The Significance of Neuroendocrine Expression in Undifferentiated Carcinoma of the Endometrium

Abstract

Carcinomas with neuroendocrine (NE) differentiation have been associated with poor outcome in different organs. The purpose of this study was to evaluate the presence and significance of NE expression in a series of 46 undifferentiated endometrial carcinomas diagnosed between 1988 and 2005. NE expression was studied by immunohistochemistry including synaptophysin, chromogranin, and/or CD56. The patients' age ranged from 30 to 84 years (mean 55). Staging information was available for 45 cases and according to the International Federation of Gynecology and Obstetrics system they were distributed as follows: stage I (9 cases), stage II (2 cases), stage III (9 cases), and stage IV (25 cases). NE expression was present in 19/46 (41%) cases; however, it was diffuse in only 9% of the tumors. The median survival for patients without NE expression was 7 months (95% confidence interval 4-10 mo) and for patients with NE expression was 12 months (95% confidence interval 6-27 mo). The survival curves do not differ significantly (P=0.49). NE expression is common in undifferentiated carcinoma of the endometrium, as it was found in 41% of our cases. In most cases, NE expression is only focally present (< or =10% of the cells). There is no difference in overall survival in patients with or without NE expression.

Endometrial and ovarian carcinomas with undifferentiated components: clinically aggressive and frequently underrecognized neoplasms

“…UCs can show focal neuroendocrine features and staining with neuroendocrine-related markers without any impact on clinical outcome. 17 In our study, 3 of 10 cases showed focal (less than 10%) synaptophysin and/or chromogranin staining. We would classify a tumor that shows strong and diffuse staining for neuroendocrine markers as a neuroendocrine carcinoma rather than UC.…”

Fascin expression in undifferentiated and dedifferentiated endometrial carcinoma

“…The latter tumor has been characterized relatively recently as a clinically aggressive and histologically distinctive entity typically comprising relatively monomorphous medium to large cells that are arranged in sheets without evidence of gland formation [2]. Additional histologic features that may be focally present in some cases include marked nuclear pleomorphism, spindle cells, abrupt keratinization, myxoid stroma, prominent tumor-infiltrating lymphocytes (TILs), and rhabdoid cells [3][4][5][6]. A variable proportion of UEC are associated with a low-grade (grade 1 or 2) endometrioid carcinoma, and these cases have been classified as dedifferentiated or combined carcinomas [5,7].…”

How to approach the many faces of endometrioid carcinoma

“…However, neuroendocrine carcinoma displays characteristic chromatin pattern and typically shows positivity for chromogranin, synaptophysin, NSE, and/or CD 56 in > 10% of the cells. 42 In addition, keratin expression tends to be more prominent than in undifferentiated carcinoma. Serous carcinoma.…”

“…Chromogranin and/or synaptophysin can be focally positive (≤10% of cells) but this finding does not warrant designation as a neuroendocrine carcinoma. 42 ER/PR expression is usually low or absent. Up to 80% of the tumors are PAX-8 negative.…”