Department of Pathology, Showa University, Northern Yokohama Hospital, Yokohama, Kanagawa, Japan.
Int J Gynecol Pathol. 2010 Jul;29(4):374-7. doi: 10.1097/PGP.0b013e3181cef14b.
We report on a case of a primary low-grade endometrial stromal sarcoma (ESS) that progressed to a secondary high-grade ESS. In the secondary tumor, the immunohistochemical profile and focal tumor cell proliferation pattern suggested that this tumor was not truly undifferentiated, but possessed features of endometrial stroma. Low-grade ESS of our patient's primary tumor showed p53 protein overexpression, which is unusual in low-grade ESS, and her secondary high-grade ESS showed more prominent p53 immunoreactivity. This indicates that low-grade ESS that shows p53 immunoreactivity might progress to high-grade ESS, and it is considered that such cases of low-grade ESS should pay attention to the prognosis. Immunoreactivity for epidermal growth factor receptor was observed in both tumors, suggesting a relationship between the primary and secondary tumors in our case. Further study requires more immunohistochemical data for cases in which low-grade ESS transitions to high-grade ESS; in particular, data on epidermal growth factor receptor expression are necessary to define new therapeutic strategies for ESS.
我们报告了一例原发性低度子宫内膜间质肉瘤（ESS）进展为继发性高度 ESS 的病例。在继发性肿瘤中，免疫组织化学特征和局灶性肿瘤细胞增殖模式表明该肿瘤并非真正未分化，而是具有子宫内膜间质特征。我们患者的原发性肿瘤的低度 ESS 表现出 p53 蛋白过表达，这在低度 ESS 中并不常见，而她的继发性高度 ESS 显示出更明显的 p53 免疫反应性。这表明表现出 p53 免疫反应性的低度 ESS 可能进展为高度 ESS，并且认为这种低度 ESS 病例应注意预后。两种肿瘤均观察到表皮生长因子受体的免疫反应性，提示我们的病例中原发性和继发性肿瘤之间存在关系。进一步的研究需要更多关于低度 ESS 向高度 ESS 转化的病例的免疫组织化学数据；特别是需要表皮生长因子受体表达的数据，以确定 ESS 的新治疗策略。
