Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
Histopathology. 2022 Jun;80(7):1102-1111. doi: 10.1111/his.14655. Epub 2022 May 5.
Distinction between well-differentiated endometrial carcinoma (EMCA) with microglandular/mucinous features and benign endocervical microglandular hyperplasia (MGH) can be a diagnostic challenge, especially when tissue is limited. The immunostains used to distinguish endocervical and endometrial carcinoma are less useful when the differential diagnosis is MGH. Here, we investigate the utility of p63 and phosphatase and tensin homologue (PTEN) to aid accurate classification.
Cases obtained from our pathology archives included 25 EMCA with mucinous/microglandular features, 26 MGH and nine atypical microglandular proliferations. Cases were assessed for glandular architecture, presence of mucinous and/or eosinophilic luminal secretions, subnuclear vacuoles, foamy histiocytes, inflammation, squamous metaplasia, cytological atypia and mitotic activity. The presence and pattern of immunohistochemical staining for p63 and PTEN was recorded. Microglandular proliferations with cytological atypia, mitotic activity, foamy histiocytes and complex glandular architecture were more commonly seen in EMCA, while small glands, bland nuclei and subnuclear vacuoles were enriched in MGH. All MGH cases displayed p63-positive subcolumnar reserve cells and retained PTEN expression. Four EMCA cases showed non-specific focal p63 staining either at the surface of the tumour or in areas of squamous differentiation. p63 and PTEN immunostains accurately predicted the final diagnosis for 3 atypical microglandular proliferation cases with follow-up.
While there are morphological characteristics that differentiate EMCA and MGH, there is frequent overlap between these entities. Nonetheless, the pattern and extent of p63 and PTEN can aid accurate classification. Consistent p63-positive subcolumnar reserve cells were seen only in MGH.
高分化子宫内膜癌（EMCA）伴微腺体/黏液样特征与良性宫颈微腺体增生（MGH）的鉴别具有一定挑战性，尤其是在组织有限的情况下。当鉴别诊断为 MGH 时，用于鉴别宫颈和子宫内膜癌的免疫染色就不那么有用了。在这里，我们研究了 p63 和磷酸酶张力蛋白同源物（PTEN）的效用，以帮助进行准确分类。
从我们的病理档案中获得的病例包括 25 例伴黏液样/微腺体特征的 EMCA、26 例 MGH 和 9 例不典型微腺体增生。评估了病例的腺体结构、黏液和/或嗜酸性腔内分泌物、核下空泡、泡沫状组织细胞、炎症、鳞状化生、细胞学异型性和有丝分裂活性。记录了 p63 和 PTEN 免疫组化染色的存在和模式。具有细胞学异型性、有丝分裂活性、泡沫状组织细胞和复杂腺体结构的微腺体增生更常见于 EMCA，而小腺体、温和核和核下空泡则在 MGH 中丰富。所有 MGH 病例均显示 p63 阳性的副柱状储备细胞并保留 PTEN 表达。4 例 EMCA 病例表现出非特异性的局灶性 p63 染色，要么在肿瘤表面，要么在鳞状分化区域。p63 和 PTEN 免疫组化在有随访的 3 例不典型微腺体增生病例中准确预测了最终诊断。
虽然 EMCA 和 MGH 之间存在形态学特征，但这两种实体之间存在频繁重叠。尽管如此，p63 和 PTEN 的模式和程度可以帮助进行准确分类。只有在 MGH 中才能看到一致的 p63 阳性副柱状储备细胞。
