Immunohistochemical (IHC) examination revealed negative for calcitonin, cyclin D1, HMBE1, Galectin 3 and m CEA; and positive for thyroglobulin, TTF1, synaptophysin, and cytokeratin 19
. KI67 proliferation index was assessed as 1%.
Moreover, epithelial differentiation dysfunctional marker, cytokeratin 19
and matrixmetallo proteinase 9 (MMP9) are also overexpressed.
Immunostaining exposed: positive Cytokeratin 19
in tumor cells of vascular emboli (Figure 3a), with negative HBME-1 (Figure 3b), thereby differentiating HCC from papillary thyroid carcinoma, positivity for CD31 that confirms the presence of vascular invasion (Figure 4) and positivity for CD56--a neuroendocrine marker not commonly found in this type of thyroid carcinoma (Figure 5).
Routine laboratory studies showed that results were almost within normal range, except that of the tissue polypeptide-specific antigen, which was significantly elevated to 124.23 U/L (normal: <80 U/L), serum neuron-specific enolase elevated to 17.3 ng/ml (normal: <16.3 ng/ml), and cytokeratin 19
fragment elevated to 4.7 ng/ml (normal: <3.5 ng/ml).
An immunohistochemical analysis showed pancytokeratin, TTF-1, thyroglobulin, cytokeratin 19
, galectin, and epithelial membrane antigen positivity and the absence of staining against estrogen and progesterone receptors, mesothelin, and S-100.
fragments (CK19) are expressed in almost all epithelial malignancies, including breast cancer, lung cancer, colorectal carcinoma, cervical carcinoma, and papillary thyroid carcinoma.
Immunohistochemical studies revealed that both components were immune reactive for CKAE1/AE3, cytokeratin 7, cytokeratin 19
, and, focally, monoclonal CEA.
The laboratory reports showed elevated serum level of erythrocyte sedimentation rate (25.00 mm/hour), neuron-specific enolase (NSE, 17.73 ng/mL, reference range 0-16.3 ng/mL), cytokeratin 19
fragment (CYFRA 21-1, 8.87 ng/mL, reference range 0-3.3 ng/mL), while other measured laboratory data were within normal limits, including serum leukocyte and antimycobacterium tuberculosis antibody.
The one-step nucleic acid amplification (OSNA) is an intraoperative technique which detects and quantifies the presence of cytokeratin 19
(CK-19) mRNA in a lymph node by polymerase chain reaction (PCR) .
Squamous cell carcinoma antigen (SCC), cytokeratin 19
fragment (Cyfra21-1), neuron-specific enolase (NSE), and carcinoembryonic antigen (CEA) are widely used for screening, early detection, monitoring therapy efficacy, and defining prognosis of lung cancer [10,11]; however, several studies have also shown that serum tumor marker levels are elevated in patients with chronic kidney disease (CKD) [12-15].
Kim et al., "Increased levels of IgG to cytokeratin 19
in sera of patients with toluene diisocyanate-induced asthma," Annals of Allergy, Asthma & Immunology, vol.
Detection of serum tumor markers: Blood samples of the two groups were retained to detect tumor markers using chemiluminescence assay, including cytokeratin 19
fragment (CYFR21-1), carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA) and squamous cell carcinoma-associated antigen (SCCAg).