Pathological features, immunoprofile and mismatch repair protein expression status in uterine endometrioid carcinoma: focus on MELF pattern of myoinvasion

Angela Santoro, Giuseppe Angelico, Frediano Inzani, Saveria Spadola, Damiano Arciuolo, Michele Valente, Teresa Musarra, Giovanni Capelli, Francesco Fanfani, Valerio Gallotta, Giovanni Scambia, Gian Franco Zannoni

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Microcystic, elongated, and fragmented (MELF) pattern of myoinvasion has been related with increased risk of lympho-vascular space invasion (LVSI) and lymph node metastasis. We analysed a cohort of endometrioid endometrial carcinomas (EECs) to examine the relationships between the MELF pattern of invasion and the clinico-pathological and immunohistochemical features of EEC. Methods and results: 129 EECs were evaluated for the presence of MELF pattern and immunohistochemically tested for Mismatch repair (MMR) proteins, p16, p53 and beta-catenin. We observed 28 MELF + EECs and 101 MELF- EECs. LVSI was observed in 20 MELF + cases and in MELF- tumors. Lymph-node metastases were observed in 7 MELF + cases (2 macrometastases, 3 micrometastases and 2 ITCs). None of the MELF- cases showed micrometastases or ITCs, 18 cases had macrometastatic lymph-nodes. Statistical analysis showed that MELF + tumors carry an increased risk of developing nodal metastasis independent of tumor dimension and LVSI. Loss of MMR proteins expression was observed in 11 MELF + cases and 45 MELF- cases, respectively. Our data showed a higher frequency of immunohistochemical MLH1-PMS2 loss in MELF- pattern of invasion (32.67% of MELF- cases vs 21.43% of MELF + cases) but a higher prevalence of MSH2-MSH6 loss in MELF + pattern (7.14% in MELF + population vs 3.96% of MELF- population) Conclusions: The morphological recognition of MELF pattern is more reliable than immunohistochemical and molecular signatures of EEC in predicting the risk of nodal involvement. The observed higher prevalence of MSH2-MSH6 loss in MELF + group and MLH1-PMS2 loss in MELF- group may suggest a different molecular signature.

Original languageEnglish
Pages (from-to)338-345
Number of pages8
JournalEuropean Journal of Surgical Oncology
Volume47
Issue number2
DOIs
Publication statusPublished - Feb 2021

Keywords

  • Endometrial carcinoma
  • Lymph-node-metastasis
  • Lympho-vascular invasion
  • MELF
  • Microsatellite instability
  • Mismatch repair

ASJC Scopus subject areas

  • Surgery
  • Oncology

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