Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2025; 13(21): 103841
Published online Jul 26, 2025. doi: 10.12998/wjcc.v13.i21.103841
CXCR4 expression and clinicopathological features of endometrial endometrioid carcinoma with the microcystic, elongated, and fragmented pattern
Ji-Xian Wang, Dan-Hua Shen, Xiao-Bo Zhang
Ji-Xian Wang, Dan-Hua Shen, Xiao-Bo Zhang, Department of Pathology, Peking University People’s Hospital, Beijing 100044, China
Author contributions: Shen DH and Zhang XB designed the research study; Wang JX, Shen DH, Zhang XB performed the research; Wang JX and Zhang XB wrote the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Peking University People's Hospital's ethics committee (approval 2024PHB187-001). We certify that the study was performed by the 1964 declaration of Helsinki and later amendments.
Informed consent statement: Written informed consent was obtained from all the participants before the enrollment of this study.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Data sharing statement: The authors will supply the relevant data in response to reasonable requests.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Bo Zhang, Department of Pathology, Peking University People’s Hospital, No. 11 Xizhimen South Street, Beijing 100044, China. zhangxiaobo0326@163.com
Received: December 13, 2024
Revised: March 19, 2025
Accepted: March 20, 2025
Published online: July 26, 2025
Processing time: 135 Days and 17.1 Hours
Abstract
BACKGROUND

The microcystic, elongated, and fragmented (MELF) pattern of invasion in endometrioid endometrial carcinoma (EEC) is a special mode of myometrial invasion that has been recently recognized by the pathology community. Overexpression of CXC chemokine receptor 4 (CXCR4) in tumor cells contributes to tumor growth, invasion, angiogenesis, metastasis, and recurrence.

AIM

To explore the correlation between CXCR4 expression in EEC and MELF invasion and clinicopathological features.

METHODS

A total of 205 EEC patients treated at Peking University People’s Hospital from June 2020 to December 2021 were selected (60 cases with MELF invasion, 145 cases without). The clinicopathological features of the two groups were compared, and expression of CXCR4 protein, estrogen receptor, and progesterone receptor was detected and compared by immunohistochemistry.

RESULTS

EEC with MELF invasion was significantly associated with low tumor grade, lymphovascular space invasion, deep myometrial invasion, cervical stromal involvement, and lymph node metastasis. There was a difference in CXCR4 expression between the two groups, with the MELF group having a significantly higher expression than the non-MELF group.

CONCLUSION

CXCR4 expression is significantly increased in EEC with MELF invasion and in the MELF invasion area, which may promote tumor invasion and metastasis and has some value for prognostic assessment.

Keywords: Endometrioid endometrial carcinoma; Microcystic, elongated, and fragmented invasion; CXCR4; Clinicopathological features; Prognosis

Core Tip: Endometrioid endometrial carcinoma (EEC) with the microcystic, elongated, and fragmented (MELF) invasion is a special invasive pattern, and its risk of lymphovascular space invasion and lymph node metastasis is significantly higher than that of the non-MELF group. The presence of MELF infiltration in EEC is associated with a higher expression of CXC chemokine receptor 4, which may play a role in the progression of the disease.