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Progesterone receptor (PR)

Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 5 January 2013, last major update January 2013
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PubMed Search: Progesterone receptor[title]
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● See also Breast-malignant chapter, Wikipedia
● Standardized process for initial test validation is recommended (Arch Pathol Lab Med 2010;134:930)
● Evaluate % of tumor nuclei stained and intensity of nuclear staining (none, weak, moderate or strong) - note: cytoplasmic staining only should be interpreted as negative staining
● Immunostaining now done on paraffin fixed tissue (previously required fresh tissue)

Uses by pathologists

● In breast cancer, predicts response to tamoxifen or other anti-estrogens, only weakly associated with prognosis; however, compared to ER, PR staining adds only a limited amount of additional predictive information for response to hormonal therapy (Mod Pathol 2004;17:1545)
● For metastatic tumors with unknown primary, relatively specific for breast origin (but numerous exceptions)
● Often discordance between staining in core biopsies versus resections (Ann Oncol 2009;20:1948)

Micro images

Bladder: metastatic breast cancer (middle image)

Breast: normal epithelium

Breast: colloid carcinoma is PR+ (upper right)

Breast: invasive ductal carcinoma is PR+; results not dependent on fixation

Breast: invasive ductal carcinoma is PR+ (contributed by Leica Microsystems)

Breast: invasive ductal carcinoma - PR cytoplasmic staining (left-figure B) or membranous staining (right-figure B) is considered negative

Cervix: metastatic breast cancer

CNS: meningioma (fig 3-left) is PR+

Kidney: mixed epithelial and stromal tumor

Liver: hepatic adenoma (bottom)

Stomach: metastasis from breast carcinoma is PR+ (figure 3b)

Uterus: endometrial polyp with metastatic breast lobular carcinoma

Uterus: endometrial stromal sarcoma

Uterus (left to right): leiomyoma, atypical leiomyoma, STUMP

Positive staining - normal

● Breast epithelial cells, Toker cells; endocervical epithelial cells

Positive staining - disease

● Breast: fibroadenoma (stromal cells), myofibroblastoma, phyllodes tumors (epithelial cells), pseudoangiomatous stromal hyperplasia
● Breast carcinoma (usually well differentiated tumors, lobular, mucinous/colloid, sebaceous); endometrial adenocarcinoma (75-96%)
● Cervical carcinoma: endometrioid, minimal deviation
● Endometriosis (glands and stroma)
● Kidney: mixed epithelial and stromal tumor
● Liver: biliary cystadenoma (stroma), hepatic adenoma
● Lymphangiomyomatosis
● Ovarian tumors: endometrioid, ependymoma, fibroma, granulosa cell (juvenile), mucinous borderline-endocervical type; serous (50%)
● Soft tissue aggressive angiomyxoma, angiomyofibroblastoma, cellular angiofibroma
● Solitary fibrous tumor
● Uterus: endometrial carcinoma, endometrial stromal tumors, leiomyoma, STUMP (Diagn Pathol 2012;7:1)

Negative staining

● Breast: apocrine metaplasia and carcinomas, microglandular adenosis, myoepithelium and myoepithelial tumors
● Breast carcinomas-various (triple negative, including adenosquamous, basal-like, BRCA1-related, medullary, metaplastic; also lipid-rich)
● Endocervical adenocarcinoma, ovarian clear cell carcinoma
● Salivary gland intraductal and other carcinomas
● Soft tissue: fibromastosis
● Uterus: serous carcinoma

End of Stains > Progesterone receptor

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