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Farolfi A, Gentili N, Testoni S, Rusconi F, Massa I, Danesi V, Altavilla A, Cursano MC, Gurioli G, Burgio SL, Ibarburu GH, De Giorgi U. Endometriosis and endometrial cancer: A propensity score-adjusted real-world data study. iScience 2024; 27:109680. [PMID: 38646168 PMCID: PMC11033158 DOI: 10.1016/j.isci.2024.109680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/12/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024] Open
Abstract
Endometriosis is a benign condition characterized by the presence of ectopic endometrial tissue. Our study investigated the effect of endometriosis on the risk of endometrial cancer (EC) and the prognosis of endometriosis-associated EC. In our study, 197,196 patients with endometriosis and without a previous diagnosis of EC were compared with 6,455,556 females encountering health services for examinations, with body mass index (BMI) data, and without endometriosis or EC. A propensity score generated 197,141 matched pairs. In the endometriosis cohort, 875 cases of EC were seen, whereas 558 were in the control group: the hazard ratio (HR) was 1.56 (95% CI 1.40-1.73, p < 0.001). Women with endometriosis were more likely to develop invasive endometrioid (p = 0.005) and clear cell (p < 0.001) EC. There was no difference in overall survival between endometriosis-associated EC and EC without endometriosis. Our epidemiological findings were consistent with the evidence of an association between endometriosis and EC.
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Affiliation(s)
- Alberto Farolfi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Nicola Gentili
- Outcome Research, IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) “Dino Amadori”, Meldola, ItalyW
| | - Sara Testoni
- Biostatistics and Clinical Trials Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | | | - Ilaria Massa
- Outcome Research, IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) “Dino Amadori”, Meldola, ItalyW
| | - Valentina Danesi
- Outcome Research, IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) “Dino Amadori”, Meldola, ItalyW
| | - Amelia Altavilla
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Maria C. Cursano
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Giorgia Gurioli
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Salvatore L. Burgio
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Gema Hernandez Ibarburu
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
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Fadare O. Mucinous Proliferations of the Uterine Corpus: Comprehensive Appraisal of an Evolving Spectrum of Neoplasms. Adv Anat Pathol 2022; 29:275-296. [PMID: 35499137 DOI: 10.1097/pap.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A variety of endometrial lesions may contain mucinous cells. Herein, the author reviews the literature on the classification and clinicopathologic significance of uterine corpus proliferations with a significant mucinous component, assesses the 2020 World Health Organization classification of such lesions, and presents a diagnostic framework. The key epithelial mucinous lesions include mucinous metaplasia, atypical mucinous glandular proliferation and mucinous carcinoma. Each of these categories are classifiable into "usual" and gastrointestinal subtypes, the latter being indicative of intestinal (presence of goblet cells) and/or gastric-type (abundant, pale eosinophilic or clear cytoplasm and well-defined cell borders) morphology. It has been proposed that at least focal expression of gastrointestinal immunohistochemical markers be required for all gastrointestinal type lesions, and for gastrointestinal type atypical mucinous glandular proliferation and carcinoma, minimality or absence of estrogen receptor expression, and the absence of an endometrioid component. Mucinous carcinomas of the usual type, in which >50% of the tumor is comprised of a mucinous component, are the most common. Morphologic subtypes include mucinous carcinoma with microglandular features and mucinous carcinoma with signet rings (signet ring carcinoma). Endometrioid carcinomas with a less than a 50% mucinous component are classified as endometrioid carcinoma with mucinous differentiation. Several studies have directly compared endometrioid and mucinous carcinomas, the latter presumably of the usual type, with respect to patient outcomes after treatment. All have found no difference in overall and disease free survival between these groups. However, three major studies have found mucinous carcinomas to be associated with a higher risk of lymph node metastases. Nineteen cases of mucinous carcinoma of the gastrointestinal type have been reported, and the limited data on their follow-up after primary treatment suggests that this subtype is more clinically aggressive and should accordingly be classified separately from mucinous carcinomas of the usual type. The morphologic spectrum of mucinous carcinoma of the gastrointestinal type is unclear and continues to evolve. Mucinous change, which may sometimes be extensive, may also be associated with papillary proliferation of the endometrium, adenomyoma of the endocervical type, atypical, and typical adenomyomas. In a curettage or biopsy, intestinal type mucinous epithelium may be indicative of any of the gastrointestinal lesions mentioned above, but may also represent samplings of uterine teratomas, yolk sac tumors, genital and extragenital adenocarcinomas with intestinal differentiation, or low-grade appendiceal mucinous neoplasms that secondarily involve the endometrium.
