Expression of cancer stem cell markers and epithelial-mesenchymal transition-related factors in anaplastic thyroid carcinoma

Background: Anaplastic thyroid carcinoma (ATC) is an undifferentiated tumor of the thyroid that has poor prognosis owing to its aggressive behavior and resistance to current treatments. We hypothesized that the stem cell properties induced by the epithelial-mesenchymal transition (EMT) was one of reasons for the dismal outcome of ATC. Materials and methods: Paraffin blocks and slides of 17 ATC cases were retrieved. We also collected 60 cases of papillary thyroid carcinoma (PTC) for comparison. We used immunohistochemistry to examine the expression of multiple markers of cancer stem cells and EMT-activating transcriptional factors. Results: Majority of ATC cases showed loss of epithelial (E)-cadherin expression (15/17); however, all PTC cases (60/60) retained E-cadherin expression. EMT-activating transcription factors, such as snail and slug, were more frequently expressed in ATC than PTC cases (35.3% versus 6.7%, 76.5% versus 5%, respectively). Cancer stem cell markers such as CD133 and nestin were more highly expressed in ATC than PTC (52.9% versus 5%, 52.9% versus 0%, respectively). Conclusion: We found that the expression of EMT-related factors and stem cell markers was higher in ATC than PTC. We therefore conclude that stemness induced by EMT plays an important role in the pathogenesis of ATC.