Immunohistochemical Study of Ghrelin and CD24 in Normal Cyclic Endometrium, Endometrial Hyperplasia and Endometrioid Carcinoma

Endometrial carcinoma (EC) is the sixth most common cancer in women worldwide. The distinction between atypical endometrial hyperplasia (EH) and endometrioid carcinoma, especially the well-differentiated grade, is particularly difficult with overlapping distinguishing criteria and small biopsy. Ghrelin is a 28 amino acid peptide that is synthesized by gastric mucosa and is expressed in a variety of normal and tumor tissues. CD24 is cell adhesion protein, which has been shown to be overexpressed in several carcinomas and to be associated with a poor clinical outcome. In the present study, immunohistochemical expression of Ghrelin and CD24 were evaluated using formalin-fixed and paraffin embedded tissue samples. Specimens included 20 cases cyclic endometrium, 30 cases EH without atypia, 25 cases atypical EH and 35 cases endometrioid carcinoma. Ghrelin loss and CD24 overexpression were significantly related to endometrioid carcinoma, compared with cyclic, EH without atypia and atypical EH (p<0.001). The combined Ghrelin negative and CD24 positive expression can help in the distinction of endometrioid carcinoma from atypical EH with high specificity and low sensitivity.