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Affiliation(s)
- Oluwole Fadare
- Department of Pathology, University of California San Diego, San Diego, CA
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Liu D, Chen T, Yu K, Li J, Wang S, Ma X, Zhu Q, Ning Y, Wang Y. A 2-tier subdivision of papillary proliferations of the endometrium (PPE) only emphasizing the complexity of papillae precisely predicts the neoplastic risk and reflects the neoplasia-related molecular characteristics-a single-centered analysis of 207 cases. Virchows Arch 2022; 481:585-593. [PMID: 35796805 PMCID: PMC9534819 DOI: 10.1007/s00428-022-03367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 12/05/2022]
Abstract
Papillary proliferation of the endometrium (PPE) is subdivided based on the complexity of the papillae and the proliferation of lesions, and the complex group is considered to have an increased risk of concurrent/subsequent endometrial neoplasia. However, the current subdivision criteria fail to prove the equivalence of the quantity of simple papillae and structural complexity. In this study, we divided PPE of 207 cases from 2014 to 2022 into 3 groups according to structural complexity and proliferation degrees: Group 1 equaled to the simple PPE with a simple papillary structure and typical localized proliferation; group 2 had the simple structure similar to group 1 but occupy over 50% of the endometrial polyp or > 2 lesions in the surface of nonpolypoid endometrium; group 3 had the truly complex branching papillae despite of its proportion. Group 3 was implicated with significantly more concurrent endometrial neoplasia (EAH and carcinoma) compared with groups 1 and 2 (P < 0.01), while no difference was found between groups 1 and 2. In 128 cases with no concurrent endometrial abnormalities in the initial biopsy or curettage specimens, 4 cases presented endometrial neoplasia (3 carcinoma and 1 atypical hyperplasia) in the subsequent specimens, all of which presented PPE of group 3 but not group 1 or 2 in the prior tissues (P < 0.01). The immunochemistry of 83 cases showed similar expressions of ER, PTEN, ARID1A, PTEN, p16, β-catenin, and p53 between PPE and the surrounding normal endometrium. Nearly 100% of PPE cases lost expressions of PR. A total of 2/83 cases showing PAX2 expression were all in the group 3 and correlated with endometrial neoplasia (2/17, 11.76%, P < 0.05). 76/83 (91.57%) of PPE lesions had KRAS mutations, and the distributions of which were similar among 3 groups. The frequency of mucinous metaplasia was significantly higher in the PPE lesions with KRAS mutations (72/74, 97.30%, P < 0.01). Group 3 showed higher frequency of single KRAS mutations compared with the combination of groups 1 and 2 (P < 0.01). Finally, the concordance of KRAS mutation profiles between PPE and endometrial neoplasia was significantly higher in group 3 than either group 1 or 2 (P < 0.01), while no difference was found between group 1 and 2. Thus, a new 2-tier subdivision system only emphasizing the complexity of papillae is recommended, which might precisely predict the risk of endometrial neoplasia and neoplasia-related molecular characteristics.
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Affiliation(s)
- Danyang Liu
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China
| | - Tingting Chen
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China
| | - Kexuan Yu
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China
| | - Jing Li
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China
| | - Shunni Wang
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China
| | - Xiaoxi Ma
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China
| | - Qin Zhu
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China
| | - Yan Ning
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China.
| | - Yiqin Wang
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China.
