Endometrial stromal tumours of the uterus: a practical approach using conventional morphology and ancillary techniques

Baker, Patricia M.; Oliva, Esther

doi:10.1136/jcp.2005.031203

Cited by 75 publications

(61 citation statements)

References 76 publications

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“…MTS showed smooth muscle differentiation. Our findings support those of Baker et al 8 The clinical, gross pathologic and microscopic features of our cases are compatible with those reported in the literature.…”

Section: 5005/jp-journals-10006-1128supporting

confidence: 83%

Reappraisal of Endometrial Stromal Sarcoma: Report of Four Cases with Review of Literature

Bn¹,

Rao²,

Kr³

2011

Journal of South Asian Federation of Obstetrics and Gynaecology

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Endometrial stromal sarcomas (ESSs) are morphologically heterogenous and diagnosed by light microscopy in most instances. The distinction between smooth muscle neoplasms, such as cellular leiomyoma and low-grade ESS can be problematic. The diagnoses of ESS on the basis of systematic assessment of gross and histological parameters are highlighted.Hysterectomy from four patients for a clinical diagnosis of leiomyoma was studied. Grossly, three had polypoidal lesion and in one myometrial widening with obvious permeation was noted. Microscopy showed features of ESS in three cases. Other case was diagnosed as cellular leiomyoma thought to be endometrial polyp. Reticulin stain was employed to highlight the characteristic spiral arterioles in ESS and thick-walled vessels in cellular leiomyoma.

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Section: 5005/jp-journals-10006-1128supporting

confidence: 83%

Reappraisal of Endometrial Stromal Sarcoma: Report of Four Cases with Review of Literature

Bn¹,

Rao²,

Kr³

2011

Journal of South Asian Federation of Obstetrics and Gynaecology

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“…5,[28][29][30][31][32][33][34][35] Of these, CD10 is the most sensitive for endometrial differentiation and rarely endometrial stromal sarcomas are negative for this marker. 7,23,30 However, CD10 may be expressed in other uterine mesenchymal tumors such as leiomyosarcoma, cellular leiomyomas, rhabdomyosarcomas and carcinosarcomas 5,7,30 as well as extra-uterine tumors like hemangiopericytoma and solitary fibrous tumor. 29 In distinguishing endometrial stromal sarcoma from uterine smooth muscle neoplasms, H-caldesmon has been touted as a more specific marker whereas desmin, smooth muscle actin, muscle-specific actin and calponin have all been variably shown to stain endometrial sarcomas.…”

Section: Discussionmentioning

confidence: 99%

“…1,3 Occasionally, these tumors may show unusual variations including epithelial sex cord-like patterns, presence of endometrioid glands, smooth muscle metaplasia, fibro-myxoid change or adipose and skeletal muscle differentiation. [4][5][6][7] Low-grade endometrial stromal sarcoma is also characterized by chromosomal translocations in a subset of cases, most commonly t(7;17)(p15;q21) involving zincfinger genes, JAZF1 and SUZ1. [8][9][10][11][12][13][14] The WHO identifies undifferentiated endometrial sarcoma as displaying marked cellular atypia and lacking morphologic evidence of an endometrial stromal phenotype.…”

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confidence: 99%

Endometrial sarcomas: an immunohistochemical and JAZF1 re-arrangement study in low-grade and undifferentiated tumors

et al. 2013

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The current World Health Organization classification divides endometrial sarcomas into low-grade endometrial stromal sarcoma and undifferentiated endometrial sarcoma. Recent studies suggest undifferentiated endometrial sarcoma is a heterogeneous group and a subgroup with uniform nuclei is more akin to lowgrade endometrial stromal sarcoma in terms of morphologic, immunohistochemical and genetic features. We classified endometrial sarcomas treated at our institution from 1998 to 2011 into low-grade endometrial stromal sarcoma and undifferentiated endometrial sarcoma, the latter being further categorized into a group with either uniform or pleomorphic nuclei. Morphological features, immunoprofile and fluorescence in situ hybridization rearrangements of JAZF1 and PHF1 genes were correlated with tumor category and outcome. A total of 40 cases were evaluated comprising 23 low-grade endometrial stromal sarcomas, 10 undifferentiated endometrial sarcomas with nuclear uniformity and 7 undifferentiated endometrial sarcomas with nuclear pleomorphism. Low-grade endometrial stromal sarcomas were more often estrogen and progesterone receptor positive (83%) compared with undifferentiated endometrial sarcoma with nuclear uniformity (10%) or with nuclear pleomorphism (0%) (Po0.001). Positivity for p53 was restricted to undifferentiated endometrial sarcomas with more frequent expression in the group with nuclear pleomorphism (57%) than with nuclear uniformity (10%) (P ¼ 0.06). Ki-67 proliferation index in 410% of tumor cells more frequent in undifferentiated endometrial sarcoma than low-grade endometrial stromal sarcoma (P ¼ o0.001). JAZF1 rearrangement was detected in 32% of low-grade endometrial stromal sarcomas and in none of the undifferentiated sarcomas. Rearrangement of PHF1 was found in two patients, one with JAZF1 À PHF1 fusion. There were no significant differences in clinical behavior between undifferentiated endometrial sarcoma with nuclear uniformity versus nuclear pleomorphism. In conclusion, we found undifferentiated endometrial sarcoma subtypes and low-grade endometrial stromal sarcoma have distinct immunohistochemical and cytogentic profiles. Our data do not show any difference in clinical behavior between subgroups in undifferentiated sarcomas. Modern Pathology (2013) 26, 95-105;

