1
|
Shibahara M, Kurita T, Harada H, Tsuda Y, Hisaoka M, Yoshino K. Therapeutic management of uterine tumours resembling ovarian sex cord tumours including a focus on fertility: A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 295:1-7. [PMID: 38310674 DOI: 10.1016/j.ejogrb.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/14/2023] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE Uterine tumours resembling ovarian sex cord tumours (UTROSCTs) are extremely rare. To date, most patients with UTROSCTs have undergone hysterectomy and had a benign clinical course. Fertility-preserving surgery should be considered because some patients with UTROSCTs are aged < 40 years. This paper reviews the treatment and prognosis for patients with UTROSCTs, with a focus on fertility. METHODS PubMed, MEDLINE and Scopus were searched systematically for case reports and case series of UTROSCTs published in English from inception to December 2022, and initial treatment and recurrence rates were compared. The following data were extracted: age; symptoms; initial therapy; metastasis at diagnosis; disease-free survival (DFS); and recurrence. RESULTS In total, 147 patients (72 studies) reporting the clinical course of UTROSCTs were analysed. The median age at diagnosis was 50 years, and 28 (19.0 %) patients were aged < 40 years. Most patients (n = 125, 85.0 %) underwent hysterectomy as the initial surgery, with a recurrence rate of 17.6 % (n = 22). The recurrence rate was 30 % (n = 6) in patients who underwent mass resection (n = 20). Among the 15 patients who underwent mass resection aged < 40 years, seven went on to achieve pregnancy (46.7 %) and six had successful deliveries (40.0 %). No significant differences in 5- and 10-year DFS were found between the hysterectomy and mass resection groups (p = 0.123 and 0.0612, respectively). Bilateral salpingo-oophorectomy in addition to hysterectomy was not significantly associated with 10-year DFS (p = 0.548). CONCLUSION While total hysterectomy is the recommended treatment for UTROSCTs based on recurrence rates, mass resection is an acceptable treatment option for patients who wish to retain their childbearing potential. It is recommended that these women should plan for pregnancy and delivery as soon as possible after mass resection, and should undergo hysterectomy within 5 years.
Collapse
Affiliation(s)
- Mami Shibahara
- Department of Obstetrics and Gynaecology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Tomoko Kurita
- Department of Obstetrics and Gynaecology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
| | - Hiroshi Harada
- Department of Obstetrics and Gynaecology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Yojiro Tsuda
- Department of Pathology and Oncology, University of Occupational and Environmental Health Japan, Kitakyushu, Fukuoka, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, University of Occupational and Environmental Health Japan, Kitakyushu, Fukuoka, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynaecology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| |
Collapse
|
2
|
Lin J, Liu L, Wang L, Ma N, Zhang K, Xie N, Yu H, Deng S, Sun Y. The management of uterine tumor resembling an ovarian sex cord tumor ( UTROSCT): case series and literature review. World J Surg Oncol 2024; 22:42. [PMID: 38310233 PMCID: PMC10837875 DOI: 10.1186/s12957-024-03319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
AIMS To present a case series of 11 rare uterine tumors resembling ovarian sex cord tumors (UTROSCTs), and review the literature on this topic to offer up-to-date treatment management for UTROSCTs. METHOD Eight cases from Fujian Cancer Hospital between January 2017 and May 2023 and three patients from Fujian Union Hospital between October 2012 and October 2020 were retrospectively reviewed. All cases were pathologically confirmed as UTROSCTs by two senior and experienced pathologists. Clinical behaviors, medical data, histopathological features, therapy approaches, and survival outcomes were discussed. RESULTS The median age at initial diagnosis was 53 years (29-70 years). 3 (27.3%) patients were under 40. Seven cases presented with abnormal vaginal bleeding, one with menstrual disorder, one with abnormal vaginal secretion, and two patients were accidentally found by physical examination without any symptoms. Three patients were initially misdiagnosed with endometrial cancer by MRI. Curettage was performed in all cases. Nine of them were well diagnosed by routine curettage, except for two samples, which were identified after surgery. Immunohistochemical biomarkers, such as CD99, Desmin, WT-1, CK, Vimentin, SMA, α-Inhibin, Ki67, CD56, ER, PR, and CR, tend to be positive in UTRO SCs patients. Six patients underwent hysterectomy with bilateral salpingo-oophorectomy. Two cases received a radical hysterectomy with bilateral salpingo-oophorectomy, retroperitoneal lymph node dissection, and omentum dissection. Three UTROSCTs were under observation after mass resection. The median PFS was 24 months (range 1-125 months). CONCLUSION UTROSCT is a rare mesenchymal tumor with low malignant potential. Treatment modalities should be carefully considered to balance the therapy outcomes and patient needs. Surgery conservative management might be suitable for young women with fertility desires.
