Immunoprofile of adenocarcinomas of the endometrium, endocervix, and ovary with mucinous differentiation.

Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Applied immunohistochemistry & molecular morphology: AIMM / official publication of the Society for Applied Immunohistochemistry (Impact Factor: 1.63). 10/2008; 17(1):8-11. DOI: 10.1097/PAI.0b013e318174f012
Source: PubMed

ABSTRACT Primary mucinous tumors of the female genital tract have morphologic features similar to primary gastrointestinal adenocarcinomas, and distinguishing these malignancies may be extremely difficult. The purpose of this study was to characterize the immunostaining patterns of tumors of the female genital tract that show mucinous differentiation using cytokeratin 7 (CK7), CK20, and CDX2 and to evaluate the usefulness of these markers in differentiating these tumors from gastrointestinal tract adenocarcinomas and also from each other. A total of 64 cases were collected, including adenocarcinomas of the ovary (n=13), endocervix (n=16), endometrium (n=34), and vagina (n=1), all of which showed predominant mucinous differentiation. Intestinal mucinous differentiation was present in 11 of the cases (6 endocervical, 4 ovarian, and 1 vaginal adenocarcinoma). All tumors were at least focally positive for CK7 with the exception of 3 cases. The majority of tumors were negative for CK20 and CDX2. However, 25% of endocervical, 24% of ovarian, and 3% of endometrial adenocarcinomas were positive for CDX2, CK20, or both. The positivity for CDX2 and CK20 correlated with intestinal differentiation: 73% of all intestinal mucinous adenocarcinomas and 4% of all Müllerian mucinous adenocarcinomas showed positivity for the hindgut markers. In 70% of the tumors positive for CK20/CDX2, the intensity of CK7 stain was stronger than the intensity of either CK20 or CDX2 stain. In conclusion, immunostaining for CK7/CK20/CDX2 is helpful in distinguishing Müllerian subtype of mucinous gynecologic tumors from lower gastrointestinal tract malignancies. In gynecologic mucinous tumors with intestinal differentiation, the overlap of staining positivity may be a limiting factor. However, a dominant CK7 staining pattern was observed.

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    ABSTRACT: Mucinous tumours can arise in the uterus but are uncommon and account for less than 5% in most series. It is said that they may account for between 1 and 9% of uterine cancer, the percentage being higher where there are mixed tumours with mucinous and other cell types but mucinous predominates. Pure mucinous tumours are far less common and probably do represent around 1%. The differential diagnoses will include an endocervical tumour or metastatic deposits from a gastrointestinal tumour or ovarian mucinous tumour. There are similarities to mucinous endocervical tumours. Rare primary mucinous tumours do exist and may have a signet ring appearance. This again may add to the confusion with metastatic disease. Once again the importance of access to experienced pathologists is critical [1–11].
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