Morphological Evaluation of the Endometrial Hyperplasia and Carcinoma with Overexpression of HE4

Farhana Zulfiqar; Noshaba Rahat; Humera Shahzad; Asma Jalbani; Bhawani Shanker; Prih Bashir

Farhana Zulfiqar Assistant Professor of Pathology, Main clinical Pathology/ Laboratory JPMC, Karachi
Noshaba Rahat Professor of Pathology, BMSI, JPMC Karachi
Humera Shahzad Assistant Professor of Pathology, BMSI, JPMC, JSMU
Asma Jalbani MPhil Scholar, BMSI, JPMC Karachi
Bhawani Shanker Associate Professor of pathology, Muhammad Medical College Mirpur-khas
Prih Bashir MPhil scholar, BMSI, JPMC Karachi

Keywords: Endometrium, HE4 expression, Immunohistochemistry

Abstract

Objective: To determine endometrial carcinoma in our population and the significance of he4 expression in malignant and normal endometrial tissue.

Methodology: This study was carried out in The Department of Pathology, Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi from January 2014 to December 2020. Total of 330 endometrial cases were received over a period of seven years, out of which 103 cases of endometrial specimen were selected and analyzed for HE4 immuno-expression by immunohistochemistry.

Results: Out of 330 endometrial lesions, 103 were selected for immunostaining, with an average age of 44.27 ± 13.07 years. The most common finding was well-differentiated endometrioid adenocarcinoma (35.9%), followed by moderately (3.9%) and poorly differentiated (4.9%) endometrioid adenocarcinoma. Hyperplasia without atypia was present in 10.7% of cases, and hyperplasia with atypia in 7.8%. Normal endometrial phases included secretory phase endometrium (17.5%) and proliferative phase endometrium (19.4%). Endometrioid adenocarcinoma exhibited the highest intensity of HE4 expression (3+) in 37.9% of cases and the highest extent (19.4% at level 3 and 10.7% at level 4). Hyperplasia without atypia and other lesions showed lower HE4 intensity and extent, with significant differences (p=0.001). Strong positive HE4 expression was found in 83.3% of endometrioid adenocarcinoma cases, compared to lower levels in hyperplasia and normal endometrial phases.

Conclusion: Study revealed that the HE4 is a significant tissue biomarker, with strong immunointensity correlating with abnormal cellular proliferation, invasion, and tumor progression. Its expression levels may serve as a valuable predictor for evaluating the clinical behavior of endometrial tumors.