Uterine carcinosarcomas (UCS) result in ~15% of uterine cancer-associated deaths. C-kit, ERBB2, EGFR and AKT expressions
were studied by immunohistochemistry, in order to evaluate their roles in the pathogenesis of UCS. In addition, exons 9
and 20 of PIK3CA gene, a critical gene in the AKT pathway, have been sequenced with ABI 3130xl Genetic Analyzer. The
cohort (n=37) was composed of twenty-three early-stage (I and II) and fourteen late-stage (III and IV) tumors. The majority
of carcinomatous components were pure serous adenocarcinoma (n=13). Fourteen cases showed heterologous elements in the
sarcomatous components. An immunostaining score (IS) ranging from 0 to (6+) was calculated for C-kit, EGFR and AKT by
adding the score of intensity and the percentage of positively stained cells. ASCO/CAP guidelines were used to evaluate ERBB2.
AKT was positive in 35/37 cases with an IS ranging from (2+) to (5+). ERBB2 immunostain was (3+) in one case. EGFR was
positive in 21/37 cases. Only six cases showed low IS with C-kit. AKT was expressed significantly more in the early-stage disease
than late-stage disease (p=0.016). The sarcomatous component had a significantly higher IS than that of epithelial component
(p=0.006). The expression of AKT in the epithelial component was associated with the survival (p=0.026). In one case, H1047R
mutation on PIK3CA gene has been detected in both carcinomatous and sarcomatous components. These results indicate that
AKT pathway is important in pathogenesis of UCS. Further studies with larger cohorts are warranted to confirm the observed
associations in this study.
Ozlen Saglam has gained her M.D. degree from Marmara University, Istanbul, Turkey in 1992. She did AP/CP residency at Henry Ford Hospital, Detroit, MI. She has oncologic surgical pathology and cytopathology fellowships. Currently she is a member of women?s health group in the department of pathology at Yale University. Her areas of interest are breast and gynecologic pathology. She is serving as an editorial board member for the Journal of Clinical and Experimental Pathology.
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