Clinicopathological and Immunohistochemical Analysis of Recurrent Endometrial Carcinomas: A Retrospective Study from...

A significant proportion of endometrial carcinomas (EC) recur, necessitating the identification of prognostic factors to refine treatment strategies. This study aims to identify predictors of recurrence.

This retrospective analysis examines clinicopathological and immunohistochemical features of recurrent EC in an Indian cohort, which were also categorized by ESMO-ESGO-ESTRO risk stratification.

Seventeen cases of recurrent EC (2012-2024) treated in our hospital were analyzed. Surgical resection was performed in 16 patients, with one managed palliatively. All except one recurrence was biopsied. The median age at recurrence was 62 years, with a median recurrence interval of 24 months. Endometrioid carcinoma (64.7%) was the most common histological type. Tumors were nearly evenly distributed between low- versus high grade (41.2% vs. 58.8%) and FIGO Stage I versus II-IV (56.3% vs. 43.8%). Superficial myometrial invasion and diffuse invasion patterns were seen in 62.5% of cases, with inflammatory stromal responses in 43.8%. None exhibited a MELF pattern. High- and high-intermediate-risk tumors comprised 56.3%. Vaginal recurrences (n = 8) often occurred in low-grade, superficially invasive tumors without lymph node involvement. Immunohistochemistry (IHC) revealed PgR loss in 56% of recurrent tumors. One high-grade EC demonstrated p53 mutation-type staining in recurrences despite wild-type staining in the primary tumor. Other types showed stable IHC profiles.

Risk stratification is a more reliable predictor of recurrence than individual parameters. Vaginal recurrences may not indicate aggressive tumor biology. Loss of PgR expression may contribute to disease progression. Molecular studies and extended follow-up are critical for understanding tumor biology and improving outcomes.