Endometrioid adenocarcinoma: endocervical v endometrial v ovarian v pseudoendometrioid colonic adenocarcinoma

Endometrioid carcinoma is usually treated by simple hysterectomy with bilateral salpingo-oophorectomy, whereas endocervical carcinoma is usually managed by radical hysterectomy with lymphadenectomy, or by chemoradiotherapy. Differentiating endometrial from endocervical adenocarcinoma may be problematic. Both may show endometrioid differentiation. Biopsy or curettage may not reveal precursor lesions. Endometrial carcinoma may involve the lower uterine segment and fractional curettage may show either tumour type in either fraction. To a lesser extent, the problem extends to endometrioid carcinoma of the ovary and pseudoendometrioid adenocarcinoma of the colon.

Immunohistochemistry

Positivity for ER, PR and vimentin favours an endometrial origin²², while positivity for HPV and CEA favours an endocervical origin.

		Endometrial	Endocervical	Ovarian	Colonic
	ER	75%(18/24 (of the six cases considered negative, 5 showed focal positivity)1, 28/305, 89/126)	28%(1/24 (one case showed focal weak positivity: the other 23 cases were completely negative.)1, 10/26 (weak, focal)5, 4/10 (of endometrioid type: 17/84 of all types)10, 12/4711, 6/1212, 16/5414)	19/22 (cytological cell blocks from effusions)19, 12/12 (endometrioid: ERa)20
	PR	60%(23/24 (the case considered negative showed staining of <10% of nuclei; this case was also considered negative for ER)1, 66/126)	26%(1/24 (one case showed focal moderate positivity: the other 23 cases were completely negative.)1, 6/10 (of endometrioid type: 23/84 of all types)10, 13/4711, 19/5414)	11/22 (cytological cell blocks from effusions)19, 11/12 (endometrioid)20
	HPV in situ hybridisation / PCR	0/24 (in situ hybridisation)1, 0/23 (by PCR)15, 2/30 (by Southern blot)16, 2/20 (endometrioid type)17, 14/54 (by PCR)18	16/24 (in situ hybridisation)1, 35/50 (by PCR)15
	CEA	15%(8/303, 0/27 (both mCEA and CEA D-14)4, 21/30 (largely confined to squamoid areas: only 12 showed focal membranous staining of glandular areas)5, 0/122 (in addition, 11/15 adenosquamous carcinomas were positive)5, 11/21 (focal, mainly at the apical surface)7)	81%(18/293, 15/23 (CEA D-14)4, 22/23 (mCEA)4, 25/26 (mainly diffuse cytoplasmic and membranous)5, 86/107 (this excluded mesonephroid adenocarcinomas)5, 13/13 (many diffuse and cytoplasmic)7)	0/27 (both mCEA and CEA D-14)4	26/31 (CEA D-14)4, 28/31 (mCEA)4
	Vimentin	92%(29/303, 22/27 (crisp paranuclear band of staining)4, 29/305)	9%(2/293, 3/23 (rare focal staining)4, 2/265)	5/16 (diffuse)4	2/31 (rare focal staining)4
	CK7	28/303	29/293	positive	negative
	CK20	0/303	2/293	negative	positive
	EMA	30/303	26/293
	34bE12	27/30 (27/30 showed staining of some glandular areas: squamoid areas showed stronger positivity)5	25/265

There is disagreement as to the frequency of endometrioid carcinoma of the cervix: mucin depletion is not sufficient to diagnose endometrioid carcinoma²¹. Some report that mucinous carcinoma of the endometrium appears to retain positivity for ER, but looses vimentin positivity²¹. Others find that immunohistochemistry is uninformative in mucinous and clear cell carcinomas of the endometrium⁸, which are ER and PR negative¹³. One study assessed whether the site or the line of differentiation determines the imunophenotype.

References

¹Staebler, A., M. E. Sherman, et al. (2002). "Hormone receptor immunohistochemistry and human papillomavirus in situ hybridization are useful for distinguishing endocervical and endometrial adenocarcinomas." Am J Surg Pathol 26(8): 998-1006.

²Zaino, R. J. (2002). "The fruits of our labors: distinguishing endometrial from endocervical adenocarcinoma." Int J Gynecol Pathol 21(1): 1-3.

³Castrillon, D. H., K. R. Lee, et al. (2002). "Distinction between endometrial and endocervical adenocarcinoma: an immunohistochemical study." Int J Gynecol Pathol 21(1): 4-10.

