Table of Contents
Definition / general | Uses by pathologists | Microscopic (histologic) images | Positive staining - normal | Positive staining - not malignant | Positive staining - malignant | Negative stainingCite this page: Cytokeratin 7 (CK7, K7). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/stainsck7.html. Accessed July 12th, 2017.
Definition / general
- Type II keratin of simple nonkeratinizing epithelia (OMIM 148059); molecular weight 54 kDa
- Found in breast, lung, ovary and urothelium, but usually NOT in GI or stratified squamous epithelium
Uses by pathologists
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General patterns (specificity varies):
- CK7+ / CK20+: carcinomas of bile duct (extrahepatic / gallbladder, often, Pathol Res Pract 2003;199:65), lung-mucinous bronchioloalveolar (Am J Clin Pathol 2004;122:421), pancreas (Cancer 2006;106:693, but see Arch Pathol Lab Med 2000;124:1196), urothelium (often, Arch Pathol Lab Med 2001;125:921, Hum Pathol 2002;33:1136); also primary mucinous tumors of ovary (74%), upper GI tract (78%) and endocervix (88%, Am J Surg Pathol 2006;30:1130)
- CK7+ / CK20-: carcinomas of bile duct (intrahepatic, Pathol Res Pract 2003;199:65), breast (Ann Diagn Pathol 1999;3:350), endocervical and endometrial adenocarcinoma (Int J Gynecol Pathol 2002;21:4), esophagus (distal, Am J Surg Pathol 2002;26:1213), lung (not mucinous bronchioloalveolar, BMC Cancer 2006;6:31), salivary gland (Pathol Int 2005;55:386), thyroid (Appl Immunohistochem Mol Morphol 2000;8:189); mesothelioma (Cancer 2001;92:2727)
- CK7- / CK20+: carcinoma of colon (particularly early stage, Hum Pathol 2005;36:275); primary mucinous tumors of lower GI tract (79%, Am J Surg Pathol 2006;30:1130), primary bladder adenocarcinoma (29%, Am J Surg Pathol 2001;25:1380)
- CK7- / CK20-: carcinoma of adrenal cortex, prostate (Mod Pathol 2000;13:962)
- To distinguish primary lung carcinoma (CK7+ / CK20-) from metastatic colonic carcinoma to lung (CK7- / CK20+, BMC Cancer 2006;6:31)
- To distinguish adenocarcinoma of distal esophagus (CK7+ / CK19+: 90%, CK7+ / CK20-: 74%) from proximal stomach (CK7+ / CK19+: 44%, CK7+ / CK20-: 24%, Am J Surg Pathol 2002;26:1213)
- To distinguish chromophobe carcinoma (diffuse CK7+ staining) from oncocytoma (usually CK7-, Anal Quant Cytol Histol 2006;28:228)
- To help distinguish papillary renal cell carcinoma (CK7+) from metanephric adenoma (CK7-, Mod Pathol 2006;19:218)
- To distinguish endometrioid and clear cell carcinoma (CK7+) from yolk sac tumors (CK7-, Am J Surg Pathol 2004;28:1499)
Microscopic (histologic) images
Images hosted on Pathout server:
Ureter (normal)-Cytokeratin 7 (RN7) with
intense cytoplasmic staining (contributed
by Leica Microsystems, Biosystems Division)
Images hosted on other servers:
Kidney: left - chromophobe carcinoma-eosinophilic variant is CK7+ (fig 2C); right - oncocytoma has scattered CK7+ cells (fig 6)
Ovarian mucinous cystadenoma is CK7+ (5B),
but testicular mucinous cystadenoma (fig 3B)
and colonic epithelium (fig 4B) are negative
Images hosted on Nature.com:
Salivary gland carcinomas (left to right): mucoepidermoid are CK7+ (fig B, E); adenoid cystic (fig B, E); salivary duct (fig B, E)
Various carcinomas (left to right): pancreatic-fig 1A, cholangiocarcinoma-fig 1C, urothelial-fig 1E; breast-fig 3A, ovary-fig 3C, lung-fig 3E, endometrium-fig 3G; colon-fig 4A, Merkel cell-fig 4C
Images hosted on Flickr:
Positive staining - normal
- Anal glands and anal transition zone (Arch Pathol Lab Med 2001;125:1074)
- Bile ducts (Exp Cell Res 1987;170:235)
- Breast
- Cervical glands
- Endometrium
- Fallopian tube
- Fetal cells in transcervical mucus (J Obstet Gynaecol Res 2005;31:500)
- Gallbladder
- Kidney collecting ducts
- Lung
- Mesothelium
- Ovarian epithelium (Am J Pathol 1991;138:455)
- Pancreatic ducts (J Pathol 1998;184:234)
- Salivary gland acini (Mod Pathol 2004;17:803), intercalated ducts and intercalated duct lesions (Am J Surg Pathol 2009;33:1322)
- Thyroid epithelium
- Toker cells (Am J Dermatopathol 2005;27:185)
- Trophoblast (J Immunol Methods 2004;286:21)
- Urothelium (Eur J Cell Biol 2004;83:27)
Positive staining - not malignant
- Cystitis glandularis (bladder) of usual type (intestinal type is CK7-)
- Colonic serrated adenoma (Dig Dis Sci 2005;50:1741)
- Ependymoma: extra-axial (80%) versus CNS (10%, Am J Surg Pathol 2008;32:710)
