Coal-based carbon nanosheets contained carbon microfibers modified with grown carbon nanotubes as efficient air electrode material for rechargeable zinc-air batteries.

Coal-based oxygen electrocatalysts hold immense promise for cost-effective applications in rechargeable Zn-air batteries (ZABs) and the value-added, clean utilization of traditional coal resources. Herein, an electrospun membrane electrode comprising coal-derived carbon nanosheets and directly grown carbon nanotubes (CNS/CMF@CNT) was successfully synthesized. The hierarchical porous structure of the electrode, composed of multiple components, significantly facilitates mass and ion transportation, resulting in exceptional electrochemical performance. Employing Fe as the catalyst for CNT growth, the CNS/CMF@CNT electrode exhibits a remarkable onset potential of 0.96 V and a half-wave potential of 0.87 V in the oxygen reduction reaction (ORR). In-situ surface-enhanced Raman spectroscopy reveals that hydroxyl radical desorption on the surface of CNS/CMF@CNT(Fe) is the rate-determining step of the ORR. Notably, the aqueous ZAB featuring the CNS/CMF@CNT(Fe) electrode achieved a peak power density of 216.0 mW cm-2 at a current density of 414 mA cm-2 and maintained a voltage efficiency of 65.1 % after 2000 charge/discharge cycles at 5 mA cm-2. Furthermore, the all-solid-state ZAB incorporating this electrode displayed an open-circuit voltage of 1.43 V, a peak power density of 70.1 mW cm-2 at a current density of 110 mA cm-2, and a voltage efficiency of 66.5 % after 150 charge/discharge cycles. The utilization of abundant coal as the raw material for electrode fabrication not only brings conceivable economic benefits in ZAB construction, but also commendably advances the effective application of traditional coal resources in a more sustainable manner.

TRPS1 function beyond breast: A retrospective immunohistochemical study on non-breast cytology specimens.

INTRODUCTION: Trichorhinophalangeal syndrome type 1 (TRPS1) has emerged as a reliable immunohistochemistry (IHC) marker for identifying breast origin in metastatic carcinomas. This study investigates the utility of TRPS1 IHC in non-breast cytology specimens. MATERIALS AND METHODS: A retrospective search of our pathology database for the year 2021 identified fluids (pleural and peritoneal) and liver, lung and bone fine needle aspirations (FNAs) with surgical follow-up confirming non-breast metastatic carcinomas. Cell blocks from cases with sufficient neoplastic cells underwent immunostaining using a rabbit polyclonal antibody against human TRPS1. Cases lacking tumor on deeper levels after the original work-up were excluded from the study. Two pathologists independently interpreted the TRPS1 staining. RESULTS: Of 136 cases assessed, 31 (22.79%) exhibited positive TRPS1 staining, while 105 (77.21%) were nonreactive. Positivity rates were observed in tumors of Mullerian cell origin, gastrointestinal tract (GIT), and lung origin at 28.85%, 25%, and 21.57%, respectively. Of the tumors of Mullerian cell origin 10 (66.67%) were serous carcinomas, 4 (26.67%) were endometrioid carcinomas, and one (6.67%) was a clear cell carcinoma. Lung tumors comprised seven (63.64%) squamous cell carcinomas and four (36.36%) adenocarcinomas, while the gastrointestinal tumors consisted of 14 (80%) adenocarcinomas and one (20%) squamous cell carcinoma. CONCLUSIONS: Although recognized as a sensitive marker for mammary carcinomas, TRPS1 immunostaining was also detected in Mullerian, lung, and GIT carcinomas. This highlights the significance of being cautious when depending solely on TRPS1 immunostaining to distinguish metastatic breast tumors.

Gas Phase-Heat Absorption-Condensate Phase Stepwise Flame Retardant Strategy to Prepare Coal Tar Pitch-Based Porous Carbon for Supercapacitor.

