ZEB1 overexpression associated with E-cadherin and microRNA-200 downregulation is characteristic of undifferentiated endometrial carcinoma

Mod Pathol. 2013 Nov;26(11):1514-24. doi: 10.1038/modpathol.2013.93. Epub 2013 Jun 7.

Abstract

Undifferentiated endometrial carcinomas are very aggressive high-grade endometrial carcinomas that are frequently under-recognized. This study aimed to analyze the molecular alterations underlying the development of these endometrial carcinomas, focusing on those related to dedifferentiation. We assessed a series of 120 tumors: 57 grade 1 and 2 endometrioid endometrial carcinomas, 15 grade 3 endometrioid endometrial carcinomas, 27 endometrial serous carcinomas, and 21 undifferentiated endometrial carcinomas. We found a high frequency of DNA mismatch repair deficiency (38%) and moderate rate of p53 overexpression (∼33%) in undifferentiated carcinomas. In contrast to the characteristic endometrioid phenotype, there was a dramatic downregulation of E-cadherin expression in the undifferentiated subtype. Quantitative methylation studies dismissed CDH1 promoter hypermethylation as the mechanism responsible for this change in gene expression, while immunohistochemistry revealed that the E-cadherin repressor ZEB1 was frequently overexpressed (62%) in undifferentiated endometrial carcinomas. This finding was accompanied by a sharp downregulation in the expression of the miR-200 family of microRNAs, well-known targets of ZEB1. Furthermore, there was enhanced expression of epithelial-to-mesenchymal transition markers in undifferentiated endometrial carcinomas, such as N-cadherin, cytoplasmic p120, and osteonectin. In addition, HMGA2, a regulator of epithelial-to-mesenchymal transition that is expressed in aggressive endometrial tumors, such as endometrial serous carcinomas and carcinosarcomas, was expressed in >20% of undifferentiated carcinomas. These results suggest that ZEB1 overexpression, associated with E-cadherin and miR-200s downregulation, and the expression of mesenchymal markers might enhance the metastatic potential of undifferentiated endometrial carcinomas, leading to a poor prognosis. In addition, our observations suggest that the immnohistochemical analysis of E-cadherin and ZEB1 can aid in the differential diagnosis of the more agressive undifferentiated endometrial carcinomas from grade 3 endometrioid carcinomas.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antigens, CD
  • Biomarkers, Tumor / analysis*
  • Biomarkers, Tumor / genetics
  • Cadherins / analysis*
  • Cadherins / genetics
  • Carcinoma / chemistry*
  • Carcinoma / genetics
  • Carcinoma / pathology
  • Cell Differentiation*
  • DNA Methylation
  • DNA Mismatch Repair
  • Down-Regulation
  • Endometrial Neoplasms / chemistry*
  • Endometrial Neoplasms / genetics
  • Endometrial Neoplasms / pathology
  • Epithelial-Mesenchymal Transition
  • Female
  • Gene Expression Regulation, Neoplastic
  • Homeodomain Proteins / analysis*
  • Humans
  • Immunohistochemistry
  • MicroRNAs / analysis*
  • Neoplasm Grading
  • Predictive Value of Tests
  • Prognosis
  • Promoter Regions, Genetic
  • Spain
  • Transcription Factors / analysis*
  • Tumor Suppressor Protein p53 / analysis
  • United States
  • Up-Regulation
  • Zinc Finger E-box-Binding Homeobox 1

Substances

  • Antigens, CD
  • Biomarkers, Tumor
  • CDH1 protein, human
  • Cadherins
  • Homeodomain Proteins
  • MIRN200 microRNA, human
  • MicroRNAs
  • TP53 protein, human
  • Transcription Factors
  • Tumor Suppressor Protein p53
  • ZEB1 protein, human
  • Zinc Finger E-box-Binding Homeobox 1