1
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The JAZF1-SUZ12 fusion protein disrupts PRC2 complexes and impairs chromatin repression during human endometrial stromal tumorogenesis. Oncotarget 2018; 8:4062-4078. [PMID: 27845897 PMCID: PMC5354813 DOI: 10.18632/oncotarget.13270] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/29/2016] [Indexed: 11/27/2022] Open
Abstract
The Polycomb repressive complex 2 (PRC2), which contains three core proteins EZH2, EED and SUZ12, controls chromatin compaction and transcription repression through trimethylation of lysine 27 on histone 3. The (7;17)(p15;q21) chromosomal translocation present in most cases of endometrial stromal sarcomas (ESSs) results in the in-frame fusion of the JAZF1 and SUZ12 genes. We have investigated whether and how the fusion protein JAZF1-SUZ12 functionally alters PRC2. We found that the fusion protein exists at high levels in ESS containing the t(7;17). Co-transient transfection assay indicated JAZF1-SUZ12 destabilized PRC2 components EZH2 and EED, resulting in decreased histone methyl transferase (HMT) activity, which was confirmed by in vitro studies using reconstituted PRC2 and nucleosome array substrates. We also demonstrated the PRC2 containing the fusion protein decreased the binding affinity to target chromatin loci. In addition, we found that trimethylation of H3K27 was decreased in ESS samples with the t(7;17), but there was no detectable change in H3K9 in these tissues. Moreover, re-expression of SUZ12 in Suz12 (−/−) ES cells rescued the neuronal differentiation while the fusion protein failed to restore this function and enhanced cell proliferation. In summary, our studies reveal that JAZF1-SUZ12 fusion protein disrupts the PRC2 complex, abolishes HMT activity and subsequently activates chromatin/genes normally repressed by PRC2. Such dyesfunction of PRC2 inhibits normal neural differentiation of ES cell and increases cell proliferation. Related changes induced by the JAZF-SUZ12 protein in endometrial stromal cells may explain the oncogenic effect of the t(7;17) in ESS.
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2
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Przybyl J, Kowalewska M, Quattrone A, Dewaele B, Vanspauwen V, Varma S, Vennam S, Newman AM, Swierniak M, Bakuła-Zalewska E, Siedlecki JA, Bidzinski M, Cools J, van de Rijn M, Debiec-Rychter M. Macrophage infiltration and genetic landscape of undifferentiated uterine sarcomas. JCI Insight 2017; 2:94033. [PMID: 28570276 DOI: 10.1172/jci.insight.94033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/02/2017] [Indexed: 12/18/2022] Open
Abstract
Endometrial stromal tumors include translocation-associated low- and high-grade endometrial stromal sarcomas (ESS) and highly malignant undifferentiated uterine sarcomas (UUS). UUS is considered a poorly defined group of aggressive tumors and is often seen as a diagnosis of exclusion after ESS and leiomyosarcoma (LMS) have been ruled out. We performed a comprehensive analysis of gene expression, copy number variation, point mutations, and immune cell infiltrates in the largest series to date of all major types of uterine sarcomas to shed light on the biology of UUS and to identify potential novel therapeutic targets. We show that UUS tumors have a distinct molecular profile from LMS and ESS. Gene expression and immunohistochemical analyses revealed the presence of high numbers of tumor-associated macrophages (TAMs) in UUS, which makes UUS patients suitable candidates for therapies targeting TAMs. Our results show a high genomic instability of UUS and downregulation of several TP53-mediated tumor suppressor genes, such as NDN, CDH11, and NDRG4. Moreover, we demonstrate that UUS carry somatic mutations in several oncogenes and tumor suppressor genes implicated in RAS/PI3K/AKT/mTOR, ERBB3, and Hedgehog signaling.
