Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Pathol Int. 2017 Sep;67(9):472-476. doi: 10.1111/pin.12557. Epub 2017 Jun 30.
Endometrial dedifferentiated carcinoma consists of a combination of undifferentiated and differentiated carcinomas. To date, clear cell carcinoma components in endometrial dedifferentiated carcinoma have not been reported. We report the first case of endometrial dedifferentiated carcinoma with clear cell carcinoma in a 58-year-old woman. The uterine corpus was completely replaced and enlarged by a heterogeneous mass. The endometrial cut surface showed a yellowish papillary growing mass involving endometrium and deeper myometrium. Microscopically, the three components (endometrioid carcinoma, FIGO grade 1, clear cell carcinoma and undifferentiated carcinoma) were noted with differentiated carcinoma components lining the endometrial cavity, while undifferentiated carcinoma components were identified in deeper endometrium and myometrium. Our histologic diagnosis was supported by the pattern of immunoreactivity. Tumor cells showed loss of expression of MLH1/PMS2 protein and displayed high microsatellite-instability in all three components. Furthermore, all three components including clear cell carcinoma had loss of PTEN and ARID1A expression. Our observations suggest that the three components derived from a monoclonal origin, as the three components had in common specific genetic alterations.
子宫内膜去分化癌由未分化癌和分化癌组成。迄今为止，子宫内膜去分化癌中尚未有透明细胞癌成分的报道。我们报道了首例 58 岁女性子宫内膜去分化癌伴透明细胞癌。子宫体完全被一个异质性肿块取代并增大。子宫内膜切面可见一个累及子宫内膜和更深肌层的黄白色乳头状生长肿块。镜下，三个成分（子宫内膜样癌，FIGO 分级 1，透明细胞癌和未分化癌）均可见分化癌成分排列在子宫内膜腔，而未分化癌成分位于更深的子宫内膜和肌层。我们的组织学诊断得到了免疫反应模式的支持。肿瘤细胞显示 MLH1/PMS2 蛋白表达缺失，并在所有三个成分中均显示高度微卫星不稳定性。此外，包括透明细胞癌在内的所有三个成分均存在 PTEN 和 ARID1A 表达缺失。我们的观察结果表明，这三个成分来源于一个克隆起源，因为这三个成分具有共同的特定遗传改变。