Collapse
Affiliation(s)
- Jie Lin
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Linying Liu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Linghua Wang
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Ning Ma
- Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Kailin Zhang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ning Xie
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Haijuan Yu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Sufang Deng
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Yang Sun
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China.
| |
Collapse
|
3
|
Shibahara M, Kurita T, Murakami M, Harada H, Tsuda Y, Hisaoka M, Kagami S, Matsuura Y, Yoshino K. Uterine Tumor Resembling Ovarian Sex Cord Tumor: A Case Report. J UOEH 2022; 44:161-6. [PMID: 35660681 DOI: 10.7888/juoeh.44.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Uterine tumors resembling ovarian sex cord tumors (UTROSCTs) are extremely rare, occurring in less than 1% of uterine stromal tumors, and they are considered to have a low malignant potential. Due to the small number of cases, no standard treatment has been defined. A 77-year-old woman with postmenopausal bleeding was admitted to our department. Imaging studies revealed a substantial mass around 30 mm in size on the anterior uterine wall. A total hysterectomy and bilateral salpingo-oophorectomy were performed for further diagnosis and treatment. The tumor revealed histopathological findings of a sex cord-like growth pattern in the form of fascicles, cords, or small nests. Immunohistochemical findings revealed that the tumor cells were positively reactive to alpha-SMA, calretinin, CD99, estrogen receptor, and progesterone receptor, collectively diagnosed as UTROSCT. No recurrence was observed over 12 months after treatment. We experienced the treatment of UTROSCT, an extremely rare tumor that occurs in elderly women. Although most cases of UTROSCT have a benign clinical course, several cases of recurrence and metastasis have been reported. It should be followed up for a long term after treatment.
Collapse
|
4
|
Abstract
This review focuses on recent advances in epithelioid and myxoid uterine mesenchymal neoplasms, a category of tumors whereby diagnostic criteria have been rapidly evolving due to advances in molecular testing. Pertinent clinicopathological and molecular features are highlighted for perivascular epithelioid cell tumors, uterine tumors resembling ovarian sex cord tumors, BCOR/BCORL1-altered high-grade endometrial stromal sarcomas, and inflammatory myofibroblastic tumors. Novel developments in epithelioid and myxoid leiomyosarcomas are briefly discussed, and differential diagnoses with key diagnostic criteria are provided for morphologic mimickers.
Collapse
Affiliation(s)
- Elizabeth C Kertowidjojo
- Department of Pathology, University of Chicago Medicine, 5837 South Maryland Avenue, MC 6101, Chicago, IL 60637, USA
| | - Jennifer A Bennett
- Department of Pathology, University of Chicago Medicine, 5837 South Maryland Avenue, MC 6101, Chicago, IL 60637, USA.
| |
Collapse
|
5
|
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: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
6
|
Kommoss FKF, Stichel D, Schrimpf D, Kriegsmann M, Tessier-Cloutier B, Talhouk A, McAlpine JN, Chang KTE, Sturm D, Pfister SM, Romero-Pérez L, Kirchner T, Grünewald TGP, Buslei R, Sinn HP, Mechtersheimer G, Schirmacher P, Schmidt D, Lehr HA, Sahm F, Huntsman DG, Gilks CB, Kommoss F, von Deimling A, Koelsche C. DNA methylation-based profiling of uterine neoplasms: a novel tool to improve gynecologic cancer diagnostics. J Cancer Res Clin Oncol 2019; 146:97-104. [PMID: 31768620 DOI: 10.1007/s00432-019-03093-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Uterine neoplasms comprise a broad spectrum of lesions, some of which may pose a diagnostic challenge even to experienced pathologists. Recently, genome-wide DNA methylation-based classification of central nervous system tumors has been shown to increase diagnostic precision in clinical practice when combined with standard histopathology. In this study, we describe DNA methylation patterns of a diverse set of uterine neoplasms and test the applicability of array-based DNA methylation profiling. METHODS A multicenter cohort including prototypical epithelial and mesenchymal uterine neoplasms was collected. Tumors were subject to pathology review and array-based DNA methylation profiling (Illumina Infinium HumanMethylation450 or EPIC [850k] BeadChip). Methylation data were analyzed by unsupervised hierarchical clustering and t-SNE analysis. RESULTS After sample retrieval and pathology review the study cohort consisted of 49 endometrial carcinomas (EC), 5 carcinosarcomas (MMMT), 8 uterine leiomyomas (ULMO), 7 uterine leiomyosarcomas (ULMS), 15 uterine tumor resembling ovarian sex cord tumors (UTROSCT), 17 low-grade endometrial stromal sarcomas (LGESS) and 9 high-grade endometrial stromal sarcomas (HGESS). Analysis of methylation data identified distinct methylation clusters, which correlated with established diagnostic categories of uterine neoplasms. MMMT clustered together with EC, while ULMO, ULMS and UTROSCT each formed distinct clusters. The LGESS cluster differed from that of HGESS, and within the branch of HGESS, we observed a notable subgrouping of YWHAE- and BCOR-rearranged tumors. CONCLUSION Herein, we describe distinct DNA methylation signatures in uterine neoplasms and show that array-based DNA methylation analysis holds promise as an ancillary tool to further characterize uterine neoplasms, especially in cases which are diagnostically challenging by conventional techniques.
