A Panel of Immunohistochemical Stains, Including Carcinoembryonic Antigen, Vimentin, and Estrogen Receptor, Aids the Distinction Between Primary Endometrial and Endocervical Adenocarcinomas

McCluggage, W. Glenn; Sumathi, Vaiyapuri P.; McBride, H A; Patterson, Anna

doi:10.1097/00004347-200201000-00003

Cited by 187 publications

(106 citation statements)

References 9 publications

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“…CEA has been touted as a good discriminatory marker for endometrial carcinoma vs histologic mimics, including endocervical carcinoma, [4][5][6][7]34 because endometrial carcinoma is usually CEA-negative and endocervical carcinoma is usually positive. Dallenbach-Hellweg et al, 5 however, reported that both endometrial and endocervical mucinous carcinomas expressed CEA; this was refuted by Kamoi et al, 9 who reported significantly more CEA expression in endocervical adenocarcinomas of the usual type compared to endometrioid adenocarcinomas of endometrium and endocervix and mucinous endometrial adenocarcinomas.…”

Section: Discussionmentioning

confidence: 99%

“…Morphologically similar carcinomas, such as endocervical adenocarcinomas, have been reported to express p16 [1][2][3] and carcinoembryonic antigen (CEA), [4][5][6] whereas endometrial adenocarcinomas frequently show estrogen receptor (ER), 7,8 progesterone receptor (PR), 7,8 and vimentin expression. 4,7,9 In practice, many pathologists have used immunohistochemical panels composed of markers against these antigens for determining site of origin.…”

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confidence: 99%

“…4,7,9 In practice, many pathologists have used immunohistochemical panels composed of markers against these antigens for determining site of origin. In most cases, this approach is not problematic because endometrioid adenocarcinomas usually derive from the uterine corpus.…”

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Immunophenotypic diversity of endometrial adenocarcinomas: implications for differential diagnosis

et al. 2006

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Many endometrial adenocarcinomas, particularly those of endometrioid type, express estrogen receptors (ERs), progesterone receptors (PRs), and vimentin. This typical immunophenotype is frequently considered a standard against which others are compared when immunohistochemistry is used for differential diagnosis. We tested large numbers of endometrial cancers, enriched for high-grade tumors, to determine whether this reported immunophenotype was valid and whether expression differences between types of endometrial carcinoma could be exploited for diagnostic purposes. Immunohistochemical stains were performed on the following types of endometrial cancers using established methodology: International Federation of Gynecology and Obstetrics (FIGO) grades 1 and 2 endometrioid-42; FIGO grade 3 endometrioid-40; serous-24; clear cell-11; carcinosarcoma-9. In total, 92% of serous carcinomas expressed p16 strongly compared to weak-tomoderate expression of p16 in 7-67% of other tumors (FIGO grades 1 and 2 carcinoma and carcinosarcoma, respectively). A total of 84% of FIGO grades 1 and 2 carcinomas expressed ER compared to 9-54% of other tumors (clear cell and serous carcinomas respectively); 83% of FIGO grades 1 and 2 expressed PR compared to 11-54% of other carcinomas (carcinosarcoma and serous carcinoma, respectively). Most carcinomas were negative for monoclonal carcinoembryonic antigen (mCEA), and those that were positive showed mostly only focal membrane expression. Vimentin was expressed in nearly every tumor. Most tumors were diffusely vimentin positive, but a large range of expression patterns, from focal to diffuse and from weak to strong, was noted. Only 70% of FIGO grades 1 and 2 endometrioid carcinomas and 26% of grade 3 endometrioid carcinomas possessed the reportedly characteristic endometrial cancer immunophenotype p16 (À), ER ( þ ), PR ( þ ), mCEA (À), and vimentin ( þ ). Endometrial cancers demonstrate substantial immunophenotypic diversity that remained apparent even within groups of similar histologic subtype and grade. ER, PR, and p16 expression was more illustrative of tumor type and degree of differentiation than they were of endometrial origin. In contrast, the vimentin-positive/CEA-negative phenotype remained the most constant among all endometrial cancers.

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Section: Discussionmentioning

confidence: 99%

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Immunophenotypic diversity of endometrial adenocarcinomas: implications for differential diagnosis

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“…This result is in keeping with other studies demonstrating a low frequency of hormone receptor expression in primary endocervical adenocarcinomas. [56][57][58][59][60][61] Metastatic endocervical adenocarcinomas in the ovary usually simulate either primary ovarian endometrioid tumors or mucinous tumors of gastrointestinal (not seromucinous/endocervical-like) type. The infrequent expression of hormone receptors in endocervical adenocarcinomas, lack of expression of hormone receptors in both primary ovarian atypical proliferative (borderline) mucinous tumors of gastrointestinal type and ovarian mucinous carcinomas of usual type in this study, and frequent expression of hormone receptors in ovarian endometrioid tumors observed in other studies 16,24,26,31 indicate that ER/PR expression is most often useful only in the distinction of endocervical adenocarcinomas from primary ovarian endometrioid but not mucinous tumors.…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemistry for estrogen and progesterone receptors in the distinction of primary and metastatic mucinous tumors in the ovary: an analysis of 124 cases

