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Giordano G, Guareschi D, Thai E. Uterine Tumor Resembling Ovarian Sex-Cord Tumor (UTROSCT): A Rare Polyphenotypic Neoplasm. Diagnostics (Basel) 2024; 14:1271. [PMID: 38928686 PMCID: PMC11203005 DOI: 10.3390/diagnostics14121271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is a rare form of uterine mesenchymal neoplasm. Although UTROSCT generally exhibits benign behavior with a favorable prognosis, this neoplasm is nevertheless classified as being of uncertain malignant potential, given its low rate of recurrence and the fact that it rarely produces metastases (e.g., in the lymph nodes, epiploic appendix, omentum, small bowel, subcutaneous tissue, lungs). Its histogenesis is also uncertain. Typically, UTROSCT occurs in peri-menopausal or menopausal women, but it can sometimes be observed in young women. Usually, this neoplasm can be found in the uterine corpus as a nodular intramural lesion, while it is less frequently submucosal, subserosal, or polypoid/intracavitary. UTROSCT can cause abnormal bleeding, pelvic pain, enlarged uterus, and mass sensation, but sometimes it is found purely by chance. This neoplasm can be considered polyphenotypic on morphological, immunohistochemical, and genetic analyses. Generally, upon microscopic examination, UTROSCT shows a predominant pattern of the cords, nests, and trabeculae typical of sex-cord tumors of the ovary, while immunohistochemically it is characterized by a coexpression of epithelial, smooth muscle, and sex-cord markers. The aim of this review is to report clinical and pathological data and genetic alterations to establish their impact on the prognosis and management of patients affected by this rare entity.
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Affiliation(s)
- Giovanna Giordano
- Department of Medicine and Surgery, Pathology Unit, University of Parma, Viale A. Gramsci, 14, 43126 Parma, Italy; (D.G.); (E.T.)
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El Hayek P, Chlala W, Younes K, Ghaname W, Ziadeh H. Severe hemoperitoneum from spontaneous rupture of uterine tumor resembling ovarian sex-cord tumor: A very rare case. Int J Gynaecol Obstet 2024; 164:355-357. [PMID: 37743788 DOI: 10.1002/ijgo.15151] [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] [Received: 07/25/2023] [Revised: 08/26/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
SynopsisA case of uterine tumor resembling ovarian sex‐cord tumor with an unfamiliar presentation. Management was performed based on the clinical findings and the literature recommendations.
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Affiliation(s)
- Pamela El Hayek
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Walid Chlala
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Kenny Younes
- Department of General Surgery, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Wadih Ghaname
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hanane Ziadeh
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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Ferrara M, Pecorino B, D’Agate MG, Angelico G, Capoluongo ED, Malapelle U, Pepe F, Scollo P, Mereu L. Uterine Tumours Resembling Ovarian Sex-Cord Tumors: A Case Report and Review of the Literature. J Clin Med 2023; 12:7131. [PMID: 38002745 PMCID: PMC10671931 DOI: 10.3390/jcm12227131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are thought to develop from pluripotent uterine mesenchymal cells or endometrial stromal cells with secondary sex-cord differentiation. The patient was a 73-year-old postmenopausal woman who had abnormal vaginal bleeding, and she underwent a laparoscopic hysterectomy with bilateral salpingo-oophorectomy. The diagnosis was a case of UTROSCT. A scoping review of the UTROSCT case report present in the literature has been conducted, and 63 articles were found, of which 45 were considered for the 66 clinical cases examined. At the time of diagnosis, six metastatic localizations were found in 59 patients undergoing demolitive surgery (10.2%). Recurrences were diagnosed in 13/59 (22%) patients with multiple locations. A molecular study was performed in 18/66 cases (27.3%) and genetic alterations were found in 10/18 (55.6%) patients. UTROSCTs are considered rare uterine tumors, typically with a favorable prognosis, and are generally considered to have a good prognosis. But, from the review done, they may already manifest themselves at advanced stages, with the possibility of recurrences even at a distance. It would, therefore, be important to be able to define the most aggressive forms and, perhaps, molecular investigation with sequencing could help identify patients most at risk.
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Affiliation(s)
- Martina Ferrara
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna “Kore”, 94100 Enna, Italy; (B.P.); (M.G.D.); (P.S.)
| | - Basilio Pecorino
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna “Kore”, 94100 Enna, Italy; (B.P.); (M.G.D.); (P.S.)
| | - Maria Gabriella D’Agate
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna “Kore”, 94100 Enna, Italy; (B.P.); (M.G.D.); (P.S.)
| | - Giuseppe Angelico
- Department of Anatomic Pathology and Histology, Cannizzaro Hospital, 95100 Catania, Italy;
| | | | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, 80126 Naples, Italy; (U.M.); (F.P.)
| | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, 80126 Naples, Italy; (U.M.); (F.P.)
| | - Paolo Scollo
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna “Kore”, 94100 Enna, Italy; (B.P.); (M.G.D.); (P.S.)
| | - Liliana Mereu
- Department of Obstetrics and Gynecology, Policlinico G Rodolico, CHIRMED, University of Catania, 95124 Catania, Italy
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Sarabia Ochoa R, García de la Torre J, Amezcua Recover A. Tumor uterino que recuerda a los tumores de los cordones sexuales del ovario (UTROSCT): un caso clinicopatológico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sonwani T, Bora RR, Khanna G, Joshi R. Uterine Tumour Resembling Ovarian Sex Cord Tumour Coexisting with Osseous Metaplasia of Leiomyoma: A Rare Entity—Case Report and Literature Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-021-00594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pang L, Dai Y, Ren F, Peng X, Guo Z. Uterine Tumor Resembling Ovarian Sex Cord Tumors (UTROSCT): Two Case Reports of the Rare Uterine Neoplasm with Literature Review. Curr Med Imaging 2022; 18:1125-1131. [PMID: 35339187 DOI: 10.2174/1573405618666220325095615] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/04/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Uterine tumors resembling ovarian sex cord tumors (UTROSCTs) are rare neoplasms with unknown etiology. This type of tumor has low malignant potential and mostly manifests as a benign clinical course. MATERIALS AND METHODS This article analyzes the case data, clinical manifestations, and histopathological characteristics of two cases of UTROSCT, and reviews the relevant literature. The diagnosis of UTROSCT is mainly based on histopathological examination. The histological characteristics of granulosa and Sertoli cell tumours are similar to the ovary under the microscope. These cases' clinical and radiological (MRI) findings have also been discussed. RESULTS The sex cord components are mixed in different proportions. The immunohistochemistry is diverse and can express sex cord markers together with both epithelial and smooth muscle markers. Both two cases revealed the signs of intratumoral cystic degeneration, intratumoral hemorrhage, and necrosis under MRI. These MRI features were helpful to prompt UTROSCT, which is histologically similar to granular cell tumors and is conducive to the differential diagnosis. CONCLUSION The current recommended treatment is total hysterectomy, but its biological behavior is not yet clear, and long-term follow-up is needed.
