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Clinicopathological features of 50 mismatch repair (MMR)-deficient endometrial carcinomas, tested by immunohistochemistry: A single institutional feasibility study, India.
Ann Diagn Pathol. 2020 Jun 20; 47:151558.AD

Abstract

There are few comprehensive studies from Asia on clinicopathologic features of mismatch repair (MMR)-deficient endometrial carcinomas, including rarely from our country. One hundred and four cases of endometrial carcinomas were tested for four MMR proteins by immunohistochemistry. Among 50 MMR-deficient (MMRd) tumors(48%), age-range was 27-68 years(median = 53) and tumor size(n = 34) varied from 1.2-10 cm(average = 4.6). Lower uterine segment(LUS) was involved in 21/31 cases(67.7%). Histopathologically, all cases were endometrioid adenocarcinomas(EMACs), of FIGO grade 2(low-grade)(18 cases) and 3(high-grade)(32 cases), displaying de-differentiated, undifferentiated and lymphoepithelioma(LE)-like patterns, in 24 cases(48%). Tumor infiltration ≥ half of myometrium was seen in 30/44 cases (68.1%); lymphovascular emboli in 19/43 cases(44.1%); and lymph node metastasis in 7/22(31.8%) cases. Uncommonly, clear cell component(n = 2) and focal neuroendocrine differentiation (n = 2) were observed. Immunohistochemically, tumor cells showed paired loss of MLH1 and PMS2 in 33(66%) and MSH2 and MSH6 in 14(28%) cases, along with loss of MSH2 and PMS2, in two and a single case, respectively. Nine patients(18%) were treated for another cancer and 9/33(27.2%) disclosed familial history of cancer. MSH2 was the most frequently lost MMR protein in those cases. Additionally, tumor cells displayed ER positivity in 41/50 cases(82%), PR in 38/41cases(92.6%) and wild-type p53 staining in 24/28 cases(85.7%). Tumor with LE-pattern showed PDLI immunoexpression. Certain clinicopathologic features suggestive for MMRd associated ECs, such as relatively large-sized tumors, involving LUS; especially high-grade, infiltrative EMACs, with undifferentiated/de-differentiated, and LE-like patterns; showing deep muscle invasion, frequent PR immunoexpression and invariably, wild-type p53 immunostaining can be useful in screening cases of Lynch syndrome. This constitutes the first report on these tumors from our country.

Authors+Show Affiliations

Department of Surgical Pathology, Tata Memorial Hospital, HBNI University, Mumbai, India. Electronic address: rekhi.bharat@gmail.com.Department of Surgical Pathology, Tata Memorial Hospital, HBNI University, Mumbai, India.Department of Surgical Pathology, Tata Memorial Hospital, HBNI University, Mumbai, India.Department of Medical Oncology, Tata Memorial Hospital, HBNI University, Mumbai, India.Department of Surgical Oncology, Tata Memorial Hospital, HBNI University, Mumbai, India.Department of Radiation Oncology (Gynecology, Disease Management group), Tata Memorial Hospital, HBNI University, Mumbai, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32619922

