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Zhao Z, Nadarajah R, Busmanis I. Synchronous Bilateral Ovarian Mesonephric-like Adenocarcinomas with Separate Origins from High-Grade Mullerian Adenosarcoma and Endometriosis: Report of a Rare Case. Int J Gynecol Pathol 2024; 43:382-388. [PMID: 37922943 DOI: 10.1097/pgp.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Mesonephric-like adenocarcinoma (MLA) of the ovary is a recently recognized, rare malignancy with aggressive clinical behavior, and is thought to originate from Mullerian epithelium with mesonephric transdifferentiation. Emerging evidence suggests that MLA may be classified as an endometriosis-associated neoplasm. The presence of a sarcomatous component within MLA is extremely rare, with common differential diagnoses including the spindle cell component of MLA, carcinosarcoma, as well as mixed Mullerian adenocarcinoma and adenosarcoma. Herein, we report a 58-year-old Chinese woman with bilateral ovarian solid-cystic masses. The left ovarian mass comprised a biphasic tumor with a predominantly high-grade sarcomatous component displaying heterologous mesenchymal differentiation, including liposarcoma, rhabdomyosarcoma and chondrosarcoma-like areas, with a null-type p53 expression. The epithelial component ranged from a bland appearance in areas diagnostic of adenosarcoma to a clearly invasive carcinoma, both with mesonephric-like phenotype, being negative for estrogen receptor, progesterone receptor, and Wilms' tumor 1, variably positive for paired box gene 8, GATA binding protein 3, and thyroid transcription factor 1, with a wild-type p53 expression. The differing p53 expression between the epithelial and sarcomatous elements mitigated against a diagnosis of carcinosarcoma. The right ovarian mass showed endometriosis with focal direct evidence of the development of malignancy within a benign endometriotic cyst, exhibiting the identical immunoprofile of MLA but originating as another malignancy. To the best of our knowledge, this case represents the first reported case of synchronous bilateral ovarian MLAs with separate origins, from high-grade Mullerian adenosarcoma and endometriosis respectively, which broadens the morphologic spectrum of MLA and provides further evidence supporting the Mullerian origin theory.
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Affiliation(s)
- Zitong Zhao
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital (Z.Z., I.B.)
| | | | - Inny Busmanis
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital (Z.Z., I.B.)
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Wei CH, Sadimin E, Agulnik M, Yost SE, Longacre TA, Fadare O. SMARCA4 / BRG1 -deficient Uterine Neoplasm With Hybrid Adenosarcoma and Carcinoma Features: Expanding the Molecular-morphologic Spectrum of SMARCA4 -driven Gynecologic Malignancies. Int J Gynecol Pathol 2024; 43:354-361. [PMID: 38113031 PMCID: PMC11166733 DOI: 10.1097/pgp.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
SMARCA4 gene encodes BRG1 , a member of the SWItch/sucrose non-fermentable protein family involved in epigenetic transcriptional regulation of important cellular processes. In the uterine corpus, SMARCA4 / BRG1 deficiency is associated with a novel class of undifferentiated uterine sarcomas, characterized by younger age onset, rhabdoid histology, focal phyllodiform architecture, high-risk pathologic findings, and dismal prognosis. Herein, we report a case of a 34-year-old Asian woman with a SMARCA4 / BRG1 -deficient uterine tumor fulfilling the clinicopathologic features of an undifferentiated uterine sarcoma. However, the tumor exhibited several unique features that have not been previously emphasized, including (1) conspicuous phyllodiform architecture recapitulating conventional adenosarcoma, (2) rhabdoid tumor cells forming cords and keratin-positive cohesive epithelial islands, and (3) cooccurrence with a spatially distinct and discrete endometrial complex atypical hyperplasia from the rest of the proliferation. By immunohistochemistry, the tumor cells were diffusely positive for synaptophysin, whereas BRG1 was lost. Pertinent molecular findings included frameshift mutations in the SMARCA4 gene, mutations in histone modification and chromatin remodeling genes, including KMT2C , ARID1B , KAT6A , and NCOR1 , and mutations in Wnt signaling involving APC and CTNNB1 . Copy number gain in MDM2 and CDK4 were also identified. The tumor mutation burden was intermediate (6.8/MB) and it was microsatellite stable. On balance, our case exhibited morphologic and molecular features that overlap with (1) an undifferentiated uterine sarcoma, (2) an adenosarcoma with sarcomatous overgrowth, and (3) a mixed adenosarcoma and undifferentiated endometrial carcinoma. These hybrid features further expand the molecular-morphologic spectrum of SMARCA4 / BRG1 -deficient uterine neoplasms.
