CD Markers
CD44


Last author update: 27 January 2022
Last staff update: 27 January 2022

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PubMed Search: CD44[TI] pathology review[PT] full text[SB]

Sawsan Ismail, M.D.
John Yahya I. Elshimali, M.D.
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Cite this page: Ismail S, Elshimali JYI. CD44. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cdmarkerscd44.html. Accessed December 6th, 2022.
Definition / general
Essential features
  • Complex transmembrane adhesion glycoprotein
  • Surface marker of cancer stem cells
  • Plays a crucial role in cell adhesion, differentiation, migration and signaling (Exp Hematol Oncol 2020;9:36)
  • CD44 might represent a therapeutic target in various tumor types
Terminology
Pathophysiology
Diagrams / tables

Images hosted on other servers:

CD44 molecule structure with ligands

Clinical features
  • Might represent a therapeutic target in various tumor types, including ovarian cancer (Front Oncol 2020;10:589601)
  • High expression of CD44 is associated with recurrence and metastases in several cancer types, including gastric, colorectal and bladder cancer (Oncol Rep 2016;36:2852)
  • Treatment is based on suppression of CD44 expression by peptide mimetics, aptamers and natural compounds (J Hematol Oncol 2018;11:64)
  • CD44 deletion enhances the fibrogenic response, increases leukocyte infiltration and delays the accumulation of fibrillar collagen (Matrix Biol 2019;75-76:314)
Interpretation
  • Membranous
Uses by pathologists
Prognostic factors
  • Increased expression is associated with invasiveness and increased chemotherapy resistance
  • Might represent a therapeutic target in various tumor types
  • CD44v high expression correlates to progression and poor outcome in various cancers, including non-Hodgkin lymphoma, hepatocellular carcinoma, breast, bone, ovarian, pancreatic, colorectal, bladder, gastric, head and neck squamous cell carcinomas, leukemias and lymphomas (Front Oncol 2020;10:589601)
Microscopic (histologic) description
  • Positive cells should demonstrate a strong plasma membrane staining pattern
  • Cells that lack membranous staining or demonstrate only cytoplasmic staining are considered negative
  • Reference: PLoS One 2016;11:e0165253
Microscopic (histologic) images

Contributed by John Yahya I. Elshimali, M.D. and Maria Tretiakova, M.D., Ph.D.
Epithelium of fallopian tube

Epithelium of fallopian tube

Fallopian stromal cells

Fallopian stromal cells

CD44 CD44 CD44 CD44

CD44 positive epithelial cells in fallopian tube


CD44

CD44 positive epithelial cells in fallopian tube

CD44

Positive CD44 expression in fallopian tube epithelium

CD44 CD44 CD44

Decidual and stromal cells in fallopian pregnancy positive for CD44


Normal bladder mucosa

Normal bladder mucosa

 CD44 - full thickness in normal bladder mucosa

CD44 - full thickness in normal bladder mucosa

Bladder CIS

Bladder CIS

CD44 - loss of CD44 expression

CD44 - loss of CD44 expression

Pagetoid CIS vs reactive inflammation

Pagetoid CIS vs reactive inflammation

CD44 - patchy loss of expression in pagetoid CIS

CD44 - patchy loss of expression in pagetoid CIS

Positive staining - normal
Positive staining - disease
Negative staining
Molecular / cytogenetics description
Molecular / cytogenetics images

Images hosted on other servers:

CD44 transmembrane receptor function

Sample pathology report
  • Breast, right mastectomy:
    • Invasive triple negative breast carcinoma (see comment)
    • CD44 IHC (clone 156-3C11, Thermo Fisher Scientific)
    • Comment: CD44 is a marker for cancer stem cell and a biomarker for embryonic stem cells. Surgically resected specimen was fixed in 10% buffered formalin and embedded in paraffin. Positive cells were defined as those demonstrating a strong plasma membrane staining pattern. Cells that lacked membranous staining were considered negative. Positive rates were semiquantitatively assessed. The tumor was considered positive since more than 5% of cancer cells revealed a CD44 positive staining pattern on the cell membrane.
CD44R
Board review style question #1

A CD44 immunostain is shown above. Which of the following statements regarding CD44 is correct?

  1. CD44 deletion enhances the fibrogenic response, increases the kinetics of leukocyte infiltration and delays the accumulation of FAP+ fibroblasts
  2. CD44 is encoded by 20 exons, CD44v is encoded by 10 constant exons
  3. CD44v9 is associated with increased free survival in metastatic invasive bladder cancer
  4. The main ligand for CD44 is collagen
Board review style answer #1
A. CD44 deletion enhances the fibrogenic response, increases the kinetics of leukocyte infiltration and delays the accumulation of FAP+ fibroblasts. The main ligand for CD44 is hyaluronic acid (HA). CD44 is encoded by 19 exons; CD44s is encoded by 10 constant exons. CD44v9 is associated with poor prognosis in metastatic invasive bladder cancer.

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