Citation

Rekhi, Bharat, et al. "Clinicopathological Features of 50 Mismatch Repair (MMR)-deficient Endometrial Carcinomas, Tested By Immunohistochemistry: a Single Institutional Feasibility Study, India." Annals of Diagnostic Pathology, vol. 47, 2020, p. 151558.
Rekhi B, Menon S, Deodhar KK, et al. Clinicopathological features of 50 mismatch repair (MMR)-deficient endometrial carcinomas, tested by immunohistochemistry: A single institutional feasibility study, India. Ann Diagn Pathol. 2020;47:151558.
Rekhi, B., Menon, S., Deodhar, K. K., Ghosh, J., Chopra, S., & Maheshwari, A. (2020). Clinicopathological features of 50 mismatch repair (MMR)-deficient endometrial carcinomas, tested by immunohistochemistry: A single institutional feasibility study, India. Annals of Diagnostic Pathology, 47, 151558. https://doi.org/10.1016/j.anndiagpath.2020.151558
Rekhi B, et al. Clinicopathological Features of 50 Mismatch Repair (MMR)-deficient Endometrial Carcinomas, Tested By Immunohistochemistry: a Single Institutional Feasibility Study, India. Ann Diagn Pathol. 2020 Jun 20;47:151558. PubMed PMID: 32619922.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinicopathological features of 50 mismatch repair (MMR)-deficient endometrial carcinomas, tested by immunohistochemistry: A single institutional feasibility study, India. AU - Rekhi,Bharat, AU - Menon,Santosh, AU - Deodhar,Kedar K, AU - Ghosh,Jaya, AU - Chopra,Supriya, AU - Maheshwari,Amita, Y1 - 2020/06/20/ PY - 2020/05/16/received PY - 2020/05/30/revised PY - 2020/06/18/accepted PY - 2020/7/4/pubmed PY - 2020/7/4/medline PY - 2020/7/4/entrez KW - Endometrioid carcinoma KW - MMR deficient endometrial carcinoma KW - Microsatellite instability KW - Mismatch repair proteins KW - Uterine malignancy SP - 151558 EP - 151558 JF - Annals of diagnostic pathology JO - Ann Diagn Pathol VL - 47 N2 - There are few comprehensive studies from Asia on clinicopathologic features of mismatch repair (MMR)-deficient endometrial carcinomas, including rarely from our country. One hundred and four cases of endometrial carcinomas were tested for four MMR proteins by immunohistochemistry. Among 50 MMR-deficient (MMRd) tumors(48%), age-range was 27-68 years(median = 53) and tumor size(n = 34) varied from 1.2-10 cm(average = 4.6). Lower uterine segment(LUS) was involved in 21/31 cases(67.7%). Histopathologically, all cases were endometrioid adenocarcinomas(EMACs), of FIGO grade 2(low-grade)(18 cases) and 3(high-grade)(32 cases), displaying de-differentiated, undifferentiated and lymphoepithelioma(LE)-like patterns, in 24 cases(48%). Tumor infiltration ≥ half of myometrium was seen in 30/44 cases (68.1%); lymphovascular emboli in 19/43 cases(44.1%); and lymph node metastasis in 7/22(31.8%) cases. Uncommonly, clear cell component(n = 2) and focal neuroendocrine differentiation (n = 2) were observed. Immunohistochemically, tumor cells showed paired loss of MLH1 and PMS2 in 33(66%) and MSH2 and MSH6 in 14(28%) cases, along with loss of MSH2 and PMS2, in two and a single case, respectively. Nine patients(18%) were treated for another cancer and 9/33(27.2%) disclosed familial history of cancer. MSH2 was the most frequently lost MMR protein in those cases. Additionally, tumor cells displayed ER positivity in 41/50 cases(82%), PR in 38/41cases(92.6%) and wild-type p53 staining in 24/28 cases(85.7%). Tumor with LE-pattern showed PDLI immunoexpression. Certain clinicopathologic features suggestive for MMRd associated ECs, such as relatively large-sized tumors, involving LUS; especially high-grade, infiltrative EMACs, with undifferentiated/de-differentiated, and LE-like patterns; showing deep muscle invasion, frequent PR immunoexpression and invariably, wild-type p53 immunostaining can be useful in screening cases of Lynch syndrome. This constitutes the first report on these tumors from our country. SN - 1532-8198 UR - https://www.unboundmedicine.com/medline/citation/32619922/Clinicopathological_features_of_50_mismatch_repair_(MMR)-deficient_endometrial_carcinomas,_tested_by_immunohistochemistry:_A_single_institutional_feasibility_study,_India L2 - https://linkinghub.elsevier.com/retrieve/pii/S1092-9134(20)30101-5 DB - PRIME DP - Unbound Medicine ER -
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