Collapse
Affiliation(s)
- Felix K F Kommoss
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany
| | - Damian Stichel
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mark Kriegsmann
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany
| | - Basile Tessier-Cloutier
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada
| | - Aline Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada
| | - Jessica N McAlpine
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Dominik Sturm
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura Romero-Pérez
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Thomas Kirchner
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Thomas G P Grünewald
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Rolf Buslei
- Institute of Pathology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Hans-Peter Sinn
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany
| | - Gunhild Mechtersheimer
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany
| | - Peter Schirmacher
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany
| | | | - Hans-Anton Lehr
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - David G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada
| | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Koelsche
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany.
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
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: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
9
|
Croce S, Lesluyes T, Delespaul L, Bonhomme B, Pérot G, Velasco V, Mayeur L, Rebier F, Ben Rejeb H, Guyon F, McCluggage WG, Floquet A, Querleu D, Chakiba C, Devouassoux-Shisheboran M, Mery E, Arnould L, Averous G, Soubeyran I, Le Guellec S, Chibon F. GREB1-CTNNB1 fusion transcript detected by RNA-sequencing in a uterine tumor resembling ovarian sex cord tumor ( UTROSCT): A novel CTNNB1 rearrangement. Genes Chromosomes Cancer 2019; 58:155-163. [PMID: 30350331 DOI: 10.1002/gcc.22694] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022] Open
Abstract
Mutations of CTNNB1 have been implicated in tumorigenesis in many organs. However, tumors harboring a CTNNB1 translocation are extremely rare and this translocation has never been reported in a uterine mesenchymal neoplasm. We report a novel translocation t(2;3)(p25;p22) involving the GREB1 (intron 8) and CTNNB1 (exon 3) in a uterine tumor resembling ovarian sex cord tumor (UTROSCT), which exhibited extrauterine metastasis. The translocation detected by RNA-sequencing was validated by RT-PCR, and resulted in nuclear expression of β-catenin. Juxtapositioning with GREB1, which is overexpressed in response to estrogens, resulted in overexpression of a truncated and hypophosphorylated nuclear β-catenin in the primary and recurrent tumors. This accumulation of nuclear β-catenin results in a constitutive activation of the Wnt/β-catenin signaling pathway with a major oncogenic effect. The CTNNB1 gene fusion, promoted by an estrogen-responsive gene (GREB1), could be a potential driver of tumorigenesis in this case and a therapeutic target with adapted inhibitors. RT-PCR and immunohistochemistry performed on 11 additional UTROSCTs showed no CTNNB1 fusion transcript or nuclear β-catenin immunoreactivity.
Collapse
Affiliation(s)
- Sabrina Croce
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Tom Lesluyes
- Comprehensive Cancer Center, INSERM U1218, Institut Bergonié, Bordeaux, France.,University of Bordeaux, Bordeaux, France.,Cancer Research Center of Toulouse, Oncosarc, INSERM UMR1037, Toulouse, France.,Department of Pathology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Lucile Delespaul
- University of Bordeaux, Bordeaux, France.,Cancer Research Center of Toulouse, Oncosarc, INSERM UMR1037, Toulouse, France
| | - Benjamin Bonhomme
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Gaëlle Pérot
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Valérie Velasco
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Laetitia Mayeur
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Flora Rebier
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Houda Ben Rejeb
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Frédéric Guyon
- Department of Surgery, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Anne Floquet
- Department of Oncology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Denis Querleu
- University of Bordeaux, Bordeaux, France.,Department of Surgery, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Camille Chakiba
- Department of Oncology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | | | - Eliane Mery
- Department of Pathology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Laurent Arnould
- Department of Pathology, Centre JF Leclerc, Comprehensive Cancer Center, Dijon, France
| | | | - Isabelle Soubeyran
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Sophie Le Guellec
- Cancer Research Center of Toulouse, Oncosarc, INSERM UMR1037, Toulouse, France.,Department of Pathology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Frédéric Chibon
- Cancer Research Center of Toulouse, Oncosarc, INSERM UMR1037, Toulouse, France.,Department of Pathology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| |
