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To evaluate cytokeratin 19 (CK19) expression in normal and cancerous tissues, 15,977 samples from 122 tumor types and 608 samples of 76 normal tissue types were analyzed by immunohistochemistry (IHC). In normal tissues, CK19 expression occurred in epithelial cells of most glandular organs but was strictly limited to the basal cell layer of nonkeratinizing squamous epithelium and absent in the skin. CK19 expression in ≥90% of cases was seen in 34% of the tumor entities including the adenocarcinomas of the pancreas (99.4%), colorectum (99.8%), esophagus (98.7%), and stomach (97.7%), as well as breast cancer (90.0%-100%), high-grade serous (99.1%) or endometrioid (97.8%) ovarian cancer, and urothelial carcinoma (92.6%-100%). A low CK19 positivity rate (0.1-10%) was seen in 5 of 122 tumor entities including hepatocellular carcinoma and seminoma. A comparison of tumor versus normal tissue findings demonstrated that upregulation and downregulation of CK19 can occur in cancer and that both alterations can be linked to unfavorable phenotypes. CK19 downregulation was linked to high grade (p = 0.0017) and loss of estrogen receptor- and progesterone receptor-expression (p 0.0001 each) in invasive breast carcinoma of no special type. CK19 upregulation was linked to nodal metastases in neuroendocrine tumors and papillary thyroid carcinomas (p 0.05 each) and to poor grade in clear cell renal cell carcinoma (p 0.05). CK19 upregulation was particularly common in squamous cell carcinomas. We concluded that CK19 IHC might separate primary liver cell carcinoma from liver metastases, seminoma from other testicular tumors, and helps in the detection of early neoplastic transformation in squamous epithelium.

Desmoglein-3 (Dsg3) is a transmembrane glycoprotein which is preferably found in desmosomes of keratinocytes in squamous epithelium. Both loss and upregulation of Dsg3 have been implicated in cancer progression. To comprehensively evaluate Dsg3 expression in normal and neoplastic tissues, a tissue microarray containing 15,869 samples from 137 different tumor types and subtypes as well as 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry. Dsg3 immunostaining was detectable in 47 (34.3 %) tumor categories including 15 (10.9 %) tumor types with at least one strongly positive case. The highest rate of Dsg3 positivity was found in squamous cell carcinomas from various sites (71.2-97.3 %), basal cell carcinomas of the skin (41.9 %), various tumors from salivary glands (12.9-38.9 %), and in urothelial neoplasms (2.1-20.7 %). Dsg3 positivity in less than 10 % of cases was seen in 23 additional cancer categories. Dsg3 staining was almost always weak and rarely moderate in these tumors. High Dsg3 expression was linked to invasive growth in urothelial carcinoma (p 0.0001), as well as to advanced pT stage (p = 0.0102), nodal metastasis (p = 0.0162), blood vessel infiltration (p = 0.0189) and lymph vessel infiltration (p = 0.0151) in colorectal cancer. Reduced Dsg3 expression was linked to high grade in a cohort of 599 squamous cell carcinomas from 11 different sites of origin (p 0.0001). Associations between Dsg3 immunostaining and clinicopathological features were not found in invasive breast cancer of no special type, ductal adenocarcinomas of the pancreas and in gastric adenocarcinomas. In summary, Dsg3 expression predominates in squamous cell carcinomas and loss of Dsg3 immunostaining goes along with dedifferentiation of these tumors. The identification of focal squamous differentiation in other neoplasms may constitute a diagnostic application of Dsg3 immunohistochemistry.

Pancreatic secretory granule membrane major glycoprotein 2 (GP2) is a membrane component of zymogen granules which is abundantly secreted by pancreatic acinar cells. Because RNA based analyses suggest a strict limitation of GP2 expression to the pancreas in normal tissues, and a strong preference to pancreatic cancer among tumors, GP2 expression analysis might have diagnostic utility. To better understand the role of GP2 protein expression, GP2 was successfully analyzed in 27,965 tumor samples from 132 different tumor types and subtypes as well as 8 samples each of 76 different normal tissue types by immunohistochemistry in a tissue microarray format (TMA). GP2 immunostaining was seen in 14 of 16 (87.5 %) acinar cell carcinomas, 6 of 507 (1.2 %) ductal adenocarcinomas, and 3 of 99 neuroendocrine neoplasms of the pancreas (3.0 %). GP2 was also found in 23 extra-pancreatic tumor entities including several types of neuroendocrine neoplasms (14.3-58.8 %), prostatic adenocarcinomas (8.2-18.8 %), various other adenocarcinomas (0.1-7.7 %), and several categories of benign and malignant salivary gland tumors (2.3-3.1 %). A strong GP2 positivity was only seen in 6 tumor categories including 50 % of 16 pancreatic acinus cell carcinomas, 11.8 % of 17 neuroendocrine tumors of the lung, 1.3 % of 80 primary Gleason 4 + 4 % and 0.6 % of 181 recurrent prostate cancers, as well as 0.8 % of 133 adenocarcinomas of the lung. In a cohort of 14,747 prostate cancers with follow up data, GP2 immunostaining was strongly linked to advanced pT stage, high Gleason grade, lymph node metastasis, and recurrence free survival (p 0.0001 each). The prognostic impact of GP2 positivity was independent of established parameters in TMPRSS2:ERG fusion-negative cancers (p 0.0001). In summary, our data show that GP2 is preferentially expressed in acinar cell carcinomas of the pancreas but the glycoprotein can - rarely - also be expressed in a variety of other tumor entities.