It is important to differentiated types 1 and 2 endometrial carcinoma, since they have different prognostic and therapeutic implications. In difficult cases, a combination of ER, MIB1, p53 may be helpful.
|
Type 1 |
Type 2 |
prototypic form |
endometrioid carcinoma |
uterine (papillary) serous carcinoma |
typical patient |
perimenopausal or early postmenopausal women |
elderly women |
|
background of endometrial hyperplasia |
background of atrophic endometrium |
|
low-grade |
high-grade |
|
oestrogen-dependent |
not oestrogen-dependent |
|
may show a focal or diffuse papillary pattern |
a glandular variant shows little or no papillary formation but has high-grade cytology |
usually positive; high grade cases may be negative |
negative |
|
MIB1 proliferation index |
low |
high |
negative; high grade cases may be positive |
diffuse positivity |
|
8/17 in grade III endometrioid carcinoma4 |
0/174 |
|
1/17 in grade III endometrioid carcinoma4 |
7/174 |
|
One study5 established criteria, then applied them to problematic cases:
Reference 5 |
typical uterine serous carcinoma |
FIGO grade II endometrial endometrioid carcinoma |
diagnostically challenging uterine serous carcinoma (tubular/glandular architecture without prominent papillae initially diagnosed as EEC, but with high grade cytology and/or metastasis as USC) |
||
p53 over-expression (all positive cases showed staining of at least 75% of tumour nuclei) |
14/16 (one case showed complete negativity, one case weak staining of less than 25% of nuclei) |
1/13 (five cases showed weak focal staining) |
6/8 (two cases were completely negative: one case was heterogeneous) |
||
b-catenin (all positive cases showed cytoplasmic/nuclear staining of less than 25% of tumour cells) |
0/16 |
9/13 |
1/8 |
||
Cyclin-D1 (most positive cases were focal) |
3/16 |
7/13 |
0/8 |
||
ER (positive cases usually showed staining of more than 75% of tumour nuclei) |
5/16 |
11/12 |
3/8 |
||
PR |
2/16 |
12/13 (greater than 75% of nuclei in 9 cases) |
3/8 |
||
PTEN loss (scored positive if more than 90% loss of staining) |
0/16 |
8/13 |
1/8 |
||
On discriminant analysis, 6 of 8 cases were confidently diagnosed as serous |
|||||
On multivariate analysis, lack of p53 over-expression, PR positivity and loss of PTEN were most predictive of endometrioid carcinomas. |
|||||
References
This page last revised 4.1.2005.
©SMUHT/PW Bishop