Uterus

Abstract

This chapter is an overview of frequently used markers in the differential diagnosis of both common and less common tumors of the uterine cervix and corpus, with a focus on the effective markers employed to differentiate adenocarcinoma of the endocervix vs. endometrium, low-grade vs. high-grade endometrial neoplasms, benign vs. malignant mimics of cervical and endometrial lesions. Other useful panels in the differential diagnosis of undifferentiated tumors of the uterine corpus and gestational trophoblastic lesions in addition to the less common carcinomas of the cervix are also addressed. There are 43 tables in this chapter with immunohistochemical markers answering questions that may arise when examining hematoxylin and eosin-stained sections. A summary of useful and frequently used markers with potential pitfalls is also provided. The effective diagnostic panels of antibodies for several entities are highlighted in several tables.

Frequently Asked Questions

• 19.1. Summary of applications and limitations of useful markers (Table 19.1)

  Table 19.1 Summary of applications and limitations of useful markers

• 19.2. Summary of useful markers in common tumors (Table 19.2)

  Table 19.2 Summary of useful markers in common tumors (most commonly used markers are shaded)

• 19.3. Markers for normal and non-neoplastic lesions of the cervix (Table 19.3)

  Table 19.3 Markers for normal and non-neoplastic lesions of the cervix

  Fig. 19.1

  

  Mesonephric remnant hyperplasia (a), with diffuse positive vimentin (b), and luminal CD10 positivity (c)

• 19.4. Markers for normal and non-neoplastic lesions of the endometrium (Table 19.4)

  Table 19.4 Markers for normal and non-neoplastic lesions of the endometrium

  Fig. 19.2

  

  Endometrial squamous metaplasia with lack of CEA staining (a), patchy staining pattern with p16 (b), and lack of staining with vimentin in the metaplastic foci (c)

• 19.5. Markers for cervical high grade squamous intraepithelial lesion (Table 19.5)

  Table 19.5 Markers for cervical high grade squamous intraepithelial lesion

  Fig. 19.3

  

  High grade SIL on H & E (a), with full thickness and intense nuclear staining with p16 (b), and increased Ki-67 proliferative index involving upper layers (c)

• 19.6. Markers for in-situ endocervical adenocarcinoma (Table 19.6)

  Table 19.6 Markers for in-situ endocervical adenocarcinoma (most commonly used are shaded)

  Fig. 19.4

  

  Adenocarcinoma in-situ of the endocervix on H & E (a), with CEA positive staining (b), diffuse and intense p16 nuclear and cytoplasmic staining (c), and increased Ki-67 proliferative index (d)

• 19.7. Markers for invasive squamous cell carcinoma of cervix (Table 19.7)

  Table 19.7 Markers for invasive squamous cell carcinoma of the cervix

• 19.8. Markers for invasive endocervical (mucinous) and endometrioid adenocarcinoma of cervix (Table 19.8)

  Table 19.8 Markers for invasive endocervical (mucinous) and endometrioid adenocarcinoma of cervix

  Fig. 19.5

  

  Invasive endocervical adenocarcinoma on H & E (a), with p16 diffuse and intense positive staining (b) and positive inclusions by in-situ hybridization for HPV (c)

• 19.9. Markers for in-situ and invasive intestinal-type endocervical adenocarcinoma (Table 19.9)

  Table 19.9 Markers for in-situ and invasive intestinal-type endocervical adenocarcinoma

• 19.10. Markers for minimal deviation adenocarcinoma of the cervix (Table 19.10)

  Table 19.10 Markers for Minimal deviation adenocarcinoma of the cervix

• 19.11. Markers for small cell poorly differentiated carcinoma of the uterine cervix (Table 19.11)

  Table 19.11 Markers for small cell poorly differentiated carcinomas of the uterine cervix

• 19.12. Markers for mesonephric adenocarcinoma of cervix (Table 19.12)

  Table 19.12 Markers for mesonephric adenocarcinoma of cervix

  Fig. 19.6

  

  Mesonephric carcinoma on H & E (a) and positive vimentin (b)

• 19.13. Markers for endometrioid adenocarcinoma of the endometrium (Table 19.13)

  Table 19.13 Markers for endometrioid adenocarcinoma of the endometrium

  Fig. 19.7

  

  Intense vimentin staining in endometrioid adenocarcinoma

• 19.14. Markers for serous carcinoma of the endometrium and putative precursors EIC (Table 19.14)

  Table 19.14 Markers for serous carcinoma of the endometrium and putative precursors EIC EIC (most commonly used shaded)

• 19.15. Markers for clear cell carcinoma of the endometrium (Table 19.15)

  Table 19.15 Markers for clear cell carcinoma of the endometrium^a

• 19.16. Markers for carcinosarcoma of the endometrium (Table 19.16)

  Table 19.16 Markers for Carcinosarcoma of the endometrium^a,b,c

• 19.17. Markers for atypical polypoid adenomyoma (Table 19.17)

  Table 19.17 Markers for atypical polypoid adenomyoma (most commonly used shaded)

• 19.18. Markers for stromal nodule and low grade endometrial stromal sarcoma (Table 19.18)

  Table 19.18 Markers for stromal nodule and low grade endometrial stromal sarcoma^a,b

• 19.19. Markers for high grade endometrial stromal sarcoma (Table 19.19)

  Table 19.19 Markers for high grade endometrial stromal sarcoma^a,b

• 19.20. Markers for undifferentiated uterine sarcoma (Table 19.20)

  Table 19.20 Markers for undifferentiated uterine sarcoma^a

• 19.21. Markers for low grade müllerian adenosarcoma (stromal component) (Table 19.21)

  Table 19.21 Markers for low grade müllerian adenosarcoma^a (stromal component)

