Polymorphism 1558 C > T in the aromatase gene (CYP19A1) in low-grade endometrial stromal sarcoma

Low-grade endometrial stromal sacomas (ESS) are estrogen-sensitive tumors. Polymorphic variation in the CYP19 gene can affect estrogen synthesis by increasing aromatase activity resulting in elevated levels of estrone and estradiol. We examined the polymorphism 1558 C > T in he aromatase gene (CYP19A1) in a series of 20 low-grade endometrial stromal sarcomas. Archival formalinfixed and paraffin-embedded material was analyzed with a fast real-time PCR system. The homozygous C/T- and the homozygous mutant T/T-genotypes were detected in 10/20 (50%) and 7/20 (35%) samples, respectively. Polymorphism 1558 C > T in the aromatase gene may represent a high-risk allele with increased local estrogen levels.

High levels of xenoestrogens in patients with low-grade endometrial stromal sarcoma--report of two cases

BACKGROUND

Endometrial stromal sarcomas (ESS) are rare uterine tumors with unknown etiological risk factors, but estrogen-dependent growth promotion.

CASES

We present two patients with advanced ESS, who had increased levels of p,p-DDE; hexachlorobenzene; PCB 28; PCB 52; PCB 101; PCB 138; PCB 153 and PCB 180 in abdominal adipose tissue. Other xenoestrogens were within expected limits for the non-exposed European population.

CONCLUSION

Increased levels of xenoestrogens in patients with ESS may be involved in the pathogenesis of ESS. Chronic exposure to xenoestrogens may be a risk factor for tumor progression.

Dermatofibrosarcoma protuberans of the vulva: a case report

Dermatofibrosarcoma protuberans (DFSP) is a low-grade to intermediate-grade well-differentiated sarcoma of dermal origin. Local recurrence rates are high but distant metastases are rare. This report describes a case of vulvar DFSP requiring four resections for primary clearance. A 56-year-old woman referred after excision of a vulvar tumour and histology had DFSP extending to the resection margins. Two more extended excisions again yielded a specimen with positive margins. The last excision was performed with intraoperative frozen section analysis of the margins. Frozen section analysis of the resected specimen revealed clear margins and this was confirmed by final pathology. The postoperative course was uneventful. The patient has been without recurrence for 15 months. A wide and deep local excision is recommended for both primary and recurrent lesions. The patient had three resections before clear surgical margins were achieved. Intraoperative frozen section analysis is helpful in assessing resection margins.