{"id":177,"date":"2026-07-01T07:55:17","date_gmt":"2026-07-01T07:55:17","guid":{"rendered":"https:\/\/blogs.imperial.ac.uk\/my-path\/?p=177"},"modified":"2026-07-01T07:56:16","modified_gmt":"2026-07-01T07:56:16","slug":"cdx2-immunohistochemistry","status":"publish","type":"post","link":"https:\/\/blogs.imperial.ac.uk\/my-path\/2026\/07\/01\/cdx2-immunohistochemistry\/","title":{"rendered":"CDX2 Immunohistochemistry"},"content":{"rendered":"<p class=\"font-claude-response-body break-words whitespace-normal\"><strong>CDX2 Immunohistochemistry<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal\">CDX2 is a homeobox transcription factor involved in intestinal epithelial development and differentiation. In diagnostic IHC, it is used as a sensitive and relatively specific marker of intestinal differentiation, most commonly applied to identify adenocarcinomas of gastrointestinal origin \u2014 particularly colorectal adenocarcinoma. Staining is nuclear.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal\"><strong>Utility and limitations<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal\">CDX2 positivity is seen in the great majority of colorectal adenocarcinomas, making it a workhorse marker when confirming intestinal-type differentiation in a metastatic adenocarcinoma of unknown primary. However, it is not colorectal-specific: CDX2 is also expressed in a range of other tumours with intestinal or intestinal-type differentiation, including gastric adenocarcinoma (particularly intestinal-type), a subset of pancreaticobiliary adenocarcinomas, mucinous ovarian tumours, and some urothelial carcinomas with glandular\/intestinal metaplasia.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal\">Loss of CDX2 expression has also been reported as a marker of aggressive behaviour and worse prognosis in a subset of colorectal cancers, and can occur in poorly differentiated or dedifferentiated tumours \u2014 so a negative result doesn&#8217;t exclude colorectal origin, especially in high-grade lesions.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal\"><strong>Panel context<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal\">Because of these overlaps, CDX2 is best used as part of a panel rather than as a standalone site-of-origin marker:<\/p>\n<ul class=\"[li_&amp;]:mb-0 [li_&amp;]:mt-1 [li_&amp;]:gap-1 [&amp;:not(:last-child)_ul]:pb-1 [&amp;:not(:last-child)_ol]:pb-1 list-disc flex flex-col gap-1 pl-8 mb-3\">\n<li class=\"font-claude-response-body whitespace-normal break-words pl-2\"><strong>CK7\/CK20<\/strong>: classic colorectal profile is CK20+\/CK7\u2212, though this pattern has well-known exceptions.<\/li>\n<li class=\"font-claude-response-body whitespace-normal break-words pl-2\"><strong>SATB2<\/strong>: increasingly regarded as more specific for colorectal origin than CDX2, since SATB2 is less frequently positive in upper GI and pancreaticobiliary tumours.<\/li>\n<li class=\"font-claude-response-body whitespace-normal break-words pl-2\"><strong>Villin<\/strong>: broadly supports intestinal\/brush-border differentiation but shows similarly broad expression across GI sites.<\/li>\n<\/ul>\n<p class=\"font-claude-response-body break-words whitespace-normal\">Combining CDX2 with SATB2, CK7, CK20, and villin gives a more reliable picture of the site of origin than any single marker, particularly when trying to distinguish colorectal from upper GI or pancreaticobiliary adenocarcinoma in a metastatic workup.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>CDX2 Immunohistochemistry CDX2 is a homeobox transcription factor involved in intestinal epithelial development and differentiation. In diagnostic IHC, it is used as a sensitive and relatively specific marker of intestinal differentiation, most commonly applied to identify adenocarcinomas of gastrointestinal origin \u2014 particularly colorectal adenocarcinoma. Staining is nuclear. Utility and limitations CDX2 positivity is seen in [&hellip;]<\/p>\n","protected":false},"author":1119,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[318397,290084,318392,1],"tags":[],"class_list":["post-177","post","type-post","status-publish","format-standard","hentry","category-consultant","category-gastro-intestinal-pathology","category-trainee","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>CDX2 Immunohistochemistry - My Path<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.imperial.ac.uk\/my-path\/2026\/07\/01\/cdx2-immunohistochemistry\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CDX2 Immunohistochemistry - My Path\" \/>\n<meta property=\"og:description\" content=\"CDX2 Immunohistochemistry CDX2 is a homeobox transcription factor involved in intestinal epithelial development and differentiation. 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