Munakata Satoru, Kushibiki Hanae, Akimoto Taishi, Yamashita Tsuyoshi, Shimoyama Norihiko
Department of Pathology, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan.
Department of Obstetrics and Gynecology, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan.
Case Rep Pathol. 2021 Sep 20;2021:5868818. doi: 10.1155/2021/5868818. eCollection 2021.
Carcinosarcomas (CSs) of the endometrium have admixture of malignant epithelial and mesenchymal components. The carcinomatous component exhibit endometrioid, serous, or clear cell differentiation, or are undifferentiated. CSs are considered homologous or heterologous according to the type of sarcomatous component. Sertoliform endometrioid carcinomas (SECs) of the endometrium which comprise a rare subtype of endometrial cancer, typically occur in the ovary. SECs as a carcinomatous component of CS of the endometrium have not been reported. Here, we report an endometrial carcinosarcoma that contains an SEC component. An 88-year-old female presented to a clinic with atypical genital bleeding. She was referred to our hospital and underwent total hysterectomy, bilateral adnexectomy and partial omentectomy due to endometrial carcinoma. Gross examination revealed a polypoid mass in the uterine cavity with massive myometrial invasion. Histologically, the tumor was a high-grade endometrioid carcinoma. In addition to an ordinary conventional endometrioid carcinoma, approximately 30% of the area exhibited sex cord-like pattern and contained small hollow tubules, anastomosing cords and trabeculae, and tightly packed nests. Immunohistochemically, the SEC component showed diffuse p53 staining. Sex cord-like area, especially the solid area, showed positive staining for EMA, vimentin, -inhibin, CD99, calretinin, p53, CD56, synaptophysin, and chromogranin A, which is a staining pattern similar to that previously reported SEC of the endometrium. Diminished membranous and positive cytoplasmic staining for -catenin was observed. This is the first case report of an endometrial carcinosarcoma containing an SEC component. SECs of the endometrium might exhibit sex cord-like differentiation in contrast to SECs of the ovary, which do not exhibit sex cord differentiation.
子宫内膜癌肉瘤（CSs）具有恶性上皮和间充质成分的混合。癌性成分表现为子宫内膜样、浆液性或透明细胞分化，或未分化。根据肉瘤成分的类型，CSs被认为是同源性或异源性的。子宫内膜的支持细胞样子宫内膜癌（SECs）是子宫内膜癌的一种罕见亚型，通常发生在卵巢。作为子宫内膜CS癌性成分的SECs尚未见报道。在此，我们报告一例含有SEC成分的子宫内膜癌肉瘤。一名88岁女性因非典型生殖器出血就诊于诊所。她被转诊至我院，因子宫内膜癌接受了全子宫切除术、双侧附件切除术和部分大网膜切除术。大体检查显示宫腔内有一息肉样肿物，伴有广泛的肌层浸润。组织学上，肿瘤为高级别子宫内膜样癌。除了普通的传统子宫内膜样癌外，约30%的区域呈现性索样模式，包含小的空心小管、吻合的条索和小梁以及紧密排列的巢状结构。免疫组化显示，SEC成分呈弥漫性p53染色。性索样区域，尤其是实性区域，EMA、波形蛋白、α-抑制素、CD99、钙视网膜蛋白、p53、CD56、突触素和嗜铬粒蛋白A呈阳性染色，这一染色模式与先前报道的子宫内膜SEC相似。观察到β-连环蛋白的膜性染色减弱和胞质阳性染色。这是首例关于含有SEC成分的子宫内膜癌肉瘤的病例报告。与不表现性索分化的卵巢SEC不同，子宫内膜SEC可能表现出性索样分化。
