title: Clear cell carcinomas of the mullerian system: does the pathogenesis vary depending on their nuclear grade and their association with endometriosis? An immunohistochemical analysis.
abstract: Clear cell carcinomas (CCC) of the mullerian system are considered high grade tumors, but morphologically, the cells of CCC show both low and high grade features. The aims of the current study were to categorize CCC into low and high nuclear grade types, correlate their association with endometriosis, and then observe possible variations in pathogenesis based on their expression of p53 and Ki-67. We studied 41 pure mullerian CCCs and designated each as either a high (HNG) or low (LNG) nuclear grade tumor. Morphologically, 17 (41%) CCCs were LNG and 24 (59%) were HNG. Nine (38%) HNG and 2 (12%) LNG tumors showed positive immunostaining with p53. Endometriosis was associated with 8 (47%) LNG tumors and 8 (33%) HNG CCCs. Of the 11 cases with p53 alteration, 4 (1 LNG and 3 HNG) were associated with endometriosis.
  
  
  CONCLUSIONS
  HNG CCCs, irrespective of their association with endometriosis, have alterations of p53. In general, LNG ovarian and endometrial CCCs, irrespective of their association with endometriosis/adenomyosis, are less likely to show p53 alteration. It appears that mullerian CCCs may have variable pathogenesis depending on their nuclear grade and association with endometriosis. A larger study is needed to validate these findings.
authors.affiliation: Department of Pathology, The Warren Alpert Medical School of Brown University and Women & Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alduaij
authors.forename: Katrine
authors.initials: K
authors.lastname: Hansen
authors.forename: Tahreem A
authors.initials: TA
authors.lastname: Karim
authors.forename: Cunxian
authors.initials: C
authors.lastname: Zhang
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Lomme
authors.forename: C James
authors.initials: CJ
authors.lastname: Sung
authors.forename: W Dwayne
authors.initials: WD
authors.lastname: Lawrence
authors.forename: M Ruhul
authors.initials: MR
authors.lastname: Quddus