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“…68 This differential diagnosis may be confounded by the fact that some low-grade endometrial stromal sarcomas are associated with a high-grade component (high-grade endometrial stromal sarcoma with t(10,17) 69 showing relatively small but epithelioid tumor cells forming nests that can be confused with an epithelioid smooth muscle component. Helpful features to establish the diagnosis of low-grade endometrial stromal sarcoma include; (a) typical tongue-like pattern of infiltration, (b) absence of fascicular growth, (c) arteriole-like vessels, (d) in most cases, areas of conventional endometrial stromal neoplasia, 70 and (e) lack of positivity for h-caldesmon. 71 In the highgrade areas, the tumor cells are small with very brisk mitotic activity and are associated with a prominent sinusoidal vasculature.…”

Section: Tumor Cell Necrosismentioning

confidence: 99%

Practical issues in uterine pathology from banal to bewildering: the remarkable spectrum of smooth muscle neoplasia

Oliva

2016

Modern Pathology

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Among mesenchymal tumors of the uterus, smooth muscle neoplasms are most common. The wide morphologic spectrum, especially within the category of leiomyomas, is responsible for diagnostic problems more frequently with leiomyosarcoma (including mitotically active, apoplectic, and leiomyoma with bizarre nuclei) but also with endometrial stromal tumors. In the former scenario, clinical information, gross appearance as well as strict utilization of morphologic criteria including cytologic atypia, mitotic activity, and tumor cell necrosis are clues in establishing the correct diagnosis. It is important to keep in mind that mitotic rate thresholds vary for the different subtypes of leiomyosarcoma. Of note, p16 should be used with caution in supporting a diagnosis of leiomyosarcoma as it is often positive in leiomyomas with bizarre nuclei and leiomyomas with apoplectic change (in the latter most frequently and more intense near areas of necrosis). MED12 mutations have also a very limited role in this differential diagnosis. Endometrial stromal tumors are by far, less common than smooth muscle tumors, but can be confused with leiomyosarcomas if they are associated with an undifferentiated uterine sarcoma and the low-grade component is overlooked or they have a myxoid/fibroblastic morphology. The differential diagnosis may be confounded if the latter is associated with a high-grade endometrial stromal sarcoma. It is important to highlight that CD10 is not a reliable marker in these differentials and should be used as a part of a panel of antibodies that also includes desmin and h-caldesmon. Two other recently categorized tumors in the uterus that merit special mention are PEComa and inflammatory myofibroblastic tumor as they enter in the differential diagnosis of smooth muscle tumors. PEComa may be part of the tuberous sclerosis syndrome and may show either a predominantly epithelioid or spindle morphology or combination thereof. Rarely, it may contain melanin pigment. There is variable positivity for HMB-45, MelanA, MiTF, and CathepsinK, and some tumors have been shown to express TFE-3 especially when associated with "clear cell" morphology. Patients with adverse outcome have tumors with ≥ 2 of the following features: ≥ 5 cm, infiltration, high-grade cytologic features, mitotic rate ≥ 1/50 high-power fields, necrosis, or lymphovascular invasion. Inflammatory myofibroblastic tumor is important to recognize as it often mimics myxoid smooth muscle tumors, either benign or malignant. The presence of an associated lymphoplasmacytic infiltrate should alert to that possibility and ALK studies (immunostain or FISH) are helpful in establishing this diagnosis. These tumors can behave in a malignant manner if large, associated with abundant myxoid change, brisk mitotic rate or show tumor cell necrosis.

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Endometrial stromal tumours of the uterus: a practical approach using conventional morphology and ancillary techniques

Cited by 75 publications

References 76 publications

Reappraisal of Endometrial Stromal Sarcoma: Report of Four Cases with Review of Literature

Reappraisal of Endometrial Stromal Sarcoma: Report of Four Cases with Review of Literature

Endometrial sarcomas: an immunohistochemical and JAZF1 re-arrangement study in low-grade and undifferentiated tumors

Practical issues in uterine pathology from banal to bewildering: the remarkable spectrum of smooth muscle neoplasia

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