Role of Morphometry and Matrix Metalloproteinase-9 Expression in Differentiating between Atypical Endometrial Hyperplasia and Low Grade Endometrial Adenocarcinoma

• Published in: Asian Pacific journal of cancer prevention : APJCP Vol. 19; no. 8; pp. 2291 - 2297
• Main Authors: Assaf, Magda I, Abd El-Aal, Wafaa, Mohamed, Samah S, Yassen, Noha N, Mohamed, Eman A
• Format: Journal Article
• Language: English
• Published: Thailand West Asia Organization for Cancer Prevention 24.08.2018
• Subjects: Adult; Biomarkers, Tumor - metabolism; Carcinoma, Endometrioid - metabolism; Carcinoma, Endometrioid - pathology; Case-Control Studies; Endometrial Hyperplasia - metabolism; Endometrial Hyperplasia - pathology; Endometrium - metabolism; Endometrium - pathology; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted - methods; Matrix Metalloproteinase 9 - metabolism; Middle Aged; Precancerous Conditions - metabolism; Precancerous Conditions - pathology; Prognosis; Retrospective Studies; D score; MMP9; atypical endometrial hyperplasia; Endometrial adenocarcinomas
• ISSN: 1513-7368; 2476-762X
• DOI: 10.22034/APJCP.2018.19.8.2291

Background: Endometrial carcinomas are common gynecologic malignancies worldwide. In Egypt they represent 2.6 %. We evaluated the role of morphometry and MMP-9 immunohistochemical expression to differentiate atypical endometrial hyperplasia from low grade endometrial adenocarcinoma. Methods: 60 cases of endometrial lesions that included 25 cases of complex endometrial hyperplasia with atypia, 25 cases of low grade endometrioid adenocarcinoma, in addition to 10 cases of proliferative endometrium as a control group. Morphometric measurements and D-score were evaluated. MMP9 was performed using streptavidin –biotin immunoperoxidase system. Results: D score was more than 1 in 100% of cases of proliferative endometrium. In atypical hyperplasia 28 % of cases had a D-score more than 1, 44% less than 0 and 28% of cases had a D score between 0 and 1 with uncertain prognosis. All carcinoma cases had D-score less than 0. MMP9 was positive in all cases of the study but differ in its degree of expression; proliferative endometrium with low expression. Atypical hyperplasia divided as 52% low expression and 48% high expression. Most of the Endometrial adenocarcinoma cases (92%) showed high expression. There was significant difference in expression of MMP9 in atypical endometrial hyperplasia and endometrial adenocarcinoma (p> 0.001). Conclusion: The relation between MMP9 expression and D-score value in cases of atypical endometrial hyperplasia was highly significant P>0.001Thus, incorporating both MMP9 immunoexpression and D-score value would increase the accuracy of diagnosis of atypical endometrial hyperplasia and low grade endometrial adenocarcinoma.