Immunohistochemical Expression of Paired Box 2 (PAX2) in Normal Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and its Association with Clinicopathological Parameters: A Cross-sectional Study

Introduction: Endometrial Carcinoma (EC) is an increasingly problematic gynaecological cancer. Endometrial Hyperplasia (EH), particularly with atypia, is known to precede endometrial adenocarcinoma. Paired box 2 (PAX2) is a member of the paired box gene family that is involved in transcriptional reg...

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Main Authors: HG Sowjanya, Vijaya V Mysorekar, BK Sujani
Format: Article
Language:English
Published: JCDR Research and Publications Private Limited 2025-05-01
Series:Journal of Clinical and Diagnostic Research
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Online Access:https://jcdr.net/articles/PDF/20974/76047_CE[Ra1]_F(IS)_QC(AN_SS)_PF1(VD_SS)_redo_PFA(IS)_PB(VD_IS)_PN(IS).pdf
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author HG Sowjanya
Vijaya V Mysorekar
BK Sujani
author_facet HG Sowjanya
Vijaya V Mysorekar
BK Sujani
author_sort HG Sowjanya
collection DOAJ
description Introduction: Endometrial Carcinoma (EC) is an increasingly problematic gynaecological cancer. Endometrial Hyperplasia (EH), particularly with atypia, is known to precede endometrial adenocarcinoma. Paired box 2 (PAX2) is a member of the paired box gene family that is involved in transcriptional regulation during embryogenesis and has been found to mutate early during endometrial carcinogenesis. Studies regarding PAX2 expression in endometrial lesions are limited. Aim: To determine the expression of PAX2 in proliferative endometrium, non atypical hyperplasia, atypical EH, and EC, and its association with other clinicopathological parameters. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India, on endometrial specimens received for routine histopathological evaluation from the Department of Obstetrics and Gynaecology (OBG) between March 2021 and October 2022. A total of 78 endometrial biopsy specimens and 30 total abdominal hysterectomy specimens were received. All specimens underwent Haematoxylin and Eosin staining (H&E) and Immunohistochemistry (IHC) with a PAX2 antibody. All H&E-stained slides were screened for histological type; in the case of carcinoma, slides were also screened for tumour grade, stage, myometrial invasion, angiolymphatic invasion, lymph node metastasis, and parametrial involvement. Data were analysed using Statistical Packages of Social Sciences (SPSS) version 22.0 (IBM SPSS Statistics, Somers, NY, USA) software. The Chi-square test, Fisher’s-exact test, and Analysis of Variance (ANOVA) test were primarily applied. A p-value of <0.05 was considered statistically significant. Results: A statistically significant difference was found between histological diagnosis and PAX2 intensity (p<0.001). During progression from normal to malignancy, PAX2 expression decreases in both distribution and intensity of staining. There was no association between PAX2 expression and clinicopathological parameters like tumour size, grade, angiolymphatic invasion, and lymph node metastasis, except for the stage of carcinoma (p=0.04). Conclusion: PAX2 staining is lost with the progression of lesions to atypical hyperplasia and endometrioid adenocarcinoma. Follow-up studies correlating PAX2 expression with cancer-specific 5-year survival statistics need to be conducted to assess the prognostic value of PAX2 in EC.