• 19.22. Markers for uterine smooth muscle tumors (Table 19.22)

  Table 19.22 Markers for uterine smooth muscle tumors

• 19.23. Markers for adenomatoid tumor (Table 19.23)

  Table 19.23 Markers for adenomatoid tumor

• 19.24. Markers for PECOMAs (Table 19.24)

  Table 19.24 Markers for PECOMAs

• 19.25. Markers for gestational trophoblastic lesions (Table 19.25)

  Table 19.25 Markers for gestational trophoblastic lesions

• 19.26. Differentiating high grade SIL of cervix from benign mimics and low grade SIL (Table 19.26)

  Table 19.26 Differentiating high grade SIL from benign mimics and low grade SIL

• 19.27. Differentiating in-situ adenocarcinoma of cervix from endometriosis (Table 19.27)

  Table 19.27 Differentiating in-situ adenocarcinoma of cervix and endometriosis or tubal-endometrial metaplasia

• 19.28. Differential diagnosis of cervical microglandular hyperplasia (Table 19.28)

  Table 19.28 Differential diagnosis of cervical microglandular hyperplasia

• 19.29. Endocervical vs. low grade endometrial adenocarcinoma (Table 19.29)

  Table 19.29 Endocervical vs. low grade endometrial adenocarcinoma^a

• 19.30. Differentiating Epithelioid Trophoblastic Tumor and cervical squamous cell carcinoma (Table 19.30)

  Table 19.30 Differentiating epithelioid trophoblastic tumor and cervical squamous cell carcinoma (most commonly used shaded)

• 19.31. Differentiating adenoid cystic, adenoid basal, basaloid squamous cell, and small cell neuroendocrine carcinomas (Table 19.31)

  Table 19.31 Differentiating adenoid cystic (ACC), adenoid basal (ABC), basaloid squamous cell (BSCC), and small cell neuroendocrine (SCNEC) carcinomas^a

• 19.32. Arias-Stella reaction and clear cell carcinoma of endometrium (Table 19.32)

  Table 19.32 Arias-Stella reaction and clear cell carcinoma of endometrium^a

• 19.33. Endometrial adenocarcinoma and carcinosarcoma (MMMT) (Table 19.33)

  Table 19.33 Endometrial adenocarcinoma and carcinosarcoma (MMMT)^a

• 19.34. Clear cell carcinoma vs malignant mimics with clear cytoplasm (glycogen rich squamous cell carcinoma, clear cell sarcoma, metastatic renal cell carcinoma and yolk sac tumor) (Table 19.34)

  Table 19.34 Clear cell carcinoma (CCC) vs. malignant mimics with clear cytoplasm [glycogen rich squamous cell carcinoma (GRSCC), clear cell sarcoma (CCS), metastatic renal cell carcinoma (MCCRCC) and yolk sac tumor (YST)]

• 19.35. Endometrial serous vs endometrioid and clear cell adenocarcinoma (Table 19.35)

  Table 19.35 Endometrial serous vs endometrioid and clear cell adenocarcinoma

• 19.36. Useful markers in the differential diagnosis of endometrial undifferentiated carcinoma (Table 19.36)

  Table 19.36 Useful markers in the differential diagnosis of endometrial undifferentiated carcinoma (UC)

• 19.37. Differentiating leiomyosarcoma and endometrial stromal sarcoma (Table 19.37)

  Table 19.37 Differentiating leiomyosarcoma and endometrial stromal sarcoma (ESS)

• 19.38. Differentiating Leiomyosarcoma and PEComa (Table 19.38)

  Table 19.38 Differentiating leiomyosarcoma and PEComa

• 19.39. Differentiating leiomyosarcoma, gastrointestinal stromal tumor, inflammatory myofibroblastic tumor, and spindle cell rhabdomyosarcoma (Table 19.39)

  Table 19.39 Differentiating leiomyosarcoma (LMS), gastrointestinal stromal tumor (GIST), inflammatory myofibroblastic tumor (IMT), and spindle cell rhabdomyosarcoma (RHABDO)

• 19.40. Complete hydatidiform mole and partial hydatidiform mole (Table 19.40)

  Table 19.40 Complete hydatidiform and partial hydatidiform mole

• 19.41. Epithelioid trophoblastic tumor and poorly differentiated endometrial adenocarcinoma (Table 19.41)

  Table 19.41 Epithelioid trophoblastic tumor and poorly differentiated endometrial adenocarcinoma

• 19.42. Differentiating placental site trophoblastic tumors and mimics (exaggerated placental site, epithelioid trophoblastic tumor, choriocarcinoma, epithelioid smooth muscle tumor, and metastatic carcinoma) (Table 19.42)

  Table 19.42 Differentiating placental site trophoblastic tumor and mimics [exaggerated placental site (EPS), epithelioid trophoblastic tumor (ETT), choriocarcinoma (CC), epithelioid smooth muscle tumor (ESMT), metastatic carcinoma (MC) and Malignant Melanoma (MM)]

  Fig. 19.8

  

  Exaggerated placental site on H & E (a) with negative Ki-67 (b) compared to Choriocarcinoma on H & E (c) that demonstrates extremely elevated Ki-67 proliferative indes (d)

• 19.43. Summary of common markers of primary uterine carcinoma and the more common metastatic carcinomas (Table 19.43)

  Table 19.43 Summary of common markers of primary uterine carcinoma and the more common metastatic carcinomas (recommended markers highlighted)

Note for All Tables

Note: “+”, usually greater than 70 % of cases are positive; “−”, less than 5 % of cases are positive; “+ or −”, usually more than 50 % of cases are positive; “− or +”, less than 50 % of cases are positive. ND no data available, V variable.