Napsin a expression across subtypes of thyroid carcinoma: an immunohistochemical diagnostic encounter with prognostic correlates

Napsin a expression across subtypes of thyroid carcinoma: an immunohistochemical diagnostic encounter with prognostic correlates

Authors

  • Heba Sheta Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • Maha M. Fawzy Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • Amal Abd El hafez Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Faculty of Medicine, Horus University-Egypt (HUE), New Damietta, Egypt
  • Amr Hossam Surgical Oncology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • Sherihan I. Gouda Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • Ahmad Darwish Pediatric Hematology, Oncology and Bone Marrow Transplantation Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • Doaa Sh. Alemam Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • Reham Alghandour Medical Oncology Unit, Oncology Center-Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • Doaa H. Sakr Medical Oncology Unit, Oncology Center-Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt

Keywords:

Thyroid carcinoma, Napsin A, Frequency, Therapy, Prognosis

Abstract

Background and aim: Novel aspartic proteinase of pepsin family A (Napsin A) is a diagnostic marker for pulmonary adenocarcinoma. Recently, it was detected in carcinomas of various organs including thyroid carcinomas (TCs), raising a diagnostic challenge especially when combined with positive thyroid transcription factor-1 (TTF-1). Methods: This retrospective study investigates the frequency of Napsin A immunohistochemical (IHC) expression across subtypes of TC focusing on its association with the prognostic parameters. Sixty-three TC patients who underwent thyroidectomy were enrolled. After collecting the clinicopathological, laboratory, surgical, therapeutic and survival data, IHC was applied to TC tissue microarray-prepared sections using anti-Napsin A. IHC scoring divided TCs as: Napsin A positive & negative. Statistical and survival analyses were performed using SPSS version 26. Results: Napsin A was expressed in 17.5% of TCs with 100% expression in anaplastic TC and 19.5% expression in papillary TC. Other TC subtypes were negative. Statistically significant associations were noticed between Napsin A and some less favorable TC prognostic variables as the involvement of both lobes, anaplastic histopathology, larger tumor size, higher pathological stage, and a shorter mean OS and DFS of patients (all P ≤0.05). Conclusions: Napsin A is predominately expressed in anaplastic and papillary TC subtypes. In patients with a possible metastatic lung carcinoma or malignancy of unknown origin co-expressing Napsin A and TTF-1, the diagnosis of TC should be considered and supported with a panel of other TC markers. Considering its less favorable prognostic associations, Napsin A may be added as a molecular marker for TC risk stratification, and treatment targeting. However, the other subtypes must be evaluated in a larger series to support these conclusions. 

References

Weidemann S, Böhle JL, Contreras H et al. Napsin A expression in human tumors and normal tissues. Pathol Oncol Res. 2021;27:613099. doi:10.3389/pore.2021.613099

SinoBiological. Accessed at https://www.sinobiological.com/resource/napsin-a/proteins on 22 June 2023.

Ueno T, Elmberger G, Weaver TE et al. The aspartic protease Napsin A suppresses tumor growth independent of its catalytic activity. Lab Invest. 2008;88(3):256-263. doi:10.1038/labinvest.3700718

Ordóñez NG. Napsin A expression in lung and kidney neoplasia. Adv Anat Pathol. 2012; 19(1):66-73. doi:10.1097/PAP. 0b013e31823e472e

Chuman Y, Bergman A, Ueno T, et al. Napsin A, a member of the aspartic protease family, is abundantly expressed in normal lung and kidney tissue and is expressed in lung adenocarcinomas. FEBS Lett. 1999;462(1-2):129-134. doi:10.1016/s0014-5793(99)01493-3

Zhang P, Han YP, Huang L et al. Value of Napsin A and thyroid transcription factor-1 in the identification of primary lung adenocarcinoma. Oncol Lett. 2010;1(5):899-903. doi: 10.3892/ol_00000160

Lee JG, Kim S, Shim HS. Napsin A is an independent prognostic factor in surgically resected adenocarcinoma of the lung. Lung Cancer. 2012;77(1):156-161. doi:10.1016/j.lungcan.2012.02.013

Yang X, Liu Y, Lian F et al. Lepidic and micropapillary growth pattern and expression of Napsin A can stratify patients of stage I lung adenocarcinoma into different prognostic subgroup. Int J Clin Exp Pathol. 2014;7(4):1459-1468

Bulutay P, AkyÜrek N, MemiŞ L. Clinicopathological and prognostic significance of the EML4-ALK translocation and IGFR1, TTF1, Napsin A expression in patients with lung adenocarcinoma. Turk Patoloji Derg. 2021;37(1):7-17. doi:10.5146/tjpath.2020.01503

Zhou L, Lv X, Yang J et al. Overexpression of Napsin A resensitizes drug-resistant lung cancer A549 cells to gefitinib by inhibiting EMT. Oncol Lett. 2018;16(2):2533-2538. doi:10.3892/ol.2018.8963

