An immunohistochemical and molecular analysis of papillary proliferation of the endometrium

Stewart, Colin J.R.; Bigby, Susan M.; Giardina, Tino; Grieu-Iacopetta, Fabienne; Amanuel, Benhur

doi:10.1016/j.pathol.2017.10.013

Cited by 10 publications

(12 citation statements)

References 30 publications

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“…Moreover, it would be now practical and feasible to evaluate the PPE lesions in the fractioned curettage specimens as the new classification only focusing on the structures of papillae, which would avoid the further overrated treatments. Previous studies indicated that the immunochemistry of p16, PAX2, and β-catenin could be abnormal in the PPE lesions with different frequencies [10]. The diffuse positive nucleus of p16 could suggest the possibility of high grade carcinoma, and the nucleus staining of β-catenin as well as the loss of PAX2 suggest the risk of endometrioid neoplasia and poorer outcomes [10,12].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, previous studies have reported the presence of KRAS mutations in PPE [ 10 , 11 ] while the results seemed to be contradictory. Stewart et al found KRAS mutations in PPE with complex branching papillae, but not in simple PPE [ 10 ]. On the contrary, Liu et al detected the high frequencies of KRAS mutations in both two groups of PPE [ 11 ].…”

Section: Introductionmentioning

confidence: 95%

“…KRAS mutations have been found to facilitate tumorigenesis in approximately 30% of all human cancers and 23% of the endometrial hyperplasia and the endometrioid carcinoma [5][6][7][8][9]. Interestingly, previous studies have reported the presence of KRAS mutations in PPE [10,11] while the results seemed to be contradictory. Stewart et al found KRAS mutations in PPE with complex branching papillae, but not in simple PPE [10].…”

Section: Introductionmentioning

confidence: 99%

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A 2-tier subdivision of papillary proliferations of the endometrium (PPE) only emphasizing the complexity of papillae precisely predicts the neoplastic risk and reflects the neoplasia-related molecular characteristics—a single-centered analysis of 207 cases

Liu

Chen

et al. 2022

Virchows Arch

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Papillary proliferation of the endometrium (PPE) is subdivided based on the complexity of the papillae and the proliferation of lesions, and the complex group is considered to have an increased risk of concurrent/subsequent endometrial neoplasia. However, the current subdivision criteria fail to prove the equivalence of the quantity of simple papillae and structural complexity. In this study, we divided PPE of 207 cases from 2014 to 2022 into 3 groups according to structural complexity and proliferation degrees: Group 1 equaled to the simple PPE with a simple papillary structure and typical localized proliferation; group 2 had the simple structure similar to group 1 but occupy over 50% of the endometrial polyp or > 2 lesions in the surface of nonpolypoid endometrium; group 3 had the truly complex branching papillae despite of its proportion. Group 3 was implicated with significantly more concurrent endometrial neoplasia (EAH and carcinoma) compared with groups 1 and 2 (P < 0.01), while no difference was found between groups 1 and 2. In 128 cases with no concurrent endometrial abnormalities in the initial biopsy or curettage specimens, 4 cases presented endometrial neoplasia (3 carcinoma and 1 atypical hyperplasia) in the subsequent specimens, all of which presented PPE of group 3 but not group 1 or 2 in the prior tissues (P < 0.01). The immunochemistry of 83 cases showed similar expressions of ER, PTEN, ARID1A, PTEN, p16, β-catenin, and p53 between PPE and the surrounding normal endometrium. Nearly 100% of PPE cases lost expressions of PR. A total of 2/83 cases showing PAX2 expression were all in the group 3 and correlated with endometrial neoplasia (2/17, 11.76%, P < 0.05). 76/83 (91.57%) of PPE lesions had KRAS mutations, and the distributions of which were similar among 3 groups. The frequency of mucinous metaplasia was significantly higher in the PPE lesions with KRAS mutations (72/74, 97.30%, P < 0.01). Group 3 showed higher frequency of single KRAS mutations compared with the combination of groups 1 and 2 (P < 0.01). Finally, the concordance of KRAS mutation profiles between PPE and endometrial neoplasia was significantly higher in group 3 than either group 1 or 2 (P < 0.01), while no difference was found between group 1 and 2. Thus, a new 2-tier subdivision system only emphasizing the complexity of papillae is recommended, which might precisely predict the risk of endometrial neoplasia and neoplasia-related molecular characteristics.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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A 2-tier subdivision of papillary proliferations of the endometrium (PPE) only emphasizing the complexity of papillae precisely predicts the neoplastic risk and reflects the neoplasia-related molecular characteristics—a single-centered analysis of 207 cases

