Published: 2021-07-28

A study on histopathological examination of colorectal carcinoma with special reference to expression of CK20 in colorectal adenocarcinoma at a tertiary care centre

Biman J. Deori, Nandinee Lahkar, Musfika Tabassum


Background: Colorectal carcinoma is the third most common cancer worldwide, over 1.8 million new cases are estimated in the year 2018. In terms of mortality, colorectal carcinoma ranks second with estimated 881,000 deaths in 2018. Histopathological study plays a central role for diagnosis and definitive treatment of colorectal carcinoma. In present time, immunohistochemical markers with adjunct to morphology helps in diagnosis and also in prognosis and treatment. Therefore, in colorectal carcinoma, along with morphology, many such immunohistochemical markers are being studied.

Methods: This study was carried out in the Department of Pathology at a tertiary care health centre in the southern part of Assam for a period of 1 year from June 2018 to May 2019. 52 cases of colorectal carcinoma diagnosed by histopathological study were included in the study. All patients were analysed for age, gender, type of growth and location of growth. Immunohistochemical staining of cytokeratin (CK) 20 was done and expression was studied and correlated with age, location of tumour, grade and tumour stage.

Results: Out of total 52 patients, 33 were male and 19 were female. Average age of presentation was 48.46±15.51 years. On gross examination rectal tumours were the most common and maximum tumours had polypoidal type of growth. On immunohistochemical study CK20 expression was detected in 82.7% out of 52 cases of colorectal adenocarcinoma and negative in 17.3% cases.

Conclusions: The correlation between CK20 expression and grading and tumour stages of colorectal adenocarcinoma was statistically significant. Further, large scale population-based studies with more number of cases and follow-up of these cases need to be done for better assessment of this immunohistochemical marker in colorectal adenocarcinoma that can be used for assessment of prognosis.  


Colorectal carcinoma, Immunohistochemistry, Cytokeratin, Grading, Tumour stage, Prognosis

Full Text:



Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.

National Cancer Registry Programme. Three year report of the population based cancer registry 2009-2011. ICMR, Bangalore, India. 2013.

Bayrak R, Haltas H, Yenidunya S. The value of CDX2 and cytokeratins 7 and 20 expression in differentiating colorectal adenocarcinomas from extraintestinal gastrointestinal adenocarcinomas: cytokeratin 7-/20+ phenotype is more specific than CDX2 antibody. DiagnPathol. 2012;7:9.

Bayrak R, Yenidünya S, Haltas H. Cytokeratin 7 and cytokeratin 20 expression in colorectal adenocarcinomas. Pathol Res Pract. 2011;207(3):156-60.

Halder S, Bhattacharjee P.K, Bhar P, Pachaury A, Biswas R. R et al. Epidemiological, Clinico-pathological Profile and Management of Colorectal Carcinoma in a Tertiary Referral Centre of Eastern India. JKIMSU. 2013;2(1).

Virk R, Gill S, Yoshida E, Radley S, Salh B. Racial differences in the incidence of colorectal cancer. Can J Gastroenterol. 2010;24(1):47-51.

Laishram RS, Kaiho N, Rachel S, Devi SB, Punyabati P, Sharma D. Histopathological Evaluation of Colorectal Carcinomas Status in Manipur, India. International Journal of Pathology. 2010;8(1):5-8.

Rasool M, Mubeen B, Andrabi R, Hamid S, Rasool Z et al. Histopathological study of neoplastic lesions of large intestine in Kashmir Valley, India. Int J Res Med Sci. 2014;2(3):1097-100.

Haleshappa RA, Rao SA, Garg S, Kuntegowdanahalli CL, Kanakasetty GB, Dasappa L. Is Colorectal Cancer in Young (<40 Years) Different from those in the Elderly (>40 Years): Experience from a Regional Care Center. Indian J Med Paediatr Oncol. 2017;38(4):466-70.

Peedikayil MC, Nair P, Seena SM, Radhakrishnan L, Sadasivan S, Naryanan VA, Balakrishnan V. Colorectal cancer distribution in 220 Indian patients undergoing colonoscopy. Indian J Gastroenterol. 2009;28(6):212-5.

Ibrahim KO, Anjorin AS, Afolayan AE, Badmos KB. Morphology of colorectal carcinoma among Nigerians: a 30-year review. Niger J Clin Pract. 2011;14(4):432-5.

Al-Maghrabi J, Emam E, Gomaa W. Immunohistochemical staining of cytokeratin 20 and cytokeratin 7 in colorectal carcinomas: Four different immunostaining profiles. Saudi J Gastroenterol. 2018;24:129-34.

Gheini MH, Naderi NJ. The Relationship Between Cytokeratins 7 and 20 Expression, and Prognostic Factors in Colon Adenocarcinoma: An Immunohistochemical Study. Iran J Pathol.2017;12(2):94-98.

Park SY, Kim HS, Hong EK, Kim WH. Expression of Cytokeratins 7 and 20 in Primary Carcinomas of the Stomach and Colorectum and Their Value in the Differential Diagnosis of Metastatic Carcinomas to the Ovary. Human Pathology. 2002;33(11):1078-85.

Hernandez BY, Frierson HF, Christoper AM, Li YJ, Clegg L, Trimothy R et al. CK20 and CK7 protein expression in colorectal cancer: demonstration of the utility of a population-based tissue microarray. Human Pathol. 2005;(36):275-81.