| Objective:To explore the clinical pathological features of Atypical endometrial hyperplasia(AEH),analyzing the expression of PTEN,PAX-2 andβ-catenin in AEH,with the proliferative endometrium,endometrial hyperplasia without atypical hyperplasia and endometrial endometrioid adenocarcinoma(EEA)as the control group.Analyzed the correlation and differences of the expression of each index in different groups to find the specific histological structure and immunohistochemical index of AEH and EEA for the diagnosis and differential diagnosis of preoperative curettage specimens.Methods:In the electronic case system of pathology department of the First Affiliated Hospital of Wannan Medical College,endometrial sections and wax blocks filed from January 2018 to January 2022 were selected,45 patients in AEH group were diagnostic curettage specimens;48 patients after radical resection of endometrial cancer in the same period were screened,all of which were clearly diagnosed as EEA;Selected 25 patients of diagnostic curettage for irregular vaginal bleeding in the same period,and diagnosed as proliferative endometrium;Selected 25 patients of diagnostic curettage for irregular vaginal bleeding in the same period,and diagnosed as endometrial hyperplasia without atypical hyperplasia.All selected patients had clear pathological diagnosis results and complete clinical data;patients with preoperative chemochemotherapy or hormonal therapy were excluded,and patients with other systemic malignancies were excluded.Immunohistochemistry Envision was selected to label all patients and observe the differential expression profiles of PTEN,PAX-2 andβ-catenin in the groups.Select statistical software SPSS 26.0;analyze the correlation and difference between the expression of three indicators in each group.Results:1.The age range in the AEH group was between 28 and 66 years old,the mean age was 46.00 years;In the EEA group,The age range was between 35 and 79 years,the mean age was 60.33 years;The age difference between the two groups was statistically significant(t=7.19,P<0.05);The valuable histological morphology for diagnosis of AEH:Gland crowding(38/45);The hyperplastic glandular epithelium is significantly different from the invaginated endometrial lining in the background(45/45);A small number of remaining endometrial stromal cells remain between the glands(40/45);Reconlamination of gland cells(40/45);Nuclear enlargement and rounding(36/45);Obvious nucleoli(35/45);Coarse granular nuclear chromatin(30/45);Lost polarity(22/45);Increasing ratio of nucleus to cytoplasm(20/45);Cytoplasmic mass/rough(15/45);Nuclear membrane thickening(12/45);.2.PTEN was loss of expression in the diseased endometrial tissue,there was one case(4.0%)of loss of expression in proliferative endometrium and endometrial hyperplasia without atypical hyperplasia;The proportion of the loss of expression rate in AEH and EEA was 64.4%and 68.8%respectively;The difference in loss of expression rate between endometrial hyperplasia without atypical hyperplasia and AEH was statistically significant(X~2=21.57,P<0.05);There was no difference in the loss of expression rate in proliferative endometrium versus endometrial hyperplasia without atypical hyperplasia(Fisher Exact probability method,P=1.000);The differences in expression between AEH and EEA were not statistically significant(X~2=0.19,P>0.05);3.PAX-2 expression was absent in the diseased endometrium,The loss of PAX-2 expression in proliferative endometrium,endometrial hyperplasia without atypical hyperplasia,AEH,and EEA was 8.0%,24.0%,71.1%,and 72.9%respectively.The difference in loss of expression rate between endometrial hyperplasia without atypical hyperplasia and AEH was statistically significant(X~2=14.37,P<0.05);However,the difference in loss of expression rate between proliferative endometrium and endometrial hyperplasia without atypical hyperplasia,between AEH and EEA was not statistically significant(X~2=1.34、0.04,P=0.247、0.846).4.With the endometrium,abnormal positive expression ofβ-catenin was localized in the nucleus,The proportion of abnormal expression cases in proliferative endometrium,endometrial hyperplasia without atypical hyperplasia,AEH and EEA was 0.0%,8.0%,35.6%and 41.7%respectively;The difference in nuclear positive rate between endometrial hyperplasia without atypical hyperplasia and AEH was statistically significant;The difference in nuclear positivetivity in proliferative endometrium and endometrial hyperplasia without atypical hyperplasia was not statistically significant(Fisher Exact probability method,P>0.05);The difference in nuclear positive rate between AEH and EEA was not statistically significant(X~2=0.37,P>0.05).5.Of the 45 AEH group,26 patients(57.8%)had a simultaneous loss of both PTEN and PAX-2 expression,the number of cases with loss of PTEN expression along with positiveβ-catenin cells was 11 patients(24.4%),The number of cases with loss of PAX-2 expression along with positiveβ-catenin cells was 9 patients(20.0%).After the Spearman rank correlation analysis,The results show a significant positive and moderate correlation between the loss of PTEN and PAX-2 expression in AEH group(0.4<r<0.7,P<0.05),loss of PTEN expression was not significantly correlated with the aberrant positive expression localization ofβ-catenin to the nucleus in AEH group(r=-0.13,P>0.05),loss of PAX-2 expressionwas not significantly correlated with the aberrant positive expression localization ofβ-catenin to the nucleus in AEH group(r=0.17,P>0.05).Conclusion:1.According to the histological pathology,most AEH can be confirmed,but a few cases of diagnostic curettage are still difficult to distinguish from EEA;compared with EEA,the age of AEH is small,and the difference is statistically significant,so age is a risk factor for AEH progression to EEA,which can be used as a reliable reference factor for diagnosis.2.The differences in the abnormal expression rate of PTEN,PAX-2 andβ-catenin between endometrial hyperplasia without atypical hyperplasia and AEH were all statistically significant,suggesting that the combination of the three indexes can confirm the diagnosis and differentiation of these two cases.3.The abnormal expression rate of PTEN,PAX-2 andβ-catenin in the proliferative endometrial,endometrial hyperplasia without atypical hyperplasia,AEH and EEA gradually increased,suggesting that these three indicators may play important functions in the occurrence and development of endometrial diseases.4.The positive correlation between PTEN and PAX-2 expression in AEH,suggesting that both indicators may play a synergistic role in the development of AEH. |
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