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