Homeobox transcription factor engrailed homeobox 1 is a possible diagnostic marker for adenoid cystic carcinoma and polymorphous adenocarcinoma

Pathol Int. 2021 Feb;71(2):113-123. doi: 10.1111/pin.13050. Epub 2020 Dec 17.


Diagnostic utility of a homeobox transcription factor, engrailed homeobox 1 (En1) in the histopathology of salivary gland neoplasms was studied. The expression of En1 was immunohistochemically examined in 51 cases of adenoid cystic carcinoma (AdCC) and 143 cases of other salivary gland neoplasms. In all 51 AdCCs, En1 was expressed in 30-100% of tumor cells. In eight of nine polymorphous adenocarcinomas (PACs), En1 was expressed in 40-100% of tumor cells. Less than 5% of tumor cells expressed En1 in three of 12 epithelial-myoepithelial carcinomas, one of 17 basal cell adenomas (BCAs), and one of 34 pleomorphic adenomas (PAs). Among 55 other carcinoma cases, 1-30% of tumor cells expressed En1 in three salivary duct carcinomas (SDCs) ex PA. None of the myoepitheliomas and Warthin tumors expressed En1. When the cut-off value of the percentage of En1-expressing cells was set to 25%, all 51 AdCCs, eight of nine PACs and one SDC ex PA were En1-positive and the others were En1-negative. En1 is expressed consistently in AdCCs, frequently in PACs, but rarely in other salivary gland neoplasms. En1 is a possible diagnostic marker for AdCC and PAC in the histopathology of salivary gland neoplasms.

Keywords: adenoid cystic carcinoma; engrailed homeobox 1; polymorphous adenocarcinoma; salivary gland tumor.

MeSH terms

  • Adenoma / diagnosis
  • Adenoma / metabolism
  • Adenoma / pathology
  • Adenoma, Pleomorphic / diagnosis
  • Adenoma, Pleomorphic / metabolism
  • Adenoma, Pleomorphic / pathology
  • Biomarkers, Tumor / metabolism*
  • Carcinoma, Adenoid Cystic / diagnosis*
  • Carcinoma, Adenoid Cystic / metabolism
  • Carcinoma, Adenoid Cystic / pathology
  • Diagnosis, Differential
  • Homeodomain Proteins / metabolism*
  • Humans
  • Immunohistochemistry
  • ROC Curve
  • Salivary Gland Neoplasms / diagnosis*
  • Salivary Gland Neoplasms / metabolism
  • Salivary Gland Neoplasms / pathology
  • Sensitivity and Specificity


  • Biomarkers, Tumor
  • EN1 protein, human
  • Homeodomain Proteins