Darvishian Farbod, Hummer Amanda J, Thaler Howard T, Bhargava Rohit, Linkov Irina, Asher Marina, Soslow Robert A
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Am J Surg Pathol. 2004 Dec;28(12):1568-78. doi: 10.1097/00000478-200412000-00004.
Uterine serous carcinomas (USCs) can exhibit an architecturally well-differentiated tubuloglandular morphology with or without an accompanying papillary growth pattern. These features make it difficult to distinguish USCs from endometrial endometrioid carcinomas (EECs). Given the aggressive behavior of USC, compared with EEC, and differences in management, it is important to correctly classify endometrial carcinomas that exhibit a tubuloglandular architecture with high nuclear grade. We sought an immunohistochemical panel to minimize subjectivity in the distinction of USC from EEC.
We identified 8 problematic endometrial cancers, exhibiting a tubuloglandular growth pattern and high nuclear grade, whose classification as EEC or USC was debated or resulted in disagreement. We selected 13 cases of International Federation of Gynecology and Obstetrics (FIGO) grade 2 EEC and 16 cases of USC as controls. An immunohistochemical panel, including p53, beta-catenin, cyclin D1, estrogen receptor (ER), progesterone receptor (PR), and PTEN, was evaluated.
As a group, the clinical features and immunoprofile of the study cases resembled those of the serous controls. The study cases expressed p53, beta-catenin, cyclin D1, and ER and PR, and showed loss of PTEN in 75%, 12.5%, 0%, 37.5%, 37.5%, and 12.5% of cases, respectively. p53, beta-catenin, cyclin D1, ER and PR expression, and PTEN loss were seen in 87.5%, 0%, 19%, 31%, 12%, and 0% of the serous controls and in 7%, 70%, 54%, 92%, 92%, and 61.5% of the endometrioid controls, respectively. The combination of lack of p53 expression, positive PR expression, and loss of PTEN best distinguished between EEC and USC using discriminant analysis (multivariate P = 0.008, <0.001, and 0.05, respectively).
In endometrial carcinomas exhibiting high nuclear grade and low architectural grade, using a panel of immunohistochemical stains may facilitate the distinction of USC from EEC. Our clinical and immunohistochemical data also support the concept that there is a group of endometrial adenocarcinomas composed of tubular glands that are indeed serous carcinomas.
子宫浆液性癌（USC）可呈现出结构上分化良好的微腺管形态，伴或不伴有乳头状生长模式。这些特征使得USC难以与子宫内膜样癌（EEC）相区分。鉴于USC与EEC相比具有侵袭性，且管理方式存在差异，正确分类具有高核级微腺管结构的子宫内膜癌很重要。我们寻求一组免疫组化指标，以尽量减少在区分USC和EEC时的主观性。
我们识别出8例有问题的子宫内膜癌，其呈现微腺管生长模式且核级高，关于其分类为EEC还是USC存在争议或意见不一。我们选择13例国际妇产科联盟（FIGO）2级EEC和16例USC作为对照。评估了一组免疫组化指标，包括p53、β-连环蛋白、细胞周期蛋白D1、雌激素受体（ER）、孕激素受体（PR）和PTEN。
作为一个整体，研究病例的临床特征和免疫表型与浆液性对照相似。研究病例分别在75%、12.5%、0%、37.5%、37.5%和12.5%的病例中表达p53、β-连环蛋白、细胞周期蛋白D1、ER和PR，并显示PTEN缺失。浆液性对照中分别有87.5%、0%、19%、31%、12%和0%的病例出现p53、β-连环蛋白、细胞周期蛋白D1、ER和PR表达以及PTEN缺失，而子宫内膜样对照中分别有7%、70%、54%、92%、92%和61.5%的病例出现上述情况。使用判别分析，缺乏p53表达、PR表达阳性和PTEN缺失的组合最能区分EEC和USC（多变量P值分别为0.008、<0.001和0.05）。
在具有高核级和低结构级的子宫内膜癌中，使用一组免疫组化染色可能有助于区分USC和EEC。我们的临床和免疫组化数据也支持这样一种概念，即存在一组由微腺管组成的子宫内膜腺癌，它们实际上是浆液性癌。