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Affiliation(s)
- Li Pang
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shen Yang, China
| | - Yawen Dai
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shen Yang, China
| | - Fang Ren
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shen Yang, China
| | - Xu Peng
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shen Yang, China
| | - Zhiqiang Guo
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shen Yang, China
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Pereira S, Sousa R, Constantino L, Abrantes C. When the uterine mass is not a leiomyoma. BMJ Case Rep 2021; 14:e243845. [PMID: 34404659 PMCID: PMC8372803 DOI: 10.1136/bcr-2021-243845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/04/2022] Open
Abstract
A 37-year-old nulliparous woman with abnormal uterine bleeding and a uterine mass suggestive of a leiomyoma not responding to medical therapy was submitted to two hysteroscopies with histological analysis. The first one showed a 'leiomyoma' and the second a 'uterine smooth muscle tumour of uncertain malignant potential/epithelioid leiomyosarcoma, with positivity for hormonal receptors'. The patient was submitted to a total hysterectomy with bilateral salpingo-oophorectomy, and the microscopic examination of the tumour revealed a 'uterine tumour resembling ovarian sex-cord tumours'. According to the literature, most cases are diagnosed in postmenopausal women and have a favourable prognosis. These rare tumours have uncertain malignant potential and have no established treatment protocol, but it appears that a fertility-sparing approach is possible once they are well diagnosed.
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Affiliation(s)
- Sofia Pereira
- Gynaecology, Centro Hospitalar Leiria EPE, Pousos, Portugal
| | - Rita Sousa
- Gynaecology, Francisco Gentil Portuguese Institute for Oncology of Coimbra, Coimbra, Coimbra, Portugal
| | - Liliana Constantino
- ARS Centro, UCSP Anadia I, Anadia, Beira Litoral, Portugal
- Clínica Universitária de Medicina Geral e Familiar, Universidade de Coimbra Faculdade de Medicina, Coimbra, Beira Litoral, Portugal
| | - Carlos Abrantes
- Pathology Department, Coimbra University Hospital Centre, Coimbra, Portugal
- Pathology Department, Instituto Portugues de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Coimbra, Portugal
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Zhou FF, He YT, Li Y, Zhang M, Chen FH. Uterine tumor resembling an ovarian sex cord tumor: A case report and review of literature. World J Clin Cases 2021; 9:6907-6915. [PMID: 34447841 PMCID: PMC8362530 DOI: 10.12998/wjcc.v9.i23.6907] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endometrial stromal tumors originate from the endometrial stroma and account for < 2% of all uterine tumors. Uterine tumor resembling an ovarian sex cord tumor (UTROSCT) is a rare histological class of endometrial stromal and related tumors according to the latest World Health Organization classification of female genital tumors. Here, we report a case of UTROSCT in a 51-year-old woman.
CASE SUMMARY A 51-year-old woman had irregular menses for 6 mo. The patient visited a local hospital for vaginal bleeding. Pelvic computed tomography (CT) showed a mass in the pelvic cavity. Five days later, she came to our hospital for further diagnosis. The results of contrast-enhanced CT and pelvic ultrasound at our hospital suggested a malignant pelvic tumor. She then underwent total removal of the uterus with bilateral salpingectomy. Postoperative histological examination showed that the tumor cells had abundant cytoplasm, ovoid and spindle-shaped nuclei, fine chromatin, a high nucleoplasm ratio, and a lamellar distribution. The findings were consistent with UTROSCT, and the results of immunohistochemical analysis supported that diagnosis. The tumor was International Federation of Gynecology and Obstetrics stage IB. No adjuvant therapy was administered after radical surgery. The patient was followed up for 58 mo, and no recurrence was found.
CONCLUSION We report a case of UTROSCT with abnormal menstruation as a symptom, which is one of the most common symptoms. In patients with vaginal bleeding, ultrasonography can be used as a screening test because of its convenience, speed, and lack of radiation exposure. For patients with long-term tamoxifen use, routine monitoring of the endometrium is recommended. As UTROSCT may have low malignant potential, surgery remains the primary management strategy. Additionally, fertility preservation in patients of childbearing age is a vital consideration.
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Affiliation(s)
- Fang-Fang Zhou
- Department of Ultrasound, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
| | - Ying-Tao He
- Department of Ultrasound, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
| | - Ying Li
- Department of Ultrasound, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
| | - Min Zhang
- Department of Pathology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
| | - Fang-Hong Chen
- Department of Ultrasound, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
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Carbone MV, Cavaliere AF, Fedele C, Vidiri A, Aciuolo D, Zannoni G, Scambia G. Uterine tumor resembling ovarian sex-cord tumor: Conservative surgery with successful delivery and case series. Eur J Obstet Gynecol Reprod Biol 2020; 256:326-332. [PMID: 33264692 DOI: 10.1016/j.ejogrb.2020.11.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/18/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022]
Abstract
Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is a rare distinct cancer included in the current World Health Organization classification of endometrial stromal tumors. A battery of immunohistochemical markers are necessary for accurate diagnosis. Although few case reports and case series have been documented and therefore providing robust prognostic information several authors agree to consider UTROSCT as a low malignant potential tumour. In literature only five cases of conservative management were reported. We reported our experience and a review of conservative cases of literature. In this article we describe a series of 10 cases of UTROSCT and their clinical and pathologic feature. We report two cases of conservative surgical approach obtaining a successfully pregnancies. All of the patients are still alive. In conclusion, fertility sparing surgery should be offered to patients who wish preserve their fertility however radical surgery must be considerate after childbirth. Close follow-up is required for all patients due to the lack of prognostic biomarkers and long follow up is needed to evaluate safety of conservative surgery.
