Endometrial sarcomas: an immunohistochemical and JAZF1 re-arrangement study in low-grade and undifferentiated tumors.
子宫内膜肉瘤:一项在低级别和未分化肿瘤中进行的免疫组织化学及JAZF1基因重排研究
Jakate K,Azimi F,Ali RH,Lee CH,Clarke BA,Rasty G,Shaw PA,Melnyk N,Huntsman DG,Laframboise S,Rouzbahman M
Abstract
The current World Health Organization classification divides endometrial sarcomas into low-grade endometrial stromal sarcoma and undifferentiated endometrial sarcoma. Recent studies suggest undifferentiated endometrial sarcoma is a heterogeneous group and a subgroup with uniform nuclei is more akin to low-grade endometrial stromal sarcoma in terms of morphologic, immunohistochemical and genetic features. We classified endometrial sarcomas treated at our institution from 1998 to 2011 into low-grade endometrial stromal sarcoma and undifferentiated endometrial sarcoma, the latter being further categorized into a group with either uniform or pleomorphic nuclei. Morphological features, immunoprofile and fluorescence in situ hybridization rearrangements of JAZF1 and PHF1 genes were correlated with tumor category and outcome. A total of 40 cases were evaluated comprising 23 low-grade endometrial stromal sarcomas, 10 undifferentiated endometrial sarcomas with nuclear uniformity and 7 undifferentiated endometrial sarcomas with nuclear pleomorphism. Low-grade endometrial stromal sarcomas were more often estrogen and progesterone receptor positive (83%) compared with undifferentiated endometrial sarcoma with nuclear uniformity (10%) or with nuclear pleomorphism (0%) (P<0.001). Positivity for p53 was restricted to undifferentiated endometrial sarcomas with more frequent expression in the group with nuclear pleomorphism (57%) than with nuclear uniformity (10%) (P=0.06). Ki-67 proliferation index in >10% of tumor cells more frequent in undifferentiated endometrial sarcoma than low-grade endometrial stromal sarcoma (P=<0.001). JAZF1 rearrangement was detected in 32% of low-grade endometrial stromal sarcomas and in none of the undifferentiated sarcomas. Rearrangement of PHF1 was found in two patients, one with JAZF1-PHF1 fusion. There were no significant differences in clinical behavior between undifferentiated endometrial sarcoma with nuclear uniformity versus nuclear pleomorphism. In conclusion, we found undifferentiated endometrial sarcoma subtypes and low-grade endometrial stromal sarcoma have distinct immunohistochemical and cytogentic profiles. Our data do not show any difference in clinical behavior between subgroups in undifferentiated sarcomas.
摘要
当前,世界卫生组织(WHO)将子宫内膜肉瘤划分为低级别子宫内膜间质肉瘤和未分化子宫内膜肉瘤。最近研究显示,未分化子宫内膜肉瘤是一种异质性肿瘤,其中具有单形性细胞核特点的一部分在形态学、免疫组织化学以及遗传学特征方面类似于低级别子宫内膜间质肉瘤。我们将1998年至2011年间我们机构诊断的子宫内膜肉瘤分为低级别子宫内膜间质肉瘤和未分化子宫内膜肉瘤,后者进一步分为单形性细胞核类和多形性细胞核类。形态学特征、免疫表达谱系以及荧光原位杂交(FISH)JAZF1和PHF1基因重排与肿瘤的分类和预后相关。我们总共对40例进行了评估,其中包括低级别子宫内膜间质肉瘤23例、伴单形性细胞核的未分化子宫内膜肉瘤10例以及伴多形性细胞核的未分化子宫内膜肉瘤7例。低级别子宫内膜间质肉瘤通常为雌激素受体(ER)和孕激素受体(PR)阳性(83%),伴单形性细胞核的未分化子宫内膜肉瘤和伴多形性细胞核的未分化子宫内膜肉瘤分别为10%和0%(P<0.001)。P53的表达限定于未分化子宫内膜肉瘤,伴多形性细胞核的未分化子宫内膜肉瘤(57%)较伴单形性细胞核的未分化子宫内膜肉瘤(10%)的表达要高(P=0.06)。Ki-67增殖指数>10%的肿瘤中,未分化子宫内膜肉瘤较低级别子宫内膜间质肉瘤的例数要多(P=<0.06)。FISH检测发现32%的低级别子宫内膜间质肉瘤出现JAZF1基因重排,而未分化子宫内膜肉瘤为0%。2例患者发现PHF1基因重排,其中1例为JAZF1- PHF1融合。伴单形性细胞核的未分化子宫内膜肉瘤与伴多形性细胞核的未分化子宫内膜肉瘤之间在临床行为上无显著差异性。简而言之,我们发现未分化子宫内膜肉瘤亚型和低级别子宫内膜间质肉瘤之间具有不同的免疫组织化学和细胞学谱系。我们的数据资料显示子宫内膜肉瘤亚型在临床行为方面的无任何差异。
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