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Affiliation(s)
- Joanna Przybyl
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.,Department of Molecular and Translational Oncology, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland.,Department of Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Magdalena Kowalewska
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland.,Department of Immunology, Biochemistry and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Anna Quattrone
- Department of Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Barbara Dewaele
- Department of Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Vanessa Vanspauwen
- Department of Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Sushama Varma
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Sujay Vennam
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Aaron M Newman
- Institute for Stem Cell Biology and Regenerative Medicine.,Department of Medicine, Division of Oncology, Stanford Cancer Institute, Stanford University, Stanford, California, USA
| | - Michal Swierniak
- Human Cancer Genetics, Center of New Technologies, CENT, University of Warsaw, Warsaw, Poland
| | | | - Janusz A Siedlecki
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Mariusz Bidzinski
- Department of Gynecologic Oncology, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland.,The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Jan Cools
- KU Leuven and Flanders Interuniversity Institute for Biotechnology (VIB), Leuven, Belgium
| | - Matt van de Rijn
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Maria Debiec-Rychter
- Department of Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
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3
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Abstract
INTRODUCTION Uterine sarcomas are rare cancers, of which the most common entities are leiomyosarcoma and endometrial stromal sarcoma. These two tumors may have overlapping clinical presentation, morphology and immunohistochemical profile, but are increasingly recognized to be two molecularly distinct entities. Endometrial stromal sarcomas are further currently divided into a low-grade and high-grade group based on molecular characteristics. Area covered: This review discusses recent data which shed light on the molecular profile of these two cancers and may aid in understanding their evolution and progression, in the aim of improving their diagnosis and management. Search was through PubMed, with focus on studies published in the last 5 years. Expert commentary: The literature presented and discussed documents rapidly expanding knowledge of the genetic characteristics of leiomyosarcoma and endometrial stromal sarcoma, with an array of molecules and pathways implicated in the biology of these cancers. Several of these molecules are potential therapeutic targets. Assessment of their predictive and prognostic role awaits larger studies.
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Affiliation(s)
- Ben Davidson
- a Department of Pathology , Norwegian Radium Hospital, Oslo University Hospital , Oslo , Norway.,b Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Francesca Micci
- c Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Norwegian Radium Hospital , Oslo University Hospital , Oslo , Norway.,d Centre for Cancer Biomedicine , University of Oslo , Oslo , Norway
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4
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Genomic characterization of endometrial stromal sarcomas with array comparative genomic hybridization. Exp Mol Pathol 2015; 98:367-74. [PMID: 25758203 DOI: 10.1016/j.yexmp.2015.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/06/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The endometrial stromal sarcoma (ESS) is a very rare uterine sarcoma, counting for 1-3% of all gynecologic malignancies. ESS represents 0.2-8% of all uterine malignant tumors and accounts for about 10% of all uterine sarcomas. With regard to chromosomal aberrations, very little is known about benign and malignant endometrial stromal tumors. METHODS 30 tumors, consisting of 4 cases of benign endometrial stromal nodule (ESN), 22 cases of low-grade ESS and 4 cases of undifferentiated endometrial sarcoma (UES), were analyzed by array-comparative genomic hybridization (aCGH). RESULTS ESN did not show many copy number changes (CNCs) by aCGH. Frequent losses could be identified on chromosomes 7p and 19, and gains on chromosomes 1q, 6p and 8q. Low-grade ESS presented as a very heterogeneous group. 90% (20/22) of cases displayed aberrations. Most frequent changes were losses on chromosomes 7 and 22, and gains on chromosome 1q or 11. UES showed a high number of chromosomal aberrations and on every chromosome CNCs were detected. Most frequent changes were losses on chromosomes 1q, 2q (3/4, 75%) and 13, and gains on chromosomes 1q and 17p. CONCLUSION Our data shows an increasing number of CNCs from ESN to low-grade ESS and to UES. However, the chromosomal aberrations differ considerably between the investigated ESN-, low-grade ESS- and UES cases and thus, a linear tumor progression seems to be unlikely.