- Esophagus-Barrett’s: strong diffuse CK7+ surface and crypt epithelium, strong CK20+ surface and superficial crypt staining; interpretation is affected by fixative (Hum Pathol 2005;36:58, but see Mod Pathol 2002;15:611); pattern may help distinguish short segment Barrett’s from cardiac intestinal metaplasia (World J Gastroenterol 2005;11:6360)
- Eye: Fuchs endothelial dystrophy (Cornea 2006;25:956)
- Liver: bile duct adenoma, mesenchymal hamartoma, chronic allograft rejection (Am J Clin Pathol 2011;135:238). perivenular hepatocytes associated with cholestatic chemistry profile and heart failure (Mod Pathol 2010;23:1650)
- Lymph nodes: individual / clusters of neuroendocrine cells (Am J Surg Pathol 2010;34:1701)
- Nephrogenic adenoma of GU tract (Am J Surg Pathol 2009;33:1654)
- Pancreas: lymphoepithelial cyst (Mod Pathol 2010;23:1467)
- Salivary gland oncocytoma (Laryngoscope 2005;115:1097)
Positive staining - malignant
- Adenocarcinomas-mucinous from ampulla, biliary tree, esophagus, pancreas, stomach (93%, Am J Surg Pathol 2011;35:1830)
- Adenocarcinoma-mucinous from colon / rectum / anus (only 19% are CK7+, most from rectum/anus, Am J Surg Pathol 2011;35:1830)
- Anal duct carcinoma (Hum Pathol 2012;43:216)
- Appendiceal epithelial neoplasms (benign and malignant-33%, Hum Pathol 2005;36:1217)
- Basaloid squamous cell carcinoma of Waldeyer’s ring (Hum Pathol 2000;31:1096)
- Bile duct carcinoma (90%, Hum Pathol 2005;36:1226)
- Bladder adenocarcinoma (63%, Appl Immunohistochem Mol Morphol 2005;13:358)
- Breast carcinoma (Ann Diagn Pathol 1999;3:350)
- Carcinoid (GI, 11%, Hum Pathol 2001;32:1087)
- Cervical adenocarcinoma (Am J Clin Pathol 2009;132:531)
- Colon adenocarcinoma related to ulcerative colitis (59%, Virchows Arch 2006;448:756)
- Germ cell tumors at various sites (variable, but usually negative)
- Kidney: renal cell carcinoma (chromophobe-Am J Clin Pathol 2007;127:225, clear cell tubulopapillary-Am J Surg Pathol 2010;34:1608, collecting duct, papillary-Am J Surg Pathol 2011;35:949)
- Liver: hepatocellular carcinoma (10-34% positive, Mod Pathol 2006;19:460, particularly scirrhous / fibrolamellar type, Histopathology 2005;47:382 or age 30 or younger, Am J Clin Pathol 2005;124:512)
- Lung: adenocarcinoma-94% vs. squamous cell-60% (Hum Pathol 2006;37:542, Am J Surg Pathol 2011;35:15)
- Merkel cell (50%, J Eur Acad Dermatol Venereol 2005;19:546)
- Mesothelioma, including with rhabdoid features (Mod Pathol 2006;19:373)
- Ovarian carcinoma (Mod Pathol 2006;19:1421), but mucinous carcinoma with pseudomyxoma ovarii (suggesting teratomatous derivation) are CK7- (Am J Surg Pathol 2007;31:854); ovarian carcinoids (24%), Sertoli cell tumors (13%, Am J Surg Pathol 2007;31:255)
- Paget’s cells (breast, anal, vulvar, esophageal, but not vulvar secondary to anorectal carcinoma, Am J Surg Pathol 1998;22:170-perianal, Hum Pathol 2002;33:545-vulvar, Am J Surg Pathol 2008;32:1068-esphageal)
- Pancreatic carcinoma including intestinal type (Ann Diagn Pathol 2007;11:3)
- Pseudomyxoma peritonei (almost all cases have variable positivity, Histopathology 2006;49:381)
- Salivary gland: carcinoma (100%, Pathol Int 2005;55:386), lymphadenoma (Mod Pathol 2012;25:26)
- Sinonasal adenocarcinoma (most, Ann Otol Rhinol Laryngol 2006;115:59)
- Small intestinal adenocarcinoma (Am J Surg Pathol 2004;28:1499)
- Synovial sarcoma (many, Mod Pathol 2006;19:659)
- Urothelial carcinoma (87%), urothelial carcinoma in situ of the bladder with glandular differentiation (Hum Pathol 2011;42:1653)
- Uterus: endometrioid adenocarcinoma (100%), endocervical (50%, Int J Gynecol Pathol 2012;31:57); most mucinous tumors (Appl Immunohistochem Mol Morphol 2009;17:8)
Negative staining
- Adrenocortical carcinoma
- Cervical squamous epithelium
- Endometrial stromal sarcoma (Hum Pathol 2008;39:1459)
- GI epithelium (normal)
- GI carcinomas-nonmucinous (but see exceptions above)
- Hepatocytes; hepatoid adenocarcinoma
- Kidney: normal tubules, carcinoid (may have focal staining, Am J Surg Pathol 2007;31:1539), clear cell carcinoma (usually), oncocytoma
- Nasal cavity: nonkeratinizing nasopharyngeal carcinoma-differentiated and undifferentiated
- Pituitary adenomas (usually, Endocr Pathol 2005;16:201)
- Prostate adenocarcinoma (Mod Pathol 2000;13:962), but prostatic mucin producing urothelial-type carcinoma is usually CK7+ (83%, Am J Surg Pathol 2007;31:1323)
- Skin (squamous epithelium)
- Tongue (Exp Cell Res 1987;170:235)
- Yolk sac tumor (Am J Surg Pathol 2004;28:1499)














