Collapse
|
10
|
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] [What about the content of this article? (0)] [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]
|
11
|
Schraag SM, Caduff R, Dedes KJ, Fink D, Schmidt AM. Uterine Tumors Resembling Ovarian Sex Cord Tumors - Treatment, recurrence, pregnancy and brief review. Gynecol Oncol Rep 2017; 19:53-56. [PMID: 28119954 PMCID: PMC5238603 DOI: 10.1016/j.gore.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/29/2016] [Accepted: 01/09/2017] [Indexed: 12/17/2022] Open
Abstract
Background Uterine Tumors Resembling Ovarian Sex Cord Tumors (UTROSCT) are rare tumors of low malignancy. In the past, these tumors were mainly treated by hysterectomy. More recently, some authors have proposed conservative surgical management for women wishing to preserve fertility. This article is the first to report on organ-preserving treatment in the case of recurrence or disease persistence. Cases We report on three patients with UTROSCT, two of them young, not having completed family planning. One even gave birth to a healthy child after fertility-preserving treatment of a persistent UTROSCT. To our knowledge, this is the first pregnancy reported after surgical treatment of a persistent UTROSCT so far. Conclusion A fertility-sparing approach should always be considered in young women with UTROSCT who wish to preserve their fertility, also in cases of recurrence or disease persistence. First report on organ-preserving treatment in case of UTROSCT recurrence First pregnancy reported after surgical treatment of a persistent UTROSCT Fertility-preserving approach also in cases of recurrence or disease persistence
Collapse
Affiliation(s)
- Sabrina M Schraag
- Department of Gynecology, Zurich University Hospital, CH-8091 Zurich, Switzerland
| | - Rosmarie Caduff
- Department of Pathology, Zurich University Hospital, CH-8091 Zurich, Switzerland
| | - Konstantin J Dedes
- Department of Gynecology, Zurich University Hospital, CH-8091 Zurich, Switzerland
| | - Daniel Fink
- Department of Gynecology, Zurich University Hospital, CH-8091 Zurich, Switzerland
| | - Ana-Maria Schmidt
- Department of Gynecology, Zurich University Hospital, CH-8091 Zurich, Switzerland
| |
Collapse
|
12
|
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: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
13
|
Gomes JR, Carvalho FM, Abrão M, Maluf FC. Uterine tumors resembling ovarian sex-cord tumor: A case-report and a review of literature. Gynecol Oncol Rep 2016; 15:22-4. [PMID: 26937483 DOI: 10.1016/j.gore.2015.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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
|
14
|
Watrowski R, Jäger C, Möckel J, Kurz P, Schmidt D, Freudenberg N. Hysteroscopic treatment of uterine tumor resembling ovarian sex cord-like tumor ( UTROSCT). Gynecol Endocrinol 2015; 31:856-9. [PMID: 26369991 DOI: 10.3109/09513590.2015.1080682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The decision to preserve the uterus in a young nulliparous woman with an extremely rare tumor is challenging. Uterine tumor resembling ovarian sex cord-like tumor (UTROSCT) belongs to the rarest uterine pathologies. A 22-year-old nulligravida with uterine bleeding underwent a hysteroscopic resection of an intrauterine mass presumed as grade-1 submucous myoma. According to the presence of sex cord-like differentiation and positivity for calretinin, CD99, estrogen receptor, vimentin, WT1 and Melan-A, the tumor was diagnosed as UTROSCT. After 28 months, without any adjuvant therapy, the patient is still free of recurrence. This is the youngest patient with UTROSCT reported so far, with the longest follow-up among all five cases treated via hysteroscopy. Although UTROSCT has been traditionally treated with hysterectomy (with or without bilateral salpingo-oophorectomy), no established treatment protocol for UTROSCT exists. UTROSCT shows a low-malignant potential, but metastasizing and recurrent cases occur. In light of the probably less aggressive tumor biology and with respect to the patient's autonomy, a conservative, uterus preserving treatment appears to be justified in selected cases in which close follow-up can be guaranteed. Further case reports are needed to prove the safety of organ-preserving strategy in UTROSCT.
Collapse
Affiliation(s)
- Rafal Watrowski
- a Department of Gynecology and Obstetrics, St. Josefskrankenhaus , Teaching Hospital of the University of Freiburg , Freiburg , Germany
| | - Christoph Jäger
- a Department of Gynecology and Obstetrics, St. Josefskrankenhaus , Teaching Hospital of the University of Freiburg , Freiburg , Germany
| | - Jochen Möckel
- b Laboratory for Cytodiagnostics , Freiburg , Germany
| | - Philipp Kurz
- c Department of Pathology , University Hospital Freiburg , Freiburg , Germany , and
| | - Dietmar Schmidt
- d Institute of Pathology, Center for Gynecopathology , Mannheim , Germany
| | - Nikolaus Freudenberg
- b Laboratory for Cytodiagnostics , Freiburg , Germany
- c Department of Pathology , University Hospital Freiburg , Freiburg , Germany , and
| |
Collapse
|