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PAX8 expression in uterine malignant mesodermal mixed tumor (carcinosarcoma).

Brittany J Holmes¹, Allen M Gown, Russell Vang

¹Departments of Pathology (B.J.H., R.V., B.M.R., A.Y.) Gynecology and Obstetrics (R.V., B.M.R.), The Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland PhenoPath Laboratories (A.M.G), Seattle, Washington.

International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists

|June 6, 2014

Summary

PAX8 is a helpful marker for gynecologic cancers. In uterine malignant mesodermal mixed tumors (MMMT), PAX8 is highly expressed in the epithelial parts but rarely in mesenchymal areas, aiding diagnosis of metastatic disease.

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Area of Science:

Gynecologic Pathology
Surgical Pathology
Oncology

Background:

PAX8 is a recognized immunohistochemical marker for gynecologic epithelial neoplasms.
Detailed characterization of PAX8 expression in uterine malignant mesodermal mixed tumors (MMMT) is lacking.

Purpose of the Study:

To evaluate PAX8 expression in uterine MMMTs.
To analyze PAX8 distribution within the epithelial and mesenchymal components of these tumors.

Main Methods:

Immunohistochemistry was performed on 37 uterine MMMT cases.
PAX8 expression was scored separately for epithelial and mesenchymal components.
Staining extent was categorized from 1+ to 4+ based on positive cell percentage.

Main Results:

PAX8 was expressed in the epithelial component of 97% of tumors, with 92% showing extensive staining (3+ or 4+).
The mesenchymal component lacked PAX8 expression in 73% of cases.
Undifferentiated areas showed variable or negative PAX8 expression (67% negative).

Conclusions:

PAX8 shows uniform and extensive expression in the carcinomatous component of uterine MMMTs.
This pattern supports PAX8's utility in diagnosing extrauterine carcinomatous metastases of uterine MMMT.
Limited PAX8 expression in sarcomatous/undifferentiated components restricts its use for identifying gynecologic origin in sarcoma-predominant metastases.