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spelling doaj-art-9becd4b2a63747b8bab3adff09abd2ad2025-08-20T01:50:57ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2025-05-01195EC26EC2910.7860/JCDR/2025/76047.20974Immunohistochemical Expression of Paired Box 2 (PAX2) in Normal Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and its Association with Clinicopathological Parameters: A Cross-sectional StudyHG Sowjanya0Vijaya V Mysorekar1BK Sujani2Senior Resident, Department of Pathology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India.Professor, Department of Pathology, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research (A Unit of Dayananda Sagar), Harohalli, Karnataka, India.Professor, Department of Obstetrics and Gynaecology, Ramaiah Medical College, Bengaluru, Karnataka, India.Introduction: Endometrial Carcinoma (EC) is an increasingly problematic gynaecological cancer. Endometrial Hyperplasia (EH), particularly with atypia, is known to precede endometrial adenocarcinoma. Paired box 2 (PAX2) is a member of the paired box gene family that is involved in transcriptional regulation during embryogenesis and has been found to mutate early during endometrial carcinogenesis. Studies regarding PAX2 expression in endometrial lesions are limited. Aim: To determine the expression of PAX2 in proliferative endometrium, non atypical hyperplasia, atypical EH, and EC, and its association with other clinicopathological parameters. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India, on endometrial specimens received for routine histopathological evaluation from the Department of Obstetrics and Gynaecology (OBG) between March 2021 and October 2022. A total of 78 endometrial biopsy specimens and 30 total abdominal hysterectomy specimens were received. All specimens underwent Haematoxylin and Eosin staining (H&E) and Immunohistochemistry (IHC) with a PAX2 antibody. All H&E-stained slides were screened for histological type; in the case of carcinoma, slides were also screened for tumour grade, stage, myometrial invasion, angiolymphatic invasion, lymph node metastasis, and parametrial involvement. Data were analysed using Statistical Packages of Social Sciences (SPSS) version 22.0 (IBM SPSS Statistics, Somers, NY, USA) software. The Chi-square test, Fisher’s-exact test, and Analysis of Variance (ANOVA) test were primarily applied. A p-value of <0.05 was considered statistically significant. Results: A statistically significant difference was found between histological diagnosis and PAX2 intensity (p<0.001). During progression from normal to malignancy, PAX2 expression decreases in both distribution and intensity of staining. There was no association between PAX2 expression and clinicopathological parameters like tumour size, grade, angiolymphatic invasion, and lymph node metastasis, except for the stage of carcinoma (p=0.04). Conclusion: PAX2 staining is lost with the progression of lesions to atypical hyperplasia and endometrioid adenocarcinoma. Follow-up studies correlating PAX2 expression with cancer-specific 5-year survival statistics need to be conducted to assess the prognostic value of PAX2 in EC.https://jcdr.net/articles/PDF/20974/76047_CE[Ra1]_F(IS)_QC(AN_SS)_PF1(VD_SS)_redo_PFA(IS)_PB(VD_IS)_PN(IS).pdfendometrial biopsymyometrial invasiontumour suppressor gene
spellingShingle HG Sowjanya
Vijaya V Mysorekar
BK Sujani
Immunohistochemical Expression of Paired Box 2 (PAX2) in Normal Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and its Association with Clinicopathological Parameters: A Cross-sectional Study
Journal of Clinical and Diagnostic Research
endometrial biopsy
myometrial invasion
tumour suppressor gene
title Immunohistochemical Expression of Paired Box 2 (PAX2) in Normal Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and its Association with Clinicopathological Parameters: A Cross-sectional Study
title_full Immunohistochemical Expression of Paired Box 2 (PAX2) in Normal Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and its Association with Clinicopathological Parameters: A Cross-sectional Study
title_fullStr Immunohistochemical Expression of Paired Box 2 (PAX2) in Normal Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and its Association with Clinicopathological Parameters: A Cross-sectional Study
title_full_unstemmed Immunohistochemical Expression of Paired Box 2 (PAX2) in Normal Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and its Association with Clinicopathological Parameters: A Cross-sectional Study
title_short Immunohistochemical Expression of Paired Box 2 (PAX2) in Normal Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and its Association with Clinicopathological Parameters: A Cross-sectional Study
title_sort immunohistochemical expression of paired box 2 pax2 in normal endometrium endometrial hyperplasia endometrial adenocarcinoma and its association with clinicopathological parameters a cross sectional study
topic endometrial biopsy
myometrial invasion
tumour suppressor gene
url https://jcdr.net/articles/PDF/20974/76047_CE[Ra1]_F(IS)_QC(AN_SS)_PF1(VD_SS)_redo_PFA(IS)_PB(VD_IS)_PN(IS).pdf
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AT vijayavmysorekar immunohistochemicalexpressionofpairedbox2pax2innormalendometriumendometrialhyperplasiaendometrialadenocarcinomaanditsassociationwithclinicopathologicalparametersacrosssectionalstudy
AT bksujani immunohistochemicalexpressionofpairedbox2pax2innormalendometriumendometrialhyperplasiaendometrialadenocarcinomaanditsassociationwithclinicopathologicalparametersacrosssectionalstudy