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Immunohistochemical Comparison of Ovarian and Uterine Endometrioid Carcinoma, Endometrioid Carcinoma With Clear Cell Change, and Clear Cell Carcinoma.

卵巢与子宫的子宫内膜样癌、子宫内膜样癌伴透明细胞变以及透明细胞癌的免疫组织化学比较

Lim D,Ip PP,Cheung AN,Kiyokawa T,Oliva E

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.

摘要

透明细胞癌(CCC)与子宫内膜样癌(EC)的准确区分具有重要的临床意义,但是显示透明细胞变的EC(EC-CC)常常酷似CCC。我们运用了一组免疫组织化学指标来研究是否能够帮助区分这些肿瘤。对64例CCC(卵巢40例和子宫24例)、34例EC(卵巢21例和子宫13例)以及34例EC-CC(卵巢6例和子宫28例)进行了HNF1β、BAF250a、Napsin A、ER以及PR免疫组织化学染色。评估免疫反应强度及范围。89%(57/64)CCC、41%(14/34)EC-CC以及47%(16/34)EC表达HNF1β,88%(56/64)CCC、12%(4/34)EC-CC以及3%(1/34)EC表达Napsin A。研究显示,大多数CCC对两种免疫标记至少为中等、弥漫性着色,而大多数EC-CC/EC仅为局灶性、弱表达。在鉴别CCC和EC-CC/EC时, Napsin A较HNF1β显示较强的特异性(93.0% vs. 55.9%, P<0.0001)以及相似的敏感性(87.5% vs. 89.1%)。20%(13/64)CCC、18%(6/34)EC-CC以及6%(2/34)EC显示BAF250a表达缺失。16%(10/64)CCC、88%(30/34)EC-CC以及97%(3/34)EC表达ER,然而14%(9/64)CCC、77%(26/34)EC-CC以及97%(33/34)EC表达PR。绝大多数EC和EC-CC显示ER/PR弥漫性着色,而大多数CCC显示非常局灶的阳性。CCC与EC/EC-CC之间HNF1β、Napsin A、ER和PR的免疫表达具有显著地统计学差异,与HNF1β相比,Napsin A为CCC的一种较为特异的标记。综上,较CCC而言,EC-CC的免疫表达谱与EC更具有可比性。应用一组免疫染色可以帮助鉴别EC-CC和CCC。
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