Myoinvasive Pattern as a Prognostic Marker in Low-Grade, Early-Stage Endometrioid Endometrial Carcinoma

Abstract

Low-grade and early Federation for Gynecology and Obstetrics (FIGO) stage endometrioid endometrial carcinomas (EEC) have an excellent prognosis. However, approximately 10% of patients develop recurrence, which cannot be correctly predicted at diagnosis. We evaluated myoinvasive patterns as a prognostic factor of relapse in low-grade, early-stage EEC. Two-hundred and fifty-eight cases were selected according to the following inclusion criteria: (i) endometrioid endometrial carcinomas, (ii) grade 1 or 2 with (iii) FIGO stage I or II, and (iv) clinical follow-up. Slides were reviewed to annotate the myoinvasive pattern present in each case (infiltrative glands, microcystic, elongated and fragmented –MELF-, broad front, adenomyosis-like and adenoma malignum). Microsatellite instability was studied by immunoexpression of mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6). There were 29 recurrences (11.2%) among the 258 cases analysed. A predominant broad front myoinvasive pattern was significantly associated with tumour relapse (p = 0.003). The presence of a pattern of infiltrative glands (p = 0.001) and microsatellite instability (p = 0.004) were associated with lower disease-free survival, without having an impact on overall survival. Our observations suggest the potential value of the pattern of myoinvasion as a prognostic factor in low-grade, early-stage endometrioid endometrial carcinoma.

Proteomic Analysis of Low-Grade, Early-Stage Endometrial Carcinoma Reveals New Dysregulated Pathways Associated with Cell Death and Cell Signaling

“…Two representative cores of 1.2 mm were obtained from the selected areas of the paraffin block. The tissue cores were arrayed into a receptor paraffin block using a tissue array (TMA) Workstation (Beecher instruments, Silver Spring, MD, USA), as previously described [ 55 ]. A total of 265 patients had available tissue for TMA construction, and 14 TMAs containing tumor tissue cores were constructed.…”

“…Any spot not fulfilling quality standards was not considered in further analyses. Complete description of the cohort’s clinical characteristics can be found in a previously published article [ 55 ].…”

Liquid biopsy in endometrial cancer

“…In 2013, the Cancer Genome Atlas Research Network (TCGA) suggested implementing a classification with molecular characterization [10] , which can be useful to define targeted therapy and monitor cancer development and treatment; nevertheless, today, there are no targeted therapies: in fact, there is no molecular target for treatment, detection, or monitoring [11] . LB represents a novel tool, due to the minimally invasive-or non-invasive procedure for biomarker collection, overcoming the limit of classical tissue biopsy and allowing the monitoring of tumor burden, the efficacy of therapy, the arise of resistance, and the development of cancer change, relapse, and metastasis.…”

“…Moreover, there are currently no targeted therapies: in fact, there is no molecular target for treatment, detection, or monitoring. Finally, 75% of patients have early-stage, low-grade endometrial endometrioid carcinoma (EEC), which can be treated by surgery; however, about 15% of patients develop recurrence, which cannot be correctly predicted at diagnosis [11] .…”

Clinicopathological and Molecular Differences Between Gastric-type Mucinous Carcinoma and Usual-type Endocervical Adenocarcinoma of the Uterine Cervix

“…Since this pattern of invasion is not familiar to pathologists, for accurate diagnosis, they must know that the MELF invasion pattern can be observed in UEA. Many previous studies reported that the MELF invasion pattern is significantly related to more frequent lymphovascular invasion and isolated tumor lymph node metastasis, as well as poor prognosis of patients with endometrial carcinoma (42,43). Espinosa et al (44) observed that MELF-positive endometrioid carcinoma cases had more frequent lymph node metastases than those without MELF.…”