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5
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Dewaele B, Przybyl J, Quattrone A, Finalet Ferreiro J, Vanspauwen V, Geerdens E, Gianfelici V, Kalender Z, Wozniak A, Moerman P, Sciot R, Croce S, Amant F, Vandenberghe P, Cools J, Debiec‐Rychter M. Identification of a novel, recurrent
MBTD1‐CXorf67
fusion in low‐grade endometrial stromal sarcoma. Int J Cancer 2013; 134:1112-22. [DOI: 10.1002/ijc.28440] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/15/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Barbara Dewaele
- Department of Human GeneticsKU Leuven and University Hospitals LeuvenLeuven Belgium
| | - Joanna Przybyl
- Department of Human GeneticsKU Leuven and University Hospitals LeuvenLeuven Belgium
- Department of Molecular and Translational OncologyThe Maria Sklodowska‐Curie Memorial Cancer Centre and Institute of OncologyWarsaw Poland
- Postgraduate School of Molecular MedicineWarsaw Medical UniversityWarsaw Poland
| | - Anna Quattrone
- Department of Human GeneticsKU Leuven and University Hospitals LeuvenLeuven Belgium
| | | | - Vanessa Vanspauwen
- Department of Human GeneticsKU Leuven and University Hospitals LeuvenLeuven Belgium
| | - Ellen Geerdens
- Department of Human GeneticsKU Leuven and Flanders Interuniversity Institute for Biotechnology (VIB)Leuven Belgium
| | - Valentina Gianfelici
- Department of Human GeneticsKU Leuven and Flanders Interuniversity Institute for Biotechnology (VIB)Leuven Belgium
| | - Zeynep Kalender
- Department of Human GeneticsKU Leuven and Flanders Interuniversity Institute for Biotechnology (VIB)Leuven Belgium
| | - Agnieszka Wozniak
- Laboratory of Experimental OncologyDepartment of OncologyKU Leuven and Department of General Medical OncologyUniversity Hospitals LeuvenLeuven Belgium
| | - Philippe Moerman
- Department of PathologyKU Leuven and University Hospitals LeuvenLeuven Belgium
| | - Raf Sciot
- Department of PathologyKU Leuven and University Hospitals LeuvenLeuven Belgium
| | - Sabrina Croce
- Department of PathologyInstitute BergoniéBordeaux France
| | - Frederic Amant
- Department of OncologyKU Leuven and Leuven Cancer InstituteUniversity Hospitals LeuvenLeuven Belgium
| | - Peter Vandenberghe
- Department of Human GeneticsKU Leuven and University Hospitals LeuvenLeuven Belgium
| | - Jan Cools
- Department of Human GeneticsKU Leuven and Flanders Interuniversity Institute for Biotechnology (VIB)Leuven Belgium
| | - Maria Debiec‐Rychter
- Department of Human GeneticsKU Leuven and University Hospitals LeuvenLeuven Belgium
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6
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Panagopoulos I, Thorsen J, Gorunova L, Haugom L, Bjerkehagen B, Davidson B, Heim S, Micci F. Fusion of the ZC3H7B and BCOR genes in endometrial stromal sarcomas carrying an X;22-translocation. Genes Chromosomes Cancer 2013; 52:610-8. [PMID: 23580382 DOI: 10.1002/gcc.22057] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/14/2013] [Indexed: 12/13/2022] Open
Abstract
Endometrial stromal sarcomas (ESS) are genetically heterogeneous uterine tumors in which a JAZF1-SUZ12 chimeric gene resulting from the chromosomal translocation t(7;17)(p15;q21) as well as PHF1 rearrangements (in chromosomal band 6p21) with formation of JAZF1-PHF1, EPC1-PHF1, and MEAF6-PHF1 chimeras have been described. Here, we investigated two ESS characterized cytogenetically by the presence of a der(22)t(X;22)(p11;q13). Whole transcriptome sequencing one of the tumors identified a ZC3H7-BCOR chimeric transcript. Reverse transciptase-PCR with the ZC3H7B forward and BCOR reverse primer combinations confirmed the presence of a ZC3H7-BCOR chimeric transcript in both ESS carrying a der(22)t(X;22) but not in a control ESS with t(1;6) and the MEAF6-PHF1 fusion. Sequencing of the amplified cDNA fragments showed that in both cases ESS exon 10 of ZC3H7B (from 22q13; accession number NM_017590 version 4) was fused to exon 8 of BCOR (from Xp11; accession number NM_001123385 version 1). Reciprocal multiple BCOR-ZC3H7B cDNA fragments were amplified in only one case suggesting that ZC3H7B-BCOR, on the der(22)t(X;22), is the pathogenetically important fusion gene. The putative ZC3H7B-BCOR protein would contain the tetratricopeptide repeats and LD motif from ZC3H7B and the AF9 binding site (1093-1233aa), the 3 ankyrin repeats (1410-1509 aa), and the NSPC1 binding site of BCOR. Although the presence of these motifs suggests various functions of the chimeric protein, it is possible that its most important role may be in epigenetic regulation. Whether or not the (patho)genetic subsets JAZF1-SUZ12, PHF1 rearrangements, and ZC3H7B-BCOR correspond to any phenotypic, let alone clinically important, differences in ESS remain unknown.