Porous carbon is widely used in energy storage-conversion systems, and the question of how to explore an efficient strategy for preparation is very significant. Herein, the flame retardant capability of (NH4 )2 SO4 /Mg(OH)2 that contains gas phase-heat absorption-condensate phase components is assisted to carbonize coal tar pitch in air and obtain the porous carbon. The mechanism of stepwise inflaming retarding is systematically investigated. In the carbonization process in a muffle furnace, (NH4 )2 SO4 decomposes releasing gases at below 400 °C to act as the role of gas phase flame retardant. Mg(OH)2 starts to decompose at ≥ 400 °C, and it has the effect of heat absorption and condensed phase flame retardation (MgSO4 and MgO). What's more, the flame retardant also serves as an N, S source and template. The obtained porous carbon possesses an ultrahigh carbon yield of 56.9 wt.%, hierarchical pore structure, and multi-heteroatoms doping. It can still reach up to 244.7 F g-1 even loaded 20 mg of active material. In addition, the (NH4 )2 SO4 /agar gel electrolyte is synthesized, and the fabricated flexible ammonium ion capacitor exhibits a superior energy density of 40.8 Wh kg-1 . This work uncovers a new way to construct porous carbon, which is expected to synthesize more carbon materials using other carbon sources.

Cottonseed meal derived porous carbon prepared via the protease pretreatment and reduced activator dosage carbonization for supercapacitor.

The high catalytic activity and specificity of enzymes can be used to pretreat biomass. Herein, the resourceful, reproducible, cheap, and crude protein-rich cottonseed meal (CM) is selected as a precursor and the protease in the K2CO3-KHCO3 buffer solution is used as the enzyme degradation substance to pretreat CM. The crude protein content is significantly reduced by the protease degradation, and, meanwhile, it results in a looser and porous structure of CM. What is more, it significantly reduces the amount of activator. In the subsequent carbonization process, the K2CO3-KHCO3 in the buffer solution is also used as an activating agent (the mass ratio of CM to activator is 2:1), and after carbonization, the O, S, and N doped porous carbon is obtained. The optimized PCM-800-4 exhibits high heteroatom contents and a hierarchical porous structure. The specific capacitance of the prepared porous carbon reaches up to 233 F g-1 in 6M KOH even when 10 mg of active material is loaded. In addition, a K2CO3-KHCO3/EG based gel electrolyte is prepared and the fabricated flexible capacitor exhibits an energy density of 15.6 Wh kg-1 and a wide temperature range (-25 to 100 °C). This study presents a simple enzymatic degradation and reduced activator dosage strategy to prepare a cottonseed meal derived carbon material and looks forward to preparing porous carbon using other biomass.

Interface engineering strategy construction of covalent organic framework for promoting highly reversible zinc metal.

Zn-ion energy storage devices will play important roles in the future energy storage field. However, Zn-ion device development suffers significantly from adverse chemical reactions (dendrite formation, corrosion, and deformation) on the Zn anode surface. Zn dendrite formation, hydrogen evolution corrosion, and deformation combine to degrade Zn-ion devices. Zincophile modulation and protection using covalent organic frameworks (COF) inhibited dendritic growth by induced uniform Zn ion deposition, which also prevented chemical corrosion. The Zn@COF anode circulated stably for more than 1800 cycles even at high current density in symmetric cells and maintained a low and stable voltage hysteresis. This work explains the surface state of the Zn anode and provides information for further research.

Use of Fe-H3BTC and GO Compounds To Prepare N/Fe-Doped Carbon for a High-Performance Oxygen Reduction Reaction Catalyst.

Zinc-air batteries (ZABs), as a new type of energy storage and conversion device, have received lots of attention due to their high energy density and low cost. The electrode material is a key factor for improving the performance of ZABs. Here, a facile strategy for the fabrication of N-rich porous carbon is reported. H3BTC and GO are selected as carbon precursors, histidine and Fe(NO3)3 are used as ligands, and urea is used as a N source and template. After the conventional drying of the complex and following carbonization process, serial N-doped carbon materials are prepared. The composition and structure of the material are characterized, and the effect of the ligand is studied. The hierarchical porous structure facilitates the full exposition of N and trace of Fe active sites and benefits the transportation of electrolytes, thus improving the oxygen reduction reaction (ORR). The ORR performances show that the porous carbon has a positive initial and half-wave potential, good limiting current density, a near four-electron transfer process, and better methanol resistance and durability. The assembled ZAB exhibits high specific capacity (880.4 mAh gZn-1), excellent open-circuit voltage (1.54 V), and superior cycling stability, which further provides the significant potential for its application.

LRG1 Is Involved in the Progression of Ovarian Cancer via Modulating FAK/AKT Signaling Pathway.

