J Pathol Transl Med.  2019 May;53(3):164-172. 10.4132/jptm.2019.02.12.

Potential Role for a Panel of Immunohistochemical Markers in the Management of Endometrial Carcinoma

• Salama A
• Arafa M
• ElZahaf E
• Shebl AM
• Awad AA
• Ashamallah SA
• Hemida R
• Gamal A
• Foda AA
• Zalata K
• Abdel-Hady ESM

• KMID: 2449339
• DOI: http://doi.org/10.4132/jptm.2019.02.12

Abstract

BACKGROUND
In order to improve the efficacy of endometrial carcinoma (EC) treatment, identifying prognostic factors for high risk patients is a high research priority. This study aimed to assess the relationships among the expression of estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, and the different histopathological prognostic parameters in EC and to assess the value of these in the management of EC.
METHODS
We examined 109 cases of EC. Immunohistochemistry for ER, PR, HER2, and Ki-67 were evaluated in relation to age, tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage and grade, depth of infiltration, cervical and ovarian involvement, lymphovascular space invasion (LVSI), and lymph node (LN) metastasis.
RESULTS
The mean age of patients in this study was 59.8 ± 8.2 years. Low ER and PR expression scores and high Ki-67 expression showed highly significant associations with non-endometrioid histology (p = .007, p < .001, and p < .001, respectively) and poor differentiation (p = .007, p < .001, and p <. 001, respectively). Low PR score showed a significant association with advanced stage (p = .009). Low ER score was highly associated with LVSI (p = .006), and low PR scores were associated significantly with LN metastasis (p = .026). HER2 expression was significantly related to advanced stages (p = .04), increased depth of infiltration (p = .02), LVSI (p = .017), ovarian involvement (p = .038), and LN metastasis (p = .038). There was a close relationship between HER2 expression and uterine cervical involvement (p = .009). Higher Ki-67 values were associated with LN involvement (p = .012).
CONCLUSIONS
The over-expression of HER2 and Ki-67 and low expression of ER and PR indicate a more malignant EC behavior. An immunohistochemical panel for the identification of high risk tumors can contribute significantly to prognostic assessments.

Keyword

Endometrial neoplasms; Prognosis; Steroid receptors; HER2; Ki-67

MeSH Terms

Endometrial Neoplasms*
Female
Gynecology
Humans
Immunohistochemistry
Lymph Nodes
Neoplasm Metastasis
Obstetrics
Prognosis
Receptor, Epidermal Growth Factor
Receptors, Estrogen
Receptors, Progesterone
Receptors, Steroid
Receptor, Epidermal Growth Factor
Receptors, Estrogen
Receptors, Progesterone
Receptors, Steroid

Figure

• 

  Fig. 1. Examples of different patterns of immunohistochemical expression in endometrial carcinomas. (A) Estrogen receptor (ER) expression score (6) in a case of well differentiated endometrial carcinoma (EC). (B) ER expression score (4) in a poorly differentiated EC. (C) progesterone receptor (PR) expression score (6) in a moderately differentiated EC. (D) PR expression score (2) in a poorly differentiated EC. (E) Positive human epidermal growth factor receptor 2 (HER2) overexpression (score +3) in a case of poorly differentiated EC. (F) HER2 score (+ 1), which is considered negative, in a well differentiated EC. (G) High Ki-67 index in a poorly differentiated EC. (H) Low Ki-67 index in a well differentiated EC.

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