Expression And Significance Of E-cadherin And Fascin In Dedifferentiated/Undifferentiated Endometrial Carcinomas

Background and PurposeEndometrial cancer is one of the most common malignant tumors in women.It has many types,including endometrioid endometrial cancer,serous cancer,clear cell cancer and undifferentiated cancer.Endometrial dedifferentiated cancer was first proposed in 2006.In 2014,it was listed in WHO Female Reproductive System Classification.Undifferentiated endometrial carcinoma is an epithelial malignant tumor with no differentiation direction.Dedifferentiated endometrial carcinoma is composed of undifferentiated endometrial carcinoma and FIGO grade 1 or 2 endometrioid endometrial carcinoma(low-grade endometrioid endometrial carcinoma).In FIGO grade 3 endometrioid endometrial carcinomas,solid regional components can account for more than 50%.Misinterpretation of the solid region of the tumors may lead to dedifferentiated endometrial carcinoma being mistaken for FIGO grade 3 endometrial tumors.It was also found that dedifferentiated endometrial carcinomas had faster clinical progression and worse prognosis than FIGO grade 3 endometrioid endometrial carcinomas.Therefore,it is one of the hotspots to find new indicators for differentiating dedifferentiated/undifferentiated endometrial carcinomas.Epithelial-mesenchymal transformation is considered to be an important invasive mechanism in common epithelial malignant tumors,including endometrial cancer.The expression of E-cadherin is down-regulated and the expression of mesenchymal markers is increased,which is a characteristic marker of epithelial-mesenchymal transition.These indicators are promising tools for the treatment,metastasis and differential diagnosis of various types of malignant tumors.Fascin is a kind of actin bundle protein,which plays an important role in cell movement under physiological and pathological conditions.Immature epithelial cells can express Fascin highly.In some types of tumors,epithelial-mesenchymal transformation is closely related to the increase or abnormal expression of Fascin.In endometrioid carcinoma,Fascin can be seen as microencapsulated,striped and fragmented tumor areas,suggesting that it may be a process of epithelial-mesenchymal transformation.Studies have found that abnormal expression of E-cadherin in endometrial cancer is associated with worse prognosis.The abnormal expression rate of E-cadherin and the high expression rate of Fascin increased with the increase of endometrial cancer grade.It was also found that the abnormal expression of E-cadherin was closely related to the high expression of Fascin in endometrial cancer.However,there are few studies on the expression of E-cadherin and Fascin proteins in dedifferentiated and undifferentiated endometrial carcinomas,and the correlation between the two proteins in dedifferentiated and undifferentiated endometrial carcinomas has not been reported yet.The expression of E-cadherin and Fascin proteins in atypical endometrial hyperplasia,FIGO grade 3 endometrioid endometrial carcinoma and dedifferentiated endometrial carcinoma were detected in this study.The consistency of the expression of E-cadherin and Fascin proteins in endometrial dedifferentiated and undifferentiated carcinomas was analyzed.This provides a basis for the diagnosis of dedifferentiated/undifferentiated endometrial carcinomas.Methods 1.Collect 30 cases of atypical endometrial hyperplasia and 26 cases of FIGO grade 3 endometrioid endometrial carcinoma.Collect 24 cases of dedifferentiated/undifferentiated endometrial cancer tissue specimens(18 cases of First Affiliated Hospital of Zhengzhou University,3 cases of Zhengzhou Central Hospital and 3 cases of Henan People's Hospital).2.Immunohistochemical SP method was used to detect the expression of E-cadherin and Fascin in atypical endometrial hyperplasia,FIGO grade 3 endometrioid endometrial carcinoma and dedifferentiated/undifferentiated endometrial carcinoma.3.Statistical analysis: SPSS17.0 software was used for data analysis and classification and counting data processing.Statistical methods: Chi-square test of rows and columns(test level(bilateral)? = 0.05,in-group test level ? = 0.0167),paired four-table consistency test(test level ? = 0.05).Results1.The abnormal expression rates of E-cadherin protein in atypical endometrial hyperplasia,FIGO grade 3 endometrioid endometrial carcinoma and dedifferentiated/undifferentiated endometrial carcinoma were 46.6%,69.2% and 91.7%.The total abnormal expression rate of E-cadherin protein was different among the three groups(?2=12.02,P < 0.05).The abnormal expression rate of E-cadherin protein in dedifferentiated/undifferentiated endometrial carcinomas was higher than that in FIGO grade 3 endometrioid endometrial carcinomas(?2=6.21,P<0.0167).2.The high expression rates of Fascin protein in atypical endometrial hyperplasia,FIGO grade 3 endometrioid endometrial carcinoma and dedifferentiated/undifferentiated endometrial carcinoma were 23.3%,57.7% and 70.8%.The high expression rate of Fascin protein in the three groups was significantly different(?2=13.27,P < 0.05).The positive expression rate of Fascin protein in endometrial dedifferentiated and undifferentiated carcinomas was higher than that in FIGO grade 3 endometrioid endometrial carcinomas(P > 0.0167).3.In FIGO grade 3 endometrioid endometrial carcinoma,the coincidence rate of abnormal expression of E-cadherin and Fascin protein with normal expression at the same time was 73.1%.The coincidence rate was statistically significant(Kappa=0.44,P<0.05).In dedifferentiated/undifferentiated endometrial carcinomas,the expression of E-cadherin and Fascin was 70.8%,and there was no statistical significance(Kappa=0.11,P >0.05).Conclusion1.The abnormal expression rate of E-cadherin and high expression rate of Fascin in dedifferentiated/undifferentiated endometrial carcinomas tissues are increased,which is helpful to differentiate endometrial dedifferentiated/undifferentiated carcinoma from FIGO grade 3 endometrioid endometrial carcinoma,so it can be used as a reference index to assist the diagnosis of dedifferentiated/undifferentiated endometrial carcinomas.2.In FIGO grade 3 endometrioid endometrial carcinomas,the expression of E-cadherin and Fascin had a high coincidence rate and good coincidence,but in dedifferentiated /undifferentiated endometrial carcinomas,the expression of E-cadherin and Fascin had a low coincidence rate and poor coincidence.The combination of E-cadherin and Fascin protein is of little significance in the diagnosis of endometrial dedifferentiated and undifferentiated carcinomas.