated that TTF-1 is expressed in a small subset of
all categories of endometrial adenocarcinoma as follows:
 2% low grade endometrioid
 11% grade 3 endometrioid
 9% serous
 7% clear cell
 they showed that TTF-1 positivity in low grade
endometrioid adenocarcinomas is a poor prognostic factor.
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23. Number of
cases
Technique Positivity
(%)
Bejarano et al, 1996 8 Conventional 12
Deavers et al, 2 008 31 Conventional 16
Zhang et al, 2012 58 TMA 1-6.4
Turner et al, 2012 48 TMA 2
Ervine et al, 2014 331 TMA 2-11
Al-Maghrabi et al, 2014 116 TMA 1.7
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24. Conclusion
 Our study confirms that TTF-1 is expressed in a
small proportion of endometrial
adenocarcinomas
 In patient with TTF-1 immunoexpression,
endometrial carcinomas should be considered
when evaluating patients with adenocarcinoma
of unknown origin.
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25. Conclusion
 TTF-1 immunostaining has the potential to
misguide the pathologists, So care should be
exercised in its interpretation, for example, in
cases where there is a lung lesion in a patient with
a background of a gynaecological malignancy.
 TTF-1 positivity cannot be used as an indicator of
poorer prognosis in endometrial carcinoma.
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26. Acknowledgment
This study was supported by a grant from the
Scientific Chair of Prof. Abdullah Hussain,
Basalamah for Gynecological Cancer.
King, Abdulaziz University, Jeddah, Saudi
Arabia
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27. Thanks