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Affiliation(s)
- Ioannis Panagopoulos
- Section for Cancer Cytogenetics, Institute for Medical Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
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7
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Amador-Ortiz C, Roma AA, Huettner PC, Becker N, Pfeifer JD. JAZF1 and JJAZ1 gene fusion in primary extrauterine endometrial stromal sarcoma. Hum Pathol 2011; 42:939-46. [DOI: 10.1016/j.humpath.2010.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 10/30/2010] [Accepted: 11/03/2010] [Indexed: 01/12/2023]
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8
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Cytogenetic and molecular aberrations in endometrial stromal tumors. Hum Pathol 2011; 42:609-17. [DOI: 10.1016/j.humpath.2010.12.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 11/24/2010] [Accepted: 12/02/2010] [Indexed: 12/23/2022]
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9
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Molecular profiling of endometrial malignancies. Obstet Gynecol Int 2010; 2010:162363. [PMID: 20368795 PMCID: PMC2846683 DOI: 10.1155/2010/162363] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 12/09/2009] [Accepted: 01/14/2010] [Indexed: 01/16/2023] Open
Abstract
Molecular profiling of endometrial neoplasms reveals genetic changes in endometrial carcinomas that support the dualistic model, in which type I carcinomas are estrogen-dependent, low grade lesions and type II carcinomas are nonestrogen dependent and high grade. The molecular changes in type I endometrial carcinomas include mutations in PTEN, PIK3CA, KRAS, and β-catenin, along with microsatellite instability, whereas type II endometrial carcinomas are characterized by genetic alterations in p53, HER2/neu, p16, and E-cadherin. For endometrial neoplasms with a malignant mesenchymal component, C-MYC mutations and loss of heterozygosity are frequently seen in carcinosarcomas, and a fusion gene, JAZF1/JJAZ1, is distinctive for endometrial stromal sarcoma. In addition, p53 mutations may play an important role in tumorigenesis of undifferentiated endometrial sarcoma. These molecular changes can help in the diagnosis of endometrial neoplasms, as well as form the basis of molecular targeted therapy.
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10
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Lee CH, Ali R, Gilks CB. Molecular Genetics of Mesenchymal Tumors of the Female Genital Tract. Surg Pathol Clin 2009; 2:823-34. [PMID: 26838781 DOI: 10.1016/j.path.2009.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mesenchymal tumors of the female genital tract are a heterogeneous group of neoplasms that can be classified based on cellular differentiation into 3 main groups: smooth muscle tumors, endometrial stromal tumors, and other differentiated and undifferentiated tumors. Genomic analysis techniques have revealed important genetic aberrations such as the t(7;17) translocation, resulting in JAZF1-JJAZ1 gene fusion, characteristic of endometrial stromal tumors. These analyses have demonstrated genetic complexity and heterogeneity in many mesenchymal tumor types. This article focuses on current understanding of the molecular genetics of mesenchymal tumors of the female genital tract, with emphasis on diagnostic and prognostic molecular features.
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Affiliation(s)
- Cheng-Han Lee
- Department of Pathology & Laboratory Medicine, University of British Columbia, 1st Floor JPPN, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Rola Ali
- Department of Pathology & Laboratory Medicine, University of British Columbia, 1st Floor JPPN, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - C Blake Gilks
- Department of Pathology & Laboratory Medicine, University of British Columbia, 1st Floor JPPN, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
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11
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Uterine tumors resembling ovarian sex cord tumors (UTROSCT) lack the JAZF1-JJAZ1 translocation frequently seen in endometrial stromal tumors. Am J Surg Pathol 2009; 33:1206-12. [PMID: 19542872 DOI: 10.1097/pas.0b013e3181a7b9cf] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Uterine tumor resembling ovarian sex cord tumor (UTROSCT) is a rare uterine neoplasm composed predominantly or exclusively of cells which resemble those seen in sex cord tumors of the ovary. Since its initial morphologic description, it has been unclear whether UTROSCT represents a variant within the spectrum of endometrial stromal tumors (ESTs), which may rarely exhibit areas of sex cord-like differentiation, or whether it is a distinct uterine neoplasm unrelated to ESTs. Recently, several studies have revealed a recurrent t(7;17) translocation resulting in a JAZF1-JJAZ1 gene fusion in over 60% of EST and its variants, including 2 out of 4 endometrial stromal tumors with sex cord-like elements (ESTSCLE). We examined UTROSCTs for evidence of the JAZF1-JJAZ1 gene fusion by fluorescence in situ hybridization and by reverse transcriptase polymerase chain reaction in 24 and 20 cases, respectively. The JAZF1-JJAZ1 gene fusion was not identified in any tumor by either method. Although we cannot entirely exclude that UTROSCT represents a variant of ESTSCLE which lacks this translocation, our findings suggest that UTROSCT does not share the genetic mechanism common to the majority of ESTs with or without sex cord-like differentiation, and therefore most likely represents a distinct neoplasm unrelated to ESTSCLE.
