Purpose:The identification of genes and pathways that are affected by estrogenization may shed light on the mechanisms of estrogen action. Here, we describe the expression pattern of a novel estrogen-induced gene, EIG121, in distinct types of endometrial cancer. Experimental Design: EIG121was identified by cDNA microarray analysis of endometrial RNA from women receiving either placebo or estrogen replacement therapy. The expression level of EIG121 was then measured by real-time quantitative reverse transcription-PCR in benign, hyperplastic, and malignant endometrial samples. A polyclonal antibody was used to detect EIG121 protein by immunohistochemistry. Results: In postmenopausal endometrium, estrogen replacement therapy with Premarin and synthetic estrogen sulfate conjugates induced the expression of EIG1212-and 3-fold, respectively. In premenopausal endometrium, the expression of EIG121was higher in the estrogen-dominated proliferative phase than the secretory phase. In endometrial complex, hyperplasia, and endometrioid adenocarcinoma, neoplastic proliferations associated with estrogen excess, the expression of EIG121 was significantly elevated (on average 3.8-fold in hyperplasias and 21-fold in grade 1 tumors). Although the level of EIG121mRNA in grade 3 endometrioid carcinoma was still 3.5-fold of that in benign endometrium, EIG121 expression tended to decline with increasing tumor grade and disease stage. Immunohistochemistry showed faint staining of normal endometrial epithelium, but intense staining of endometrioid tumors. In sharp contrast, EIG121 expression was significantly suppressed in both uterine papillary serous carcinoma and uterine malignant mixed mullerian tumor, two tumors not associated with estrogen exposure, to <5% of the level in benign endometrium. Conclusions: Our results suggest that EIG121is a good endometrial biomarker associated with a hyperestrogenic state and estrogen-related type I endometrial adenocarcinoma.The endometrium, a complex tissue that lines the uterine cavity, is composed of both glandular and stromal elements. Endometrial carcinoma, which arises from the epithelial component, is the most common gynecologic malignancy and accounts for the majority of the estimated 40,880 new cases and 7,310 related deaths from uterine corpus cancer among women in the U.S. in 2005 (1). Clinicopathologic studies have shown that there are two major types of endometrial carcinoma: type I, an estrogen-related, low-grade endometrioid neoplasm that occurs in younger, premenopausal women and is associated with low clinical stage; and the more clinically aggressive type II, which is usually estrogen-independent, shows nonendometrioid histology, and occurs in postmenopausal women (2). Based on the distinctive clinical and histologic features of the two types of endometrial carcinomas, a dualistic model of carcinogenesis has been proposed for type I and type II tumors (3 -5). Type I endometrial carcinomas are thought to develop in response to prolonged and unopposed estrogen stimulation...