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Correlation of microcystic, elongated and fragmented (MELF) pattern invasion with prognostic parameters in endometrial carcinoma

Objective: To evaluate the presence of MELF pattern invasion in endometrioid endometrial carcinomas (EEC) and its association with the known prognostic parameters. Method: 185 cases of EEC were reviewed to select tumours with and without MELF invasion. Double staining immunohistochemistry (D2-40/ CD31) was performed to highlight lymphatic and blood vessels in the same slide. Tumour grade, stage, and frequency of lymphatic and blood vessels invasion were assessed in MELF negative and MELF positive tumours. The impact of MELF invasion on the overall survival of patients was estimated. Results: MELF type invasion was present in 22% cases. The majority of MELF positive tumours were grade 1 or grade 2 (93 %). MELF pattern invasion was observed mostly in FIGO stage IB (46 % ). The frequency of lymphatic vessels invasion was significantly higher in MELF positive tumours than in MELF negative tumours (66 % vs 22 %, respectively). The frequency of blood vessels invasion was twice as common in MELF positive than in MELF negative tumours (22 % vs. 10 %, respectively). The presence of MELF invasion had no impact on overall survival. Conclusion: MELF pattern invasion is associated with advanced myometrial invasion and LVSI, however, MELF pattern has no prognostic significance in EEC. We should consider the possibility that MELF pattern invasion is a side effect of advancing tumour invasion.

MELF pattern invasion ; endometrioid endometrial carcinoma ; prognosis

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