Vang

Gown²,

Barry³

et al. 2006

Modern Pathology

108

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Estrogen (ER) and progesterone receptor (PR) expression in primary ovarian mucinous tumors and the utility of these markers for distinguishing metastatic mucinous carcinomas in the ovary from primary ovarian mucinous tumors have not been extensively investigated. Immunohistochemical studies were performed on 124 mucinous tumors, including 52 primary ovarian tumors (30 atypical proliferative (borderline) mucinous tumors of gastrointestinal type, 11 atypical proliferative (borderline) mucinous tumors of seromucinous (endocervicallike) type, and 11 invasive mucinous carcinomas of usual (gastrointestinal) type) and 72 metastatic mucinous carcinomas in the ovary (primary sites: colorectum (24), pancreas (13), endocervix (eight), stomach (four), gallbladder/bile duct (four), appendix (four), and unknown (15)). All atypical proliferative mucinous tumors of gastrointestinal type, primary ovarian mucinous carcinomas, and metastatic mucinous carcinomas were negative for ER and PR with the exception of three metastatic endocervical adenocarcinomas which exhibited only weak expression of ER without PR. All atypical proliferative mucinous tumors of seromucinous type expressed ER to some degree and seven had some expression of PR. Immunohistochemical assessment of hormone receptor expression is of no value in distinguishing the common types of primary ovarian mucinous tumors (atypical proliferative mucinous tumors of gastrointestinal type and mucinous carcinomas of usual type) from the vast majority of mucinous carcinomas metastatic to the ovary. The above observations on hormone receptor expression in primary ovarian mucinous tumors support the concept that atypical proliferative (borderline) mucinous tumors of gastrointestinal and seromucinous (endocervical-like) Keywords: ovary; mucinous tumor; mucinous carcinoma; metastases; estrogen receptor; progesterone receptor Among ovarian epithelial tumors, the mucinous tumors pose the greatest difficulty with regard to distinction of primary from metastatic tumors. The primary ovarian mucinous tumors, including the atypical proliferative (borderline) tumors and carcinomas, and metastatic mucinous carcinomas in the ovaries are usually easily distinguished when they exhibit characteristic gross and microscopic features. The primary tumors are typically large (usually greater than 15 cm), unilateral multicystic tumors with smooth capsules and are most often unassociated with extraovarian disease. The carcinomas most often arise in association with atypical proliferative (borderline) tumors and while they can exhibit destructive stromal invasion, they frequently display confluent glandular or expansile, rather than infiltrative, patterns of invasion. In contrast, typical features of metastatic mucinous carcinomas in the ovary that distinguish them from primary tumors include bilaterality, smaller size (often less

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“…Endometrioid adenocarcinomas of the uterine corpus usually exhibit cytoplasmic vimentin positivity. 5,6 Therefore, in those cases where the associated uterine tumour is endometrioid in type, vimentin staining may be of value in excluding tumour involvement of the cervix. Most other histological types of uterine carcinoma, including serous and clear cell, are vimentin negative.…”

Section: Discussionmentioning

confidence: 99%

Atypical reactive proliferation of endocervix: a common lesion associated with endometrial carcinoma and likely related to prior endometrial sampling

2006

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We describe a common, but hitherto not well described, reactive change of the endocervical surface epithelium, commonly seen in association with endometrial carcinoma, and which we term 'atypical reactive proliferation'. This lesion, especially when florid, has the potential to be misinterpreted as a manifestation of a stage 2A endometrial cancer (endocervical glandular involvement). We examined the cervical sections in 80 consecutive hysterectomy specimens of endometrial cancer. In 22 cases (27.5%), there was cervical involvement by tumour and these cases were excluded from further analysis. Of the remaining cases, atypical reactive proliferation involved the endocervical surface in 40 of 58 (69%) cases, although the degree of abnormality varied widely between individual cases. Histological features characteristic of atypical reactive proliferation (not all features were present in each case) included nuclear stratification and multilayering with short micropapillary processes, squamoid change, hobnail cells and mild cytological atypia. Other features present in some cases were surface erosion, clearing of the cytoplasm, fibrin deposition, an inflammatory cell infiltrate and fibrosis of the subepithelial tissue. In 20 control cases, comprising hysterectomy specimens for benign conditions, similar changes were not seen. Vimentin immunohistochemistry was undertaken in eight cases in which atypical reactive proliferation was particularly florid. Five cases were completely negative and three exhibited very focal positivity. Atypical reactive proliferation involving the endocervical surface is commonly seen in association with endometrial cancer and has the potential to be misinterpreted as endocervical involvement by tumour. Although this could represent a reactive change associated with the presence of an endometrial cancer, we feel atypical reactive proliferation is most likely a reactive/reparative response to recent endometrial biopsy or curettage. The vimentin-negative immunophenotype may be of value in cases where the uterine carcinoma is endometrioid in type as these neoplasms are generally vimentin positive.

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A Panel of Immunohistochemical Stains, Including Carcinoembryonic Antigen, Vimentin, and Estrogen Receptor, Aids the Distinction Between Primary Endometrial and Endocervical Adenocarcinomas

Cited by 187 publications

References 9 publications

Immunophenotypic diversity of endometrial adenocarcinomas: implications for differential diagnosis

Immunophenotypic diversity of endometrial adenocarcinomas: implications for differential diagnosis

Immunohistochemistry for estrogen and progesterone receptors in the distinction of primary and metastatic mucinous tumors in the ovary: an analysis of 124 cases

Atypical reactive proliferation of endocervix: a common lesion associated with endometrial carcinoma and likely related to prior endometrial sampling

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