Review of immunohistochemical typing of endometrial carcinoma at the Lagos University Teaching Hospital

Utility of ER, p53, CEA and Napsin A in Histological Subtyping of Endometrial Carcinoma and Their Correlation with Clinicopathological Prognostic Parameters: Experience from a Referral Institute

Background & Objective

Endometrial Carcinoma (EC) is the most common gynecological cancer with a global incidence of 23.2 per 1 lakh population. Histological subclassification of EC is extremely crucial for the diagnosis, proper management strategies, and prognosis. This study was conducted in a tertiary care institute to analyze the expression pattern of a minimum panel of 4 markers (ER, p53, CEA, Napsin A) with emphasis on their utility in the routine histological subtyping, aberrant expression, and correlation with various clinicopathological parameters.

Methods

A time-bound cross-sectional observational and analytical study was conducted, which includes cases diagnosed in our laboratory from January 2016 to April 2021.

Results

Sixty cases diagnosed as EC during the study period formed the sample cases. The ER was expressed in 85% (53/60) of cases in the current study. Among them, 94% (50/53) were endometrioid endometrial carcinomas (EECs). A negative correlation was found between ER intensity and age (r= -1.48). Of 60 EC cases, 10 (16%) cases expressed p53. The tumors positive for p53 with higher intensity were negative for ER and vice versa. The expression pattern of ER and p53 was statistically significant (P=-0.021). On IHC, 84.6% (11/13) of CEA-positive cases expressed both ER and CEA, suggesting mucinous differentiation. Napsin A was expressed in two cases of EEC, FIGO grade I, and one case of serous carcinoma.

Conclusion

An inverse association was found between ER and p53 expression. The CEA is valuable in identifying EEC with mucinous differentiation.

Histopathological patterns of endometrial carcinoma in a tertiary hospital in North-West Nigeria

Background

There are relatively few studies in Nigeria, and indeed, sub-Saharan Africa that have documented the relative frequencies and histomorphological patterns of endometrial carcinoma. This study aimed to determine the relative frequencies and clinic-epidemiological characteristics of endometrial carcinoma and its histological variants in Kano, North-Western, Nigeria.

Method

A 10-year retrospective study of all endometrial carcinoma cases in the Department of Pathology, Aminu Kano Teaching Hospital, Kano. All relevant information was retrieved and data was analysed using Statistical Package for Social Sciences version 22.

Results

Endometrial carcinoma showed an increment in prevalence from 0.5% of all gynaecologic admission in 2008 to 1.0% in 2017. Type I endometrial carcinoma, specifically endometrioid adenocarcinoma accounted for 80% of cases, while endometrial serous carcinoma was the most common type II endometrial carcinoma representing 20% of cases. Over 75% of endometrial carcinomas occurred in postmenopausal women with a mean age of 59 years.

Conclusion

There is a rise in the prevalence of endometrial carcinoma and endometrioid adenocarcinoma is the most common histologic type.

Hormonal receptor expression in endometrial carcinoma: A retrospective immunohistochemical study in a Nigerian tertiary hospital

Background:

Endometrial carcinoma is the commonest genital tract malignancy in most developed nations, but it lags behind cervical carcinoma and ovarian cancers in most developing nations including Nigeria. Estrogen has been described as a promoter of endometrial carcinogenesis.

Objectives:

The aim of this study was to demonstrate the frequency of estrogen receptor (ER) and progesterone receptor (PR) expressions of endometrial carcinoma and to correlate it with tumour grade.

Materials and Methods:

Cases of endometrial carcinoma diagnosed in the Department of Pathology over a 10-year period were reviewed retrospectively. The paraffin-embedded blocks were retrieved, and immunohistochemistry for ER and PR was performed on them. Haematoxylin and eosin (H&E) slides were reviewed, and tumours were graded by three independent pathologists. Data were analysed using SPSS version 22. The level of significance was set at P ≤ 0.05.

Results:

There were 44 cases of endometrial carcinoma. ER and PR were positive in 29.5% and 18.2% of endometrial carcinoma, respectively. There was no significant association between ER (P = 0.361) and PR (P = 0.204) expressions and histological grade of the tumour. The most common histological grade was grade 3 with 70% of cases (36 cases), whereas 13 cases (26%) were grade 2 and only 2 cases (4%) were grade 1.

Conclusion:

The positive expressions of ER and PR in endometrial carcinoma suggest that steroid receptor studies may be of potential benefit in the management of some patients with endometrial carcinoma. Future studies employing larger sample size are therefore recommended.

Editorial

Nil.