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Hasegawa C, Washimi K, Hiroshima Y, Kasajima R, Kikuchi K, Notomi T, Kato H, Hiruma T, Sato S, Okubo Y, Yoshioka E, Ono K, Miyagi Y, Yokose T. Differential diagnosis of uterine adenosarcoma: identification of JAZF1-BCORL1 rearrangement by comprehensive cancer genomic profiling. Diagn Pathol 2023; 18:5. [PMID: 36639698 PMCID: PMC9837955 DOI: 10.1186/s13000-022-01279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Uterine adenosarcoma is a rare malignant tumor that accounts for 8% of all uterine sarcomas, and less than 0.2% of all uterine malignancies. However, it is frequently misdiagnosed in clinical examinations, including pathological diagnosis, and imaging studies owing to its rare and non-specific nature, which is further compounded by the lack of specific diagnostic markers. CASE PRESENTATION We report a case of uterine adenosarcoma for which a comprehensive genomic profiling (CGP) test provided a chance to reach the proper diagnosis. The patient, a woman in her 60s with a history of uterine leiomyoma was diagnosed with an intra-abdominal mass post presentation with abdominal distention and loss of appetite. She was suspected to have gastrointestinal stromal tumor (GIST); the laparotomically excised mass was found to comprise uniform spindle-shaped cells that grew in bundles with a herringbone architecture, and occasional myxomatous stroma. Immunostaining revealed no specific findings, and the tumor was diagnosed as a spindle cell tumor/suspicious adult fibrosarcoma. The tumor relapsed during postoperative follow-up, and showed size reduction with chemotherapy, prior to regrowth. CGP was performed to identify a possible treatment, which resulted in detection of a JAZF1-BCORL1 rearrangement. Since the rearrangement has been reported in uterine sarcomas, we reevaluated specimens of the preceding uterine leiomyoma, which revealed the presence of adenosarcoma components in the corpus uteri. Furthermore, both the uterine adenosarcoma and intra-abdominal mass were partially positive for CD10 and BCOR staining. CONCLUSION These results led to the conclusive identification of the abdominal tumor as a metastasis of the uterine adenosarcoma. The JAZF1-BCORL1 rearrangement is predominantly associated with uterine stromal sarcomas; thus far, ours is the second report of the same in an adenosarcoma. Adenosarcomas are rare and difficult to diagnose, especially in atypical cases with scarce glandular epithelial components. Identification of rearrangements involving BCOR or BCORL1, will encourage BCOR staining analysis, thereby potentially resulting in better diagnostic outcomes. Given that platinum-based chemotherapy was proposed as the treatment choice for this patient post diagnosis with adenosarcoma, CGP also indirectly contributed to the designing of the best-suited treatment protocol.
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Affiliation(s)
- Chie Hasegawa
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Kota Washimi
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Yukihiko Hiroshima
- grid.414944.80000 0004 0629 2905Division of Advanced Cancer Therapeutics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa Japan ,grid.414944.80000 0004 0629 2905Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
| | - Rika Kasajima
- grid.414944.80000 0004 0629 2905Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa Japan ,grid.414944.80000 0004 0629 2905Division of Molecular Pathology and Genetics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa Japan
| | - Keiji Kikuchi
- grid.414944.80000 0004 0629 2905Division of Advanced Cancer Therapeutics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa Japan ,grid.414944.80000 0004 0629 2905Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
| | - Tsuguto Notomi
- grid.414944.80000 0004 0629 2905Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
| | - Hisamori Kato
- grid.414944.80000 0004 0629 2905Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
| | - Toru Hiruma
- grid.414944.80000 0004 0629 2905Department of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
| | - Shinya Sato
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan ,grid.414944.80000 0004 0629 2905Division of Molecular Pathology and Genetics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa Japan
| | - Yoichiro Okubo
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Emi Yoshioka
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Kyoko Ono
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Yohei Miyagi
- grid.414944.80000 0004 0629 2905Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa Japan ,grid.414944.80000 0004 0629 2905Division of Molecular Pathology and Genetics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa Japan
| | - Tomoyuki Yokose
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan ,grid.414944.80000 0004 0629 2905Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
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