BACKGROUND: Rapid progression and early metastasis remain the main cause of high mortality in epithelial ovarian cancer (EOC) patients. The objective of this study was to explore the mechanisms of EOC progression and detect the function of leucine-rich alpha-2-glycoprotein 1 (LRG1) in modulating the pathologic process. METHODS: Ultracentrifugation was initially performed to extract exosomes from the urine samples of EOC patients and healthy female subjects. Mass spectrometry (MS) was employed to analyze differentially expressed proteins. Survival analysis was performed to examine the association between LRG1 levels and the prognosis of EOC patients. LRG1 silencing ovarian cancer cell lines were built and cell migration was further evaluated via wound healing and transwell assays. Immunoblot, immunofluorescence and immunohistochemistry analyses were performed. A subcutaneous tumor model was established to study the function of LRG1 in vivo. RESULTS: Exosomal LRG1 was specifically expressed in urine samples of EOC patients and high LRG1 levels were significantly associated with poor prognosis. Function analyses showed that LRG1 was associated with ovarian cancer migration and progression. Mechanistically, LRG1 was significantly related to the focal adhesion kinase/protein kinase B (FAK/AKT) signaling pathway. CONCLUSIONS: LRG1 participated in progression and metastasis of ovarian cancer via activation of the FAK/AKT pathway probably.

Endometrial cancer in a transgender male: A rare case and review of the literature.

Objective: Endometrial cancer is the most common gynecological malignancy in the United States. Despite the high prevalence amongst cisgender females the prevalence of this gynecological malignancy in transgender men has not been clearly identified. To date, only four reported cases have been described in the literature. Case: A 36-year-old nulliparous assigned female at birth, transgender premenopausal male underwent a laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, sentinel lymph node mapping and omental biopsy after having an endometrial biopsy that demonstrated well differential endometroid adenocarcinoma. He had been on testosterone therapy for at least five years prior to presenting to his gynecologist with the chief complaint of vaginal bleeding. Final pathology showed FIGO Stage 1A endometroid endometrial carcinoma. Conclusion: This case report adds to the body of literature demonstrating that transgender men can develop endometrial carcinoma while on exogenous testosterone therapy. In addition, this report illustrates the importance of routine gynecological care in the transgender patient population.

Starch-based porous carbon microsphere composited NiCo2O4 nanoflower as bifunctional electrocatalyst for zinc-air battery.

It is significant to explore and design outstanding bifunctional oxygen electrocatalysts to promote the oxygen evolution reaction (OER) and oxygen reduction reaction (ORR) in zinc-air batteries. Herein, a novel porous carbon microspheres (CMS2) modified by NiCo2O4 nanoflower (CMS2-NiCo2O4) have been prepared as an ORR and OER catalyst. The hierarchical porous structure of CMS provides high conductivity and abundant active sites for ORR, whereas the synergistic effect of NiCo2O4 nanosheets and a small amount of FeZn oxides act as the positive phase for OER. The efficient oxygen catalytic activity is gained by creating a coupling interface between NiCo2O4 and CMS. The optimized CMS2-NiCo2O4 shows a half-wave potential of 0.82 V toward ORR and an overpotential of 392 mV toward OER. Particularly, CMS2-NiCo2O4 also exhibits an excellent peak power density (175.5 mW cm-2) as a catalyst for zinc-air batteries, which is superior to the commercial Pt/C + RuO2 catalyst (120.5 mW cm-2), and it also demonstrates a remarkable stability even after the charge-discharge cycles of 167 h. The prepared CMS2-NiCo2O4 is promising for the application of the bimetallic oxide catalyst for zinc-air battery.

S/N-codoped carbon nanotubes and reduced graphene oxide aerogel based supercapacitors working in a wide temperature range.

Among many supercapacitor electrode materials, carbon materials are widely used due to their large specific surface area, good electrical conductivity and high economic efficiency. However, carbon-based supercapacitors face the challenges of low energy density and limited operating environment. This work reports a facile self-assembled method to prepare three-dimensional carbon nanotubes/reduced graphene oxide (CNTs/rGO) aerogel material, which was applied as both positive and negative electrodes in a symmetric superacapacitor. The fabricated supercapacitor exhibited prominent capacitive performance not only at room temperature, but also at extreme temperatures (-20 âˆ¼ 80 °C). The specific capacitances of the symmetric supercapacitors based on CNTs/rGO at a weight ratio of 2:5 respectively reached 107.8 and 128.2 F g-1 at 25 °C and 80 °C with KOH as the electrolyte, and 80.0 and 144.6 F g-1 at -20 °C and 60 °C with deep eutectic solvent as the electrolyte. Notably, the capacitance retention and coulombic efficiency of the assembled supercapacitors remained almost unchanged after 20,000 cycles of charge/discharge test over a wide temperature range. The work uncovered a possibility for the development of high-performance supercapacitors flexibly operated at extreme temperatures.

