Department of Pathology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada.
Int J Gynecol Pathol. 2012 Jan;31(1):57-65. doi: 10.1097/PGP.0b013e318223118a.
Undifferentiated carcinoma of the endometrium is a rare neoplasm, which, when involving the cervix, raises a question about its origin. Diffuse p16 positivity of uterine cancers is usually interpreted as a surrogate marker for high-risk human papilloma virus and favors cervical origin. In this study, we investigated the expression of cytokeratin 7 (CK7), monoclonal carcinoembryonic antigen (mCEA), estrogen receptor (ER), vimentin, and p16 in 28 cases of undifferentiated endometrial carcinoma, 20 high-grade endometrioid adenocarcinomas, and 50 cervical adenocarcinomas. Staining was considered positive when it was cytoplasmic for CK7, mCEA, and vimentin, nuclear for ER, and both nuclear and cytoplasmic for p16. Percentages of cells staining were recorded as follows: negative (0%-5%), 1+ (6%-25%), 2+ (26%-50%), 3+ (51%-75%), and 4+ (>75%). P16 was considered positive if it stained more than 75% of the tumor cells. Diffuse/strongly positive staining for p16 was seen in 40/50 (80%) cases of cervical adenocarcinoma and 14/28 (50%) cases of undifferentiated endometrial carcinoma. In high-grade endometrioid adenocarcinoma, staining was mainly patchy. CK7, mCEA, ER, progesterone receptor, and vimentin staining in undifferentiated endometrial carcinoma was as follows: 10/28 (36%), 4/28 (14%), 21/28 (75%), 23/28 (82%), and 26/28 (93%), respectively; for high-grade endometrioid carcinoma: 20/20 (100%), 1/20 (5%), 17/20 (85%), 18/20 (90%), and 19/20 (95%); for endocervical adenocarcinoma: 50/50 (100%), 45/50 (90%), 9/50 (18%), 8/50 (16%), and 6/50 (12%), respectively. Our data indicate that p16 may play a role in the tumorigenesis of a subset of undifferentiated endometrial carcinoma. In the setting of p16 positivity, undifferentiated endometrial carcinomas are more likely to be ER, progesterone receptor, and vimentin positive and mCEA negative when compared with endocervical adenocarcinomas. Distinction between undifferentiated endometrial carcinoma and endocervical adenocarcinoma, both of which can share diffuse p16 expression, should rely on detection of human papilloma virus in the latter.
未分化子宫内膜癌是一种罕见的肿瘤,当涉及宫颈时,会引起其起源的问题。子宫癌症弥漫性 p16 阳性通常被解释为高危型人乳头瘤病毒的替代标志物,并有利于宫颈起源。在这项研究中,我们研究了 28 例未分化子宫内膜癌、20 例高级别子宫内膜样腺癌和 50 例宫颈腺癌中细胞角蛋白 7(CK7)、单克隆癌胚抗原(mCEA)、雌激素受体(ER)、波形蛋白和 p16 的表达。对于 CK7、mCEA 和波形蛋白,细胞质染色阳性,对于 ER,核染色阳性,对于 p16,核和细胞质染色均阳性。记录细胞染色的百分比如下:阴性(0%-5%)、1+(6%-25%)、2+(26%-50%)、3+(51%-75%)和 4+(>75%)。如果 p16 染色超过 75%的肿瘤细胞,则认为 p16 阳性。在 50 例宫颈腺癌中有 40 例(80%)和 28 例未分化子宫内膜癌中有 14 例(50%)表现为弥漫性/强阳性 p16 染色。在高级别子宫内膜样腺癌中,染色主要为斑片状。在未分化子宫内膜癌中,CK7、mCEA、ER、孕激素受体和波形蛋白的染色如下:10/28(36%)、4/28(14%)、21/28(75%)、23/28(82%)和 26/28(93%);对于高级别子宫内膜样癌:20/20(100%)、1/20(5%)、17/20(85%)、18/20(90%)和 19/20(95%);对于宫颈腺癌:50/50(100%)、45/50(90%)、9/50(18%)、8/50(16%)和 6/50(12%)。我们的数据表明,p16 可能在未分化子宫内膜癌的一部分肿瘤发生中起作用。在 p16 阳性的情况下,与宫颈腺癌相比,未分化子宫内膜癌更有可能为 ER、孕激素受体和波形蛋白阳性,mCEA 阴性。为了区分未分化子宫内膜癌和宫颈腺癌,这两种癌都可能有弥漫性的 p16 表达,应该依赖于后者人乳头瘤病毒的检测。