The Immunoexpressions of Biomarkers (p16, Ki67, and ProExC) Are Beneficial for the Differential Diagnosis of Transitional Cell Metaplasia from High Grade Cervical Intraepithelial Neoplasia of the Uterine Cervix in Perimenopausal and Postmenopausal Women
SH Park, YH Lee, KR Kim. University of Ulsan College of Medicine, Seoul, Republic of Korea
Background: Transitional cell metaplasia (TCM), usually occuring in peri/postmenopausal women, is often misdiagnosed as high grade intraepithelial neoplasia (HGCIN) and thus can lead to unnecessary treatment. We have often encountered patients showing HGCIN associated with TCM in the background epithelium in the LEEP conization specimens and have thus difficulty in the determining the extent of their disease, especially when HGCIN showed grooved nuclei or TCM had nuclear atypia. To define the characteristics of TCM, we compared the histological findings and immunohistochemical expressions of p16 (CINtecR), Ki67, and ProExTMC in various lesions, including TCM, HGCIN, senile atrophy, and normal exocervical mucosa in peri/postmenopausal women.
Design: Of 337 LEEP conization specimens from patients aged 50 or older during the period 2006-2007, TCM (n=29) with or without HGCIN, HGCIN (n=33), senile atrophy (n=23), and normal cervical epithelium (n=13) were retrieved, and compared their histological findings and the immunohistochemical expression patterns of p16 (CINtecR), Ki67, and ProExTMC.
Results: As TCM showed occasional nuclear enlargement (41.4%), clear cytoplasm (75.9%), and frequent endocervical glandular involvement (48.2%) as seen in the cervical intraepithelial neoplasia, while HGCIN showed elongated grooved nuclei (48.5%) as seen in TCM, this often caused difficulty in arriving at the differential diagnosis. Ki-67 positive cells were mostly confined to the basal layer in all cases of TCM and senile atrophy, but occasionally only a few more Ki-67 positive cells were scattered in the upper layers of the TCM. P16 (CINtecR), and ProExTMC expressions were absent in all cases of TCM and senile atrophy, in contrast to HGCIN. In the vicinity of HGCIN, thin epithelium composed of cells having mild to moderate nuclear atypia without mitoses showed immunopositivities for Ki-67, p16 (CINtecR), and ProExTMC throughout the entire thickness, thus suggesting that atrophic HGCIN in peri/postmenopausal women may have lower levels of nuclear atypia and mitoses compared to those in younger women.
Conclusions: In our study, TCM and senile atrophy showed similar expression patterns of biomarkers that are distinguishable from HGCIN, thus suggesting that TCM may be a form of atrophy and that the biomerkers are very useful in the differential diagnosis in some difficult cases.
Tuesday, March 10, 2009 1:30 PM
Platform Session: Section C, Tuesday Afternoon