Polysaccharide of agar based ultra-high specific surface area porous carbon for superior supercapacitor.

Although extensive research has been focused on porous carbon in supercapacitor, the simple and non-template preparation of high specific surface area (SSA) carbon material with hierarchical porous structure is still a lingering issue. Herein, the cross-linked hierarchical porous carbon with ultra-high SSA of 3184 m2 g-1 is prepared via the sol-gel follows the freeze drying and followed activation process. Agar is used as carbon precursor, L-arginine is nitrogen sources, and the formed gel is activated by KHCO3. The obtained N-doped porous carbon shows a superior specific capacitance of 443.0 F g-1 at 0.5 A g-1 in 6 M KOH, and exhibits an excellent rate capability (255 F g-1 at 50 A g-1). Furthermore, due to the combined synergistic effect of high SSA, hierarchical porous structure and N doping, the symmetric supercapacitor that assembled with the prepared gel electrolyte of Agar-Na2SO4 achieves a superior energy density of 35.5 Wh kg-1 and a long cycle life with the capacitance retention of 99.7% after 20,000 cycles. This work provides an efficient and simple method to prepare ultra-high surface area, hierarchical porous structure carbon materials for high performance supercapacitor.

Ag Nanoparticles@Agar Gel as a 3D Flexible and Stable SERS Substrate with Ultrahigh Sensitivity.

Flexible surface-enhanced Raman scattering (SERS) substrates have become one of the research hot spots due to the facile sampling by swabbing or wrapping on rough surfaces and the sensitive and nondestructive detection of contaminants. In this work, we proposed a simple and fast in situ reduction method to prepare Ag nanoparticles (Ag NPs) composited agar hydrogel (Ag NPs@Agar) flexible SERS substrate. Owing to the three-dimensional (3D) structure, good hydrophilicity and adsorption of the agar hydrogel, Ag NPs were grown uniformly in the 3D cross-linked structure. The distribution density of Ag NPs was further increased by the volume shrinkage when the hydrogel was dried in air. This high density and uniformly distribution of Ag NPs produced a large number of highly active SERS regions. In addition, the sensitivity of Ag NPs@Agar was further improved with the assistance of hydrophilic agar gel, which can trap the probe molecules into highly active SERS areas. The SERS results showed that the substrate can be used to detect dye molecules (rhodamine 6G), the minimum detectable concentration was 10-15 M, the relative standard deviation tested at 18 different positions was only 7.58%, and the intensity of the characteristic peak at 611 cm-1 decreased only about 10% after 49 days of storage, demonstrating the superior stability. Moreover, the Ag NPs@Agar substrate also could successfully achieve the micro-trace detection of melamine and sodium penicillin G in Xinjiang specialty camel milk powder. The above available results show that the prepared flexible Ag NPs@Agar SERS substrates possess potentials for the illegal additives and antibiotics in food safety analysis.

Microinvasive breast cancer and the role of sentinel lymph node biopsy.

Whether sentinel lymph node biopsy (SLNB) should be performed in patients with microinvasive breast cancer (MIBC) has been a matter of debate over the last decade. MIBC has a favorable prognosis and while metastasis to the axilla is rare, it can impact treatment recommendations. In this study we evaluated clinical and histological features in both MIBC and background DCIS including ER, PR, and HER-2, number of foci of MIBC, the extent of the DCIS, nuclear grade, presence of comedo necrosis, as well as surgical procedures, adjuvant treatment and follow up to identify variables which predict disease free survival (DFS), as well as the factors which influence clinical decision making. Our study included 72 MIBC patients with a mean patient follow-up time of 55 months. Three patients with MIBC had recurrence, and two deceased, leaving five patients in total with poor long-term outcomes and a DFS rate of 93.1%. Performing mastectomy, high nuclear grade, and negativity for ER and HER-2 were found to be associated with the use of SLNB, although none of these variables were found to be associated with DFS. One positive lymph node case was discovered following SLNB in our study. This suggests the use of SLNB may provide diagnostic information to some patients, although these are the anomalies. When comparing patients who had undergone SLNB to those which had not there was no difference in DFS. Certainly, the use of SLNB in MIBC is quite the conundrum. It is important to acknowledge that surgical complications have been reported, and traditional metrics used for risk assessment in invasive breast cancer may not hold true in the setting of microinvasion.

Computational portraits of the tumoral microenvironment in human breast cancer.

