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Background: Endometrial carcinoma is considered the sixth most common cancer in women worldwide comprising 4% of all cancers in women. CD24 protein was originally reported to be expressed by pre-B lymphocytes. This protein had been recognized only as a cell marker for hematopoietic cell lineages. CD24 expression is considered as an important biomarker for diagnosis, disease progression and cancerrelated death in many solid tumors, like breast, colonic and ovarian carcinomas. Aim: The present work was conducted to study the immunohistochemical expression of CD24 in normal cyclic endometrium, hyperplastic endometrium and endometrial carcinoma, in order to demonstrate its expression pattern and to examine its association with various clinicopathological variables in endometrial carcinoma cases. Material and Methods: The present study comprised 110 cases of endometrial tissue: 20 cases (18.2%) of cyclic endometrium, 30 cases (27.3%) of endometrial hyperplasia without atypia, 25 cases (22.7%) of atypical endometrial hyperplasia and 35 cases (31.8%) of endometrioid carcinoma. Immunohistochemistry was performed using the avidin biotinperoxidase complex method. Results: CD24 immunostaining was membranous and cytoplasmic. In the normal cyclic endometrium, membranous CD24 showed down-regulation in the proliferative phase and up-regulation in the secretory phase. Both membranous and cytoplasmic CD24 expression was statistically increase in endometrial carcinoma and reduced in hyperplastic lesion p<0.001 and p=0.004 respectivebly. Among cases of carcinoma, membrnuos CD24 expression was statistically significant with grade, stage and myometrial invasion (p=0.040 & p=0.044 and p=0.036 respectively). Cytoplasmic expression showed significant association with grade only (p=0.037). Membranous CD24 had 71.4% sensitivity and 76% specificity for differentiation of endometrioid carcinoma from atypical EH. Cytoplasmic CD24 had low sensitivity (40%) but high specificity (80%) for distinction of endometrioid carcinoma from atypical endometrial hyperplasia. Total CD24 had 77.2% sensitivity and 76% specificity for distinction of atypical endometrial hyperplasia from endometrioid carcinoma. Correspondence to: Dr. Rehab K. Mohammed Yousef, E-Mail: rehab_kemo@yahoo.com Conclusion: Membernous CD24 was expressed in a cyclic pattern in the normal endometrium. CD24 expression was increased in case of endometrial carcinoma than hyperplastic lesion. These results suggest that CD24 can be a useful as diagnostic marker in differentiation between endometrial hyperplasia and carcinoma. Also CD24 implicated in progression of endometrial carcinoma. Total CD24 expression (membernous and cytoplasmic) is more specific and more sensitive in differentiation of atypical endometrial hyperplasia from endometrioid carcinoma.

Differential Expression of CD24 and its Significance in Normal Endometrium, Hyperplastic Lesions and Endometrial Carcinoma