1.Immunohistochemistry And Clinicopathological Features Of Endometrial Cancer And Colorectal Cancer 2.Lynch Syndrome And Gynecologic Oncology

Objective:Approximately 2%to 6%of all endometrial carcinomas is susceptibly hereditary.Lynch syndrome is the most common hereditary syndrome manifesting as endometrial carcinoma.Patiente diagnosed with Lynch syndrome have synchronous or metachronous endometrial carcinoma and colorectal carcinoma.Up to 50%of female patients with LS will present with endometrial carcinoma as their sentinel tumor.Mutations in the DNA mismatch repair(MMR)gene result in defect of mismatch repair(MMR)protein,including MLH1,MSH2,MSH6,and PMS2.Many studies have performed to discover suitable screening strategy of Lynch syndrome in patients with colorectal cancer,while there are few researches in endometrial cancer.We studied immunohistochemistry and clinicopathological features in patients with endometrial carcinoma and colorectal carcinoma,to discuss the diagnosis and new therapy of multiple primary cancer and the screening of the second primary tumor.Method:We conducted a retrospective analysis of 102 endometrial cancer diagnosed and treated at Cancer Hospital of Chinese Academy of Medical Sciences from July,1999 to July,2016.All patients were divided into three groups,the first group including 34 patients with endometrial cancer and colorectal cancer,the second group including 34 endometrial cancer patients with family history of gastrointestinal cancer,the third group including 34 patients only with endometrial cancer but without family history of gastrointestinal cancer.All available paraffin-embedded tissue sections were stained for immunohistochemistry.We compared the difference of MSH2?MLH1?MSH6?PMS2 protien expression and clinicopathological features and analyzed influence on prognosis of protein defect.Result:The median age of the total endometrial cancer patients was 52.0 years.The mean internal time was 6.7 years in multiple primary cancer,and the median interval time was 5.5 years.In all patients,MMR protein defect was identified in 30(37.0%)patients.The number respectively for MSH2?MLH1?MSH6?PMS2 is 17(21.0%)?11(13.6%)?14(17.3%)?12(14.8%).Patients with family history of gastrointestinal cancer are more likely with MMR protein defect(52.8%and22.7%,P=0.019)than patients without.Patients who were younger than 50 years old have more possibility with MMR protein defect(53.6%and28.3%,P=0.025)than older.Multivariate analysis indicates that family history has great influence on protein expression defect,P=0.019,OR=3.262.By univariate analysis,multiple primary cancer may developed with a chance of 26.7%,when MMR protein defect was identified in endometrial tissue.Patients may have multiple primary cancer at 26.7%when MMR protein was normal,P=0.907.Between patients with multiple primary cancer and without multiple primary cancer,the value of P respectively is 0.316?0.766?0.553?0.726?0.322 for family history?younger age(<50)?younger age(<60)?tumor location?lymph vascular space involvement.There is no significant difference for disease free survival in three groups by survival analysis.Conclusion:The expression of MMR protein has a significant correlation with age of developing endometrial cancer and family history of gastrointestinal cancer.There is no significant difference for disease free survival between multiple primary cancer group and simple endometrial group.Lynch syndrome,an autosomal dominant inherited cancer susceptibility syndrome,also known as hereditary non-polyposis colorectal cancer(HNPCC),is the most prevalent hereditary modality of colorectal cancer.Patient with Lynch syndrome are often diagnosed more than one kind of cancer,such as endometrial cancer or ovarian cancer,which can function as a "sentinel".cancer in Lynch syndrome.For women with Lynch syndrome,the lifetime risk of endometrial carcinoma(EC,up to 60%)may exceed their risk of colorectal cancer(CRC).It is an efficient strategy to combine clinical criteria with immunohistochemistry assessment.By means of endometrial biopsy(1 to 2 years,not every year)and risk-reducing surgery after delivery,women with Lynch syndrome will get efficient screening and prevention.And we are continually getting new discoveries of Lynch syndrome and Lynch syndrome related endometrial cancer and ovarian cancer.In this review,we summarized the clinical criteria of screening the Lynch syndrome and the characteristics of Lynch syndrome related endometrial cancer and ovarian cancer.