Breast cancer is the most diagnosed cancer in humans. In recent years, myxoid and proportionated stroma have been described as clinically significant in many cancer subtypes. Here computational portraits of tumor-associated stromata were created from a machine learning (ML) classifier using QuPath to evaluate proportionated stromal area (PSA), myxoid stromal ratio (MSR), and immune stroma proportion (ISP) from whole slide images (WSI). The ML classifier was validated in independent training (n = 40) and validation (n = 109) cohorts finding MSR, PSA, and ISP to be associated with tumor stage, lymph node status, Nottingham grade, stromal differentiation (SD), tumor size, estrogen receptor (ER), progesterone receptor (PR), and receptor tyrosine-protein kinase erbB-2 (HER-2). Overall, MSR correlated better with the clinicopathologic profile than PSA and ISP. High MSR was found to be associated with high tumor stage, low ISP, and high Nottingham histologic score. As a computational biomarker, high MSR was more likely to be associated with luminal B like, Her-2 enriched, and triple-negative biomarker status when compared to luminal A like. The supervised ML superpixel approach demonstrated here can be performed by a trained pathologist to provide a faster and more uniformed approach to the analysis to the tumoral microenvironment (TME). The TME may be relevant for clinical decision-making, determining chemotherapeutic efficacy, and guiding a more overall precision-based breast cancer care.

A Series of COVID-19 Cases With Findings in the Gastrointestinal and Hepatobiliary System.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide. Most of the infected patients present with respiratory symptoms and acute lung damage. Here, we present three cases of patients with COVID-19 disease whose main clinical manifestations are gastrointestinal symptoms. In our first case, we present a COVID-19 patient with histologic findings associated with ischemic necrosis of the small bowel. In the second and third cases, we demonstrate acute cholecystitis and histology showing microvascular thrombosis. These three cases highlight the ischemic and thrombotic changes seen in the setting of COVID-19 infection without classic respiratory symptoms, with resulting severe gastrointestinal and hepatobiliary disease requiring surgical management. Although the bile or stool viral load was not tested in these patients, the small intestine and gallbladder were infected with SARS-CoV-2, most likely via the epithelial angiotensin-converting enzyme 2 (ACE2) receptor.

A Novel Superpixel Approach to the Tumoral Microenvironment in Colorectal Cancer.

Colorectal cancer (CRC) is the most common malignancy of the gastrointestinal tract. The stroma and the tumoral microenvironment (TME) represent ecosystem-like biological networks and are new frontiers in CRC. The present study demonstrates the use of a novel machine learning-based superpixel approach for whole slide images to unravel this biology. Findings of significance include the association of low proportionated stromal area, high immature stromal percentage, and high myxoid stromal ratio (MSR) with worse prognostic outcomes in CRC. Overall, stromal computational markers outperformed all others at predicting clinical outcomes. MSR may be able to prognosticate patients independent of pathological stage, representing an optimal way to effectively prognosticate CRC patients which circumvents the need for more extensive molecular and/or computational profiling. The superpixel approaches to the TME demonstrated here can be performed by a trained pathologist and recorded during synoptic cancer reporting with appropriate quality assurance. Future clinical trials will have the ultimate say in determining whether we can better tailor the need for adjuvant therapy in patients with CRC.

Dynamics of Peripheral Blood T-lymphocytes Have Predictive Values for the Clinical Outcome of COVID-19 Patients in Intensive Care Unit.

BACKGROUND: Coronavirus disease 2019 (COVID-19) patients with severe disease had a high mortality rate. It's imperative to identify risk factors associated with disease progression and prognosis. Immune responses played an important role in the host's defense against the virus. We studied the dynamics of peripheral blood lymphocytes (PBLs) in relation to the clinical outcome in COVID-19 patients in intensive care unit (ICU). DESIGN: This cohort included 342 COVID-19 patients who were admitted to ICU between February 1 and May 30, 2020, with 178 having follow-up PBL analysis. The patients were divided into a group that survived and an expired group. PBL analysis was performed by flow cytometry. RESULTS: At time of initial flow analysis, there were no statistically significant differences in lymphocyte, T-cell and subsets, B-cell or natural killer (NK) cell counts between the 2 groups. However, during the ICU course, the surviving group demonstrated a full recovery of CD3+ T-cells, CD4+ T-cells, and CD8+ T-cells, with no significant change in B-cells, and a slight upward trend in NK-cells. In contrast, the expired group showed no recovery in T-cells (and subsets) and no significant changes in B-cells and NK-cells. We identified the earliest time points and cut-off values for T-cell subsets that predict clinical outcomes. CONCLUSION: The results of this study suggest that evaluation of PBL in COVID-19 patients could be valuable in the study of the immune responses to the disease and the prognostication of outcome.