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Travaglino A, Inzani F, Santoro A, Arciuolo D, Piermattei A, Pasquini S, Scaglione G, D’Alessandris N, Valente M, Raffone A, Fanfani F, Zannoni GF. Endometrial Metaplastic/Reactive Changes Coexistent with Endometrial Hyperplasia and Carcinoma: A Morphological and Immunohistochemical Study. Diagnostics (Basel) 2021; 12:diagnostics12010063. [PMID: 35054228 PMCID: PMC8774443 DOI: 10.3390/diagnostics12010063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the relationship between endometrial metaplastic/reactive changes (EMRCs) and endometrial neoplastic lesions. Twenty cases of “simple” (without architecture complexity) EMRCs coexistent with endometrial malignant/premalignant lesions, twenty cases of neoplasia-unassociated EMRCs, and eight cases of complex metaplastic lesions were assessed by immunohistochemistry. EMRCs coexisted with endometrioid carcinoma (n = 12), atypical endometrial hyperplasia (n = 3), serous carcinoma (n = 2), and clear cell carcinoma (n = 3). Neoplasia-associated EMRCs showed a mean Ki67 labeling index of 12.6% (range 0–30%); with nuclear atypia in 16/20 (80%) cases; diffuse p16 expression in 15/20 (75%) cases; and heterogeneous ER, PR, and vimentin expression. Compared to the associated neoplasia, EMRCs showed a lower Ki67 expression (p < 0.001) and higher p16 expression (p < 0.001). No EMRC case showed mitotic activity, PTEN loss, MMR deficiency, nuclear β-catenin, p53-mutant pattern, Napsin A, or AMACR expression. No significant differences were found between neoplasia-associated and neoplasia-unassociated EMRCs. Complex metaplastic lesions showed a lower Ki67 expression than EMRCs (p = 0.044) and PTEN loss in 5/8 cases, even in the absence of nuclear atypia. In conclusion, neoplasia-associated simple EMRCs may show evident atypia and a worrisome immunophenotype, but no data support their involvement in endometrial carcinogenesis. Architectural complexity appears as a crucial factor to identify precancerous lesions.
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Affiliation(s)
- Antonio Travaglino
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.T.); (A.S.); (D.A.); (A.P.); (S.P.); (G.S.); (N.D.); (M.V.); (G.F.Z.)
- Pathology Unit, Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy
| | - Frediano Inzani
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.T.); (A.S.); (D.A.); (A.P.); (S.P.); (G.S.); (N.D.); (M.V.); (G.F.Z.)
- Correspondence: ; Tel.: +39-0630154433
| | - Angela Santoro
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.T.); (A.S.); (D.A.); (A.P.); (S.P.); (G.S.); (N.D.); (M.V.); (G.F.Z.)
| | - Damiano Arciuolo
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.T.); (A.S.); (D.A.); (A.P.); (S.P.); (G.S.); (N.D.); (M.V.); (G.F.Z.)
- Department of Life Health and Public Health, Catholic University of the Sacred Hearth, 00168 Rome, Italy;
| | - Alessia Piermattei
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.T.); (A.S.); (D.A.); (A.P.); (S.P.); (G.S.); (N.D.); (M.V.); (G.F.Z.)
| | - Sandra Pasquini
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.T.); (A.S.); (D.A.); (A.P.); (S.P.); (G.S.); (N.D.); (M.V.); (G.F.Z.)
| | - Giulia Scaglione
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.T.); (A.S.); (D.A.); (A.P.); (S.P.); (G.S.); (N.D.); (M.V.); (G.F.Z.)
| | - Nicoletta D’Alessandris
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.T.); (A.S.); (D.A.); (A.P.); (S.P.); (G.S.); (N.D.); (M.V.); (G.F.Z.)
| | - Michele Valente
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.T.); (A.S.); (D.A.); (A.P.); (S.P.); (G.S.); (N.D.); (M.V.); (G.F.Z.)
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna. S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy;
| | - Francesco Fanfani
- Department of Life Health and Public Health, Catholic University of the Sacred Hearth, 00168 Rome, Italy;
- Gynecologic Oncology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gian Franco Zannoni
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.T.); (A.S.); (D.A.); (A.P.); (S.P.); (G.S.); (N.D.); (M.V.); (G.F.Z.)