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12
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Sandberg A. The cytogenetics and molecular biology of endometrial stromal sarcoma. Cytogenet Genome Res 2007; 118:182-9. [DOI: 10.1159/000108299] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 02/04/2007] [Indexed: 12/12/2022] Open
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13
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Micci F, Heim S. Pathogenetic mechanisms in endometrial stromal sarcoma. Cytogenet Genome Res 2007; 118:190-5. [DOI: 10.1159/000108300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 01/21/2007] [Indexed: 12/13/2022] Open
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14
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Oliva E, de Leval L, Soslow RA, Herens C. High Frequency of JAZF1-JJAZ1 Gene Fusion in Endometrial Stromal Tumors With Smooth Muscle Differentiation by Interphase FISH Detection. Am J Surg Pathol 2007; 31:1277-84. [PMID: 17667554 DOI: 10.1097/pas.0b013e318031f012] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The most common cytogenetic alteration observed in low-grade endometrial stromal tumors (EST) is the t(7;17)(p15;q21) translocation, resulting in the fusion of the JAZF1 and JJAZ1 genes. By reverse-transcription polymerase chain reaction, the translocation has been detected overall in one-third of ESTs, but only rarely in its variants. The purpose of this study was to develop a fluorescence in situ hybridization assay for detection of this translocation using archival paraffin-embedded samples of ESTs with smooth muscle differentiation and to assess the nature of the smooth muscle component of these tumors. Representative paraffin blocks of 9 endometrial stromal nodules and 1 low-grade endometrial stromal sarcoma were collected for the study. In 1 case, the block selected also contained areas of sex cordlike differentiation. A fluorescence in situ hybridization probe set was designed to detect the t(7;17)(p15;q12) on tissue sections. Six out of 10 collected ESTs were assessable. Fusion signals were detected in 3 out of 6 cases (50%) in both the conventional endometrial stromal and the smooth muscle components of the tumors. The tumor sample with sex cordlike differentiation harbored the fusion signal in all the 3 components. Our results support the contention that the endometrial stromal and smooth muscle components of these tumors have the same origin, either from a common precursor cell with pluripotential differentiation or from endometrial stromal cells that have undergone smooth muscle metaplasia. Our results indicate that the detection of this chromosomal abnormality can be used to diagnose ESTs with smooth muscle differentiation when the smooth muscle component is predominant.
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MESH Headings
- Cell Transformation, Neoplastic
- Chromosomes, Human, Pair 17
- Chromosomes, Human, Pair 7
- Co-Repressor Proteins
- DNA, Neoplasm/analysis
- DNA-Binding Proteins
- Endometrial Stromal Tumors/genetics
- Endometrial Stromal Tumors/pathology
- Female
- Gene Fusion
- Humans
- In Situ Hybridization, Fluorescence/methods
- Middle Aged
- Myocytes, Smooth Muscle/pathology
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Sarcoma, Endometrial Stromal/genetics
- Sarcoma, Endometrial Stromal/pathology
- Stromal Cells/pathology
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Translocation, Genetic
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Affiliation(s)
- Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.
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15
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Abstract
A wide variety of sarcomas occur in the uterus but two subtypes - leiomyosarcoma and endometrial stromal sarcoma - account for a majority of those more routinely encountered. Using the 2003 World Health Organization classification, this review focuses on six uterine sarcomas: endometrial stromal sarcoma, undifferentiated endometrial sarcoma, leiomyosarcoma, rhabomyosarcoma, angiosarcoma and liposarcoma. The epidemiological, clinical, pathological and molecular features are presented along with therapeutic approaches. Familiarity with molecular aspects of these tumors and application of novel technologies in their assessment should be encouraged as they may provide alternate therapies resulting in improved survival for the patient. Clinical information necessary for accurate diagnosis of these lesions is emphasised. A multidisciplinary approach to management of patients with uterine sarcomas is essential for optimal management.
