Objective-To compare the accuracy of cancer progression prediction of the molecular-genetics and morphometry-based Endometrial Intraepithelial Neoplasia (EIN) and the WHO-94 classification schemes in endometrial hyperplasias.Study Design-A multicenter multivariate analysis of 477 endometria, with a required 1 year minimum cancer-free interval from the index biopsy (1-18 years follow-up). Comparison with 197 patients with <1 year follow-up.Results-24/477 (5.0%) hyperplasias progressed to cancer over an average of 4 years (10 yrs maximum). According to WHO94, 16/123 (13%) atypical and 8/354 (2.3%) non-atypical hyperplasias progressed (Hazard ratio=HR=7). 22/118 (19%) of EINs and 2/359 (0.6%) of non-EINs progressed (HR=45). EIN was prognostic within each WHO94 subcategory. Progression rates in simple (SH), complex (CH), simple atypical (SAH), and complex atypical (CAH) hyperplasias with EIN were 3, 22, 17 and 38% respectively, contrasting with 0.0-2.0% if EIN was absent. EIN detected precancer (sensitivity 92%) better than WHO94 atypical hyperplasias collectively (67%) or CAH alone (46%). With Cox regression EIN was the strongest prognostic index of future endometrial cancer. The same holds for patients with <1 year follow-up (HR for EIN, Atypia and CAH 58, 7 and 8 respectively). Conclusions-The

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Insulin-like growth factor-II mRNA-binding protein 3 (IMP3) is a member of the insulin-like growth factor-II signaling pathway, and has recently been described as a biomarker of basal-like breast carcinomas. This study explored IMP3 expression in adenoid cystic carcinomas of the breast, a special type of basal-like, triple-negative (estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2/neu protein negative) carcinoma and compared it with a group of apocrine carcinomas, which are an example of estrogen receptor/progesterone receptor negative, special type of breast carcinoma. Eighteen breast adenoid cystic carcinomas (16 primary and 2 corresponding metastases) and 18 apocrine carcinomas (16 invasive and 2 in situ) were evaluated for the expression of IMP3 protein using immunohistochemical method. A cut-off value for IMP3 positivity was set at 10%. Thirteen of 16 (81.3%) primary adenoid cystic carcinomas overexpressed IMP3 protein, predominantly in membranous distribution. The mean percentage of positive cells among primary adenoid cystic carcinomas was 50%. Both metastatic adenoid cystic carcinomas also strongly overexpressed IMP3 protein (70% and 80% of the tumor cells, respectively). In contrast, only 4 of 16 invasive apocrine carcinomas (25%) exhibited IMP3 positivity with significantly lower percentage of positive cells (27%, P<0.001). Two in-situ apocrine carcinomas were negative. Our results indicate that IMP3 may be an additional basal-type marker in breast carcinoma whose expression can be occasionally seen in other types of breast carcinomas such as apocrine type.

-Lesions with secretory features described in this review show a pathologic spectrum, sometimes even within the same lesion. As a consequence, one should employ a low threshold for recommending reexcision on a core biopsy containing benign-appearing hypersecretory glands and use all ancillary data, including clinical presentation, imaging findings, morphology, immunohistochemistry, and molecular pathology, to render a final diagnosis.