High expression of SALL4 and fascin, and loss of E-cadherin expression in undifferentiated/dedifferentiated carcinomas of the endometrium

Abstract

Undifferentiated/dedifferentiated endometrial carcinomas (UCE/DCEs) of the endometrium are rare tumors with poor prognosis. There are few clinicopathologic studies with detailed immunohistochemical analysis regarding UCE/DCEs.We evaluated the diagnostic value of a selected tumor stem-cell marker and epithelial-mesenchymal transition (EMT) markers, in addition to previously studied markers in identifying UCE/DCEs from other types of high-grade endometrial carcinomas.Eleven cases of UCE/DCEs with complete clinical follow-up that were diagnosed between 2006 and 2015 were included in the study. For immunohistochemical comparison, 11 clinically matched cases for each type of other high-grade endometrial carcinomas (high-grade endometrioid (F3-EC), serous [SC], and clear cell carcinoma [CCC]) were used as a control group. An immunohistochemical analysis including fascin, SALL4, E-cadherin, and β-catenin, in addition to epithelial and neuroendocrine markers was performed in each case.The majority of UCE/DCEs displayed diffuse expression of fascin (81.9%) and loss of E-cadherin expression (54.5%). SALL4 expression was detected in 36.3% of the UCE/DCE cases. SALL4 expression was significantly more frequent in UCE/DCEs than all other high-grade carcinomas (P < 0.001). Loss of E-cadherin and fascin expression was significantly more frequent in UCE/DCEs than high-grade endometrioid and clear cell adenocarcinomas (P = 0.012, 0.014 and P = 0.01, 0.003, respectively).We suggest that loss of E-cadherin expression together with fascin and SALL4 immunopositivity in addition to morphologic features have an impact in differential diagnosis of UCE/DCEs from other high-grade endometrial carcinomas.

Undifferentiated endometrial carcinoma arising in the background of high‐grade endometrial carcinoma – Expanding the definition of dedifferentiated endometrial carcinoma

“…These results mirror those published in the DEC-LG literature, showing that loss of epithelial markers, PAX8 and ER are in keeping with the process of dedifferentiation. 5,6,17,26 We have also investigated the expression of claudin-4, an epithelial tight junction protein previously shown to be lost in DEC-LG, predominantly in the SWI/SNF-deficient subset. 27 We have found a similar expression pattern in our series, with predominantly negative staining in the DEC component of both LG and HG groups.…”

Dedifferentiated endometrioid adenocarcinoma; clinicopathologic and immunohistochemical features of five cases

“…Silva et al ( 1 ) described morphologic features of DEAC in 2006 and it was included in the 2014 version of the book, ‘World Health Organization Classification of the Tumors of Female Reproductive Organs’ ( 5 ). Although DEAC is generally presented as case reports, a series of such tumors was recently reported in the literature ( 6 , 7 , 8 , 9 , 10 , 11 , 12 ). DEAC primarily occurs during the 6 th and 7 th decades; consistent with previous studies, the mean age at diagnosis in our study was 58 years ( 11 , 12 , 13 , 14 , 15 ).…”

“…Although DEAC is generally presented as case reports, a series of such tumors was recently reported in the literature ( 6 , 7 , 8 , 9 , 10 , 11 , 12 ). DEAC primarily occurs during the 6 th and 7 th decades; consistent with previous studies, the mean age at diagnosis in our study was 58 years ( 11 , 12 , 13 , 14 , 15 ). Similar to existing studies, all patients in our study underwent TAH+BSO and PL ( 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ).…”

Dedifferentiated endometrial carcinoma: an ongoing diagnostic dilemma

“…Stewart et al [19] found diffuse fascin expression in the undifferentiated component of 94% of cases of dedifferentiated endometrial carcinomas. Onder et al [20] found diffuse expression of fascin in 82% of cases and loss of E-cadherin expression in 55% of cases.…”