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Affiliation(s)
- Maria Vittoria Carbone
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy.
| | - Anna Franca Cavaliere
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy.
| | - Camilla Fedele
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy.
| | - Annalisa Vidiri
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy.
| | - Damiano Aciuolo
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy.
| | - Gianfranco Zannoni
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Giovanni Scambia
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
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Nguyen CV, Phung HT, Dao LT, Ta DHH, Tran MN. Uterine Tumor Resembling Ovarian Sex Cord Tumor: Clinicopathological Characteristics of a Rare Case. Case Rep Oncol 2020; 13:807-812. [PMID: 32884523 PMCID: PMC7443644 DOI: 10.1159/000508180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/13/2022] Open
Abstract
Uterine tumor resembling ovarian sex cord tumor (UTROSCT) is a rare indolent stromal neoplasm of unclear histogenesis with a distinct histopathological entity. Immunophenotypes of sex cord positivity are the most significant information to confirm the diagnosis. We present the case of a 61-year-old female with a polypoid mass in the uterus which was successfully removed by surgical resection as hysterectomy. The pathological diagnosis was UTROSCT, which was characterized microscopically by sex cord images and immunohistochemical features of calretinin, CD99, and WT1 positivity.
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Affiliation(s)
- Chu Van Nguyen
- Department of Quan Su Pathology, National Cancer Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Huyen Thi Phung
- Department of Quan Su Pathology, National Cancer Hospital, Hanoi, Vietnam
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Abstract
The spectrum of mesenchymal neoplasia in the uterus has expanded in recent years. First, the identification of prevalent, recurrent molecular alterations has led to a more biologically and clinically congruent classification of endometrial stromal tumors. Likewise, the diagnostic criteria of several rare and miscellaneous tumor types have been refined in recent case series (Perivascular Epithelioid Cell tumor, inflammatory myofibroblastic tumor). Pure mesenchymal tumors are still broadly classified based on morphology according to the tumor cell phenotype. Smooth muscle tumors predominate in frequency, followed by tumors of endometrial stromal derivation; the latter are covered in depth in this article with an emphasis on defining molecular alterations and their morphologic and clinical correlates. The remaining entities comprise a miscellaneous group in which cell derivation does not have a normal counterpart in the uterus (eg, rhabdomyosarcoma) or is obscure (eg, undifferentiated uterine sarcoma). This article discusses their clinical relevance, recent insights into their molecular biology, and the most important differential diagnoses. Regarding the latter, immunohistochemistry and (increasingly) molecular diagnostics play a role in the diagnostic workup. We conclude with a few considerations on intraoperative consultation and macroscopic examination, as well as pathologic staging and grading of uterine sarcomas as per the most recent American Joint Cancer Commission and the Fédération Internationale de Gynécologie et d'Obstétrique staging systems.
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Uterine Tumor Resembling Ovarian Sex Cord Tumors Type II with Vaginal Vault Recurrence. Case Rep Obstet Gynecol 2019; 2019:5231219. [PMID: 32089915 PMCID: PMC7012198 DOI: 10.1155/2019/5231219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 07/07/2019] [Indexed: 01/02/2023] Open
Abstract
UTROSCTs (Uterine Tumors Resembling Ovarian Sex Cord Tumors) are rare neoplasms of unknown etiology usually occurring in middle-aged women. Less than 100 cases of UTROSCT have been reported so far. Although the typical behavior of UTROSCT is benign, metastatic and recurrent cases can occur. Here we describe an extremely rare case of vaginal vault recurrence of UTROSCT occurring 5 years after total hysterectomy with bilateral salpingo-oophorectomy. Though rare, UTROSCT should always be taken into account in the differential diagnosis of uterine masses initially considered leiomyomas.
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Jia M, Sun PL, Gao H. Uterine lesions with sex cord-like architectures: a systematic review. Diagn Pathol 2019; 14:129. [PMID: 31739799 PMCID: PMC6862816 DOI: 10.1186/s13000-019-0909-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/07/2019] [Indexed: 12/14/2022] Open
Abstract
Background Sex cord-like elements are rarely observed in uterine lesions, but these morphological patterns could appear in a variety of uterine tumors and non-tumorous lesions. In this review, we collected the literatures regarding the uterine tumorous and non-tumorous lesions containing sex cord-like elements and summarized these lesions in terms of clinicopathological, immunohistochemical, and molecular features in order to further understand these lesions and provide some new ideas for differential diagnosis. Main body This section provides a comprehensive overview of the clinicopathological, immunohistochemical, and molecular features of uterine lesions with sex cord-like architectures including uterine tumors resembling ovarian sex cord tumors, endometrial stromal tumors, adenomyosis, endometrial polyps, leiomyoma, epithelioid leiomyosarcoma, adenosarcoma, sertoliform endometrioid carcinoma, corded and hyalinized endometrioid carcinoma, mesonephric adenocarcinoma, and mesonephric-like adenocarcinoma. The differential diagnosis based on morphology, immunohistochemistry, and molecular alterations has also been discussed. Conclusion The sex cord-like areas in these lesions show heterogeneous but similar morphological features. Additionally, immunohistochemical staining plays a limited role in differential diagnosis. Furthermore, it is of significance for pathologists to better understand these lesions in order to avoid confusion and mistakes during pathological diagnosis, especially in a biopsy/curettage specimen.
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Affiliation(s)
- Meng Jia
- Department of pathology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China
| | - Ping-Li Sun
- Department of pathology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China.
| | - Hongwen Gao
- Department of pathology, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China.
