Juxtatumoral Stromal Reactions in Uterine Endometrioid Adenocarcinoma and Their Association with Prognostic Factors
S Wei, MG Conner, L Novak. The University of Alabama at Birmingham, Birmingham
Background: Uterine endometrioid adenocarcinoma is the most common invasive tumor of the female genital tract in the U.S. Tumor invading into myometrium frequently induces juxtatumoral stromal changes resulting in desmoplastic reaction or host inflammatory response. The aim of the study is to examine the association of different types of stromal reaction with known prognostic factors.
Design: A total of 103 consecutive cases of invasive uterine endometrioid adenocarcinoma were collected from the files at the authors' institution between 1/1/2004 and 12/31/2005. These tumors represented clinical stages IB, IC, II, III and IV (n=64, 11, 9, 15 and 4, respectively). Endometrioid adenocarcinomas with focal serous or clear cell differentiation were excluded. Tumor FIGO grade and lymphovascular invasion were noted. Desmoplastic reaction (n=25) was characterized by a new matrix formation due to activation of the juxtatumoral stromal cells. Inflammatory response (n=77) was further categorized as lymphocytic (mild, moderate and severe), plasmacytic and eosinophilic. No stromal response (n=20) represented the absence of both a desmoplastic reaction and an inflammatory response. Statistical analysis was carried out with Chi-square analysis and Fisher exact test.
Results: The presence of a desmoplastic reaction was associated with a higher FIGO grade (p<0.01) and lymphovascular invasion (p<0.05), as well as advanced clinical stage (stage IB vs. IC, p<0.01; stage I vs. II/III/IV, p<0.05). The intensity of the inflammatory lymphocytic response (no stromal reaction/mild vs. moderate/severe) was reversely associated with advanced tumor stage (I, II, III/IV; p<0.05), but not associated with tumor grade or lymphovascular invasion. In addition, no significant difference was seen between no stromal reaction and mild lymphocytic response. There was no correlation between plasmacytic or eosinphilic responses with the factors mentioned above.
Conclusions: A strong lymphocytic inflammatory stromal reponse was predominantly found in the uterine endometrioid adenocarcinomas with early clinical stages. In contrast, juxtatumoral desmoplastic reaction was mostly identified in moderately to poorly differentiated tumors with lymphovascular invasion and in advanced clinical stages. The presence of desmoplastic reaction in the stroma should prompt pathologist to a search for histologically unfavorable prognostic indicators such as lymphovascular invasion, cervical involvement and nodal metastasis.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 147, Wednesday Afternoon