The expression of stem cell markers CD133 and Nestin in peripheral neuroblastic tumors

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Neuroblastoma is the most common extracranial solid tumor in children; it constitutes 10% of all pediatric tumors and is responsible for 15% of all pediatric oncologic deaths. Neuroblastoma is known for its enigmatic biological behavior. Recent studies have indicated that cancer stem cells are closely related to the high malignancy of neuroblastoma. The expression of CD133, a stem cell marker for the neural crest, and Nestin, an intermediate filament in neuroectodermal cells, decreases as cells differentiate. The expression of these two markers is studied in thirty cases of peripheral neuroblastic tumors immunohistochemically and their prognostic significance is also assessed through their correlation with other prognostic factors such as age, tumor site, histopathology, stage, and MYCN status.


Thirty cases of peripheral neuroblastic tumors were analyzed. The age of the patients ranged between 1 and 72 months. A total of 15 cases were suprarenal, nine cases were retroperitoneal, five cases were mediastinal, and one case was cervical. According to Peuchmaur (2003), they were divided into 18 cases of favorable histology and 12 cases with unfavorable histology according to the presence of schwannian stroma, ganglionic differentiation, and mitotic count. CD133 and Nestin cytoplasmic positivity was graded according to the number of stained cells × the staining intensity into three grades: 2–10% +, 11–50% ++, 51–100% +++, and less than 2% is considered negative. A total of 12 cases were CD133 +, six cases were CD133 ++, and 12 cases were CD133 +++. Ten cases were Nestin +, five cases were Nestin ++, and 15 cases were Nestin +++. Nestin positivity was found to be highly positive in tumors of infants. Also, Nestin was noted in ganglion cells.


CD133 and Nestin are poor prognostic factors of neuroblastic tumors. Neuroblastoma is a stem cell disorder with strong expression of stem cell markers that can help in the isolation of neurblastoma stem cell subgroups and understanding the mechanisms of neuroblastoma development.

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