Immunohistochemical Expression of Different Sub-Types of Cytokeratins by Endometrial Stromal Sarcoma


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Iolia Akaev1,Siavash Rahimi2,Carla Marani3,Mridula Chopra1,Chit Cheng Yeoh2
1University of Portsmouth,2Portsmouth Hospitals NHS Trust,3San Carlo di Nancy Hospital

Abstract

Background

Endometrial stromal sarcomas (ESS) are rare and understudied gynaecological mesenchymal neoplasms. These tumours can be confused with many other gynaecological and not-gynaecological tumours due to their variegated morphological appearance and non-specific immunohistochemical profile.

ESS can express cytokeratin (CK) and, therefore, may be misdiagnosed as carcinoma especially in extra-uterine locations and when recurrence/metastasis is present.

The aim was to analyse the expression of a broad spectrum of common CKs antibodies in a series of two types of ESS. The relationship of CKs expression with CD10, oestrogen receptor (ER), progesterone receptor (PR), and cyclin D1 was also investigated.

Method

Immunohistochemical expression of AE1/3, CAM5.2, HMCK, MNF116, CK5, CK6, CK7, CK8/18, CK14, CK17, CK19, and CK20 in six low grade (LG) and five high grade (HG) ESS was investigated.

Additionally, staining for ER, PR, CD10 and Cyclin D1 was performed. Automated Immunohistochemistry staining was performed on Bond III Immunohistostainer.

Results

Our results showed that CKs AE1/3, CM 5.2, MNF116, and CK8/18 are more expressed in LG ESS, whereas HG ESS express more AE1/3 and CM 5.2.

CD10 was positive in all LG and HG ESSs. ER ad PR expression was variable, but with more positive cases in LGESSs. Cyclin D1 was positive in all HGESSs and negative in all LGESSs.

No relationship was found between the expression of CKs and ER, PR, CD10 and Cyclin D1.

Conclusion

Among the broad spectrum of CKs, the most diagnostically useful for both LG and HG ESS were AE1/3, MNF116, CAM 5.2, and CK8/18. There was no significant difference between LG and HG ESS in terms of expression of CKs subtypes.

In problematic cases, especially in recurrences or metastases, the immunohistochemical panel of antibodies AE1/3, MNF116, CAM 5.2, and CK8/18, together with CD10, cyclin D1, ER, and PR, may be helpful in the differential diagnosis between ESS and other malignancies.