title: ER+ /PR+ /TFF3+ /IMP3- immunoprofile distinguishes endometrioid from serous and clear cell carcinomas of the endometrium: a study of 401 cases.
abstract: OBJECTIVE
  Differentiating endometrioid adenocarcinoma (EAC) from uterine serous carcinoma (USC) and clear cell carcinoma (CCC) of the endometrium can be challenging. We undertook an immunohistochemical study to address this issue.
  
  
  RESULTS
  We evaluated 401 endometrial carcinomas cases by using four immunomarkers - oestrogen receptor (ER), progesterone receptor (PR), insulin-like growth factor II mRNA - binding protein 3 (IMP3), and intestinal trefoil factor 3 (TFF3)-on a tissue microarray. The cases included 311 EACs (G1, 146; G2, 104; and G3, 61), 69 USCs, and 21 CCCs. ER, PR and TFF3 were most frequently expressed in EACs (P < 0.001), and IMP3 was more frequently expressed in USCs and CCCs (P < 0.001). ER(+) /PR(+) /TFF3(+) /IMP3(-) was the best marker combination associated with EAC [exact odds ratio (OR) 112; 95% confidence interval (CI) 19-∞; P < 0.0001]. This marker combination remained very reliable after adjustment for tumour grade (exact OR 19.2; 95% CI 3-∞; P = 0.0004). Because distinguishing EAC G3 from USC and CCC on the basis of morphology may be difficult, the use of immunomarkers to improve reproducibility is highly recommended. We found the ER(+) /PR(+) /TFF3(+) /IMP3(-) immunoprofile to be the best combination for confirming a diagnosis of endometrioid adenocarcinoma (exact OR 19.2; 95% CI 3-∞; P = 0.0004).
  
  
  CONCLUSIONS
  We recommend using an ER/PR/TFF3/IMP3 immunohistochemical panel in selected cases of endometrial carcinoma where the differential diagnosis is challenging.
authors.affiliation: Department of Pathology, University of Southern California, Los Angeles, CA 90033, USA. pmhawech1@yahoo.com
authors.forename: Paulette
authors.initials: P
authors.lastname: Mhawech-Fauceglia
authors.forename: Li
authors.initials: L
authors.lastname: Yan
authors.forename: Song
authors.initials: S
authors.lastname: Liu
authors.forename: Tanja
authors.initials: T
authors.lastname: Pejovic
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000175:diagnosis* / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D018284:Cystadenocarcinoma, Serous / Q000175:diagnosis* / Q000378:metabolism; D003937:Diagnosis, Differential; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D008875:Middle Aged; D010455:Peptides / Q000378:metabolism*; D016601:RNA-Binding Proteins / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D012189:Retrospective Studies; D046888:Tissue Array Analysis; D000071165:Trefoil Factor-3
chemical_list: D014408:Biomarkers, Tumor; C498780:IGF2BP3 protein, human; D010455:Peptides; D016601:RNA-Binding Proteins; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C082495:TFF3 protein, human; D000071165:Trefoil Factor-3