Anaplastic thyroid carcinoma (ATC) is a rare but highly aggressive human
malignancy. It is known that disturbances in apoptotic pathways have a great
impact on tumor progression and aggressiveness. In this study the
apoptosisrelated molecules Bcl-2 (antiapoptotic), Bax (proapoptotic) and
survivin (an inhibitor of apoptosis) were analyzed immunohistochemically in
thirty archival cases of ATC. In situ apoptotic cell death was analyzed by
the TUNEL method. Mean Bcl-2 staining score (calculated from individual
scores from 0-3) was low compared to those for Bax and survivin (p<0.05).
High expression of survivin was associated with high Bax expression, and was
significantly segregated from high Bcl-2 expressing cases (p<0.05). Despite
high Bax expression, apoptotic cell death was low in the investigated
carcinomas. In addition, the mean apoptotic index in high survivin expressing
carcinomas was significantly lower than in low survivin expressing carcinomas
(p<0.05). It could be concluded that down-regulation of Bcl-2 is
counterbalanced by up-regulation of survivin, which may overcome the effects
of high Bax expression, and, at least partly, explain the low apoptosis rate
and high biological aggressiveness of ATC.