Article Text

Download PDFPDF
Comparative Use of Napsin A and Glypican 3 to Distinguish Endometrial Clear Cell from Serous and Endometrioid Carcinomas
  1. Eirwen M. Miller, MD*,,
  2. Joan Tymon-Rosario, MD,
  3. Jaya Sunkara, PhD, HTL (ASCP)§,
  4. Bryan E. Harmon, MD§,
  5. Rouzan G. Karabakhtsian, MD, PhD§ and
  6. Akiva P. Novetsky, MD, MS*
  1. *Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY;
  2. Present address: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA;
  3. Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; and
  4. §Department of Pathology and Laboratory Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
  1. Address correspondence and reprint requests to Eirwen M. Miller, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Western Pennsylvania Hospital, Allegheny Health Network, 4815 Liberty Ave, Suite GR30, Pittsburgh, PA 15224. E-mail: eirwen.m.miller{at}gmail.com.

Abstract

Objective Diagnosis of endometrial clear cell carcinomas is difficult owing to the low reproducibility of histological cell type in high-grade endometrial cancers. Recently, immunoreactivity for napsin A and glypican 3 has been reported in clear cell cancers. We sought to evaluate the use of napsin A and glypican 3 staining to distinguish clear cell carcinoma from other high-grade endometrial cancers.

Methods/Materials Twenty cases of pure and mixed endometrial clear cell carcinoma were extracted from the 2000–2014 archival material in the Departments of Obstetrics & Gynecology and Pathology at Montefiore Medical Center and compared to serous and grade 3 endometrioid controls. Representative sections were stained with monoclonal antibodies to napsin A and glypican 3. Immunostains were independently reviewed by 2 pathologists to assess frequency and pattern of staining. Charts were reviewed for clinicopathologic and treatment data.

Results Granular cytoplasmic positivity for napsin A was observed in 70% of endometrial clear cell carcinomas; only 25% showed cytoplasmic or membranous glypican 3 positivity. No serous or high-grade endometrioid tumors stained for either marker. No cases of clear cell carcinoma that stained negative for napsin A stained positive for glypican 3. No difference in the immunohistochemical profile was found between pure and mixed clear cell carcinomas and between early- and advanced-stage clear cell carcinomas.

Conclusions Napsin A is a more sensitive marker for endometrial clear cell carcinoma than glypican 3. In histologically ambiguous cases, napsin A and glypican 3 may help distinguish clear cell carcinoma from other high-grade histologies. Further investigation of endometrial clear cell carcinoma is needed to identify additional diagnostic tools for this rare histology. Correlation of a unique immunohistochemical profile and clinical outcomes is necessary.

  • High-grade endometrial cancer
  • Clear cell carcinoma
  • Immunohistochemistry
  • Napsin A
  • Glypican 3

Statistics from Altmetric.com

Footnotes

  • This research was supported by a NIH/Paul Calabresi Career Development Award for Clinical Oncology (K12) 5K12CA132783-08 (A.P.N.).

  • The authors declare no conflicts of interest.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.