Farveen Marican, Abu Backer Maricar
(2010)
Expressions of pl6ink4a, p27kipl and p21 waf1
in differentiating primary
adenocarcinoma of endocervix from
endometrium.
Masters thesis, Universiti Sains Malaysia.
Abstract
The distinction between an endocervical adenocarcinoma (ECA) and an endometrial
adenocarcinoma (EMA) can be problematic on small biopsies or when there is tumor in
both endocervical and endometrial specimens or when the tumor has extended into the
lower uterine segment. The judgment is difficult to be based on histomorphology alone
because these tumors can have similar histologic appearance. We investigated the value of pl6INK4a, p21WAFl and p27kipl immunohistochemistry
for distinguishing ECA and an EMA. We immunostained tissue sections of archival
samples from 2005 to 2008 from HUSM and HSB. The immunohistochemical staining
scores were correlated with their clinicopathologic parameters. There were 40 ECA and 92 EMA cases examined. We observed significant higher
expressions of pl6INK4a and p27kipl ([p <0.001] (80% versus 25%) and [p=0.001] (43%
versus 15%)) in ECA than in EMA. ECA could be differentiated from EMA based on the
combination expressions of pl6INK4a and p 27kipl. p21WAFl expression did not
differentiate these two carcinomas (70% versus 78%, p=0.312). There was significant
association seen between negative pl6INK4a expression and low histologic grade in EMA
(p=0.014). In ECA, p21WAFl expression shows significant association with corpus
infiltration (p-0.043) while negative p27kipl expression with lymph node invasion
(p=0.030). Multivariate analysis however shows no association between lymph node
invasion and p27kipl expression adjusted by race, histologic grade, vascular invasion, p21WAF1 expression and extension into the uterine corpus.
In conclusions, combination of p!6INK4a and p27kipl expression is helpful in
differentiating ECA from EMA. In small biopsy, the expression of p21WAFl may help in
assessing the presence of corpus infiltration. P27kipl expression is helpful in predicting
presence of lymph node invasion.
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