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Histologic Appearance and Immunohistochemistry of DNA Mismatch Repair Protein and p53 in Endometrial Carcinosarcoma

Impact on Prognosis and Insights Into Tumorigenesis

Saijo, Masayuki MD*; Nakamura, Keiichiro MD, PhD*; Ida, Naoyuki MD*; Nasu, Atsuko CT; Yoshino, Tadashi MD, PhD; Masuyama, Hisashi MD, PhD*; Yanai, Hiroyuki MD, PhD

The American Journal of Surgical Pathology: November 2019 - Volume 43 - Issue 11 - p 1493–1500
doi: 10.1097/PAS.0000000000001353
Original Articles

Endometrial carcinosarcoma (ECS) is a rare and aggressive mixed-type epithelial and mesenchymal tumor. This study focused on the histologic appearance, loss of DNA mismatch repair (MMR) protein expression, and aberrant p53 expression in the epithelial component, and overall prognosis of 57 cases with ECS. Histologically, 21 and 36 cases exhibited low-grade (endometrioid grade 1 and 2) and high-grade (others) epithelial components, respectively. In a Kaplan-Meier analysis, patients with a high-grade epithelial component exhibited worse progression-free survival (PFS), compared with those with a low-grade component. Although the former group also exhibited worse overall survival, the difference was not significant. Thirty-six cases exhibited aberrant p53 expression. Of these, 5 cases exhibited focally aberrant p53 expression in carcinomatous components with diffuse aberrant p53 expression in mesenchymal components. Aberrant expression of p53 did not show significant association with prognosis. Six patients with MMR deficiency exhibited relatively better PFS. In conclusion, a low-grade epithelial component is a superior predictor of the PFS of ECS, compared with MMR protein and p53 expression status. In some cases of ECS, TP53 mutation may be a late event associated with histogenesis of the sarcomatous component.

Departments of *Obstetrics and Gynecology

Pathology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University

Department of Pathology, Okayama University Hospital, Okayama, Japan

Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Hiroyuki Yanai, MD, PhD, Department of Pathology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan (e-mail:

Online date: August 30, 2019

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