| Abstrakt: |
The aim of our study was to identify immunohistochemical diagnostic criteria for cervical glandular intraepithelial neoplasias (CGIN). We examined 136 women with cytological diagnosis of atypical endocervical cells. These patients were divided into three groups based on a grade of the lesion: 35 patients with CGIN1 (group I), 72 patients with CGIN2 (group II), 28 patients with CGIN3 (group III). Endocervical curettages were examined by hematoxylin-eosin and immunohistochemistry using monoclonal antibodies against Ki-67, EpAg, MNF116, CEA, EMA. We used histological algorithm created by us. The comparative analysis of immunohistochemical results showed that expression of Ki-67 is seen in CGIN 2 and significantly increased in CGIN3 (p<0,05) which indicates increased proliferative activity of glandular cells in relation to increased grade of lesion. The differences in the expression of MNF116 and EMA are not statistically significant (p>0,05) which indicates that the expression of these epithelium specific markers does not change according to the grade of atypia and carcinogenesis (they can be used for determination of tumor phenotype). The expression of CEA and EpAg is strongly increased in CGIN2 and CGIN3 (p<0,05) indicating their potential role in carcinogenesis. The results suggest that evaluation of a grade of cervical glandular intraepithelial neoplasia should be based on histological and immunohistochemical studies. The morphometric algorithm should include the following criteria: type of lining epithelium (cubical, columnar), nuclear cytoplasmic index (<1, >1, =1), stratification, hyper- and hypochromasia, size and amount of nucleoli, and stromal-parenchymal ratio. The immunohistochemical study should include the expression of proliferation marker (Ki-67), carcinoembryonic antigen (CEA)and Epithelial Antigen (EpAg). We recommend the classification of CGIN into two types: low grade cervical glandular intraepithelial neoplasia (CGIN 1) and high grade cervical glandular intraepithelial neoplasia including CGIN 2 and CGIN 3. |