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Affiliation(s)
- Farid Moinfar
- Department of Pathology, Graz University School of Medicine, Austria
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16
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Nucci MR, Harburger D, Koontz J, Dal Cin P, Sklar J. Molecular Analysis of the JAZF1-JJAZ1 Gene Fusion by RT-PCR and Fluorescence In Situ Hybridization in Endometrial Stromal Neoplasms. Am J Surg Pathol 2007; 31:65-70. [PMID: 17197920 DOI: 10.1097/01.pas.0000213327.86992.d1] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nonrandom cytogenetic abnormalities of chromosomes 6, 7, and 17 have been reported within low-grade endometrial stromal sarcomas (LGESSs), and among these abnormalities, the t(7;17)(p15;q21) is the most common aberration described. Previously we had shown that this translocation joins 2 genes, JAZF1 and JJAZ1, located on chromosomes 7 and 17, respectively. To determine the frequency of the t(7;17), we analyzed 4 stromal nodules and 24 LGESS by both reverse transcriptase-polymerase chain reaction and fluorescence in situ hybridization (FISH). In addition, we examined 4 cases of highly cellular leiomyoma, a benign morphologic mimic of LGESS. Overall, evidence for the JAZF1-JJAZ1 fusion was found in 60% of endometrial stromal neoplasms analyzed (8/16 ESS and 4/4 stromal nodules). One LGESS demonstrated only rearrangement of 7p15 by FISH analysis and karyotypic analysis of this case showed t(6;7)(p21;p15). The fusion was not detected in any highly cellular leiomyomas. Our data suggest that the JAZF1-JJAZ1 fusion is a frequent, although nonuniform, feature of endometrial stromal neoplasia, irrespective of benign versus malignant classification and smooth muscle differentiation. In addition, the detection of the fusion by reverse transcriptase-polymerase chain reaction or FISH for JJAZ1 at 7p15 may be diagnostically useful.
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Affiliation(s)
- Marisa R Nucci
- Division of Molecular Oncology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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17
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Pink D, Lindner T, Mrozek A, Kretzschmar A, Thuss-Patience PC, Dörken B, Reichardt P. Harm or benefit of hormonal treatment in metastatic low-grade endometrial stromal sarcoma: single center experience with 10 cases and review of the literature. Gynecol Oncol 2005; 101:464-9. [PMID: 16368128 DOI: 10.1016/j.ygyno.2005.11.010] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 11/04/2005] [Accepted: 11/07/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Endometrial stromal sarcoma (ESS) is a rare disease with probably less than 700 new cases in the US or EU per year. ESS usually expresses steroidal receptors and is regarded to be hormone-sensitive. A higher risk in women receiving estrogen replacement therapy (ERT) or tamoxifen has been suspected, and remissions following treatment with progestins have been reported in case studies. Aromatase inhibitors represent an interesting new treatment option. Due to the rarity of the tumor, only few case series and no prospective studies are published. We therefore conducted a retrospective study to evaluate the influence of hormonal treatment to ESS. METHODS Our institutional sarcoma data bank was screened for cases of ESS since 1999. All corresponding files and radiographs were reviewed retrospectively. RESULTS Ten patients with low-grade ESS were identified. Diagnosis was established before or by hysterectomy in 6 patients, by local recurrence after previous hysterectomy for nonmalignant disease in 3 patients or by pulmonary metastases with no primary tumor found so far in 1 patient. 5/10 patients were on ERT and 3/10 on tamoxifen at the time of diagnosis of metastatic disease. Treatment strategies consisted of stopping ERT and tamoxifen, respectively, or initiation of the progestin MPA or letrozole. Three patients achieved stable disease after stopping ERT. 2/3 patients responded to MPA as first-line treatment (1 CR; 50+ months, 1 PR; 9 months). 4/5 patients responded to letrozole as first-line therapy (3 PR;3+, 9+ and 10+ months) or second-line treatment after MPA (1 PR; 37+ months). 9/10 patients are alive 33 to 255 months after hysterectomy. Survival since diagnosis of metastatic disease is 4 to 164 months. CONCLUSIONS Patients with a previous history of low-grade ESS should not be treated with estrogens or tamoxifen. If nevertheless present, withdrawal of ERT or tamoxifen is strongly advised, resulting in disease stabilization in some cases. MPA and letrozole, in particular, are highly effective and lead to sustained disease control in most cases.
