Endometrial stromal sarcoma
From Wikipedia, the free encyclopedia
| Endometrial stromal sarcoma | |
|---|---|
 | |
| Micrograph of a low-grade endometrial stromal sarcoma. H&E stain. | |
| Specialty | Oncology, gynecology |
Endometrial stromal sarcoma is a malignant subtype of endometrial stromal tumor arising from the stroma (connective tissue) of the endometrium rather than the glands. There are three grades for endometrial stromal tumors, as follows.[1] It was previously known as endolymphatic stromal myosis because of diffuse infiltration of myometrial tissue or the invasion of lymphatic channels.[2]
Low-grade endometrial stromal sarcoma consists of cells resembling normal proliferative phase endometrium, but with infiltration or vascular invasion. These behave less[3] aggressively, sometimes metastasizing, with cancer stage being the best predictor of survival. The cells express estrogen/progesterone-receptors.
Undifferentiated uterine sarcoma
Undifferentiated uterine sarcoma, or undifferentiated (high-grade) endometrial stromal sarcoma, does not resemble normal endometrial stroma and behaves much more aggressively, frequently metastasizing. The differential includes leukemia, lymphoma, high-grade carcinoma, carcinosarcoma, and differentiated pure sarcomas.
Pathology
Macroscopy
- Polypoid mass extending into broad ligament, ovaries and fallopian tubes.
- Lymphatic tumor plugs as yellow, ropy or ball-like masses.
Microscopy
- Monotonous ovoid cells to spindly cells with minimal cytoplasm.
- Prominent arterioles. Angiolymphatic invasion common.
- Up to 10-15 mitotic figures per 10 HPF in most active areas.
- Tongue-like infiltration between muscle bundles of myometrium.
- May exhibit myxoid, epithelioid and fibrous change.
- May have foam cells or hyalinization in the stroma.
Immunochemistry
- CD10+
- muscle markers (muscle specific actin MSA, smooth muscle actin SMA and desmin) positive in areas of smooth muscle differentiation
- CD117- (c-kit -)
- h-caldesmon-