HISTOLOGIC CHARACTERIZATION OF UTERINE PAPILLARY SEROUS ADENOCARCINOMA

Uterine papillary serous adenocarcinoma (UPSC) is one of the most aggr essive endometrial tumors. UPSC has been associated with an increased propensity for extrauterine spread. Survival rates of not more than 50 % are commonly reported even for tumors which appear to be confined to the uterus. Small areas of UPSC can be found in otherwise well-differ entiated endometrial lesions and yet still determine the overall progn osis. In the present study we evaluated histologic criteria that might be helpful in diagnosing small-volume UPSC, including silver-stained nucleolar organizer regions (AgNOR) which have prognostic importance i n a variety of tumors, and nuclear size which has been used for progno stication in endometrial cancer. We examined 25 UPSC specimens and com pared them to grade III (GIII, n = 10) and grade I (GI, n = 10) typica l endometrial adenocarcinoma using the following parameters: mean AgNO R count per cell was UPSC 6, GIII 6.0, and GI 4.3; mean AgNOR area was UPSC 1.28 mum2, GIII 1.35 mum2, and GI 0.86 mum2; total AgNOR area pe r cell was UPSC 7.5 mum2, GIII 8.13 mum2, GI 4.47 mum2; and nuclear si ze was UPSC 66.9 mum2, GIII 60.3 mum2, GI 34.8 mum2. All differences b etween UPSC or GIII tumors and GI lesions were statistically significa nt. Overexpression of p53, as determined histochemically, was seen in 64% of the UPSC specimens. UPSC is characterized by high AgNOR count a nd area per cell, large nuclear size, and a high rate of p53 overexpre ssion. Evaluation of these parameters in biopsy material may aid in se lecting high-risk patients for adjuvant therapy trials. (C) 1995 Acade mic Press, Inc.