Role of Morphometry and Matrix Metalloproteinase-9 Expression in Differentiating between Atypical Endometrial Hyperplasia and Low Grade Endometrial Adenocarcinoma

Background: Endometrial carcinomas are common gynecologic malignancies worldwide. In Egypt they represent 2.6 %. We evaluated the role of morphometry and MMP-9 immunohistochemical expression to differentiate atypical endometrial hyperplasia from low grade endometrial adenocarcinoma. Methods: 60 cases of endometrial lesions that included 25 cases of complex endometrial hyperplasia with atypia, 25 cases of low grade endometrioid adenocarcinoma, in addition to 10 cases of proliferative endometrium as a control group. Morphometric measurements and D-score were evaluated. MMP9 was performed using streptavidin ­biotin immunoperoxidase system. Results: D score was more than 1 in 100% of cases of proliferative endometrium. In atypical hyperplasia 28 % of cases had a D-score more than 1, 44% less than 0 and 28% of cases had a D score between 0 and 1 with uncertain prognosis. All carcinoma cases had D-score less than 0. MMP9 was positive in all cases of the study but differ in its degree of expression; proliferative endometrium with low expression. Atypical hyperplasia divided as 52% low expression and 48% high expression. Most of the Endometrial adenocarcinoma cases (92%) showed high expression. There was significant difference in expression of MMP9 in atypical endometrial hyperplasia and endometrial adenocarcinoma (p> 0.001). Conclusion: The relation between MMP9 expression and D-score value in cases of atypical endometrial hyperplasia was highly significant P>0.001Thus, incorporating both MMP9 immunoexpression and D-score value would increase the accuracy of diagnosis of atypical endometrial hyperplasia and low grade endometrial adenocarcinoma.