Abstract
ObjectiveEndocervical adenocarcinomas (ECA) and endometrial adenocarcinomas (EMA) are uterine malignancies that have differing biological behaviors. The choice of an appropriate therapeutic plan rests on the tumor's site of origin. In this study, we propose to evaluate whether PR adds value to the performance and test effectiveness of the conventional 3-marker (ER/Vim/CEA) panel in distinguishing between primary ECA and EMA.MethodsA tissue microarray was constructed using paraffin-embedded, formalin-fixed tissues from 38 hysterectomy specimens, including 14 ECA and 24 EMA. Tissue microarray (TMA) sections were immunostained with 4 antibodies, using the avidin-biotin complex (ABC) method for antigen visualization. The staining intensity and extent of the immunohistochemical (IHC) reactions were appraised using a semi-quantitative scoring system.ResultsThe three markers (ER, Vim and CEA) and their respective panel expressions showed statistically significant (p < 0.05) frequency differences between ECA and EMA tumors. Although the additional ancillary PR-marker also revealed a significant frequency difference (p < 0.05) between ECA and EMA tumors, it did not demonstrate any supplementary benefit to the 3-marker panel.ConclusionAccording to our data, when histomorphological and clinical doubt exists as to the primary site of origin, we recommend that the conventional 3-marker (ER/Vim/CEA) panel is easier, sufficient and appropriate to use in distinguishing between primary ECA and EMA. Although the 4-marker panel containing PR also reveals statistically significant results, the PR-marker offers no supplemental benefit to the pre-existing 3-marker (ER/Vim/CEA) panel in the diagnostic distinction between ECA and EMA.
Highlights
From hematoxylin and eosin (H&E) stains, it can be difficult to distinguish between pre-operative or curetting specimens of endocervical adenocarcinomas (ECA) and endometrial adenocarcinomas (EMA)
According to our data, when histomorphological and clinical doubt exists as to the primary site of origin, we recommend that the conventional 3-marker (ER/Vim/Carcinoembryonic antigen (CEA)) panel is easier, sufficient and appropriate to use in distinguishing between primary ECA and EMA
We found that IHC stained positive for the Progesterone receptor (PR)-marker in 58.3% of EMA, in contrast to 21.4% of ECA
Summary
From hematoxylin and eosin (H&E) stains, it can be difficult to distinguish between pre-operative or curetting specimens of endocervical adenocarcinomas (ECA) and endometrial adenocarcinomas (EMA). Staging is surgical for EMA; for primary ECA, staging is clinical. Treatment protocols may differ substantially between them [1,2]. We have already learned that certain immunohistochemical markers may be helpful in distinguishing between ECA and EMA. McCluggage, et al (2002) proposed that a panel of immunohistochemical stains, comprised of a 3marker (ER, CEA and Vim) panel, generally results in a confident preoperative distinction between ECA and EMA[3]. Several other studies have reported that a PR- and p16INK4a-marker revealed a significant frequency difference (p < 0.05) between ECA and EMA. We were interested to discover whether ancillary PR- or p16INK4amarker testing could produce any supplementary benefit to the traditional 3-marker panel
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