⁴Dabbs, D. J., K. Sturtz, et al. (1996). "The immunohistochemical discrimination of endometrioid adenocarcinomas." Hum Pathol 27(2): 172-7.

⁵McCluggage, W. G., V. P. Sumathi, et al. (2002). "A panel of immunohistochemical stains, including carcinoembryonic antigen, vimentin, and estrogen receptor, aids the distinction between primary endometrial and endocervical adenocarcinomas." Int J Gynecol Pathol 21(1): 11-5.

⁶Wahlstrom, T., J. Lindgren, et al. (1979). "Distinction between endocervical and endometrial adenocarcinoma with immunoperoxidase staining of carcinoembryonic antigen in routine histological tissue specimens." Lancet 2(8153): 1159-60.

⁷Cohen, C., G. Shulman, et al. (1982). "Endocervical and endometrial adenocarcinoma: an immunoperoxidase and histochemical study." Am J Surg Pathol 6(2): 151-7.

⁸Dallenbach-Hellweg, G., G. Lang-Averous, et al. (1991). "The value of immunohistochemistry in the differential diagnosis of endometrial carcinomas." APMIS Suppl 23: 91-9.

⁹Kudo, R., H. Sasano, et al. (1990). "Immunohistochemical comparison of new monoclonal antibody 1C5 and carcinoembryonic antigen in the differential diagnosis of adenocarcinoma of the uterine cervix." Int J Gynecol Pathol 9(4): 325-36.

¹⁰Fujiwara, H., G. Tortolero-Luna, et al. (1997). "Adenocarcinoma of the cervix. Expression and clinical significance of estrogen and progesterone receptors." Cancer 79(3): 505-12.

¹¹Ghandour, F. A., R. Attanoos, et al. (1994). "Immunocytochemical localization of oestrogen and progesterone receptors in primary adenocarcinoma of the cervix." Histopathology 24(1): 49-55.

¹²Ismail, S. M., G. A. Thomas, et al. (1992). "Oestrogen receptor protein and mRNA in adenocarcinoma of the uterine cervix." Br J Cancer 66(6): 1150-4.

¹³Lax, S. F., E. S. Pizer, et al. (1998). "Clear cell carcinoma of the endometrium is characterized by a distinctive profile of p53, Ki-67, estrogen, and progesterone receptor expression." Hum Pathol 29(6): 551-8.

¹⁴Masood, S., R. M. Rhatigan, et al. (1993). "Expression and prognostic significance of estrogen and progesterone receptors in adenocarcinoma of the uterine cervix. An immunocytochemical study." Cancer 72(2): 511-8.

¹⁵Hording, U., S. Daugaard, et al. (1997). "Adenocarcinoma of the cervix and adenocarcinoma of the endometrium: distinction with PCR-mediated detection of HPV DNA." Apmis 105(4): 313-6.

¹⁶Fujita, M., K. R. Shroyer, et al. (1995). "Association of human papillomavirus with malignant and premalignant lesions of the uterine endometrium." Hum Pathol 26(6): 650-8.

¹⁷O'Leary, J. J., R. J. Landers, et al. (1998). "Human papillomavirus and mixed epithelial tumors of the endometrium." Hum Pathol 29(4): 383-9.

¹⁸Semczuk, A., A. Stenzel, et al. (2000). "Detection of human papillomavirus types 16 and 18 in human neoplastic endometrium: lack of correlation with established prognostic factors." Oncol Rep 7(4): 905-10.

¹⁹Lee, B. H., J. L. Hecht, et al. (2002). "WT1, estrogen receptor, and progesterone receptor as markers for breast or ovarian primary sites in metastatic adenocarcinoma to body fluids." Am J Clin Pathol 117(5): 745-50.

²⁰Fujimura, M., T. Hidaka, et al. (2001). "Absence of estrogen receptor-alpha expression in human ovarian clear cell adenocarcinoma compared with ovarian serous, endometrioid, and mucinous adenocarcinoma." Am J Surg Pathol 25(5): 667-72.

²¹McCluggage, W. G. (2004). "A critical appraisal of the value of immunohistochemistry in diagnosis of uterine neoplasms." Adv Anat Pathol 11(3): 162-71.

This page last revised 4.5.2004.

©SMUHT/PW Bishop