Study of ER, PR and VEGF Expression in Endometrial Epithelial Neoplasms and its Association with Histological Stage and Grade of Endometrial Carcinoma

Abstract

Introduction: Exogenous or endogenous estrogen induces hyperplastic endometrium which presents with abnormal uterine bleeding. Atypical endometrial hyperplasia is the precursor for endometrial carcinoma. In case of invasive carcinoma, Rstrogen Receptor (ER) and Progesterone Receptor (PR) expressions are commonly diminished but their expressions are generally increased in high grade and high stage endometrial carcinomas. Vascular Endothelial Growth Factor (VEGF), a crucial promoter of angiogenesis in endometrial carcinogenesis, is associated with poor prognosis. This study is needed for assessment of biological behaviour of endometrial epithelial neoplasms and application of targeted antiangiogenic therapy. Aim: 1. Immunohistochemical expression of ER, PR, and VEGF in normal endometrium, hyperplastic endometrium and endometrial carcinoma. 2. Association of the changes in immunohistochemical expression with grade and stage of endometrial carcinoma. Materials and Methods: The present cross-sectional, non interventional, retrospective study was conducted in the Department of Pathology along with Department of Obstetrics and Gynaecology of N R S Medical College, Kolkata, from 1st January 2018 to 30th June 2019 comprising of 51 cases. In the present study, histopathological diagnosis was made for each endometrial lesion with grading and staging of endometrial carcinoma followed by immunohistochemical evaluation, performed on the representative sections using monoclonal antibody. Chi-square test and Z-test were used to observe the association of different study variables and to see the significant difference between two proportions. The p value of<0.05 was taken as statistically significant. Results: Out of 51endometrial samples, eight cases had proliferative endometrium, 14 cases had endometrial hyperplasia without atypia, five cases had atypical endometrial hyperplasia and 24 cases had endometrial carcinoma. ER and PR expression was seen less in endometrial hyperplasia and endometrial carcinoma than in benign proliferative endometrium and there was statistically significant association present between PR expression and histopathological diagnosis. All cases of grade-1 endometrial carcinoma showed ER and PR positivity and decreasing expression in higher grades-2 and 3, but were not statistically significant. Expression of VEGF in the groups of endometrial carcinoma (91.7%) and atypical hyperplasia (80%) was significantly increased in comparison with the groups of normal proliferative endometrium (37.5%) showing a significant statistical association. VEGF expression had no statistical association with grade and stage of endometrial carcinoma. Conclusion: ER, PR and VEGF were effectively associated with prognosis in patients with endometrial carcinoma.