Liu

Chen

et al. 2022

Virchows Arch

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“…6E). PPE show KRAS mutations in at least 50% of cases, 87,88 and PPE with mucinous change are more likely to display KRAS mutations than PPE without mucinous change. 88 In sampling specimens, PPE with mucinous change are not readily distinguishable from those iterations of AMGP that show intraglandular or surface protrusions of small papillae.…”

Section: Papillary Proliferation Of the Endometrium With Mucinous Changementioning

confidence: 98%

Mucinous Proliferations of the Uterine Corpus: Comprehensive Appraisal of an Evolving Spectrum of Neoplasms

Fadare¹

2022

Advances in Anatomic Pathology

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A variety of endometrial lesions may contain mucinous cells. Herein, the author reviews the literature on the classification and clinicopathologic significance of uterine corpus proliferations with a significant mucinous component, assesses the 2020 World Health Organization classification of such lesions, and presents a diagnostic framework. The key epithelial mucinous lesions include mucinous metaplasia, atypical mucinous glandular proliferation and mucinous carcinoma. Each of these categories are classifiable into "usual" and gastrointestinal subtypes, the latter being indicative of intestinal (presence of goblet cells) and/or gastric-type (abundant, pale eosinophilic or clear cytoplasm and well-defined cell borders) morphology. It has been proposed that at least focal expression of gastrointestinal immunohistochemical markers be required for all gastrointestinal type lesions, and for gastrointestinal type atypical mucinous glandular proliferation and carcinoma, minimality or absence of estrogen receptor expression, and the absence of an endometrioid component. Mucinous carcinomas of the usual type, in which > 50% of the tumor is comprised of a mucinous component, are the most common. Morphologic subtypes include mucinous carcinoma with microglandular features and mucinous carcinoma with signet rings (signet ring carcinoma). Endometrioid carcinomas with a less than a 50% mucinous component are classified as endometrioid carcinoma with mucinous differentiation. Several studies have directly compared endometrioid and mucinous carcinomas, the latter presumably of the usual type, with respect to patient outcomes after treatment. All have found no difference in overall and disease free survival between these groups. However, three major studies have found mucinous carcinomas to be associated with a higher risk of lymph node metastases. Nineteen cases of mucinous carcinoma of the gastrointestinal type have been reported, and the limited data on their follow-up after primary treatment suggests that this subtype is more clinically aggressive and should accordingly be classified separately from mucinous carcinomas of the usual type. The morphologic spectrum of mucinous carcinoma of the gastrointestinal type is unclear and continues to evolve. Mucinous change, which may sometimes be extensive, may also be associated with papillary proliferation of the endometrium, adenomyoma of the endocervical type, atypical, and typical adenomyomas. In a curettage or biopsy, intestinal type mucinous epithelium may be indicative of any of the gastrointestinal lesions mentioned above, but may also represent samplings of uterine teratomas, yolk sac tumors, genital and extragenital adenocarcinomas with intestinal differentiation, or lowgrade appendiceal mucinous neoplasms that secondarily involve the endometrium.

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“…Samples from the sigmoid carcinoma and from three different areas of the ovarian tumour including the histologically benign/borderline, expansile invasive, and infiltrative invasive components were extracted. Somatic sequence variant (mutation) analysis was performed using next generation sequencing (NGS) as previously described, 2 and the results are summarised in Table 1. The invasive components of the ovarian tumour (expansile and infiltrative) demonstrated identical TP53 sequence variants whereas the histologically benign/borderline areas demonstrated a KRAS sequence variant.…”

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confidence: 99%

Adjunct molecular analysis in the distinction of primary ovarian mucinous carcinoma from colon carcinoma metastatic to the ovary

et al. 2022

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An immunohistochemical and molecular analysis of papillary proliferation of the endometrium

Cited by 10 publications

References 30 publications

A 2-tier subdivision of papillary proliferations of the endometrium (PPE) only emphasizing the complexity of papillae precisely predicts the neoplastic risk and reflects the neoplasia-related molecular characteristics—a single-centered analysis of 207 cases

A 2-tier subdivision of papillary proliferations of the endometrium (PPE) only emphasizing the complexity of papillae precisely predicts the neoplastic risk and reflects the neoplasia-related molecular characteristics—a single-centered analysis of 207 cases

Mucinous Proliferations of the Uterine Corpus: Comprehensive Appraisal of an Evolving Spectrum of Neoplasms

Adjunct molecular analysis in the distinction of primary ovarian mucinous carcinoma from colon carcinoma metastatic to the ovary

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