Relationship between morular metaplasia and squamous differentiation in endometrial carcinoma

Travaglino, Antonio; Raffone, Antonio; Gencarelli, Annarita; Raimondo, Diego; Moretta, Paola; Pignatiello, Sara; Granata, Marcello; Seracchioli, Renato; Zullo, Fulvio; Insabato, Luigi

doi:10.1016/j.prp.2020.153307

Cited by 13 publications

(34 citation statements)

References 21 publications

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“…Histological methods for endometrioid carcinomas were previously reported [9]. For pilomatrixomas and pilomatrix carcinomas, the lesion was sampled in toto and surgical margins were assessed separately.…”

Section: Histological and Immunohistochemical Methodsmentioning

confidence: 99%

“…All specimens were retrieved from the archives of the Pathology Unit of the Federico II University Polyclinic of Naples. The study sample included 15 endometrioid carcinomas with MorM (out of which 11 showed overt squamous/keratinizing features) diagnosed between January 2019 and October 2020; 10 of these cases were previously described [9]. Twenty pilomatrixomas diagnosed in the 2019-2020 period and 6 pilomatrix carcinomas diagnosed in the 2010-2020 period were selected as tumors representative of hair matrix differentiation.…”

Section: Case Selectionmentioning

confidence: 99%

“…Fifteen cases of adamantinomatous craniopharyngioma (ACP) diagnosed in the 2003-2019 were also selected as tumors representative of odontogenic differentiation; 11 out of 15 ACP were previously reported [20]. Ten previously described cases of endometrioid carcinoma with conventional SqD were used as controls [9].…”

Section: Case Selectionmentioning

confidence: 99%

“…The lack of overt squamous features, such as prominent cell membranes and keratinization, has been used to distinguish MorM from conventional SqD [8]. However, we and others highlighted that MorM not uncommonly displays overt squamous features and a characteristic ghost cell keratinization [9][10][11]. Immunophenotypically, MorM differs from conventional SqD.…”

Section: Introductionmentioning

confidence: 99%

“…Instead, the expression of β-catenin (nuclear, due to CTNNB1 mutation), CD10, and CDX2 appears as a hallmark of MorM. Unlike SqD, MorM typically shows decreased CK7 expression compared to the background endometrium; CK8/18 expression, typically strong in both MorM and conventional SqD, may be lost in squamous cells originating from MorM [5,6,8,9,[12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Does endometrial morular metaplasia represent odontogenic differentiation?

et al. 2021

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The nature of endometrial morular metaplasia (MorM) is still unknown. The nuclear β-catenin accumulation and the not rare ghost cell keratinization suggest a similarity with hard keratin-producing odontogenic and hair matrix tumors rather than with squamous differentiation. We aimed to compare MorM to hard keratin-producing tumors. Forty-one hard keratin-producing tumors, including 26 hair matrix tumors (20 pilomatrixomas and 6 pilomatrix carcinomas) and 15 odontogenic tumors (adamantinomatous craniopharyngiomas), were compared to 15 endometrioid carcinomas with MorM with or without squamous/keratinizing features. Immunohistochemistry for β-catenin, CD10, CDX2, ki67, p63, CK5/6, CK7, CK8/18, CK19, and pan-hard keratin was performed; 10 cases of endometrioid carcinomas with conventional squamous differentiation were used as controls. In adamantinomatous craniopharyngiomas, the β-catenin-accumulating cell clusters (whorl-like structures) were morphologically similar to MorM (round syncytial aggregates of bland cells with round-to-spindled nuclei and profuse cytoplasm), with overlapping squamous/keratinizing features (clear cells with prominent membrane, rounded squamous formations, ghost cells). Both MorM and whorl-like structures consistently showed positivity for CD10 and CDX2, with low ki67; cytokeratins pattern was also overlapping, although more variable. Hard keratin was focally/multifocally positive in 8 MorM cases and focally in one conventional squamous differentiation case. Hair matrix tumors showed no morphological or immunophenotypical overlap with MorM. MorM shows wide morphological and immunophenotypical overlap with the whorl-like structures of adamantinomatous craniopharyngiomas, which are analogous to enamel knots of tooth development. This suggests that MorM might be an aberrant mimic of odontogenic differentiation.

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Section: Histological and Immunohistochemical Methodsmentioning

confidence: 99%

Section: Case Selectionmentioning

confidence: 99%