What is squamous differentiation

Although squamous differentiation within endometrial carcinomas has long been recognized by pathologists, its biologic significance has been the subject of continued debate.

While some authors have found a worsened prognosis for women who have tumors with squamous elements, others have reported the prognosis to be better than conventional endometrial adenocarcinomas. Persisting confusion and disagreement about the use of the terms adenoacanthoma and adenosquamous carcinoma have complicated the issue.

In this article we review the literature on the pathogenesis of squamous differentiation in the endometrium and discuss the histologic features, prevalence, and biologic behavior of adenocarcinoma with squamous differentiation. We conclude that keratin is a constituent of normal and neoplastic endometrial epithelial cells, and that overt squamous differentiation occurs by a mechanism that is currently unknown.

Molecular analysis with the aim to discover a biomarker that correlates with squamous differentiation in endometrial cancer is even more unclear. Cdx2 is an important gene transcription factor in the carcinogenesis of colorectal cancer. The strengths of our study include the fact that all patients were treated at the oncoginecology department from a tertiary cancer hospital where protocols are followed closely.

The pathology department is also divided into subspecialties, surgical specimens description, sampling and reporting are standardized, resulting in high reproducibility of the pathology reports.

Furthermore, the methodology chosen was a well-matched case-control study by age and stage, without differences between groups. Limitations of this study include its retrospective nature, though our rate of recurrence is consistent with previously published data for low and intermediate-risk stage I tumors.

Other obstacles to this study were the fact that it has been carried out in a single institution with possible referral bias and that it did not collect any immunohistochemical data. In conclusion, this case-control study provides evidence that squamous differentiation in low and intermediate-risk endometrial cancer had a 5. This finding demonstrates that more detailed histopathological information could contribute to the analysis of prognosis for the patients.

Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background Endometrial cancer presents well-defined risk factors: myometrial invasion, histological subtype, tumor grade, lymphovascular space invasion LVSI. Methods A case-control study from a cohort retrospective of patients diagnosed with low and intermediate-risk endometrioid endometrial cancer at a single institution from to was conducted. Results Twenty-one patients with recurrence were found Conclusion Our data suggest that squamous differentiation may be an adverse prognostic factor in patients with low and intermediate-risk endometrioid endometrial cancer, that showed a 5.

Funding: The author s received no specific funding for this work. Patients and methods A case-control study nested in a retrospective cohort of patients diagnosed with low and intermediate-risk endometrial cancer undergoing surgery at Barretos Cancer Hospital from January to December was conducted. Results Of the endometrial cancer patients described in this retrospective cohort, 21 patients Download: PPT.

Table 1. Univariate analysis of predictive recurrence for low and intermediate-risk endometrioid endometrial cancer. Fig 1. Histopathological difference between endometrioid adenocarcinoma with and without squamous transformation.

Table 2. Multivariate analysis of predictive recurrence for low and intermediate-risk endometrioid endometrial cancer. Discussion This case-control study of low and intermediate-risk endometrial cancer demonstrated that patients with endometrioid squamous differentiation subtype had a greater chance of recurrence when compared to patients with typical endometrioid histological subtype.

Table 3. Summary of squamous differentiation endometrioid endometrial cancer studies to predict recurrence. Supporting information. S1 File. Database case and controls. References 1. Cancer statistics , View Article Google Scholar 2. Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol ;15 1 —7. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer MRC Astec trial : a randomised study.

Lancet ; — Ann Oncol. View Article Google Scholar 6. Surgical pathologic spread patterns of endometrial cancer.

A Gynecologic Oncology Group Study. Int J Gynecol Cancer. Risk-scoring models for individualized prediction of overall survival in low-grade and high-grade endometrial cancer. Tumor size was considered as the greater diameter on macroscopic analysis of the surgical specimen. After this period they were seen every 6 months until disease progression or death.

Bladder cancer recurrences in the pelvis were considered as local recurrences, outside the pelvis as distant metastases and in the urinary tract as urothelial recurrences. Patients who died from other causes were censored at the time of death.

Statistical significance was set as a p value of 0. Statistical analysis was performed using the SPSS Mean patient age was Concomitant CIS was observed in Twenty nine patients had no information regarding tumor grade and 43 regarding lymph node status.

These last patients were treated in the beginning of the study period when routine pelvic lymphadenectomy was not performed. The remaining 70 patients underwent systematic lymphadenectomy that consisted in the removal of lymph nodes from the obturatory fossa to common iliac arteries.

As many patients had several transurethral resections before cystectomy, in 20 reports tumor size could not be precisely described. Squamous differentiation was observed in 25 Mean follow up after cystectomy was Twenty four In the present study we found a This feature was significantly related to the pathological stage.

Billis et al. Martin et al. The authors concluded that alternative methods should be sought to the former group since they may have radiotherapy resistant tumors.

Vecchioli et al. Conversely, other authors could not demonstrate the independent prognostic significance of squamous differentiation. Mazzucchelli et al. However, on multivariate analysis, only the last two variables were independent prognostic factors. Likewise, Frazier et al. In multivariate analysis only pathological stage, nodal involvement, positive surgical margins, patient age and loss of histologic differentiation achieved independent statistical significance.

This finding was associated to a 5. However, these results must be analyzed carefully. First, the study comprised a retrospective analysis of a relative small number of patients. Second, the lack of information regarding important variables such as lymph node status and tumor grade in 43 and 29 patients respectively may have influenced the results of final multivariate Cox regression analysis.

Third, tumor size, which was an independent prognostic factor along with squamous differentiation, may not be a reliable variable since TUR prior to cystectomy may have precluded an adequate measurement of the tumor. Furthermore, the independent prognostic significance of pathologic stage, which is considered one of the most powerful variables of poor outcome 6 , could not be reproduced in the present series.