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Expression of REG4 in Ovarian Mucinous Tumors

Huang, Qiong MS*; Chen, Xiaoduan MD; Lu, Weiguo MD; Lai, Maode MD, PhD*; Lu, Bingjian MD, PhD

Applied Immunohistochemistry & Molecular Morphology: April 2014 - Volume 22 - Issue 4 - p 295–301
doi: 10.1097/PAI.0b013e3182936d8e
Research Articles

Regenerating islet-deprived gene family, number 4 (REG4), is a novel marker for intestinal differentiation. We performed immunohistochemical studies on REG4, cytokeratin (CK)7, CK20, and caudal type homeobox 2 (CDX2) in 291 ovarian mucinous tumors. There were 226 primary tumors and 65 metastatic tumors. The primary tumors comprised 69/226 mucinous cystadenomas, 79/226 mucinous borderline tumors (64/79 intestinal-type and 15/79 endocervical-like tumors), and 78/226 mucinous carcinomas. We found that REG4 expression was significantly higher in mucinous borderline tumors (30/79, 38.0%) and primary mucinous carcinomas (26/78, 33.3%) than in mucinous cystadenomas (4/69, 5.8%; P<0.05). However, REG4 expression was more commonly associated with intestinal-type, borderline, mucinous tumors rather than the endocervical-like type (30/64 vs. 0/15, P<0.001). There was a significant correlation between the REG4 and CDX2 expression profiles in primary ovarian mucinous tumors (r=0.772, P<0.001). REG4, CDX2, and diffuse CK20 had higher expression frequencies in metastatic lower gastrointestinal adenocarcinoma than in primary mucinous tumors (P<0.01). The CK7/REG4 coordinate expression profile was comparable in diagnostic value to CK7/CK20 or CK7/CDX2 profile. We conclude that REG4 expression is common in mucinous borderline tumors of the intestinal type as it is absent in the endocervical-like form in this series. Expression of CK7/REG4 may contribute to the differential diagnosis between primary and metastatic ovarian mucinous tumors.

Departments of *Pathology & Pathophysiology

Surgical Pathology

Gynecologic Oncology, The Affiliated Women’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, P.R. China

Supported by grants from the Natural Science Foundation of Zhejiang Province (Y2110271), Zhejiang, P.R. China.

The authors declare no conflict of interest.

Reprints: Bingjian Lu, MD, PhD, Department of Surgical Pathology, The Affiliated Women’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang Province 310006, P.R. China (e-mail:

Received December 4, 2012

Accepted March 21, 2013

© 2014 Lippincott Williams & Wilkins, Inc.