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子宫内膜腺癌的免疫表型多样性:对鉴别诊断的意义。

Immunophenotypic diversity of endometrial adenocarcinomas: implications for differential diagnosis.

作者信息

Reid-Nicholson Michelle, Iyengar Pratibha, Hummer Amanda J, Linkov Irina, Asher Marina, Soslow Robert A

机构信息

Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.

出版信息

Mod Pathol. 2006 Aug;19(8):1091-100. doi: 10.1038/modpathol.3800620. Epub 2006 Apr 28.

Abstract

Many endometrial adenocarcinomas, particularly those of endometrioid type, express estrogen receptors (ERs), progesterone receptors (PRs), and vimentin. This typical immunophenotype is frequently considered a standard against which others are compared when immunohistochemistry is used for differential diagnosis. We tested large numbers of endometrial cancers, enriched for high-grade tumors, to determine whether this reported immunophenotype was valid and whether expression differences between types of endometrial carcinoma could be exploited for diagnostic purposes. Immunohistochemical stains were performed on the following types of endometrial cancers using established methodology: International Federation of Gynecology and Obstetrics (FIGO) grades 1 and 2 endometrioid-42; FIGO grade 3 endometrioid-40; serous-24; clear cell-11; carcinosarcoma-9. In total, 92% of serous carcinomas expressed p16 strongly compared to weak-to-moderate expression of p16 in 7-67% of other tumors (FIGO grades 1 and 2 carcinoma and carcinosarcoma, respectively). A total of 84% of FIGO grades 1 and 2 carcinomas expressed ER compared to 9-54% of other tumors (clear cell and serous carcinomas respectively); 83% of FIGO grades 1 and 2 expressed PR compared to 11-54% of other carcinomas (carcinosarcoma and serous carcinoma, respectively). Most carcinomas were negative for monoclonal carcinoembryonic antigen (mCEA), and those that were positive showed mostly only focal membrane expression. Vimentin was expressed in nearly every tumor. Most tumors were diffusely vimentin positive, but a large range of expression patterns, from focal to diffuse and from weak to strong, was noted. Only 70% of FIGO grades 1 and 2 endometrioid carcinomas and 26% of grade 3 endometrioid carcinomas possessed the reportedly characteristic endometrial cancer immunophenotype p16 (-), ER (+), PR (+), mCEA (-), and vimentin (+). Endometrial cancers demonstrate substantial immunophenotypic diversity that remained apparent even within groups of similar histologic subtype and grade. ER, PR, and p16 expression was more illustrative of tumor type and degree of differentiation than they were of endometrial origin. In contrast, the vimentin-positive/CEA-negative phenotype remained the most constant among all endometrial cancers.

摘要

许多子宫内膜腺癌,尤其是子宫内膜样类型的腺癌,表达雌激素受体(ERs)、孕激素受体(PRs)和波形蛋白。当免疫组织化学用于鉴别诊断时,这种典型的免疫表型常被视为一种标准,用于与其他情况进行比较。我们检测了大量富含高级别肿瘤的子宫内膜癌,以确定这种报道的免疫表型是否有效,以及子宫内膜癌不同类型之间的表达差异是否可用于诊断目的。使用既定方法对以下类型的子宫内膜癌进行免疫组织化学染色:国际妇产科联盟(FIGO)1级和2级子宫内膜样癌 - 42例;FIGO 3级子宫内膜样癌 - 40例;浆液性癌 - 24例;透明细胞癌 - 11例;癌肉瘤 - 9例。总体而言,92%的浆液性癌强烈表达p16,而其他肿瘤(分别为FIGO 1级和2级癌以及癌肉瘤)中p16表达为弱阳性至中度阳性的比例为7%-67%。FIGO 1级和2级癌中共有84%表达ER,而其他肿瘤(分别为透明细胞癌和浆液性癌)中这一比例为9%-54%;FIGO 1级和2级癌中有83%表达PR,而其他癌(分别为癌肉瘤和浆液性癌)中这一比例为11%-54%。大多数癌对单克隆癌胚抗原(mCEA)呈阴性,呈阳性的那些大多仅表现为局灶性膜表达。波形蛋白在几乎每个肿瘤中均有表达。大多数肿瘤波形蛋白弥漫性阳性,但也注意到从局灶到弥漫、从弱到强的广泛表达模式。只有70%的FIGO 1级和2级子宫内膜样癌以及26%的3级子宫内膜样癌具有报道中特征性的子宫内膜癌免疫表型p16(-)、ER(+)、PR(+)、mCEA(-)和波形蛋白(+)。子宫内膜癌表现出显著的免疫表型多样性,即使在组织学亚型和分级相似的组内也依然明显。ER、PR和p16的表达更能说明肿瘤类型和分化程度,而非子宫内膜起源。相比之下,波形蛋白阳性/CEA阴性表型在所有子宫内膜癌中最为恒定。

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