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Uterine Tumor Resembling Ovarian Sex Cord Tumor: A Distinct Entity Characterized by Recurrent NCOA2/3 Gene Fusions. Am J Surg Pathol 2019; 43:178-186. [PMID: 30273195 DOI: 10.1097/pas.0000000000001153] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is a rare and distinctive neoplasm of unclear histogenesis, and uncertain malignant potential. These neoplasms morphologically resemble sex-cord stromal tumors of the ovary, and possess a polyphenotypic immunophenotype. Their molecular pathogenesis has yet to be elucidated; notably, however, tumors lack alterations found in other uterine tumors bearing sex-cord-like differentiation, such as endometrial stromal sarcoma. Following identification of an index patient with an ESR1-NCOA3 fusion gene by RNA-sequencing, we undertook a retrospective review for additional cases of UTROSCT. We identified a total of 4 patients, with an average age of 53 years (range, 38 to 68 y). RNA-sequencing was performed in all cases, revealing an ESR1-NCOA3 fusion in 2 cases and one case each with related ESR1-NCOA2 and GREB1-NCOA2 fusions. Each of the tumors showed histologic and an immunophenotype features within the previously reported spectrum of UTROSCT; interestingly, one case contained prominent spindle cell fascicles and another was largely comprised of sheets of small round cells. Our results demonstrate UTROSCT are defined by recurrent fusions involving NCOA2 or NCOA3, a finding that is directly amenable to diagnostic evaluation. This study confirms UTROSCT is molecularly distinct from endometrial stromal sarcoma, and raises intriguing new questions into the pathogenesis of these neoplasms and possible relationship with other NCOA fusion-positive uterine tumors.
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Mass lesions of the myometrium: interpretation and management of unexpected pathology. Curr Opin Obstet Gynecol 2019; 31:349-355. [PMID: 31425175 DOI: 10.1097/gco.0000000000000569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Uterine leiomyomas are the most common benign uterine smooth muscle tumors. On the basis of imaging, these masses are often presumed to be benign conventional leiomyomas and surgical excision is a common treatment choice. After myomectomy or hysterectomy for presumed leiomyomas, the surgical pathology report may reveal an unexpected diagnosis of another type of mesenchymal tumor. These can range from a variant of benign smooth muscle tumors to smooth muscle tumors of uncertain malignant potential to malignant sarcomas. This review describes these variant pathologies and reviews data on recurrence risk and postoperative management. RECENT FINDINGS The majority of benign smooth muscle tumors will be classified as leiomyomas. Cellular, bizarre nuclei, mitotically active, epitheliod, myxoid, and dissecting are all terms that describe pathologic variants of benign leiomyomas. Smooth muscle tumors of uncertain malignant potential contain both benign and malignant features and should be referred to Gynecologic Oncology for follow-up. Leiomyosarcomas and low-grade endometrial stromal sarcomas may present preoperatively as benign tumors but are malignant with a high risk of recurrence and should be referred to Gynecologic Oncology. SUMMARY We advocate for the continued benefits of minimally invasive procedures in appropriately selected patients. Despite these measures, unexpected pathologic diagnoses can occur and should be managed appropriately.
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Zhang X, Zou S, Gao B, Qu W. Uterine tumor resembling ovarian sex cord tumor: a clinicopathological and immunohistochemical analysis of two cases and a literature review. J Int Med Res 2019; 47:1339-1347. [PMID: 30732515 PMCID: PMC6421383 DOI: 10.1177/0300060518821824] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A uterine tumor resembling an ovarian sex cord tumor (UTROSCT) is a rare type of neoplasm that is almost thoroughly differentiated towards ovarian sex cord elements. Because of abnormal uterine bleeding, a 64-year-old postmenopausal woman received total abdominal hysterectomy with bilateral salpingo-oophorectomy. Under a microscope, the tumor cells showed an anastomosing fascicular and trabecular pattern with a reticular architecture. Immunohistochemistry showed that the tumor cells were positive for calretinin, Wilm’s tumor-1, and vimentin. A 33-year-old woman who suffered from menorrhagia, and was treated for bilateral salpingectomy, total abdominal hysterectomy, and bilateral ovarian biopsy, was also studied. Using histology, the patient was diagnosed with UTROSCT as shown by CD99, smooth muscle actin, calretinin, vimentin, and desmin expression. As a type of rare uterine tumor, UTROSCT can be diagnosed based on morphological and immunohistochemical conditions. Generally, these tumors are benign, but can easily relapse through incomplete resection. Hysterectomy should be performed after completion of family planning.
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Affiliation(s)
- Xinxin Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shuangwei Zou
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Baohui Gao
- Department of Pathology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wanglei Qu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Segala D, Gobbo S, Pesci A, Martignoni G, Santoro A, Angelico G, Arciuolo D, Spadola S, Valente M, Scambia G, Zannoni GF. Tamoxifen related Uterine Tumor Resembling Ovarian Sex Cord Tumor (UTROSCT): A case report and literature review of this possible association. Pathol Res Pract 2019; 215:1089-1092. [PMID: 30799070 DOI: 10.1016/j.prp.2019.01.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/05/2019] [Accepted: 01/25/2019] [Indexed: 12/28/2022]
Abstract
It is well known that a large number of patients treated with Tamoxifen develops endometrial pathologies ranging from benign endometrial polyps and hyperplasia to adenocarcinomas, carcinosarcomas and adenosarcomas. UTROSCT (Uterine Tumor Resembling Ovarian Sex Cord Tumor) is defined as a mesenchymal tumors of the uterine corpus that morphologically resembles ovarian sex cord tumors, without recognizable endometrial stroma. To date only 4 cases have been reported in patients treated with tamoxifen. In this article, we describe an additional case occurring in a 62-years-old patient undergoing 3 years of Tamoxifen therapy for bilateral breast carcinoma. The present work represents a further evidence of the possible association between Tamoxifen therapy and UTROSCT. A comprehensive literature review on this topic is also provided.
