Endometrial carcinoma, types 1 vs type 2

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

oestrogen receptor

usually positive; high grade cases may be negative

negative

MIB1 proliferation index

low

high

p53

negative; high grade cases may be positive

diffuse positivity

b-catenin

8/17 in grade III endometrioid carcinoma4

0/174

E-cadherin

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

  

p53 over-expression (all positive cases showed staining of at least 75% of tumour nuclei)

14/16

1/13

6/8

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

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.
       

 

These studies showed the variation in immunophenotype in subtypes of endometrial carcinoma:

 

 

Endometrioid carcinoma

Serous carcinoma

Clear cell carcinoma

Carcinosarcoma (epithelial component)

  

FIGO grade 1 and 2

FIGO grade 3

p16

3/426

10/406

22/246

5/116

6/96

p21

19/1047

16/347

7/137

 

p27

21/1037

21/327

7/137

 

p53

3/1077

13/347

9/147

 

80/1128

35/488

 

 

ER

31/376, 106/1097

20/406, 27/347

13/246

1/116

2/96

6/137

 

PR

35/426

16/386

13/246

5/116

1/96

mCEA

3/426

1/406

3/246

2/116

0/96

Vimentin

38/426

30/376

19/236

10/116

9/96

Her2

0/1077

1/347

6/147

 

E2F-1

19/1067

11/347

7/137

 

bcl-2

34/987

8/327

0/147

 

PTEN

19/987

16/317

14/157

 
           

 

References

1 McCluggage, W. G. (2004). "A critical appraisal of the value of immunohistochemistry in diagnosis of uterine neoplasms." Adv Anat Pathol 11(3): 162-71.

2 McCluggage, W. G. (2002). "Recent advances in immunohistochemistry in gynaecological pathology." Histopathology 40(4): 309-26.

3 Wheeler, D. T., K. A. Bell, et al. (2000). "Minimal uterine serous carcinoma: diagnosis and clinicopathologic correlation." Am J Surg Pathol 24(6): 797-806.

4 Schlosshauer, P. W., L. H. Ellenson, et al. (2002). "Beta-catenin and E-cadherin expression patterns in high-grade endometrial carcinoma are associated with histological subtype." Mod Pathol 15(10): 1032-7.

5 Darvishian, F., A. J. Hummer, et al. (2004). "Serous endometrial cancers that mimic endometrioid adenocarcinomas: a clinicopathologic and immunohistochemical study of a group of problematic cases." Am J Surg Pathol 28(12): 1568-78.

6 Reid-Nicholson M, Iyengar P, Hummer AJ, et al. Immunophenotypic diversity of endometrial adenocarcinomas: implications for differential diagnosis. Mod Pathol 2006; 19:1091-100

7 Alkushi A, Clarke BA, Akbari M, et al. Identification of prognostically relevant and reproducible subsets of endometrial adenocarcinoma based on clustering analysis of immunostaining data. Mod Pathol 2007; 20:1156-65

8 Li C, Zota V, Woda BA, et al. Expression of a novel oncofetal mRNA-binding protein IMP3 in endometrial carcinomas: diagnostic significance and clinicopathologic correlations. Mod Pathol 2007; 20:1263-8

 

This page last revised 4.4.2008.

©SMUHT/PW Bishop