Clinical-morphological and Immunohistochemical Features Associated with Recurrence of Endometrioid Carcinomas of the Endometrium
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Endometrial carcinoma is one of the most common malignant tumors of the female reproductive system. Although low-grade endometrioid carcinomas are usually associated with a favorable prognosis, some patients develop local or distant recurrence. This fact indicates the need to evaluate additional clinical-morphological and immunophenotypic prognostic markers. The aim of the study was to evaluate the clinical-morphological and immunohistochemical features associated with recurrence of low-grade endometrioid endometrial carcinomas. The study was conducted on retrospective archival material. Formalin-fixed, paraffin-embedded (FFPE) endometrial tumor tissues collected in 2018–2025 were used. Low-grade endometrioid carcinomas were selected for analysis and cases were divided into non-recurrent and recurrent groups. Clinico-morphological parameters were assessed, including FIGO stage, myometrial invasion, lymphovascular invasion (LVSI), and disease-free survival (DFS). Immunohistochemical studies were performed using ER, PR, Ki67, and p53 markers. Digital analysis was performed using a whole-slide imaging system and QuPath/ImageJ software. The results of the study showed that recurrent carcinomas were more frequently associated with deep myometrial invasion, extensive LVSI, and short DFS. High ER and PR expression was maintained in the non-recurrent group, whereas reduced expression of hormone receptors was observed in recurrent tumors. The Ki67 proliferative index was significantly higher in recurrent cases. Aberrant expression of p53 was more frequently observed in tumors with an aggressive clinical course. Based on all of the above, we can conclude that recurrence of low-grade endometrioid endometrial carcinomas is associated with specific clinical-morphological and immunophenotypic changes, including deep invasion, LVSI, loss of hormone receptors, high proliferative activity, and aberrant expression of p53. A comprehensive assessment of these markers may contribute to a more accurate identification of high-risk patients.
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