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Affiliation(s)
- Diego Segala
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy; Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Stefano Gobbo
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy; Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Anna Pesci
- Department of Pathology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy; Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Guido Martignoni
- Department of Pathology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy; Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Angela Santoro
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Angelico
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Damiano Arciuolo
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Saveria Spadola
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Valente
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Giovanni Scambia
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Franco Zannoni
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy - Università Cattolica del Sacro Cuore, Rome, Italy.
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Vilos AG, Zhu C, Abu-Rafea B, Ettler HC, Weir MM, Vilos GA. Uterine Tumors Resembling Ovarian Sex Cord Tumors Identified at Resectoscopic Endometrial Ablation: Report of 2 Cases. J Minim Invasive Gynecol 2019; 26:105-109. [DOI: 10.1016/j.jmig.2018.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 12/28/2022]
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19
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Mangosing S, Perminov E, Gonzalez O, Barkei EK, Corbin EM, Kumar S, Dick EJ. Uterine Tumors Resembling Ovarian Sex Cord Tumors in Four Baboons ( Papio spp.). Vet Pathol 2018; 55:753-758. [PMID: 29661120 DOI: 10.1177/0300985818766208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Uterine tumors resembling ovarian sex cord tumors (UTROSCTs) are rare uterine neoplasms that exhibit prominent sex cord-like differentiation. The authors describe 4 cases of UTROSCTs that were identified as incidental lesions in female baboons. All baboons were in good body condition. One animal had a 2-mm-diameter yellow-tan mass in the uterine body along the attachment of the left broad ligament; the other 3 did not have any gross lesions in the uterus. Histologically, the myometrium contained multifocal well-demarcated neoplasms composed of cuboidal to columnar cells arranged in variable arrangements of sheets, nests, cords, trabecular, and retiform patterns that occasionally formed Call-Exner-like bodies. In all cases, the neoplastic cells were diffusely positive for WT-1 and negative for calretinin, CD99, and desmin. One case was positive for inhibin and CD10. To the best of the authors' knowledge, this is the first report of UTROSCTs in nonhuman primates and in the veterinary literature.
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Affiliation(s)
- Sara Mangosing
- 1 Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA.,2 College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, USA
| | - Ekaterina Perminov
- 1 Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA.,2 College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, USA
| | - Olga Gonzalez
- 1 Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
| | | | | | - Shyamesh Kumar
- 1 Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Edward J Dick
- 1 Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
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20
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Thakur A, Malhotra V, Sachan S, Aggarwal A. Uterine tumor resembling ovarian sex cord tumor: Histomorphological features. INDIAN J PATHOL MICR 2018; 61:131-133. [PMID: 29567903 DOI: 10.4103/ijpm.ijpm_702_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Uterine tumors resembling ovarian sex cord tumors are rare neoplasms with varied histological and immunophenotypic profile, uncertain histiogenesis and biological behavior. A critical evaluation of histological features is essential for diagnosis and management of these cases.
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Affiliation(s)
- Abha Thakur
- Department of Histopathology, BLK Superspeciality Hospital, New Delhi, India
| | - Veena Malhotra
- Department of Histopathology, BLK Superspeciality Hospital, New Delhi, India
| | - Seema Sachan
- Department of Histopathology, BLK Superspeciality Hospital, New Delhi, India
| | - Aanchal Aggarwal
- Department of IVF and Reproductive Medicine, BLK Superspeciality Hospital, New Delhi, India
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21
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Kazuhiro N. A rare case of uterine tumor resembling ovarian sex-cord tumor with necrosis and increased mitotic activity. Pathol Int 2018; 68:321-323. [PMID: 29446516 DOI: 10.1111/pin.12642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 12/26/2017] [Indexed: 11/29/2022]
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22
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Kuznicki ML, Robertson SE, Hakam A, Shahzad MM. Metastatic uterine tumor resembling ovarian sex cord tumor: A case report and review of the literature. Gynecol Oncol Rep 2017; 22:64-68. [PMID: 29034309 PMCID: PMC5633755 DOI: 10.1016/j.gore.2017.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/20/2022] Open
Abstract
Uterine tumors resembling ovarian sex cord tumors (UTROSCTs) are rare and commonly characterized as benign tumors, with infrequent reports of metastasis and recurrence. Treatment recommendations have not been well established, particularly for more advanced cases. We present the first reported death from a metastatic UTROSCT, summarize the available literature, and describe characteristics common to UTROSCTs with aggressive features. In this case, a 49-year-old woman presented with abdominal distension and pain; initial imaging and diagnostic workup suggested metastatic epithelial ovarian cancer to be the cause. The patient subsequently underwent neoadjuvant chemotherapy followed by optimal cytoreductive surgery and adjuvant chemotherapy. Final pathology revealed UTROSCT with omental and peritoneal metastases. She then underwent adjuvant chemotherapy with subsequent recurrence and died 15 months after her initial diagnosis. Our analysis of this case and the available literature led us to identify pathologic risk factors that may help predict aggressive UTROSCT behavior.
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Affiliation(s)
- Michelle L Kuznicki
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Sharon E Robertson
- Department of Gynecologic Oncology, University of South Florida, Tampa, FL, USA
| | - Ardeshir Hakam
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mian M Shahzad
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, USA
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23
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Uterine Tumors Resembling Ovarian Sex Cord Tumors: Case Report of Rare Pathological and Clinical Entity. Case Rep Obstet Gynecol 2017; 2017:2736710. [PMID: 29085684 PMCID: PMC5612320 DOI: 10.1155/2017/2736710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/26/2017] [Accepted: 08/06/2017] [Indexed: 02/06/2023] Open
Abstract
Uterine tumors resembling ovarian sex cord tumors (UTROSCT) are rare uterine neoplasms. These tumors are usually benign, displaying a nodular or polypoid growth pattern; common occurrence is observed at the 4th to 6th decade of life. This entity is divided according to clinical behavior and pathological typical findings including different immunohistochemical staining. Traditionally type I tumors show a predominant endometrial stromal pattern with less than 50% ovarian sex cord component. This type has been shown to behave more aggressively with a decreased disease free survival period. Type II tumors, the classical UTROSCT, are less invasive but have the tendency to recur. We report a case of a 57-year-old patient presenting with postmenopausal bleeding. Hysteroscopic polypectomy showed the diagnosis of UTROSCT. This case presents a less morbid minimally invasive treatment plan and exemplifies that in patients where low malignant potential exists and their will is taken into consideration such management is both crucial and correct.
