Endometrioid carcinoma

Vimentin coexpression is especially useful in differentiating endometrial endometrioid carcinomas in uterine curettage specimens from endocervical adenocarcinomas including the endometrioid variant of endocervical adenocarcinoma. Endometrial endometrioid carcinomas immunostain strongly for vimentin, but endocervical carcinomas rarely stain (weak focal staining in up to 13% of endocervical carcinomas). i > i However, with the current antigen retrieval techniques, moderate to occasionally strong vimentin expression may be seen in endocervical carcinomas, and a panel approach is more useful in this distinction. ... 

Mammaglobin expression in endometrioid carcinomas could be useful diagnostically. 

Young RH, Hart WR. Metastatic intestinal carcinomas simulating primary ovarian clear cell carcinoma and secretory endometrioid carcinoma a clinicopathologic and immunohistochemical study of five cases. Am J Surg Pathol. 1998 22 805-815. 

ER and PR expression is seen in a wide range of non-uterine tissues and in both benign and malignant tumors. Of note, ER and PR expression is moderate to strong in endometrioid carcinomas, but is not expressed or only weakly expressed in clear cell carcinomas.ER and... 

PR expression is just as weak in poorly differentiated endometrioid carcinomas as it is in serous and clear cell carcinomas. 

FIGURE 18.14 Markers of emerging importance in distinguishing uterine endometrioid carcinoma and uterine serous carcinoma include p33, p-catenin, and PTEN. While serous carcinomas characteristically overexpress p53 (A), endometrioid adenocarcinomas, especially when gland-forming, frequently express estrogen receptors (B), commonly show at least focal nuclear and cytoplasmic staining with anti-P-catenin (C), and lose expression of PTEN (D). 

Endometrioid carcinomas typically express CK7, CA125, ER, PR, and vimentin, while they are usually negative for CEA and CK20. 

Unlike endometrioid carcinomas, they typically overexpress p53 and pi 6 and show extremely high proliferative indices with Ki-67 most examples have low-level expression of ER and low-level or absent PR. 

Unlike serous carcinomas, pS3 and pi 6 overexpression is rare unlike typical endometrioid carcinomas, ER and PR expression is low or absent. 

FIGURE 18.16 p53 immunohistochemical staining can be used when the differential diagnosis includes uterine serous carcinoma (USQ and uterine endometrioid carcinoma (UEC). USC shows diffuse and intense nuclear immunoreactivity for p53 (A, B), as does the USC precursor EIC (C, D). Not infrequently, USC can demonstrate a glandular architectural pattern (E). Diffuse and intense p53 immunoreactivity in glandular use (F) can provide support for this entity when simple atypical hyperplasia and endometrioid adenocarcinoma are considerations. 

FIGURE 18.28 Endometrioid carcinoma, including its Sertoliform variant, shows diffuse strong staining for epithelial membrane antigen (EMA). Sertoli cell and Sertoli-Leydig cell tumors are EMA negative. 

TABLE 18.7 Endometrioid Carcinoma vs. Sex Cord Stromal Tumors ... 

FIGURE 18.30 Clear cell carcinoma. Strong positive nuclear staining for hepatocyte nuclear factor-1 p is characteristic of clear cell carcinoma. Serous and endometrioid carcinoma are usually negative for this marker. 

Immunohistochemical stains are important in the diagnosis of Sertoli-Leydig cell tumors because the various cell types can be difficult to recognize and because other tumor types, especially the Sertoliform variant of endometrioid carcinoma, share some histologic features with Sertoli-Leydig cell tumors. Sertoli cells stain for cytokeratin, which highlights tubules and delineates cords, nests, and sheets of immature Sertoli cells, but they are EMA-negative (Fig. The stromal... 

The uncommon Sertoliform variant of endometrioid carcinoma is generally cytokeratin- and EMA-positive and lacks staining for inhibin or calretinin. Positive staining for inhibin and calretinin and lack of staining for EMA helps to differentiate between a Sertoli-Leydig cell tumor and the Sertoliform variant of endometrioid carcinoma (see Table 18.7).474,545,546,550 Sertoli-... 

The immunophenotype of the FATWO overlaps with that of epithelial and sex cord-stromal tumors, but positive cytoplasmic staining for CD10 may help differentiate it. Lack of staining for EMA and positive staining for inhibin differentiate the FATWO from an endometrioid carcinoma variant. 

Lax SF, Pizer ES, Rormett BM, et al. Comparison of estrogen and progesterone receptor, Ki-67, and p53 immunoreactivity in uterine endometrioid carcinoma and endometrioid carcinoma with squamous, mucinous, secretory, and ciliated cell differentiation. Hum Pathol. 1998 29 924-931. 

Schlosshauer PW, Pirog EC, Levine RL, et al. Mutational analysis of the CTNNBl and APC genes in uterine endometrioid carcinoma. Mod Pathol. 2000 13 1066-1071. 

Catasus L, Bussaglia E, Rodrguez I, et al. Molecular genetic alterations in endometrioid carcinomas of the ovary Similar frequency of beta-catenin abnormalities but lower rate of microsatellite instability and PTEN alterations than in uterine endometrioid carcinomas. Hum Pathol. 2004 35 1360-1368. 

Carcangiu ML, Dorji T, Radice P, et al. HNPCC-related endometrial carcinomas show a high frequency of non-endometrioid types and of high FIGO grade endometrioid carcinomas. Mod Pathol. 2006 19 173A. 

Mulvany NJ, Allen DG. Combined large cell neuroendocrine and endometrioid carcinoma of the endometrium. Int J Gynecol Pathol. 2008 27 49-57. 

Silva EG, Deavers MT, Bodurka DC, et al. Association of low-grade endometrioid carcinoma of the uterus and ovary with undifferentiated carcinoma A new type of dedifferentiated carcinoma Int J Gynecol Pathol. 2006 25 52-58. 

Irving JA, Catasus L, Gallardo A, et al. Synchronous endometrioid carcinomas of the uterine corpus and ovary Alterations in the beta-catenin (CTNNBl) pathway are associated with independent primary tumors and favorable prognosis. Hum Pathol. 2005 36 605-619. 

Lopez JM, Malpica A, Deavers MT, et al. Ovatian yolk sac tumot associated with endometrioid carcinoma and mucinous cystadenoma of the ovary. Ann Diagn Pathol. 2003 7 300-305. 

Ordi J, Schammel DP, Rasekh L, et al. Sertoliform endometrioid carcinomas of the ovary A clinicopathologic and immunohistochemical study of 13 cases. Mod Pathol. 1999 12 933-940. 

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