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De Boeck A, Nohr E, El-Hallani S, Ghatage P, Lee CH, Köbel M. POLE-mutated Endometrial "Carcinosarcoma". Int J Gynecol Pathol 2024:00004347-990000000-00165. [PMID: 38833721 DOI: 10.1097/pgp.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
The molecular subtype classification of endometrial carcinomas has conceptually changed our approach to this disease. However, open questions remain about how to integrate certain histotype diagnoses with the molecular subtype. We report 2 cases with morphologic suspicion for endometrial carcinosarcoma, that still fell short of the essential criteria for diagnosing carcinosarcoma. On subsequent molecular testing pathogenic POLE mutations were detected and a descriptive diagnosis of endometrial endometrioid carcinomas, low-grade with a homologous sarcoma component was rendered. This challenges the existence of POLE-mutated "carcinosarcoma."
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Affiliation(s)
- Astrid De Boeck
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erik Nohr
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Soufiane El-Hallani
- Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Prafull Ghatage
- Department of Oncology, Division of Gynecologic Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheng Han Lee
- Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
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Bassi A, Nelson G, Lee C, Ogilvie T, Cota A, Lee S. Somatic yolk sac differentiation in tumors of the gynecologic tract: A report of two cases and review of the literature. Gynecol Oncol Rep 2022; 44:101119. [PMID: 36568896 PMCID: PMC9772801 DOI: 10.1016/j.gore.2022.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
•Somatic yolk sac tumor differentiation associated with malignant neoplasms is uncommon and associated with poor outcome.•In the gynecologic tract, somatic yolk sac differentiation most often arises in postmenopausal patients.•Somatic yolk sac differentiation shares driver mutations with and likely differentiates from the corresponding carcinoma.•This is the first report of somatic yolk sac differentiation in the gynecologic tract from a non-epithelial malignancy.
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Matias-Guiu X, Selinger CI, Anderson L, Buza N, Ellenson LH, Fadare O, Ganesan R, Ip PPC, Palacios J, Parra-Herran C, Raspollini MR, Soslow RA, Werner HMJ, Lax SF, McCluggage WG. Data Set for the Reporting of Endometrial Cancer: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S90-S118. [PMID: 36305536 DOI: 10.1097/pgp.0000000000000901] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Endometrial cancer is one of the most common cancers among women. The International Collaboration on Cancer Reporting (ICCR) developed a standardized endometrial cancer data set in 2011, which provided detailed recommendations for the reporting of resection specimens of these neoplasms. A new data set has been developed, which incorporates the updated 2020 World Health Organization Classification of Female Genital Tumors, the Cancer Genome Atlas (TCGA) molecular classification of endometrial cancers, and other major advances in endometrial cancer reporting, all of which necessitated a major revision of the data set. This updated data set has been produced by a panel of expert pathologists and an expert clinician and has been subject to international open consultation. The data set includes core elements which are unanimously agreed upon as essential for cancer diagnosis, clinical management, staging, or prognosis and noncore elements which are clinically important, but not essential. Explanatory notes are provided for each element. Adoption of this updated data set will result in improvements in endometrial cancer patient care.
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Currie JC, Demeule M, Charfi C, Zgheib A, Larocque A, Danalache BA, Ouanouki A, Béliveau R, Marsolais C, Annabi B. The Peptide-Drug Conjugate TH1902: A New Sortilin Receptor-Mediated Cancer Therapeutic against Ovarian and Endometrial Cancers. Cancers (Basel) 2022; 14:cancers14081877. [PMID: 35454785 PMCID: PMC9031804 DOI: 10.3390/cancers14081877] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/14/2022] Open
Abstract
Sortilin (SORT1) receptor-mediated endocytosis functions were exploited for this new approach for effective and safe treatments of gynecological cancers. Here, high expression of SORT1 was found in >75% of the clinically annotated ovarian and endometrial tumors analyzed by immunohistochemistry. Therefore, the anticancer properties of the peptide-drug conjugate TH1902, a peptide that targets SORT1 and which is linked to docetaxel molecules, were investigated both in vitro using ovarian and endometrial cancer cell cultures and in vivo using xenograft models. In vitro, TH1902 inhibited cell proliferation and triggered higher SORT1-dependent cell apoptosis than unconjugated docetaxel did in ES-2 and SKOV3 ovarian cancer cell lines. The uptake of the Alexa488-TH19P01 peptide from TH1902 was reduced upon siRNA-mediated silencing of SORT1. In vivo, weekly administration of TH1902 showed better tolerability compared to equivalent docetaxel doses and inhibited tumor growth in ovarian and endometrial xenograft mice models. TH1902 as a single agent inhibited ovarian tumor growth more than either of the unconjugated taxanes or carboplatin. Furthermore, TH1902 combination with carboplatin also demonstrated better efficacy when compared to both taxanes-carboplatin combinations. Overall, TH1902 shows better in vivo efficacy, compared to that of docetaxel and even paclitaxel, against SORT1-positive ovarian and endometrial cancers and could be safely combined with carboplatin.
