Department of Pathology, Hospital de la Santa Creu i Sant Pau. Institute of Biomedical Research (IIB Sant Pau), Autonomous University of Barcelona, Barcelona, 08041, Spain.
Department of Pathology, Universitá Cattolica del Sacro Cuore, Rome, 00168, Italy.
Hum Pathol. 2017 Dec;70:6-13. doi: 10.1016/j.humpath.2017.05.026. Epub 2017 Jun 7.
In endometrioid endometrial carcinomas (EECs), microcystic, elongated, and fragmented (MELF) myoinvasion is associated with easily overlooked lymph node metastases; however, the role of immunohistochemistry in their detection and their clinical significance have not been addressed. We identified MELF in 43 of 101 (43%) myoinvasive EECs. Nodes were removed in 49 (49%), 25 with MELF and 24 without MELF. Metastases were initially reported in 3 of the former (12%) and 2 of the latter (8%). All negative nodes were reviewed, and cytokeratin immunohistochemistry was performed. Three metastases were identified in the MELF group but none in the EECs without MELF. By immunohistochemistry, metastatic nodal isolated tumor cells (ITCs) were found in 6 of the remaining 19 MELF-positive cases. In contrast, lymph node metastases were detected in only 2 of the 22 EECs without MELF. MELF-positive cases had more lymph node metastases (P=.03) than myoinvasive EECs without MELF. At follow-up, all 6 patients with grade 1-2 EECs and nodal ITCs/micrometastases were alive (5 no evidence of disease and 1 with perineal disease). In contrast, 3 of 4 patients with grade 3 EECs and nodal ITCs/micrometastases died of disease, and the other patient was alive with tumor. In MELF, the frequency of ITCs/micrometastases in apparently negative lymph nodes is high. In patients with grade 1-2 EEC who had not received chemotherapy, the presence of nodal ITCs/micrometastases did not affect survival. In contrast, in high-grade tumors, ITCs/micrometastases were associated with unfavorable prognosis. Immunohistochemistry should be done in MELF-positive cases to detect occult lymph node metastases, especially in high-grade tumors.
在子宫内膜样腺癌（EEC）中，微囊性、长形和碎片状（MELF）肌浸润与容易被忽视的淋巴结转移有关；然而，免疫组织化学在其检测中的作用及其临床意义尚未得到解决。我们在 101 例肌浸润性 EEC 中发现了 43 例 MELF。49 例（49%）切除了淋巴结，其中 25 例有 MELF，24 例没有 MELF。最初报告在前一组中有 3 例（12%），在后一组中有 2 例（8%）发生转移。所有阴性淋巴结均进行了复查，并进行了细胞角蛋白免疫组织化学检查。在 MELF 组中发现了 3 例转移，但在没有 MELF 的 EEC 中没有发现转移。通过免疫组织化学检查，在其余 19 例 MELF 阳性病例中发现了 6 例淋巴结转移的孤立肿瘤细胞（ITC）。相比之下，在没有 MELF 的 22 例 EEC 中仅发现了 2 例淋巴结转移。MELF 阳性病例的淋巴结转移（P=.03）多于没有 MELF 的肌浸润性 EEC。在随访中，所有 6 例 1-2 级 EEC 和淋巴结 ITCs/微转移的患者均存活（5 例无疾病证据，1 例会阴疾病）。相比之下，4 例 3 级 EEC 和淋巴结 ITCs/微转移的患者中有 3 例死于疾病，另 1 例患者仍有肿瘤存活。在 MELF 中，明显阴性淋巴结中 ITCs/微转移的频率很高。在未接受化疗的 1-2 级 EEC 患者中，淋巴结 ITCs/微转移的存在并未影响生存。相比之下，在高级别肿瘤中，ITCs/微转移与不良预后相关。在 MELF 阳性病例中应进行免疫组织化学检查以检测隐匿性淋巴结转移，尤其是在高级别肿瘤中。
