Hernandez-Caballero Ana I, Vierkoetter Koah R, Ahn Hyeong Jun, Shimizu David, Terada Keith
University of Hawaii, John A. Burns School of Medicine, Department of Pathology, 1301 Punchbowl Street, Honolulu 96813, HI, USA.
University of Hawaii, John A. Burns School of Medicine, Department of Quantitative Health Sciences, 651 Ilalo Street, Medical Education Building, Suite 411, Honolulu 96813, HI, USA.
Gynecol Oncol Rep. 2020 Jul 27;33:100614. doi: 10.1016/j.gore.2020.100614. eCollection 2020 Aug.
In a biopsy specimen, adenocarcinomas of the endometrium and uterine cervix may demonstrate significant morphologic overlap. The distinction between these two entities prior to surgical resection is clinically significant as assigning the primary site dictates treatment and prognosis. This diagnostic dilemma is approached by the application of a panel of immunohistochemical stains, traditionally composed of CEA, vimentin, p16, ER, and PR. Most cases are successfully managed with this panel; however, in difficult cases additional tools are needed to suggest a more definitive diagnosis. In this study, we reviewed the efficacy of the customary panel of stains, as well as the added value of new stains in the diagnosis of endocervical adenocarcinoma. Our cohort included biopsy samples of 90 patients (81 endometrial and 9 endocervical adenocarcinomas) with a subsequent hysterectomy for confirmation of diagnosis. This study validated the customary panel of stains and suggests additional markers to aid in the differential diagnosis (PAX8 and CAIX). The addition of PAX8 to the traditional panel increases PPV from 85.71% to 100%. A PPV of 100% may also be attained with fewer stains (five total), with the application of a proposed new panel, which includes PAX8, CAIX, CEA, p16 and ER. This is the first-time differential expression of CAIX has been suggested in the distinction between endocervical and endometrial adenocarcinomas.
在活检标本中，子宫内膜腺癌和子宫颈腺癌可能表现出明显的形态学重叠。在手术切除前区分这两种实体在临床上具有重要意义，因为确定原发部位决定了治疗方法和预后。通过应用一组免疫组织化学染色来解决这一诊断难题，传统上这组染色包括癌胚抗原（CEA）、波形蛋白、p16、雌激素受体（ER）和孕激素受体（PR）。大多数病例通过这组染色能够成功诊断；然而，在疑难病例中，需要额外的工具来做出更明确的诊断。在本研究中，我们回顾了传统染色组的有效性，以及新染色在子宫颈管腺癌诊断中的附加价值。我们的队列包括90例患者的活检样本（81例子宫内膜腺癌和9例子宫颈管腺癌），随后进行子宫切除术以确诊。本研究验证了传统染色组，并提出了有助于鉴别诊断的其他标志物（PAX8和碳酸酐酶IX [CAIX]）。在传统染色组中加入PAX8可使阳性预测值（PPV）从85.71%提高到100%。应用一个提议的新染色组（包括PAX8、CAIX、CEA、p16和ER），使用更少的染色剂（总共五种）也可达到100%的PPV。这是首次提出CAIX的差异表达可用于区分子宫颈管腺癌和子宫内膜腺癌。
