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P4. Differentiating clear cell adenocarcinoma from serous and endometrioid adenocarcinoma in the ovary

Susanne Maria Vesterkær, Lykke Grubach, Rasmus Røge, Søren Nielsen, Anni Grove

Institute of Pathology, Aalborg University Hospital, Aalborg, Denmark

Objective: To evaluate whether the immunohistochemical markers Hepatic Nuclear Factor 1b (HNF-1b), Wilms´tumor 1 (WT1), Estrogen Receptor α (ER), Glypican 3 (GLYP3) and Insulin-Like Growth Factor Binding Protein 1 (IGFBP-1), could differentiate the ovarian adenocarcinoma subtype clear cell adenocarcinoma (CCC) from serous and endometrioid adenocarcinoma more accurately than morphology alone, since clear cell adenocarcinoma in advanced stage has a worse prognosis than the other subtypes.

Design: Method study.

Settings: Only pure adenocarcinoma subtypes diagnosed on primary surgical specimens from the Department of Gynaecology and Obstetrics, Aalborg University Hospital were included. All speciments were obtained from 1.1.1990-31.12.2012.

Population: 30 cases of serous adenocarcinoma, Silverberg grade 2, 29 cases of serous adenocarcinoma, Silverberg grade 3, 22 cases of endometrioid adenocarcinoma, Silverberg grade 2 and 3, 33 cases of CCC.

Methods: TMA blocks were made for each adenocarcinoma subtype and stained with HE, HNF-1β, WT1, ER, Glyp3 and IGFBP-1.

Main outcome measures: Staining intensity and extension was evaluated using the H-score method.

Results: In our hands, GLYP3 and IGFBP-1 were overlapping in all of the adenocarcinoma subtypes. WT1 showed a median H-score of approximately 250 in grade 2 and 3 serous adenocarcinomas, while close to zero in endometrioid and clear cell adenocarcinomas.
ER median H-score in serous and endometrioid adenocarcinomas were approximately 180, but close to zero in clear cell adenocarcinomas.
The median H-score concerning HNF-1b was 250 in clear cell adenocarcinomas, 90 in endometrioid adenocarcinomas and close to zero in serous adenocarcinomas.

Conclusion: We demonstrate that in discriminating CCC from serous and endometrioid adenocarcinomas, HNF-1b, WT1 and ER proved very useful. Thus, the typical profile of CCC is HNF-1b positive and WT1 and ER negative. Though, as expression profiles overlap between subtypes, morphology is still essential to take into account in the diagnostic settings.

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