Choroid Plexus Tumors. An Immunocytochemical Study with Particular Reference to the Coexpression of Intermediate Filament Proteins

Sixteen choroid plexus tumors (CPTs) have been investigated for the localization of different immunocytochemical markers of epithelial and nonepithelial nature, namely, simple epithelial-type cytokeratins, vimentin, glial fibrillary acidic protein (GFAP), a panepithelial antigen defined by the lu-5 monoclonal antibody (lu-5 antigen), S-100 protein, and epithelial membrane antigen (EMA). Intermediate filament proteins have been identified in paraffin sections of 14 of 16 cases (87.5%). In all these tumors, cytokeratins and vimentin were constantly coexpressed by the neoplastic cells, in a manner similar to that of the cells lining normal choroid plexus. In 7 of these 14 cases, in addition to cytokeratins and vimentin, the neoplastic cells were shown to coexpress GFAP, which is not synthesized by their normal cell counterpart. The appearance of GFAP immunoreactivity in CPTs might be related to an ependymal differentiation of the neoplastic cells, because normal ependyma and ependymomas constantly coexpress GFAP and vimentin. The simultaneous expression of three distinct intermediate filament proteins by the same neoplastic cells is an exceedingly rare phenomenon, which has never been reported by double labeling technique in neoplasms of the central nervous system. Despite the complex antigenic profile of the CPT, which includes immunoreactivity for lu-5 antigen, S-100 protein, and EMA in most of the cases, positivity for three different epithelial markers indicates that these tumors have an epithelial nature. Moreover, the immunocytochemical typing of CPT with the panel of antibodies used in the current investigation allows differentiation from other primary and metastatic central nervous system tumors.