- Department of Life Health and Public Health, Catholic University of the Sacred Hearth, 00168 Rome, Italy;
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KRAS-mutated Uterine Endometrioid Carcinoma With Extensive Surface Changes Resulting in Striking Morphologic Mimicry of an Ovarian Serous Borderline Tumor. Int J Gynecol Pathol 2021; 39:573-577. [PMID: 31855953 DOI: 10.1097/pgp.0000000000000652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Surface epithelial changes involving endometrioid carcinomas of the uterine corpus mimicking papillary syncytial metaplasia or cervical microglandular hyperplasia are relatively common. There have been rare reports of surface epithelial changes in endometrioid carcinomas mimicking ovarian serous borderline tumor or low-grade serous carcinoma. We report an endometrioid carcinoma of the uterine corpus with striking morphologic mimicking of an ovarian serous borderline tumor with only a minimal amount of conventional endometrioid carcinoma. The tumor was diffusely positive for estrogen receptor, negative for WT1, and showed wild-type immunoreactivity with p53. Targeted sequencing revealed a KRAS mutation (G12V/D/A), but no BRAF mutation. This close mimicry of a serous borderline tumor by a uterine endometrioid carcinoma has not been emphasized in the literature and this case is unique because the features involved almost the entire neoplasm. In reporting this case, we review surface changes in endometrioid carcinomas of the uterine corpus.
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Tong K, Zhu W, Fu H, Cao F, Wang S, Zhou W, Liu C, Chen D, Fan S, Hu Z. Frequent
KRAS
mutations in oncocytic papillary renal neoplasm with inverted nuclei. Histopathology 2020; 76:1070-1083. [DOI: https:/doi.org/10.1111/his.14084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Kuo Tong
- Department of Pathology Xiangya HospitalCentral South University Changsha China
- Department of Pathology The Bishan Hospital of Chongqing Chongqing China
- Department of Pathology School of Basic Medical Science Central South University Changsha China
| | - Wei Zhu
- Department of Pathology Xiangya HospitalCentral South University Changsha China
| | - Hua Fu
- Department of Pathology The Third Xiangya HospitalCentral South University Changsha China
| | - Fang Cao
- Department of Pathology Hunan Cancer Hospital Changsha China
| | - Shu Wang
- Department of Pathology Hunan Cancer Hospital Changsha China
| | - Wenxuan Zhou
- Department of Pathology Xiangya HospitalCentral South University Changsha China
- Department of Pathology School of Basic Medical Science Central South University Changsha China
| | - Chongmei Liu
- Department of Pathology Yueyang Second People's Hospital Yueyang China
| | - Dongliang Chen
- Department of Pathology Zhuzhou Central Hospital Zhuzhou China
| | - Songqing Fan
- Department of Pathology The Second Xiangya HospitalCentral South University Changsha China
| | - Zhongliang Hu
- Department of Pathology Xiangya HospitalCentral South University Changsha China
- Department of Pathology School of Basic Medical Science Central South University Changsha China
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7
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Tong K, Zhu W, Fu H, Cao F, Wang S, Zhou W, Liu C, Chen D, Fan S, Hu Z. Frequent KRAS mutations in oncocytic papillary renal neoplasm with inverted nuclei. Histopathology 2020; 76:1070-1083. [PMID: 31997427 DOI: 10.1111/his.14084] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 12/31/2022]
Abstract
AIMS Papillary renal neoplasm with reverse polarity (PRNRP) is a newly documented rare tumour type. Its molecular pathological features have thus far been very little studied. METHODS AND RESULTS There were 13 PRNRP cases including 3 The Cancer Genome Atlas (TCGA) cases and our 10 cases in this study. The 3 TCGA cases were found by a combined analysis of GATA3 mRNA expression levels and digital slides from the TCGA papillary renal cell carcinoma project. KRAS codon 12 mutations were identified in the three PRNRPs from TCGA. Of our 10 PRNRP cases, the mutations were also discovered using Sanger sequencing in seven (77.8%) of nine cases with available DNA, where KRAS p.G12V (n = 3), p.G12D (n = 2), p.G12R (n = 1) and p.G12C (n = 1) alterations were found. PRNRP shared similar gene expression profiles with renal distal tubules via an interprofile correlation analysis. Gene set enrichment analysis revealed that genes involved in 'KEGG aldosterone regulated sodium reabsorption' or 'hallmark apical surface' were enriched in PRNRP. Moreover, polarised immunostaining patterns for L1CAM and EMA in the distal tubule were maintained in PRNRP. CONCLUSIONS These results imply that the tumour potentially originates from the distal tubule, especially from the cortical collecting duct, and probably retains its cell polarity, except for nuclear inversion. We therefore propose that oncocytic papillary renal neoplasm with inverted nuclei (OPRNIN) is a better name for this tumour type. OPRNIN is a kidney site-specific KRAS mutation neoplasm different from conventional papillary renal cell carcinoma.