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24
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Kondo Y, Sakaguchi S, Mikubo M, Naito M, Shiomi K, Ohbu M, Satoh Y. Lung metastases of a uterine tumor resembling ovarian sex-cord tumor: Report of a rare case. Diagn Cytopathol 2017; 46:88-91. [DOI: 10.1002/dc.23804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 07/03/2017] [Accepted: 08/14/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Yasuto Kondo
- Department of Thoracic Surgery; Kitasato University School of Medicine; Kanagawa Japan
| | - Shinobu Sakaguchi
- Department of Pathology; Kitasato University Hospital; Kanagawa Japan
| | - Masashi Mikubo
- Department of Thoracic Surgery; Kitasato University School of Medicine; Kanagawa Japan
| | - Masahito Naito
- Department of Thoracic Surgery; Kitasato University School of Medicine; Kanagawa Japan
| | - Kazu Shiomi
- Department of Thoracic Surgery; Kitasato University School of Medicine; Kanagawa Japan
| | - Makoto Ohbu
- Department of Pathology; Kitasato University Hospital; Kanagawa Japan
| | - Yukitoshi Satoh
- Department of Thoracic Surgery; Kitasato University School of Medicine; Kanagawa Japan
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Uçar MG, Ilhan TT, Gül A, Ugurluoglu C, Çelik Ç. Uterine Tumour Resembling Ovarian Sex Cord Tumour- A Rare Entity. J Clin Diagn Res 2016; 10:QD05-QD07. [PMID: 28208949 DOI: 10.7860/jcdr/2016/22152.9061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/01/2016] [Indexed: 12/25/2022]
Abstract
Uterine Tumour Resembling Ovarian Sex-Cord Tumours (UTROSCTs) are an extremely rare type of uterine body tumours arising from the endometrial stroma. Epidemiology, aetiology, pathogenesis, management and natural history of UTROSCTs are still a question of debate, as there is little available data in the literature. Although rare, the possibility of UTROSCTs should be kept in mind, when a patient presents with abnormal bleeding and an enlarged uterus. UTROSCTs appear dirty white/cream-coloured, gelatinous, well-circumscribed mass with smooth surface on macroscopic examination. We present a rare case of endometrial stromal tumour with sex-cord-like differentiation which was successfully treated by hysterectomy with bilateral salpingo-oophorectomy. The clinical manifestations, pathologic characteristics, diagnosis and management of these tumours are reviewed here.
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Affiliation(s)
- Mustafa Gazi Uçar
- Assistant Professor, Department of Obstetrics and Gynaecology, Selçuk University Medicine Faculty , Selçuklu, Konya, Turkey
| | - Tolgay Tuyan Ilhan
- Assistant Professor, Department of Obstetrics and Gynaecology, Selçuk University Medicine Faculty , Selçuklu, Konya, Turkey
| | - Ayhan Gül
- Assistant Professor, Department of Obstetrics and Gynaecology, Selçuk University Medicine Faculty , Selçuklu, Konya, Turkey
| | - Ceyhan Ugurluoglu
- Assistant Professor, Faculty, Department of Pathology, Selçuk University Medicine Faculty , Selçuklu, Konya, Turkey
| | - Çetin Çelik
- Professor, Department of Obstetrics and Gynaecology, Selçuk University Medicine Faculty , Selçuklu, Konya, Turkey
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26
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Stewart CJR, Crook M, Tan A. SF1 immunohistochemistry is useful in differentiating uterine tumours resembling sex cord-stromal tumours from potential histological mimics. Pathology 2016; 48:434-40. [PMID: 27311867 DOI: 10.1016/j.pathol.2016.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/19/2016] [Accepted: 03/22/2016] [Indexed: 02/02/2023]
Abstract
The aim of this study was to perform an immunohistochemical comparison of uterine tumour resembling ovarian sex cord-stromal tumour (UTROSCT) and other uterine lesions with sex cord-like (SCL) differentiation. Six UTROSCTs and 10 potential histological mimics with focal SCL elements were examined, the latter comprising three endometrial stromal nodules, three low-grade endometrial stromal sarcomas, three Müllerian adenosarcomas, and one case of adenomyosis. All cases were stained immunohistochemically for SF1, FOXL2, calretinin and inhibin, and for the less specific markers smooth muscle actin, desmin, CD10, CD56, CD99, cytokeratin, oestrogen receptor and progesterone receptor. Three, four, six and three UTROSCT expressed SF1, FOXL2, calretinin and inhibin, respectively. However, calretinin staining was focal (≤50% cells positive) in five of the cases. Three potential histological mimics demonstrated calretinin, FOXL2 and/or inhibin staining but none was SF1 positive. Most cases in both groups expressed the less specific immunomarkers. SF1 and FOXL2 immunoreactivity in UTROSCT further supports the concept that these tumours demonstrate genuine sex cord-stromal differentiation. While calretinin was the most sensitive UTROSCT marker, staining was usually focal and expression was also seen in two of 10 potential histological mimics. SF1 staining was 100% specific for UTROSCT in this series but this finding should be confirmed in larger studies.
