Abstract
Background & Objective:Clear cell carcinomas (CCC) differ from other types of ovarian and endometrial carcinomas in biology, behavior and response to chemotherapy. Histopathologic diagnosis may be challenging in some situations which necessitates immunohistochemistary (IHC) assessment. In this study we investigated the diagnostic utility of Napsin-A in diagnosis of ovarian and endometrial CCCs.Methods:Ovarian and endometrial CCC samples from 2013 to 2018 in 3 general and women’s hospital in Tehran were re-evaluated by 2 expert pathologists. Forty-two samples were included as case and 42 non-clear cell carcinomas (Non-CCC) of ovary and endometrium were selected as control group. Based on IHC study tumors with sum intensity and percentage score ≥2 (at least 1+ staining in more than 1% of tumor cells) were considered positive.Results:The prevalence of endometrial and ovarian CCC in the case group were 15 and 27 respectively. The tumors in the control group included 22 cases of endometrioid, 2 high grade papillary serous carcinoma (HGSC) of endometrium, 6 endometrioid and 12 HGSC of ovary. Napsin-A positivity was observed in 35 (83%) of CCCs while 7 (17%) samples including 3 out of 15 endometrial and 4 out of 27 ovarian CCCs were Napsin-A negative. No positive reaction was seen in control group. The overall accuracy, specifity and sensitivity of Napsin-A for diagnosis of ovarian and endometrial CCCs were 83%, 100% and 83%, respectively. Sensitivity for ovarian and endometrial CCCs were 85% and 80%, orderly.Conclusion:Napsin-A is an accurate and reliable marker for distinction of CCCs from non-CCCs in ovary and endometrium. A panel of antibodies may yield the highest diagnostic accuracy.
Highlights
Clear cell carcinoma (CCC) accounts for approximately 10% of ovarian and less than 5% of endometrial epithelial carcinomas [1,2]
Forty-two samples were included as case and 42 non-clear cell carcinomas (Non-CCC) of ovary and endometrium were selected as control group
Clear cell carcinomas involve older patients and are diagnosed in higher stage of disease with worse prognosis compared with endometrioid or type I carcinomas [2,6]
Summary
Clear cell carcinoma (CCC) accounts for approximately 10% of ovarian and less than 5% of endometrial epithelial carcinomas [1,2]. The biology and clinical behavior of ovarian clear cell carcinoma (OCCC) is different from other epithelial tumors. Clear cell carcinomas involve older patients and are diagnosed in higher stage of disease with worse prognosis compared with endometrioid or type I carcinomas [2,6]. Diagnostic histopathological findings are similar in ovary and endometrial clear cell carcinomas (ECCC). In most of the cases, histopathological findings are distinctive and characteristic, other types of endometrial and ovarian carcinomas can harbor clear cell changes and make diagnostic confusion [8,9]. In a study by Han et al, moderate agreement was observed in classification of the endometrial carcinomas with clear cell changes between the reviewers, where only 46% of original ECCCs were accurately diagnosed [10]
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