Use of IHC Markers to Distinguish Endometrial Clear Cell Carcinoma From Its Morphologic Mimics

2021-04-23

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The diagnosis of clear cell (CC) carcinoma of the endometrium can be challenging, especially when endometrioid (EC) and serous (SC) endometrial cancers exhibit nonspecific clear cell changes in carcinomas with mixed histology and in the setting of Arias-Stella reaction. The authors conducted a study to assess the classic CC IHC markers napsin A, HNF-1β, and estrogen receptor (ER) and the two recent novel markers cystathionine gamma-lyase (CTH) and arginosuccinate synthase (ASS1) for their utility in distinguishing CC from its morphologic mimics. For the study, tissue microarrays containing 64 CC, 128 EC, five EC with clear-cell changes, 16 SC, five mixed carcinomas, and 11 whole Arias-Stella reaction (ASR) sections were stained. Twelve additional examples of ASR were stained subsequently. A cutoff of 70 percent and moderate intensity were used for HNF-1β; 80 percent of cells and strong intensity were used for CTH; and any staining was considered positive for the remaining markers. HNF-1β, napsin A and CTH performed well for differentiating CC from pure EC and SC. HNF-1β had higher specificity (99.3 versus 95.1 percent) but lower sensitivity (55.8 versus 73.1 percent) than napsin A. CTH did not substantially outperform HNF-1β or napsin A (sensitivity, 51.9 percent; specificity, 99.3 percent). ASS1 and ER were not helpful (specificity, 60.1 and 22.6 percent, respectively). HNF-1β, napsin A and CTH stained a large proportion of ASR and were not useful for differentiating CC from ASR. However, ER positivity and ASS1 negativity were helpful for identifying ASR (specificity, 88.2 and 95.1 percent, respectively). EC with clear-cell changes exhibited IHC patterns similar to pure EC (HNF-1β-, ER+, and CTH-). No markers were useful for confirming the CC components in mixed carcinomas.

napsin A https://www.celnovte.com/napsin-a/

ER https://www.celnovte.com/estrogen-receptor-er/

Reference

International Journal of Gynecological Pathology ( IF 1.797 ) Pub Date : 2020-07-01 , DOI: 10.1097/pgp.0000000000000609
Jennifer X Ji,Dawn R Cochrane,Basile Tessier-Cloutier,Samuel Leung,Angela S Cheng,Christine Chow,Blake Gilks,David G Huntsman,Lynn N Hoang

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