title: Immunohistochemical Comparison of Ovarian and Uterine Endometrioid Carcinoma, Endometrioid Carcinoma With Clear Cell Change, and Clear Cell Carcinoma.
abstract: Accurate distinction of clear cell carcinoma (CCC) from endometrioid carcinoma (EC) has important clinical implications, but, not infrequently, EC demonstrates clear cell change (EC-CC), mimicking CCC. We examined whether a panel of immunomarkers can help distinguish between these tumors. Sixty-four CCCs (40 ovarian and 24 uterine), 34 ECs (21 ovarian and 13 uterine), and 34 EC-CCs (6 ovarian and 28 uterine) were stained for HNF1β, BAF250a, Napsin A, ER, and PR. Intensity and extent of immunoreactivity was assessed. Fifty-seven of 64 (89%) CCCs, 14/34 (41%) EC-CCs, and 16/34 (47%) ECs expressed HNF1β, and 56/64 (88%) CCCs, 4/34 (12%) EC-CCs, and 1/34 (3%) ECs stained for Napsin A. Most CCCs demonstrated at least moderate and diffuse staining for both markers, whereas only focal and weak expression was identified in most EC-CC/EC. Compared to HNF1β, Napsin A showed increased specificity (93.0% vs. 55.9%, P<0.0001) and similar sensitivity (87.5% vs. 89.1%) in distinguishing CCC from EC-CC/EC. Thirteen of 64 (20%) CCCs, 6/34 (18%) EC-CCs, and 2/34 (6%) ECs showed loss of BAF250a. ER was expressed by 10/64 (16%) CCCs, 30/34 (88%) EC-CCs, and 33/34 (97%) ECs, whereas PR positivity was identified in 9/64 (14%) CCCs, 26/34 (77%) EC-CCs, and 33/34 (97%) ECs. The majority of EC and EC-CC demonstrated diffuse staining for ER/PR, whereas most CCCs showed very focal positivity. There is a statistically significant difference in HNF1β, Napsin A, ER, and PR immunoexpression between CCC and EC/EC-CC, with Napsin A being a more specific marker for CCC than HNF1β. Overall, the immunoprofile of EC-CC is more comparable to that of EC than CCC. The use of a panel of immunostains can help distinguish EC-CC from CCC.
authors: *Department of Pathology, National University Health System, Singapore, Singapore †Department of Pathology, University of Hong Kong, Queen Mary Hospital, Hong Kong ‡Department of Pathology, The Jikei University School of Medicine, Japan §Department of Pathology, Massachusetts General Hospital, Boston, MA.
authors: Diana
authors: D
authors: Lim
authors: Philip P C
authors: PP
authors: Ip
authors: Annie N Y
authors: AN
authors: Cheung
authors: Takako
authors: T
authors: Kiyokawa
authors: Esther
authors: E
authors: Oliva
mesh_terms: D016282:Aspartic Acid Endopeptidases / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis*; D001900:Boston; D018269:Carcinoma, Endometrioid / Q000737:chemistry* / Q000473:pathology; D004268:DNA-Binding Proteins; D003937:Diagnosis, Differential; D016889:Endometrial Neoplasms / Q000737:chemistry* / Q000473:pathology; D005260:Female; D051539:Hepatocyte Nuclear Factor 1-beta / Q000032:analysis; D006723:Hong Kong; D006801:Humans; D007150:Immunohistochemistry; D007564:Japan; D009687:Nuclear Proteins / Q000032:analysis; D010051:Ovarian Neoplasms / Q000737:chemistry* / Q000473:pathology; D011237:Predictive Value of Tests; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D014157:Transcription Factors / Q000032:analysis
chemical_list: C112476:ARID1A protein, human; D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; C496495:HNF1B protein, human; D009687:Nuclear Proteins; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D014157:Transcription Factors; D051539:Hepatocyte Nuclear Factor 1-beta; D016282:Aspartic Acid Endopeptidases; C498549:NAPSA protein, human