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Immunohistochemical analysis of the epithelial to mesenchymal transition in uterine carcinosarcoma
  1. Mitsumasa Osakabe1,
  2. Daisuke Fukagawa1,
  3. Chie Sato1,
  4. Ryo Sugimoto1,
  5. Noriyuki Uesugi1,
  6. Kazuyuki Ishida1,
  7. Hiroaki Itamochi2,
  8. Toru Sugiyama2 and
  9. Tamotsu Sugai1
  1. 1 Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, Morioka, Japan
  2. 2 Department of Obstetrics and Gynecology, School of Medicine, Iwate Medical University, Morioka, Japan
  1. Correspondence to Tamotsu Sugai, Department of Obstetrics and Gynecology, School of Medicine, Iwate Medical University, Morioka, Japan; tsugai{at}


Objective Uterine carcinosarcoma (UCS) is a highly aggressive neoplasm that is composed of an intricate admixture of carcinomatous and sarcomatous elements. The relationship between UCS and the epithelial to mesenchymal transition (EMT) has been reported. In this study, we examined how expression of E-cadherin was associated with the expression of EMT-related proteins in UCS.

Methods UCS samples were histologically divided into three components: carcinomatous, transitional, and sarcomatous regions. Next, we examined the expression of E-cadherin and EMT-related proteins, including SNAI2, ZEB1, and TWIST1, in each component of the UCS using immunohistochemistry. The expression score was determined by combining the staining intensity and staining area of the target cells.

Results The expression score of E-cadherin was significantly lower in transitional and sarcomatous components than in the carcinomatous component. In addition, a significant difference in the low expression score of E-cadherin between transitional and sarcomatous components (transitional > sarcomatous components) was found. There were significant differences between the expression scores of ZEB1 in the three components (sarcomatous > transitional > carcinomatous components). However, no difference in the expression of TWIST1 between the components was found. Conversely, the expression level of SNAI2 was higher in sarcomatous or transitional components than in the carcinomatous component. However, a significant difference between the transitional and sarcomatous components was not detected.

Conclusion These results suggest that the EMT plays an essential role in the pathogenesis of UCS.

  • uterine carcinosarcoma
  • immunohistochemistry
  • epithelial to mesenchymal transition
  • SNAI2
  • ZEB1

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  • Contributors MO, the first author, contributed to the preparation of the manuscript, including all aspects of data collection and analysis. TS, the corresponding author, contributed to writing the manuscript. DF and CS constructed the figures and tables. RS and NU supported statistical analysis. KI provided input during the preparation of the manuscript. HI and TS assisted with clinical data and experiments.

  • Patient consent Obtained.

  • Ethics approval All procedures were performed in accordance with the ethical standards of the Iwate Medical University and with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned, externally peer reviewed.