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Histopathological features of endometrial carcinomas associated with POLE mutations: implications for decisions about adjuvant therapy
Author(s) -
Bakhsh Salwa,
Kinloch Mary,
Hoang Lien N,
Soslow Robert A,
Köbel Martin,
Lee ChengHan,
McAlpine Jessica N,
McConechy Melissa K,
Gilks C Blake
Publication year - 2016
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.12878
Subject(s) - lymphovascular invasion , adjuvant therapy , medicine , endometrial cancer , pathology , serous fluid , radiation therapy , serous carcinoma , carcinoma , oncology , cancer , metastasis , ovarian cancer
Aims To characterize the histomorphological features of endometrial carcinomas ( EC s) harbouring polymerase ε ( POLE ) mutations. Methods and results Forty‐three EC s with POLE mutations were compared with a cohort of 202 EC s. Most POLE ‐mutated EC s were endometrioid [34/43 (79%)]; the remaining tumours were mixed [6/43 (14%)], serous [2/43 (5%)], and clear cell [1/43 (2%)]. The endometrioid carcinomas were predominantly International Federation of Gynecology and Obstetrics grade 3 (27/43, 63%). The histotype distribution did not differ from that of control EC s ( P = 0.69), but the grade of the EC was higher ( P < 0.0005). Both nuclear grade and mitotic index were significantly higher in POLE ‐mutated EC s than in the comparison cohort. POLE ‐mutated EC s were associated with peritumoral lymphocytes and numerous tumour‐infiltrating lymphocytes. Lymphovascular invasion was present in 20 of 43 tumours. Adjuvant radiotherapy and adjuvant chemotherapy would be offered in up to 80% and 40% of patients, respectively, on the basis of stage, grade, lymphovascular invasion, and histotype. Conclusions POLE ‐mutated EC s are typically of high grade, with prominent lymphocytic infiltration, but they are not sufficiently distinctive to allow accurate diagnosis based on routine haematoxylin and eosin staining. Even though POLE ‐mutated tumours are associated with an excellent prognosis, current guidelines for giving adjuvant treatment for EC result in most patients receiving adjuvant therapy.