ANDROGEN RECEPTOR EXPRESSION IN ENDOMETRIAL CARCINOMAS AND CORELATION WITH CLINICOPATHOLOGICAL FEATURES: A 5 YEAR STUDY AT TERTIARY CARE CENTRE

Abstract

Background : Endometrial carcinoma (ECA) is the commonest gynaecological cancer mostly affecting women in the post-menopausal age group. ECAs  are  broadly categorized into two major groups;Endometrioid type  (most common ) and Non Endometrioid type ECA. The majority of ECAs  are hormone dependent, and hormonal dysregulation is linked to disease development and progression.

Objectives

1) To evaluate the expression of Androgen Receptor (AR) in ECA as well as benign and hyperplastic endometrium and to compare it with Estrogen (ER) and Progesterone receptors (PR) on Immunohistochemistry (IHC).

2) To study the association of AR  with various clinicopathological parameters of ECA  like age, parity , menopausal status; histological grade, pathological stage etc, nodal status, lymphovascular invasion, myometrial invasion and cervical invasion.

Study Design:It was a 5 year  observational study conducted in  the Department of Pathology, SKIMS, Srinagar,out of which 3 ½ yrs study was retrospective and 1 ½ yrs study was  prospective. 

Participants: The study  included 70 cases out of which 50 were malignant ,10 benign and 10 hyperplastic endometrium.IHC staining for AR,ER and PR was  performed on an endometrium specimen. Only those cases of the endometrial tumors were   selected where the clinical details and adequate material was  available.

Methodology:In the prospective part of  study ,the specimen obtained after surgical exploration of patients were examined .In retrospective part; slides and blocks were retrieved from the archives of department of pathology SKIMS. The slides were reviewed and categorized according to WHO Classification (2018) and pathologic characteristics like histologic type, tumor grade, T stage, FIGO stage and TNM stage were evaluated.                

 Results :Most of the patients were above 50 year age.The main type of carcinoma that was diagnosed in hysterectomy specimen was Endometrioid adenocarcinoma and majority were well differentiated ECA.  Only 46%  ECA cases had positive AR ,ER and PR expression . AR  was expressed  mostly in Endometrioid type ECA   predominantly in Grade I .AR expression was  observed mostly in those cases  with early stage , no lymph node and lymphovascular invasion and low relapse  rate.

Conclusion: AR  expression was  strongly correlated with ER and PR  expression .AR expression was most commonly found in patients with low tumor grade, lower stage, absence of lymph node involvement and absence of lymphovascular invasion. The patients with AR  positive expression have also  revealed a lower recurrence rate.

 Implications: It is important to know that Androgen Receptor IHC expression may be clinically relevant prognostic indicator and can identify a subgroup of ECA  patients that can benefit from anti androgen therapy.