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Affiliation(s)
- Colin J R Stewart
- Department of Pathology, King Edward Memorial Hospital, Perth, WA, Australia; School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.
| | - Maxine Crook
- Department of Pathology, King Edward Memorial Hospital, Perth, WA, Australia
| | - Adeline Tan
- SJOG Pathology, Subiaco, Perth, WA, Australia
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27
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Conservative Resectoscopic Surgery, Successful Delivery, and 60 Months of Follow-Up in a Patient with Endometrial Stromal Tumor with Sex-Cord-Like Differentiation. Case Rep Obstet Gynecol 2016; 2016:5736865. [PMID: 27213063 PMCID: PMC4861780 DOI: 10.1155/2016/5736865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/02/2016] [Accepted: 04/05/2016] [Indexed: 02/07/2023] Open
Abstract
Uterine tumors with sex-cord-like differentiation are extremely rare types of uterine stromal neoplasm. These tumors were classified into two groups with considerable practical relevance because clinical behaviour of uterine tumor resembling ovarian sex cord tumor (UTROSCT) differs widely from its closely related endometrial stromal tumors with sex-cord-like elements (ESTSCLE). Treatment and prognosis of these tumors are unresolved issues because of the exiguous number of reported cases. We describe a rare case of endometrial stromal tumor with sex-cord-like differentiation successfully treated by resectoscopic surgery and conservation of the uterus, in an infertile patient affected by metrorrhagia. This procedure resulted in a pregnancy immediately after treatment and in a successful delivery. During 60 months of follow-up no evidence of recurrence was observed.
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28
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Cetinkaya N, Bas S, Cuylan ZF, Erdem O, Erkaya S, Gungor T. Uterine tumors resembling ovarian sex cord tumors: A case report and literature review. Oncol Lett 2016; 11:1496-1498. [PMID: 26893767 DOI: 10.3892/ol.2016.4076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 11/16/2015] [Indexed: 11/06/2022] Open
Abstract
Uterine tumors with ovarian sex cord-like elements are a rarely observed type of uterine body tumor with unknown etiology, and are divided into two groups: Endometrial stromal tumors with sex cord-like elements (ESTSCLEs) and uterine tumors resembling ovarian sex cord tumors (UTROSCTs). While ESTSCLEs are commonly associated with metastasis and recurrence, there is limited data in the relevant literature concerning the behavior of UTROSCTs. However, UTROSCTs are typically benign in nature. Although case numbers are limited, extra-uterine or lymph node metastasis has been reported. Surgical approaches may be altered according to the patient's age and desire for future fertility. Hysterectomies with bilateral salpingo-oopherectomy or hysteroscopic tumor resection are reported to be safe surgical treatment options. However, in the current report, a case of UTROSCT initially misdiagnosed as adenosarcoma following hysteroscopic tumor resection is presented. Staging surgery revealed the precise diagnosis of the tumor using appropriate immunohistochemical evaluations, and led to the discovery of a secondary tumor focus in the myometrium, adjacent to the location of the previously excised tumor. Thus, hysteroscopic resection is questionable as a definitive surgical treatment in patients exhibiting UTROSCT. If hysteroscopic resection is the selected treatment, close follow-up with diagnostic imaging is recommended.
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Affiliation(s)
- Nilufer Cetinkaya
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara 06230, Turkey
| | - Sevda Bas
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara 06230, Turkey
| | - Zeliha Firat Cuylan
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara 06230, Turkey
| | - Ozlem Erdem
- Department of Pathology, Gazi University Medical Faculty, Ankara 06510, Turkey
| | - Salim Erkaya
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara 06230, Turkey
| | - Tayfun Gungor
- Department of Obstetrics and Gynecology, Hitit University Medical Faculty, Corum 19200, Turkey
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29
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Uterine tumors resembling ovarian sex-cord tumor: A case-report and a review of literature. Gynecol Oncol Rep 2015; 15:22-4. [PMID: 26937483 PMCID: PMC4750014 DOI: 10.1016/j.gore.2015.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/24/2015] [Accepted: 11/20/2015] [Indexed: 12/11/2022] Open
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30
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Kim SS, Nam JH, Kim GE, Choi YD, Choi C, Park CS. Mesonephric Adenocarcinoma of the Uterine Corpus: A Case Report and Diagnostic Pitfall. Int J Surg Pathol 2015; 24:153-8. [PMID: 26510860 DOI: 10.1177/1066896915611489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Mesonephric adenocarcinoma is a rare tumor type that is usually found in areas where the Wolffian duct was present during the fetal period. We report a case of mesonephric adenocarcinoma of the uterine corpus in a 66-year-old woman who presented with vaginal bleeding. Pelvic magnetic resonance imaging revealed a 2.7-cm-sized irregular thickening and enhancement of the uterine body. The diagnosis following endometrial curettage biopsy was endometrioid adenocarcinoma, and the patient underwent a total hysterectomy with bilateral salpingo-oophorectomy. The tumor was composed of small tubular and ductal components, and a retiform appearance was also observed in the deeper areas. The tumor cells were immunopositive for cytokeratin, vimentin, CD10 with a luminal staining pattern, PAX2, and PAX8, and immunonegative for estrogen receptor and progesterone receptor, which was consistent with tumor of mesonephric origin. Mesonephric neoplasms reveal relatively low-grade nuclear feature, characteristic immunoprofiles (immunonegative for ER and PR, and immunopositive for CD10, PAX2, PAX8, and GATA3), and unique tumor location (myometrium), whereas Müllerian neoplasms such as endometrial adenocarcinoma show various morphology, immunopositivity for ER and PR, and primarily endometrial location. As described above, an integration of the clinical features, morphologic characteristics, and immunohistochemical profiles is needed to make a diagnosis.
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Affiliation(s)
- Sung Sun Kim
- Chonnam National University Medical School, Gwangju City, Republic of Korea
| | - Jong Hee Nam
- Chonnam National University Medical School, Gwangju City, Republic of Korea
| | - Ga-Eon Kim
- Chonnam National University Medical School, Gwangju City, Republic of Korea
| | - Yoo Duk Choi
- Chonnam National University Medical School, Gwangju City, Republic of Korea
| | - Chan Choi
- Chonnam National University Medical School, Gwangju City, Republic of Korea
| | - Chang Soo Park
- Chonnam National University Medical School, Gwangju City, Republic of Korea
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31
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Successful delivery after conservative resectoscopic surgery in a patient with a uterine tumor resembling ovarian sex cord tumor with myometrial invasion. Obstet Gynecol Sci 2015; 58:418-22. [PMID: 26430670 PMCID: PMC4588850 DOI: 10.5468/ogs.2015.58.5.418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/18/2015] [Accepted: 05/06/2015] [Indexed: 12/19/2022] Open
Abstract
Uterine tumor resembling ovarian sex cord tumors (UTROSCT) is an extremely rare type of uterine stromal neoplasm that exhibits prominent sex cord-like differentiation. The clinical characteristics of a UTROSCT are not fully understood. Most reported cases of UTROSCT were treated by hysterectomy with or without bilateral salpingo-oophorectomy; however, a few cases have been treated by only tumor resection in patients who had a strong desire to preserve their fertility. We present a case of UTROSCT with myometrial invasion, which resulted in a successful delivery after the patient was treated by resectoscopic surgery and conservation of the uterus, and a brief review of the literature.
