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Original Research

Open Access Special Issue

Concurrent immunohistochemical testing of L1CAM and MMR proteins adds value in risk stratification of endometrial cancer: a proof of concept

  • Jaswinder Chalia1
  • Musse Hussein1
  • Mariya Farooqui1
  • Jordan Mattson2
  • Sally A. Mullany2
  • Molly E. Klein1
  • Boris Winterhoff2
  • Mahmoud A. Khalifa1,*,

1Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA

2Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN 55455, USA

DOI: 10.31083/j.ejgo4205135 Vol.42,Issue 5,October 2021 pp.887-892

Submitted: 15 July 2021 Accepted: 15 September 2021

Published: 15 October 2021

(This article belongs to the Special Issue Endometrial Cancer)

*Corresponding Author(s): Mahmoud A. Khalifa E-mail: mkhalifa@umn.edu

Abstract

Objectives: Histologic classification along with clinical stage predominantly drive management of patients with endometrial cancer. However, current clinico-pathologic risk-based stratification has proven suboptimal, inciting efforts to identify additional molecular classi-fiers, such as L1CAM. This is of particular relevance for the TCGA-defined Nonspecific Molecular Profile (NSMP) and MMR-deficient (MMR-d) groups of tumors, both of which are classified as having an intermediate prognosis. In current practice, L1CAM immunostaining is reserved for NSMP tumors that have been classified as MMR-proficient. The aim of this study is to investigate L1CAM testing in tandem, rather than sequential with that of MMR. Methods: A total of 149 MMR-tested endometrial carcinoma cases from 2019–2020 were identified, of which, 45 had also undergone L1CAM immunostaining. Clinical information including grade, stage, and treatment was reviewed. This was correlated with percentage of L1CAM positivity and MMR-status. Results: L1CAM positivity was noted in 7/45 (15.6%) cases with 6/45 (13.3%) additional cases demonstrating only focal positivity. MMR deficiency was noted in 24/45 (53.3%) of the cases in which L1CAM was performed. Of the cases that showed L1CAM positivity, 6/7 (85.7%), were found to be MMR-deficient. Within the remaining group in which L1CAM was not performed, 24/104 (23.1%) of cases showed MMR deficiency. Conclusions: Current findings suggest that L1CAM positivity is not mutually exclusive when correlating with MMR status. Performing L1CAM immunostaining on all endometrial carcinomas may assist in appropriate treatment for patients with L1CAM positivity, and in particular, in MMR-proficient cases classified within the NSMP category.


Keywords

L1CAM; MMR; Endometrial cancer; Testing algorithm; Molecular classification


Cite and Share

Jaswinder Chalia,Musse Hussein,Mariya Farooqui,Jordan Mattson,Sally A. Mullany,Molly E. Klein,Boris Winterhoff,Mahmoud A. Khalifa. Concurrent immunohistochemical testing of L1CAM and MMR proteins adds value in risk stratification of endometrial cancer: a proof of concept. European Journal of Gynaecological Oncology. 2021. 42(5);887-892.

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