Prevalence of Loss of Expression of DNA Mismatch Repair Proteins in Primary Epithelial Ovarian Tumors

Fang‐I Lu, Fang-I Lu, Lu FI, Gilks CB, Cyril Blake Gilks, Anna-Marie Mulligan, Anna Marie Mulligan, Paul Ryan, Ryan P, Ghassan Allo, Allo G, Sy K, Keiyan Sy, Particia A. Shaw, Shaw PA, Aaron Pollett, Blaise Clarke, Blaise A Clarke
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · 2012 · vol. 31(6) , pp. 524–531 · doi:10.1097/pgp.0b013e31824fe2aa · PMID:23018216 · W2026955611
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Loss of DNA mismatch repair protein expression was found in 10.1% of endometriosis-associated ovarian carcinomas, a significantly higher prevalence than in high-grade serous carcinomas.

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This study evaluated the prevalence of DNA mismatch repair protein loss in primary epithelial ovarian tumors using tissue microarrays and whole-section verification. The researchers found that loss of expression was significantly more common in endometriosis-associated carcinomas, affecting 10.1% of cases, compared to high-grade serous carcinomas at 1.1%. No such loss was identified in other histologic subtypes, although the specificity of the screening method varied across different proteins. This paper is centrally about endometriosis — specifically the molecular link between endometriosis-associated ovarian carcinomas and DNA mismatch repair defects.

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Abstract

Although different histologic subtypes of epithelial ovarian tumors have long been recognized, their molecular abnormalities have not been fully defined. We examined the prevalence of DNA mismatch repair (MMR) protein loss in these tumors. Tissue microarrays (TMA) of suspected ovarian carcinomas were stained for hMLH1, hMSH2, hMSH6, and hPMS2 and scored separately by 2 groups of investigators. Loss of staining (negative) or discrepant staining results on TMA were verified on whole-section slides. Intact (positive) staining results were also verified for an additional 25 randomly selected cases. Clinical data for cases demonstrating MMR protein loss were collected. A second set of TMA composed purely of mucinous tumors was also stained for antibodies to MMR proteins and scored by 1 group of investigators. TMA was an effective method for screening a large number of ovarian tumors for MMR protein expression, with a sensitivity of 100% for all 4 MMR proteins, and a specificity of 22.2%-53.8% for different MMR proteins. Of the primary epithelial tumors of the ovary, loss of expression of MMR proteins was significantly more common in the endometriosis-associated carcinomas (7/69; 10.1%) than in high-grade serous carcinomas (2/182; 1.1%): P=0.0021. The former group also showed more frequent loss of MMR proteins compared with mucinous intestinal-type carcinomas (0/32; P=0.0940). Cases within the group of endometriosis-associated carcinomas were endometrioid (2/29 cases), clear cell (1/27 cases), undifferentiated (1/8 cases), and mixed carcinomas with an endometrioid, clear cell, and/or undifferentiated component (3/5 cases). No loss of MMR protein expression was identified in epithelial tumors of other histologic subtypes. Our study demonstrated the loss of MMR protein expression in 10.1% of endometriosis-associated ovarian carcinomas. These results raise the possibility of selective screening for Lynch syndrome in patients with these types of ovarian carcinoma.
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Prevalence of Loss of Expression of DNA Mismatch Repair Proteins in Primary Epithelial Ovarian Tumors - Fang-I Lu - Cyril Blake Gilks - Anna-Marie Mulligan - Paul Ryan - Ghassan Allo - Keiyan Sy - Particia A. Shaw - Aaron Pollett - Blaise A. Clarke Although different histologic subtypes of epithelial ovarian tumors have long been recognized, their molecular abnormalities have not been fully defined. We examined the prevalence of DNA mismatch repair (MMR) protein loss in these tumors. Tissue microarrays (TMA) of suspected ovarian carcinomas were stained for hMLH1, hMSH2, hMSH6, and hPMS2 and scored separately by 2 groups of investigators. Loss of staining (negative) or discrepant staining results on TMA were verified on whole-section slides. Intact (positive) staining results were also verified for an additional 25 randomly selected cases. Clinical data for cases demonstrating MMR protein loss were collected. A second set of TMA composed purely of mucinous tumors was also stained for antibodies to MMR proteins and scored by 1 group of investigators. TMA was an effective method for screening a large number of ovarian tumors for MMR protein expression, with a sensitivity of 100% for all 4 MMR proteins, and a specificity of 22.2%–53.8% for different MMR proteins. Of the primary epithelial tumors of the ovary, loss of expression of MMR proteins was significantly more common in the endometriosis-associated carcinomas (7/69; 10.1%) than in high-grade serous carcinomas (2/182; 1.1%): P=0.0021. The former group also showed more frequent loss of MMR proteins compared with mucinous intestinal-type carcinomas (0/32; P=0.0940). Cases within the group of endometriosis-associated carcinomas were endometrioid (2/29 cases), clear cell (1/27 cases), undifferentiated (1/8 cases), and mixed carcinomas with an endometrioid, clear cell, and/or undifferentiated component (3/5 cases). No loss of MMR protein expression was identified in epithelial tumors of other histologic subtypes. Our study demonstrated the loss of MMR protein expression in 10.1% of endometriosis-associated ovarian carcinomas. These results raise the possibility of selective screening for Lynch syndrome in patients with these types of ovarian carcinoma.

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Condition tags

endometriosis

MeSH descriptors

DNA Mismatch Repair DNA Repair Enzymes Neoplasms, Glandular and Epithelial Neoplasms, Glandular and Epithelial Ovarian Neoplasms Ovarian Neoplasms Tissue Array Analysis Adaptor Proteins, Signal Transducing Adaptor Proteins, Signal Transducing Adenosine Triphosphatases Adenosine Triphosphatases Adult Carcinoma, Ovarian Epithelial DNA-Binding Proteins DNA-Binding Proteins DNA Repair Enzymes Female Humans Middle Aged Mismatch Repair Endonuclease PMS2

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