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32
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Uterine tumors resembling ovarian sex cord tumors, a clinicopathologic study of six cases. Ann Diagn Pathol 2014; 18:329-32. [DOI: 10.1016/j.anndiagpath.2014.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 11/23/2022]
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33
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Hashmi AA, Faridi N, Edhi MM, Khan M. Uterine tumor resembling ovarian sex cord tumor (UTROSCT), case report with literature review. Int Arch Med 2014; 7:47. [PMID: 25395990 PMCID: PMC4230524 DOI: 10.1186/1755-7682-7-47] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Uterine tumors resembling ovarian sex cord tumors (UTROSCT) are uterine neoplasms of unknown histiogenesis which show near complete differentiation towards ovarian sex cord elements and are postulated to arise from pluripotential uterine mesenchymal cells or endometrial stromal cells with secondary sex cord differentiation. CASE PRESENTATION A 48 year old post-menopausal women presented with abnormal uterine bleeding for which she underwent total abdominal hysterectomy with bilateral salpingo-ophorectomy. Gross examination revealed a gelatinous grayish white tumor confined to the myometrium, 7 cm in maximum dimention. Microscopic examination revealed monomorphic round to oval tumor cells in anastomosing cords and trabeculae with myxoid background. Immunohistochemically, tumor cells showed diffuse positivity for vimentin, CD99 and S100, while focal positivity was seen with pancytokeratin immunostain. The case was diagnosed as UTROSCT. No evidence of metastasis was found on systemic clinical and radiologic workup. CONCLUSION UTROSCT are rare uterine tumors which can be diagnosed with certainty on morphologic and immunohistochemical grounds. It is important to recognize these tumors as they behave differently from endometrial stromal tumors with sex cord like elements (ESTSCLE).
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Affiliation(s)
- Atif Ali Hashmi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Naveen Faridi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan
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34
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Blake EA, Sheridan TB, Wang KL, Takiuchi T, Kodama M, Sawada K, Matsuo K. Clinical characteristics and outcomes of uterine tumors resembling ovarian sex-cord tumors (UTROSCT): a systematic review of literature. Eur J Obstet Gynecol Reprod Biol 2014; 181:163-70. [PMID: 25150955 DOI: 10.1016/j.ejogrb.2014.07.050] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/19/2014] [Accepted: 07/29/2014] [Indexed: 12/14/2022]
Abstract
Uterine tumor resembling ovarian sex-cord tumors (UTROSCT) is an extremely rare type of uterine tumor, and its clinical characteristics are not fully understood. A systematic literature search was conducted in PubMed and MEDLINE using the keywords, "uterine tumors resembling ovarian sex cord tumors", limited to case reports. Clinico-pathological characteristics and survival data were abstracted and evaluated for the analysis. Among 43 cases reporting UTROSCT, Type I (endometrial stromal tumors with sex cord-like elements, ESTSCLE) and Type II (classic UTROSCT) were reported in 5 (11.6%) and 17 (39.5%), respectively, and nearly half of reported UTROSCT did not subcategorize the histology pattern into Type I or II (unspecified, n=21, 48.8%). Mean age was 52.2. The two most common symptoms were postmenopausal vaginal bleeding (44.2%) and abnormal menstruation (39.5%). The majority underwent total hysterectomy with adnexectomy (65.1%) followed by hysterectomy alone (18.6%) and tumor resection alone (14.0%). Mean tumor size was 6.2cm, and extra-uterine spread was seen in 7.0%. By immunohistochemistry, calretinin expression was significantly correlated with CAM5.2, inhibin, and progesterone receptor expression (all, p<0.05). In survival analysis, disease-free survival (DFS) rates for all 43 cases at 1, 2, and 5 years for all cases were 97.0%, 92.7%, and 69.7%, respectively. Among recurrent cases, median time to recur was 24 months (range 9-48). Decreased DFS was significantly associated with pelvic pain (2-year rate, 81.8% versus 94.7%, p=0.006), histology subcategory (Type I versus II, 23.8% versus 100%, p=0.006), tumor size ≥10cm (75.0% versus 100%, p=0.046), cervical/extra-uterine metastasis (46.7% versus 100%, p=0.024), and lymphovascular space involvement (50% versus 100%, p=0.002). Treatment patterns were not statistically associated with DFS (hysterectomy, p=0.28; and adnexectomy, p=0.38). When histology patterns were examined, Type II disease was associated with less aggressive tumor behavior when compared to Type I disease: extra-uterine spread (Type I versus II, 40% versus 5.9%, p=0.007) and lymphovascular space invasion (50% versus 6.7%, p=0.012). Among 17 cases of Type II disease, disease recurrence was reported in 1 (5.9%) case at 3 years after the initial treatment. In conclusion, our study showed that UTROSCT was often not subcategorized. Because classic UTROSCT has a distinct clinical outcome and characteristic histological patterns when compared to ESTSCLE, distinguishing UTROSCT from ESTSCLE is an integral component of the diagnosis. While classic UTROSCT typically has a favorable prognosis, it has been known to develop a late recurrence. If risk factors for recurrence are absent, both hysterectomy and mass resection alone are possible options for management.
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Affiliation(s)
- Erin A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA; Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
| | - Todd B Sheridan
- Department of Pathology, Mercy Medical Center, Baltimore, MD, USA
| | - Karen L Wang
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC, USA
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Michiko Kodama
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenjiro Sawada
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
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