Cytokeratin 19 expression in normal endometrium and in low-grade endometrioid adenocarcinoma of the endometrium

The low-molecular-weight cytokeratin (CK) protein CK19 has been shown to have diagnostic use and prognostic significance in some types of human malignancy, but little is known of its distribution in normal endometrial mucosa or in endometrial endometrioid adenocarcinoma. However, we had observed that CK19 appeared to selectively label invasive tumor areas showing microcystic, elongated, and fragmented ("MELF") changes. Therefore, CK19 expression was assessed in 15 hysterectomy specimens showing normal proliferative, secretory, or atrophic endometrial appearances, and in 26 endometrioid adenocarcinoma cases with areas of MELF-type invasion. Normal endometrial glands were usually CK19 positive; however, there was more consistent expression in the functional layer, whereas basal zone epithelium was typically only focally stained. Proliferative epithelium frequently showed basal and apical cytoplasmic accentuation of staining. Endometrial carcinomas were also CK19 positive, but in most cases there was a distinct zonal pattern of expression with strong staining only in the central aspects of the larger tumor glands and weak-to-absent staining in peripheral glandular areas. In contrast, MELF-type tumor epithelium was consistently and strongly CK19 positive even when the adjacent "conventional"-type tumor glands were not stained. Intravascular tumor cells were also highlighted, including 2 cases in which this feature was not identified on hematoxylin and eosin stains. Thus CK19 immunohistochemistry was useful in showing the extent of myometrial invasion and subtle foci of lympho-vascular space invasion. Further studies are required to determine the mechanism and biologic significance of localized alterations in CK19 expression within endometrial neoplasms.