Immunohistochemical study of extracellular matrix metalloproteinase inducer expression and nuclear morphometry in endometrial hyperplasia and endometrioid adenocarcinoma

Background Endometrial cancer is the commonest gynecological cancer in developed countries and the second most common in developing ones. Aim This study aimed to evaluate the immunohistochemical expression of extracellular matrix metalloproteinase inducer (EMMPRIN) in endometrial hyperplasia and endometrioid adenocarcinoma and its relation with various clinicopathological variables. Moreover, we studied nuclear morphometry to assess the potential risk of patients to develop cancer endometrium. Materials and methods A total of 50 paraffin-embedded tissue blocks from endometrial hyperplasia (15 cases) and endometrioid adenocarcinoma (35 cases) specimens were immunohistochemically studied for EMMPRIN expression. Nuclear morphometric analysis was carried out by means of Olympus soft imaging system to measure the mean nuclear area (MNA), the mean nuclear minimum diameter (Mmnd) and mean nuclear maximum diameter, and mean nuclear ellipsoidy for all cases. Results There was a significantly increased EMMPRIN expression (P<0.001) in the endometrioid adenocarcinoma cases compared with the endometrial hyperplasia. Statistically significant relationships were detected between EMMPRIN expression score regarding tumor grade (P<0.01), myometrial invasion (P<0.01), lymph node metastasis (P<0.01), and International Federation of Gynecologists and Obstetricians stage (P<0.05). Kaplan–Meier analysis indicated that EMMPRIN overexpression was related to disease-specific survival (P<0.05). The nuclear morphometric parameters (MNA, Mmnd, mean nuclear maximum diameter, and mean nuclear ellipsoidy) could significantly differentiate between endometrial hyperplasia without atypia, atypical hyperplasia, and endometrioid carcinoma (P<0.001, <0.01, <0.05, and <0.01, respectively). The MNA and Mmnd had a significant positive correlation with tumor grade (P<0.01 and <0.05, respectively). The MNA was correlated with deep myometrial invasion (P<0.05), lymph node metastasis (P<0.01), International Federation of Gynecologists and Obstetricians stage (P<0.01), and disease-specific survival (P<0.01) of endometrioid adenocarcinoma cases. Conclusion EMMPRIN expression score and MNA may be used as prognostic markers to predict poor outcome in patients with endometrioid adenocarcinoma.