Immunohistochemical study of ER, PR, p53 and Ki67 expression in patients with endometrial adenocarcinoma and atypical endometrial hyperplasia

Abstract

To study Immunohistochemistry pattern of ER, PR, p53 and Ki67 expression in patients with endometrial adenocarcinoma (EC) and endometrial hyperplasia. A retrospective study of 78 cases were studied for a period of 02 year from June 2018 to May 2020, where in the clinical data included age, presenting complaints, menopausal status, history of hormonal treatment, ultrasound examination.Histopathological parameters were analysed as per WHO 2014 classification of endometrial hyperplasia into typical and atypical endometrial hyperplasia / Endometrial Intraepithelial Neoplasia (EIN) and endometrial carcinoma. ER, PR, p53 and Ki 67 IHC markers were done on cases diagnosed as endometrial adenocarcinoma and endometrial hyperplasia. Among 78 cases, there were 20 cases of EC and 58 cases of endometrial hyperplasia. EC was most commonly seen in sixth to seventh decade and hyperplasia was seen in fourth to fifth decade .There were 11 surgical specimens and 09 biopsies of EC. Out of total 20 cases, there were 17 cases of endometrioid adenocarcinoma and 03 cases were of papillary serous adenocarcinoma.ER, PR expression was seen in 10 cases of grade 1 endometrial carcinomas and 5 cases of grade 2 EC. p53 expression was seen in 01 case of grade 1 EC and 03 cases grade 3 EC. ER, PR, p53 all were negative in one case. Ki67 was <10% in 11 cases, between 10-20% in 5 cases and >20% in 04 cases. We followed up 15 out of 20 cases, out of which only 01 patient died of disease who was grade 1 endometrial carcinoma. Rest 14 had progression free survival (PFS) till date.All 58 cases of endometrial hyperplasia were reclassified complex and simple hyperplasia to typical and atypical hyperplasia (as per WHO Classification 2014). Out of 58 cases, 56 cases were typical hyperplasia and 02 cases atypical hyperplasia. ER, PR expression was positive in all the cases of typical and atypical hyperplasia. p53 expression was absent in typical and atypical hyperplasia with low Ki 67 index (<10%). High ER, PR expression along with low p53 was seen in type 1 endometrial carcinomas compared to low or absent ER, PR along with strong p53 expression in papillary serous carcinoma (Type 2). The expression of ER, PR was high in typical hyperplasia as against high p53 expression observed in atypical hyperplasia.