Nature and Significance of Stromal Differentiation, PD-L1, and VISTA in GIST.

The role of stromal differentiation (SD), program death-ligand 1 (PD-L1), and v-domain Ig suppressor of T cell activation (VISTA) in gastrointestinal stromal tumor (GIST) is largely unknown. Looking forward, the assessment of SD and immune check point inhibition will become more ubiquitous in surgical pathology. Immature, myxoid stroma has been found to be a poor prognostic signature in many cancer subtypes (colon, breast, cervix, esophagus, stomach); although little is known regarding its significance in GIST. For immune check-point inhibition, studies have demonstrated expression to be associated with patient outcomes in numerous cancer subtypes. The present body of work aims to evaluate SD, PD-L1 and VISTA; both in terms of its nature and significance in a clinical setting. Here we found PD-L1 expression in immune cells (IC) and immature SD to be associated with worse cancer free survival, while positive VISTA expression was found to be associated with improved outcomes. High-grade, immature SD had the highest propensity for death/recurrence and was the only variable found to have prognostic significance on multivariate analysis. Our findings support the evaluation of SD, PD-L1 and VISTA in GIST, with clinical practice implications for pathologists. Ultimately, we hope our findings lead to improved prognostication, further optimization of therapeutics, and improved outcomes in a true clinical environment. For GIST, PD-L1 and VISTA could be both clinically relevant and targetable, while SD may be the answer to clinical heterogeneity.

Vaccination with a Brucella ghost developed through a double inactivation strategy provides protection in Guinea pigs and cattle.

Vaccination can prevent and control animal brucellosis. Currently, live attenuated vaccines are extensively used to prevent Brucella infection. However, traditional vaccines such as live attenuated vaccines are associated with biological safety risks for both humans and animals. The bacterial ghost (BG) is a new form of vaccine with great prospects. However, bacterial cells cannot be completely inactivated by biological lysis, conferring a safety risk associated with the vaccine. In this study, we developed a Brucella abortus A19 bacterial ghost (A19BG) through a double inactivation strategy with sequential biological lysis and hydrogen peroxide treatment. This strategy resulted in 100% inactivation of Brucella, such that viable bacterial cells were not detected even at an ultrahigh concentration of 1010 colony-forming units/mL. Furthermore, A19BG had a typical BG morphology and good genetic stability. Moreover, it did not induce adverse reactions in guinea pigs. The levels of antibodies, interferon-γ, interleukin-4, and CD4+ T cells in guinea pigs inoculated with the A19BG vaccine were similar to those inoculated with the existing A19 vaccine. Immunization with A19BG conferred a similar level of protection with that of A19 against Brucella melitensis M28 in both guinea pigs and cattle. In conclusion, the combination of biological lysis and H2O2-mediated inactivation is a safe and effective strategy that can serve as a reference for the preparation of BG vaccines.

Understanding the role of indoleamine-2,3-dioxygenase and stromal differentiation in rare subtype endometrial cancer.

Endometrial cancer (EC) is a disease with good and poor prognostic subtypes. Dedifferentiated endometrial carcinoma (DEC), undifferentiated endometrial carcinoma (UEC), and clear cell endometrial carcinoma (CEC) are rare high-grade tumors, associated with a poor prognosis and high pathologic stage. Many studies have been performed on the programmed death-ligand 1 (PD-L1) axis mainly focus on endometrioid adenocarcinomas and little research has been done on rare subtypes. The present body of work aims to evaluate the role of indoleamine-2,3-dioxygenase (IDO-1) and stromal differentiation (SD), their correlation with clinicopathologic features and overall survival. Here we found that positive IDO-1 expression in immune cells correlated with worse disease-free survival (p = 0.02), recurrence (p = 0.03), high pathologic tumor stage (p = 0.024), lymph node metastasis (p = 0.028), and myometrial invasion (p = 0.03). Our findings suggest IDO-1 to be relevant in both MMR intact and deficient tumors; however, >20% immune cell staining was restricted to MMR deficient cancers. For the stroma, immature, myxoid differentiation was found to correlate with worse disease-free survival (p = 0.04). We also found the correlation between IDO-1 expression and immature stroma. Looking forward, IDO-1 could be promising for immunotherapy and SD could be the answer to clinical heterogeneity.