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Affiliation(s)
- Jean-Christophe Currie
- Theratechnologies Inc., 2015 Peel Street, 11th Floor, Montréal, QC H3A 1T8, Canada; (J.-C.C.); (M.D.); (C.C.); (A.L.); (C.M.)
| | - Michel Demeule
- Theratechnologies Inc., 2015 Peel Street, 11th Floor, Montréal, QC H3A 1T8, Canada; (J.-C.C.); (M.D.); (C.C.); (A.L.); (C.M.)
| | - Cyndia Charfi
- Theratechnologies Inc., 2015 Peel Street, 11th Floor, Montréal, QC H3A 1T8, Canada; (J.-C.C.); (M.D.); (C.C.); (A.L.); (C.M.)
| | - Alain Zgheib
- Laboratoire d’Oncologie Moléculaire, Département de Chimie, Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal, QC H3C 3P8, Canada; (A.Z.); (B.A.D.); (A.O.); (R.B.)
| | - Alain Larocque
- Theratechnologies Inc., 2015 Peel Street, 11th Floor, Montréal, QC H3A 1T8, Canada; (J.-C.C.); (M.D.); (C.C.); (A.L.); (C.M.)
| | - Bogdan Alexandru Danalache
- Laboratoire d’Oncologie Moléculaire, Département de Chimie, Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal, QC H3C 3P8, Canada; (A.Z.); (B.A.D.); (A.O.); (R.B.)
| | - Amira Ouanouki
- Laboratoire d’Oncologie Moléculaire, Département de Chimie, Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal, QC H3C 3P8, Canada; (A.Z.); (B.A.D.); (A.O.); (R.B.)
| | - Richard Béliveau
- Laboratoire d’Oncologie Moléculaire, Département de Chimie, Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal, QC H3C 3P8, Canada; (A.Z.); (B.A.D.); (A.O.); (R.B.)
| | - Christian Marsolais
- Theratechnologies Inc., 2015 Peel Street, 11th Floor, Montréal, QC H3A 1T8, Canada; (J.-C.C.); (M.D.); (C.C.); (A.L.); (C.M.)
| | - Borhane Annabi
- Laboratoire d’Oncologie Moléculaire, Département de Chimie, Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal, QC H3C 3P8, Canada; (A.Z.); (B.A.D.); (A.O.); (R.B.)
- Correspondence: ; Tel.: +1-(514)-987-3000 (ext. 7610)
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Desai GS, Rathod P. Carcinosarcoma of Uterus: a Case Report. J Obstet Gynaecol India 2022; 72:86-88. [PMID: 35125745 PMCID: PMC8804134 DOI: 10.1007/s13224-021-01503-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/15/2021] [Indexed: 02/03/2023] Open
Abstract
Carcinosarcoma is a malignant mixed Müllerian tumor with a highly malignant, biphasic tumor consisting of both epithelial and mesenchymal components. A 59-year-old nulligravida came with postmenopausal bleeding. Hysteroscopy revealed highly vascular polypoidal mass with prominent vasculature. Gross examination of specimen showed a polypoid mass, occupying whole uterine cavity and invading more than half of myometrium. Immunohistochemical analysis showed epithelial component AE1/AE3 and stromal component desi and p16. Tumor cells were negative for ER. As carcinosarcoma is a highly aggressive less common variant of endometrial cancer, early diagnosis and aggressive treatment are important to minimize morbidity and overall survival.
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Affiliation(s)
- Gaurav Shyam Desai
- Department of Obstetrics and Gynecology, Bandra Bhabha Municipal General Hospital, Mumbai, India
| | - Pallavi Rathod
- Department of Obstetrics and Gynecology, Bandra Bhabha Municipal General Hospital, Mumbai, India
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Alcindor T, Jung S, Gilbert L. Clinical Benefit from Lenvatinib and Pembrolizumab Observed in Mullerian Adenosarcoma: A Case Report. ACTA ACUST UNITED AC 2021; 28:2146-2149. [PMID: 34200874 PMCID: PMC8293099 DOI: 10.3390/curroncol28030199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/04/2022]
Abstract
A 32-year-old woman with chemorefractory mullerian adenosarcoma showed clinical benefit in response to administration of lenvatinib plus pembrolizumab. In this case report, we describe the course of her illness and her response to this treatment.
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Affiliation(s)
- Thierry Alcindor
- Cedars Cancer Center, Division of Medical Oncology, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada
- Correspondence: ; Tel.: +1-514-934-1934; Fax: +1-934-8034
| | - Sungmi Jung
- Department of Pathology, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada;
| | - Lucy Gilbert
- Cedars Cancer Center, Division of Gynecologic Oncology, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada;
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