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Subject Area

Pathology

Article Type

Original Study

Abstract

Objectives To evaluate microsatellite stability status through the immunohistochemical expression of MutL protein homolog 1 (MLH1) and MutS protein homolog 2 (MSH2) in endometrioid endometrial carcinoma; in order to correlate it with various clinical and pathological parameter, including overall survival to maximize targeted therapy benefits. Background Endometrial cancer (EC) is the fourth most common malignancy in women worldwide. Newer risk stratification models aimed at improving treatment algorithms for patients with endometrial cancer through molecular classification. One of the molecular alterations associated with endometrioid type is microsatellite instability. Methods A retrospective study included 72 hysterectomy specimens diagnosed as endometrioid adenocarcinoma from Egyptian patients. Immunohistochemical staining for MLH1 and MSH2 was done using a streptavidin-biotin-peroxidase technique and results were used to segregate cases into microsatellite stable and instable cases. They were finally correlated with the clinicopathological parameters including overall survival. Results Microsatellite instability was detected in 48.6% of the included endometroid adenocarcinoma cases and appeared to be associated with tumor infiltrating lymphocyte (P=0.049), evident necrosis (P=0.045) and hyperplastic adjacent endometrium (P=0.024). Microsatellite stability status has no impact on therapy response or overall survival. Conclusion Histopathological characteristics of endometrioid adenocarcinoma cases with MSI include prominent tumor infiltrating lymphocytes, evident necrosis and adjacent hyperplastic endometrium. More research is needed to validate the effect of microsatellite status on therapy response and overall survival for better selection of patients eligible for immune check point inhibitors (ICI) therapy

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