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Affiliation(s)
- Daniel Pink
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, HELIOS-Klinikum Berlin-Buch, Robert-Rössle-Klink, Charité Campus Buch, Lindenberger Weg 80, D-13125 Berlin, Germany
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18
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Halbwedl I, Ullmann R, Kremser ML, Man YG, Isadi-Moud N, Lax S, Denk H, Popper HH, Tavassoli FA, Moinfar F. Chromosomal alterations in low-grade endometrial stromal sarcoma and undifferentiated endometrial sarcoma as detected by comparative genomic hybridization. Gynecol Oncol 2005; 97:582-7. [PMID: 15863163 DOI: 10.1016/j.ygyno.2005.01.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 12/23/2004] [Accepted: 01/04/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Endometrial stromal sarcomas (ESS) are very rare neoplasms constituting less than 0.5% of all malignant uterine tumors. The aim of the present study was to characterize the karyotypic abnormalities in these malignant mesenchymal tumors and to find specific chromosomal aberrations with eventual correlation with histologic grades. METHODS Twelve cases of endometrial stromal sarcomas consisting of nine low-grade ESS and three undifferentiated endometrial sarcomas (UES) were investigated by comparative genomic hybridization (CGH). RESULTS Ten of the twelve cases (83.3%) displayed chromosomal gains or losses. Deletions occurred more frequently than gains (63.4% versus 36.6%). In low-grade ESS, gains on 1, 6q, 9q, 16p, 19, 20q, 22q and losses on 2, 4q, 6, 7, 11q, 13q, 15q, 16q, 20p, X were detected. CGH with UES exhibited gains on 2q, 4q, 6q, 7p, 9q, 20q and losses on 3q, 10p, 14q. One low-grade ESS and one UES did not reveal any chromosomal aberration. CONCLUSIONS Chromosomal aberrations in endometrial sarcomas are heterogeneous and do not clearly correlate with the histologic grades. There is no increased accumulation of aberrations from low-grade ESS to UES. Despite the karyotypic variations, chromosomal deletion on 7p was the most common finding (55.6%) in low-grade ESS and may play a role in tumor development and progression.
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Affiliation(s)
- Iris Halbwedl
- Department of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
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19
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Riopel J, Plante M, Renaud MC, Roy M, Têtu B. Lymph node metastases in low-grade endometrial stromal sarcoma. Gynecol Oncol 2005; 96:402-6. [PMID: 15661228 DOI: 10.1016/j.ygyno.2004.10.021] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to review our experience on lymphatic dissemination in patients with low-grade endometrial stromal sarcoma. METHODS All cases diagnosed as low-grade endometrial stromal sarcoma or endolymphatic stromal myosis before October 2003 and who had lymph node sampling at some point in their evolution were retrieved from the files of the pathology and gynecologic oncology departments of l'Hotel-Dieu de Quebec University Hospital (HDQ). RESULTS Fifteen patients with either limited lymph node biopsies or a complete lymph node dissection at some point in the course of their disease were found. Five of these patients (33%) presented lymph node metastases either at the initial hysterectomy, during a subsequent staging procedure, or at the time of a recurrence. CONCLUSION These findings suggest that the incidence of lymph node involvement in low-grade endometrial stromal sarcoma is higher than expected. More extensive sampling of lymph nodes in a larger number of patients may allow a better understanding of the frequency and prognostic significance of these metastases.