Pors J, Segura S, Cheng A et al. Napsin-A and AMACR are superior to HNF-1β in distinguishing between mesonephric carcinomas and clear cell carcinomas of the gynecologic tract. Appl Immunohistochem Mol Morphol. 2020;28(8):593-601. doi:10.1097/PAI.0000000000000801

Travaglino A, Raffone A, Arciuolo D et al. Diagnostic accuracy of HNF1β, Napsin A and P504S/Alpha-Methylacyl-CoA Racemase (AMACR) as markers of endometrial clear cell carcinoma. Pathol Res Pract. 2022;237:154019. doi:10.1016/j.prp.2022.154019

Kadivar M, Boozari B. Applications and limitations of immunohistochemical expression of "Napsin-A" in distinguishing lung adenocarcinoma from adenocarcinomas of other organs. Appl Immunohistochem Mol Morphol. 2013;21(3):191-195. doi:10.1097/PAI.0b013e3182612643

Al-Maghrabi JA, Butt NS, Anfinan N et al. Infrequent Immunohistochemical Expression of Napsin A in Endometrial Carcinomas. Appl Immunohistochem Mol Morphol. 2017;25(9):632-638. doi:10.1097/PAI.0000000000000350

Heymann JJ, Hoda RS, Scognamiglio T. Polyclonal napsin A expression: a potential diagnostic pitfall in distinguishing primary from metastatic mucinous tumors in the lung. Arch Pathol Lab Med. 2014;138(8):1067-1071. doi:10.5858/arpa.2013-0403-OA

Chernock RD, El-Mofty SK, Becker N et al. Napsin A expression in anaplastic, poorly differentiated, and micropapillary pattern thyroid carcinomas. Am J Surg Pathol. 2013;37(8):1215-1222. doi:10.1097/PAS.0b013e318283b7b2

Wu J, Zhang Y, Ding T et al. Napsin A Expression in Subtypes of Thyroid Tumors: Comparison with Lung Adenocarcinomas. Endocr Pathol. 2020;31(1):39-45. doi:10.1007/s12022-019-09600-6

Schilsky JB, Ni A, Ahn L et al. Prognostic impact of TTF-1 expression in patients with stage IV lung adenocarcinomas. Lung Cancer. 2017;108:205-211. doi: 10.1016/j.lungcan.2017.03.015

Guo R, Tian Y, Zhang N et al. Use of dual-marker staining to differentiate between lung squamous cell carcinoma and adenocarcinoma. J Int Med Res. 2020;48(4):300060519893867. doi:10.1177/0300060519893867

Wang LY, Palmer FL, Nixon IJ, et al. Multi-organ distant metastases confer worse disease-specific survival in differentiated thyroid cancer. Thyroid. 2014;24(11):1594-1599. doi:10.1089/thy.2014.0173

Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M. Pitfalls in challenging thyroid tumors: emphasis on differential diagnosis and ancillary biomarkers. Endocr Pathol. 2020;31(3):197-217. doi:10.1007/s12022-020-09638-x

Nakhjavani MK, Gharib H, Goellner JR et al. Metastasis to the thyroid gland. A report of 43 cases. Cancer. 1997;79(3):574-578. doi:10.1002/(sici)1097-0142(19970201)79:3<574::aid-cncr21>3.0.co;2-#

Mohamed AS, Abd El hafez A, Eltantawy A et al. Diagnostic and prognostic value of isolated and combined MCM3 and Glypican-3 expression in hepatocellular carcinoma: a novel immunosubtyping prognostic model. Appl Immunohistochem Mol Morphol. 2022;30(10):694-702. doi:10.1097/PAI.0000000000001080

Sung H, Ferlay J, Siegel RL et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660

Ramos-Vara JA, Frank CB, DuSold D et al. Immunohistochemical detection of Pax8 and Napsin A in canine thyroid tumours: comparison with thyroglobulin, calcitonin and thyroid transcription factor 1. J Comp Pathol. 2016;155(4):286-298. doi:10.1016/j.jcpa.2016.07.009

Fadare, O, Desouki MM, Gwin, K et al. Frequent expression of Napsin A in clear cell carcinoma of the endometrium. Am J Surg Pathol (2014) 38(2):189–96. doi:10.1097/PAS.0000000000000085

Downloads

Published

28-08-2024

Issue

Section

ORIGINAL CLINICAL RESEARCH

How to Cite

1.
Sheta H, Maha M. Fawzy, Abd El hafez A, Amr Hossam, Sherihan I. Gouda, Ahmad Darwish, et al. Napsin a expression across subtypes of thyroid carcinoma: an immunohistochemical diagnostic encounter with prognostic correlates. Acta Biomed [Internet]. 2024 Aug. 28 [cited 2024 Oct. 5];95(4):e2024067. Available from: https://mail.mattioli1885journals.com/index.php/actabiomedica/article/view/15474