Stains
Estrogen receptor

Author: Nat Pernick, M.D. (see Authors page)

Revised: 22 April 2016, last major update June 2005

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Estrogen receptor [title]

Definition / General
  • See also Breast malignant topic
  • Two subtypes: ER-alpha and ER-beta
  • ER-alpha:
    • "Classic" functions of ER
    • May render breast epithelium susceptible to proliferative stimulation of estrogen
    • Expressed in breast and endometrium
  • ER-beta:
    • "Housekeeping" functions
    • Expressed in normal ovary and granulosa cells
    • Carcinoma of breast, colon, prostate
  • Both alpha and beta share highly conserved DNA binding domain and commonly interact with estrogen-regulating factors, but may affect different genes
  • Presence of estrogen (type alpha) and progesterone receptors correlates best with response to anti-estrogen treatment (tamoxifen or others) or chemotherapy, only weakly with prognosis
    • Presence is associated with better differentiated tumors, older age
  • Evaluate % of tumor nuclei stained and intensity of staining (none, weak, moderate, strong)
  • Immunostaining now done on paraffin fixed tissue (previously required fresh tissue)
  • Metastases to skin are often positive for androgen receptor, even if ER-, PR- (Mod Pathol 2000;13:119)
  • Antigen retrieval techniques are required for ER if glyoxal fixative is used (Hum Pathol 2004;35:1058)
  • Compared to ER, PR staining adds only a limited amount of additional predictive information for response to hormonal therapy (Mod Pathol 2004;17:1545)
Interpretation
  • Nuclear stain
  • Cytoplasmic staining only is a negative result
Uses by Pathologists
  • In breast cancer, predicts response to tamoxifen or other anti-estrogens
    • Also prognostic marker for survival (ER+ is favorable)
  • Relatively specific for breast origin (but numerous exceptions)
  • Distinguishes endocervical (ER-) from endometrial (ER+) adenocarcinomas (Am J Surg Pathol 2002;26:998)
Micro Images

Images hosted on PathOut server, c/o Leica Microsystems:

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Invasive ductal carcinoma, intense nuclear staining



Images hosted on Other servers:

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Metastatic lobular carcinoma, breast

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Papillary urothelial carcinoma, bladder

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Breast carcinoma metastatic to stomach



Nature images:

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Colloid carcinoma, breast

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DCIS

Positive Staining - Disease
  • Breast carcinoma (varies by subtype and tumor grade) - well differentiated tumors are typically positive
  • Endometrial adenocarcinoma (75%)
  • Ovarian serous, mucinous and endometrioid adenocarcinoma (Am J Surg Pathol 2001;25:667), papillary urothelial carcinoma of bladder (10-20%) and ovarian transitional cell carcinoma (90%, Arch Pathol Lab Med 2005;129:194)
Negative Staining
  • Endocervical adenocarcinoma, ovarian clear cell carcinoma