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Affiliation(s)
- Kuo Tong
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.,Department of Pathology, The Bishan Hospital of Chongqing, Chongqing, China.,Department of Pathology, School of Basic Medical Science, Central South University, Changsha, China
| | - Wei Zhu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Hua Fu
- Department of Pathology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Fang Cao
- Department of Pathology, Hunan Cancer Hospital, Changsha, China
| | - Shu Wang
- Department of Pathology, Hunan Cancer Hospital, Changsha, China
| | - Wenxuan Zhou
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.,Department of Pathology, School of Basic Medical Science, Central South University, Changsha, China
| | - Chongmei Liu
- Department of Pathology, Yueyang Second People's Hospital, Yueyang, China
| | - Dongliang Chen
- Department of Pathology, Zhuzhou Central Hospital, Zhuzhou, China
| | - Songqing Fan
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhongliang Hu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.,Department of Pathology, School of Basic Medical Science, Central South University, Changsha, China
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8
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Shao Y, Liu Q, Shi H, Lu B. Ovarian mucinous tumors with mural nodules: immunohistochemical and molecular analysis of 3 cases. Diagn Pathol 2020; 15:35. [PMID: 32290854 PMCID: PMC7158139 DOI: 10.1186/s13000-020-00956-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/08/2020] [Indexed: 12/26/2022] Open
Abstract
Background Primary ovarian mucinous tumors with mural nodules are very rare. The histogenesis of the mural nodules remains unclear. Methods We investigated the clincopathological and molecular features in 3 cases with mural nodules. Results Patient 1 was diagnosed as mucinous carcinoma with mural nodules of anaplastic carcinoma that was composed of CK+ and CK7+ spindled cells and polygonal cells with marked pleomorphism. Aberrant p53 staining was found in the mural nodules rather than in the mucinous components. A concordant KRAS mutation (c.35G > A p.G12A) was identified in both mucinous tumors and mural nodules. She died of disease at 44 months. The mural nodule in patient 2 was interpreted as a sarcoma, no other specified. The uniform short spindle cells were separated by abundant myxoid matrix. They were CD10 + , CCND1-, SMA-, and negative for break-apart BCOR, PHF1, and JAZF1 FISH assay. The adenocarcinomatous component harbored LOH at D18S51 and FGA loci while the sarcomatous component had LOH at D19S433. She had lung metastasis at 18 months and was alive without evidence of disease for 40 months. Patient 3 harbored multiple mural nodules that were composed of vimentin+, focal CK+, atypical spindle cells. A diagnosis of sarcoma-like mural nodules was rendered. She was alive with no evidence of disease for 13 months. No hotspot mutant AKT1, KRAS, HRAS, and PI3KCA alleles were found in patients 2 and 3. Conclusions Mural nodules with anaplastic carcinoma or with true sarcomas may represent the dedifferentiation form of mucinous tumors or collision tumors, respectively. The worrisome histology in sarcoma-like mural nodules necessitates meticulous treatment for these patients.
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Affiliation(s)
- Ying Shao
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Qin Liu
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Haiyan Shi
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Bingjian Lu
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China. .,Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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