Coordinate patterns of estrogen receptor, progesterone receptor, and Wilms tumor 1 expression in the histopathologic distinction of ovarian from endometrial serous adenocarcinomas

Ann Diagn Pathol. 2013 Oct;17(5):430-3. doi: 10.1016/j.anndiagpath.2013.04.011. Epub 2013 May 21.

Abstract

The purpose of this study is to assess whether composite or coordinate immunoexpression patterns of estrogen receptor (ER), progesterone receptor (PR), and Wilms tumor 1 (WT1) gene can significantly distinguish between endometrial serous carcinoma (ESC) and ovarian serous carcinoma (OSC). Immunohistochemical analyses were performed on whole tissue sections from 22 uterus-confined ESCs and on a tissue microarray of 140 high-grade, pan-stage OSCs, using antibodies to ER, PR, and WT-1. Estrogen receptor, PR, and WT1 expressions were present in 37%, 49%, and 81% of OSC, respectively, but these markers were also present in 18%, 27%, and 36% of ESC. The ER+/PR+/WT1+ coordinate profile was identified in 33.6% of OSC but in none of ESC (P = .0006), resulting in a calculated sensitivity and specificity of this profile for OSC of 33.6% and 100%, respectively. By contrast, the ER-/PR-/WT1- coordinate profile was identified in 41% of ESC but in only 6.4% of OSC (P = .0001), resulting in a calculated sensitivity and specificity of this profile for ESC of 50% and 94%. In summary, in the differential diagnosis between OSC and ESC, positivity for all 3 markers favors an extrauterine origin, whereas negativity for all 3 markers is supportive of an endometrial origin. The use of single markers for this purpose is not recommended, as each lacks optimal discriminatory power. Coordinate profiles, in general, have a high specificity but low sensitivity in this differential diagnosis.

Keywords: Estrogen receptor; Progesterone receptor; Serous carcinoma; WT1.

MeSH terms

  • Biomarkers, Tumor / analysis*
  • Cystadenocarcinoma, Serous / diagnosis*
  • Cystadenocarcinoma, Serous / metabolism
  • Diagnosis, Differential
  • Endometrial Neoplasms / diagnosis*
  • Endometrial Neoplasms / metabolism
  • Female
  • Humans
  • Immunohistochemistry
  • Ovarian Neoplasms / diagnosis*
  • Ovarian Neoplasms / metabolism
  • Receptors, Estrogen / analysis
  • Receptors, Estrogen / biosynthesis
  • Receptors, Progesterone / analysis
  • Receptors, Progesterone / biosynthesis
  • Sensitivity and Specificity
  • Tissue Array Analysis
  • WT1 Proteins / analysis
  • WT1 Proteins / biosynthesis

Substances

  • Biomarkers, Tumor
  • Receptors, Estrogen
  • Receptors, Progesterone
  • WT1 Proteins
  • WT1 protein, human