The Presence of Basement Membrane Does Not Distinguish In Situ from Invasive Adenocarcinoma of the Endocervix
Brent Arville, Yoshiki Mikami, Elvio Silva. Cedars-Sinai Medical Center, Los Angeles, CA; Kyoto University Hospital, Kyoto, Japan
Background: Identifying areas of invasion in adenocarcinoma of the cervix can be difficult and it is crucial for deciding the type of surgery and additional treatment. Recently it has been proposed that laminin, a basement membrane glycoprotein composed of alpha, beta, and gamma heterotrimeric chains, might be able to distinguish in situ from invasive cases.
Design: 20 endocervical adenocarcinomas including areas of normal glands, in situ component (10 cases) and obvious invasive tumor (10 cases) were included in the study. 3 of the obvious invasive adenocarcinomas were gastric type which are known to be aggressive tumors. These 3 cases had lymph node mets which were included in the study. Anti-Laminin-5 (γ2 chain) (Millipore, clone D4B5), was applied on 4 micron thick sections from paraffin embedded tissue using the Ventana Benchmark Ultra instrument. Pretreatment was performed using Ventana Protease for 12 minutes at room temperature. Anti-Laminin-5 (1:100) was applied and stained with Ventana Ultraview DAB detection kit.
Results: 1) Normal Glands: The basement membrane of the normal epithelia was clearly stained by laminin-5 where the glands were separated; however, in areas with groups of glands laminin-5 was not continuous between glands.
2) Adenocarcinoma in situ: In adenocarcinoma in situ laminin-5 was clearly seen around single glands but was often not detected when several glands converged forming a tight group.
3) Invasive adenocarcinoma: In obvious invasive tumor some single glands also showed adjacent laminin staining, even in deep areas of the cervix and in lymph node mets.
Other factors that diminished the staining of laminin-5 were tangential sectioning of glands and inflammatory infiltrate between glands. In addition, 5 cases demonstrated a positive reaction in the cytoplasm of tumor cells which impeded the interpretation of basement membrane staining.
Conclusions: 1) Laminin-5 immunostain is positive around normal glands.
2) Laminin-5 can be difficult to identify in cases of tangential section, inflammatory infiltrate and when tumor cells show a positive reaction in the cytoplasm.
3) In adenocarcinoma in situ, laminin-5 is positive around single glands but it becomes difficult to see when glands converge to an area forming a group.
4) In invasive and metastatic adenocarcinoma single glands can show adjacent laminin staining demonstrating invasive and metastatic glands can produce basement membrane.
Category: Gynecologic & Obstetrics
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 171, Monday Morning