Immunohistochemical Comparison of Ovarian and Uterine Endometrioid Carcinoma, Endometrioid Carcinoma With Clear Cell Change, and Clear Cell Carcinoma.
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.
准确的鉴别透明细胞癌（CCC）和子宫内膜样癌（EC）有着非常重要的临床意义，部分EC伴透明细胞改变（EC-CC），可以模拟CCC。作者评估了一组免疫组织化学标记物能否帮助鉴别这几种肿瘤。64例CCCs（40例来源卵巢和24例来源子宫）、34例ECs（21例来源卵巢和13例来源子宫）及34例EC-CCs（6例来源卵巢和28例来源子宫），免疫组织化学标记HNF1β、BAF250a、Napsin A、ER和PR，并对免疫组化着色强度和范围进行评估。57/64(89%) CCCs、14/34 (41%) EC-CCs及16/34 (47%) ECs表达HNF1β，56/64 (88%) CCCs、4/34 (12%) EC-CCs及1/34 (3%) ECs表达Napsin A。大多数CCCs对这两种标记物至少中度至弥漫着色，而大多数EC-CC/EC仅局灶和弱阳性表达。和HNF1β相比，Napsin A在CCC与EC-CC/EC鉴别上，特异性较强（93.0% vs. 55.9%,P<0.0001），而敏感性相似（87.5% vs. 89.1%）。13/64 (20%) CCCs、6/34 (18%) EC-CCs及2/34 (6%) ECs不表达BAF250a。10/64 (16%) CCCs、30/34 (88%) EC-CCs及33/34 (97%) ECs表达ER，而9/64 (14%) CCCs、26/34 (77%) EC-CCs及33/34 (97%) ECs表达PR。多数EC和EC-CC对ER/PR弥漫着色，而大多数CCCs仅局灶阳性。CCC和EC/EC-CC中，HNF1β、Napsin A、ER及PR的表达在统计学上有显著差异，与HNF1β相比，Napsin A是CCC一种更特异的标记。总之，免疫标记组合在EC-CC和CCC的鉴别上更具有可比性，利用一组免疫标记物，能够帮助从CCC中鉴别出EC-CC。
Immunohistochemical Comparison of Ovarian and Uterine Endometrioid Carcinoma, Endometrioid Carcinoma With Clear Cell Change, and Clear Cell Carcinoma.
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.
准确的鉴别透明细胞癌（CCC）和子宫内膜样癌（EC）有着非常重要的临床意义，部分EC伴透明细胞改变（EC-CC），可以模拟CCC。作者评估了一组免疫组织化学标记物能否帮助鉴别这几种肿瘤。64例CCCs（40例来源卵巢和24例来源子宫）、34例ECs（21例来源卵巢和13例来源子宫）及34例EC-CCs（6例来源卵巢和28例来源子宫），免疫组织化学标记HNF1β、BAF250a、Napsin A、ER和PR，并对免疫组化着色强度和范围进行评估。57/64(89%) CCCs、14/34 (41%) EC-CCs及16/34 (47%) ECs表达HNF1β，56/64 (88%) CCCs、4/34 (12%) EC-CCs及1/34 (3%) ECs表达Napsin A。大多数CCCs对这两种标记物至少中度至弥漫着色，而大多数EC-CC/EC仅局灶和弱阳性表达。和HNF1β相比，Napsin A在CCC与EC-CC/EC鉴别上，特异性较强（93.0% vs. 55.9%,P<0.0001），而敏感性相似（87.5% vs. 89.1%）。13/64 (20%) CCCs、6/34 (18%) EC-CCs及2/34 (6%) ECs不表达BAF250a。10/64 (16%) CCCs、30/34 (88%) EC-CCs及33/34 (97%) ECs表达ER，而9/64 (14%) CCCs、26/34 (77%) EC-CCs及33/34 (97%) ECs表达PR。多数EC和EC-CC对ER/PR弥漫着色，而大多数CCCs仅局灶阳性。CCC和EC/EC-CC中，HNF1β、Napsin A、ER及PR的表达在统计学上有显著差异，与HNF1β相比，Napsin A是CCC一种更特异的标记。总之，免疫标记组合在EC-CC和CCC的鉴别上更具有可比性，利用一组免疫标记物，能够帮助从CCC中鉴别出EC-CC。
