Immunoprofile of adenocarcinomas of the endometrium, endocervix, and ovary with mucinous differentiation.
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: Intestinal differentiation in the endometrium is rare with only case reports in the international literature. We describe a case of simultaneous endocervical and intestinal-type mucinous differentiation with goblet cells arising in a FIGO grade 1 endometrioid adenocarcinoma. The patient had no involvement of the myometrium, cervix, or extra-uterine sites. There were no intestinal metaplastic changes of the endocervical canal. The etiology of this change is unknown, although recent reports suggest an association with hyperestrogenism. Virtual slides The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1209512176931698.Diagnostic Pathology 08/2013; 8(1):128. · 1.85 Impact Factor
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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].12/2010: pages 181-182;
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ABSTRACT: Intestinal metaplasia of the endometrium is extremely uncommon with only a single earlier case report. We describe 2 cases of endometrial intestinal metaplasia, one of them involving an endometrial polyp, characterized by the presence of intestinal-type epithelium containing goblet and neuroendocrine cells, which were positive with CK20, CDX2, chromogranin, and villin. In 1 case, there was concomitant intestinal and pyloric metaplasia in the endocervix. Together with the observation of the earlier reported case of endometrial intestinal metaplasia, there was also intestinal metaplasia in the cervix. This suggests a possible association between intestinal metaplasia at different sites in the female genital tract.International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists 09/2011; 30(5):492-6. · 2.07 Impact Factor