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Affiliation(s)
- J Riopel
- Department of Pathology, Centre Hospitalier Universitaire de Québec (CHUQ)-Pavillon L'Hôtel-Dieu de Québec, 11 Côte du Palais, Québec, Québec, Canada G1R 2J6
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20
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Huang HY, Ladanyi M, Soslow RA. Molecular Detection of JAZF1-JJAZ1 Gene Fusion in Endometrial Stromal Neoplasms with Classic and Variant Histology. Am J Surg Pathol 2004; 28:224-32. [PMID: 15043312 DOI: 10.1097/00000478-200402000-00010] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Endometrial stromal tumors (ESTs), including low-grade endometrial stromal sarcomas (LGESSs) and endometrial stromal nodules (ESNs) of classic histology, exhibit characteristic morphologic features and contain the nonrandom t(7;17)(p15; q21), which results in the fusion of two novel genes, JAZF1 and JJAZ1. ESTs may pose diagnostic challenges when they involve extrauterine sites, present as metastases, or display variant histologic appearances. The aim of this study was to evaluate the frequency of the JAZF1-JJAZ1 gene fusion among primary uterine, metastatic, and primary extrauterine ESTs of various histologic types and its role as a possible diagnostic adjunct. Using a nonnested reverse transcriptase-polymerase chain reaction approach, we assayed for JAZF1-JJAZ1 gene fusion transcripts in 10 cases with available fresh-frozen tissue. These included five primary uterine (two classic, one mixed smooth muscle, and one epithelioid LGESS; one classic ESN), four metastatic (two fibromyxoid, one classic, and one epithelioid LGESS), and one extrauterine (classic LGESS) tumor. The same primer set and assay conditions were used on five additional paraffin-embedded cases with adequate RNA, including three primary uterine (one fibromyxoid and one mixed smooth muscle LGESS; 1 mixed smooth muscle ESN) and two intraabdominal recurrent (two mixed smooth muscle LGESSs) ESTs. Two cellular leiomyomas and one ESS cell line (ESS-1) without the t(7;17) at the cytogenetic level were run in parallel as controls. JAZF1-JJAZ1 gene fusion transcripts were detected in five (33%) of 15 ESTs, including three of eight primary uterine, one of four metastatic, one of one extrauterine, and none of two recurrent cases. Most ESTs of classic histology showed evidence of JAZF1-JJAZ1 fusion (4 of 5 cases), whereas only one mixed smooth muscle ESN of 10 variant cases was positive. Positivity for JAZF1-JJAZ1 fusion transcripts was found in four of 10 fresh-frozen samples and in one of five paraffin-embedded ESTs. The control specimens were all negative. In conclusion, our data suggest that ESTs are genetically heterogeneous, with the prevalence of the JAZF1-JJAZ1 fusion being highest among ESTs of classic histology. Hence, the diagnostic utility of a JAZF1-JJAZ1 fusion transcript assay in ESTs may be limited to the classic histologic subset.
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Affiliation(s)
- Hsuan-Ying Huang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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21
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Leunen K, Amant F, Debiec-Rychter M, Croes R, Hagemeijer A, Schoenmakers EFPM, Vergote I. Endometrial stromal sarcoma presenting as postpartum haemorrhage: report of a case with a sole t(10;17)(q22;p13) translocation. Gynecol Oncol 2003; 91:265-71. [PMID: 14529693 DOI: 10.1016/s0090-8258(03)00477-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although the clinical picture of endometrial stromal sarcoma (ESS) is variable, it was never reported to present as a postpartum hemorrhage. In addition, ESS is a tumor type of which, due to its rarity, little is known regarding chemosensitivity and genetic changes. CASE A 28-year-old woman complaining of persistent postpartum bleeding was referred to our hospital, where she was diagnosed with ESS. At laparotomy, the invasion of nervous and vascular pelvic structures rendered her inoperable, and chemotherapy (doxorubicin 50 mg/m(2) for 15 min; ifosfamide 5 g/m(2)/24 h; mesna 5 g/m(2), every 3 weeks) was initiated. The ESS appeared to be chemosensitive because after three treatment cycles the tumor iliac metastase significantly decreased in volume and became surgically removable. Chemosensitivity was confirmed microscopically. Three additional courses of chemotherapy and pelvic irradiation were administered. Cytogenetic evaluation of both the primary as well as the metastatic lesions revealed a t(10;17)(q22;p13) as the sole cytogenetic abnormality. CONCLUSIONS Three interesting features of this particular case put ESS in a new perspective. First, the fundal ESS permitted normal conception and pregnancy but caused a postpartum haemorrhage. Second, the ESS was clearly chemosensitive. Third, we report a novel cytogenetic aberration in ESS, the molecular characterization of which might lead to the identification of the deregulated pathway(s) triggering tumor development in ESS.
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MESH Headings
- Adult
- Chromosomes, Human, Pair 10/genetics
- Chromosomes, Human, Pair 17/genetics
- Combined Modality Therapy
- Diagnosis, Differential
- Endometrial Neoplasms/complications
- Endometrial Neoplasms/diagnosis
- Endometrial Neoplasms/genetics
- Endometrial Neoplasms/therapy
- Female
- Humans
- Postpartum Hemorrhage/diagnosis
- Postpartum Hemorrhage/etiology
- Sarcoma, Endometrial Stromal/complications
- Sarcoma, Endometrial Stromal/diagnosis
- Sarcoma, Endometrial Stromal/genetics
- Sarcoma, Endometrial Stromal/therapy
- Translocation, Genetic
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Affiliation(s)
- Karin Leunen
- Division of Gynecological Oncology, Department of Obstetrics & Gynecology, University Hospitals Leuven, Belgium.
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