An 80-year-old female presented with abnormal uterine bleeding who was found to have an large endometrium mass, and she underwent hysterectomy. She does not have any other history of malignancy.
What is your big category of this lesion?
A: Primary carcinoma
B: Neuroendocrine tumor/carcinoma
C: Sex-cord stromal tumor in uterus (Uterine tumor resembling ovarian sex cord tumor)
D: Metastasis (endocervical, GI, etc)
E: Atypical endometrial hyperplasia
F: Weird sarcoma
Answer
What is your panel of stains to work-up?
IHC
ER, PR
PAX8
WT1
Inhibin
You can vote for more than one answer.
Answer
A selective panel of stains showed that both ER and PR (-); MMR normal; P53 wild-type of staining pattern. What are the possible considerations of ER, PR negative carcinomas in uterine pathology?
A: Clear cell carcinoma
B: Endometrioid carcinoma, FIGO1-2
C: Endometrioid carcinoma, FIGO 3
D: Serous carcinoma
E: Endocervical adenocarcinoma
F: CHEC (Corded and Hyalinized Endometrial Carcinoma)
G: Carcinosarcoma
H: Mucinous carcinoma of gastrointestinal type
I: Mesonephric-like adenocarcinoma
Answer
Addtional panels showed that the tumor is diffusely positive for TTF-1 and negative for GATA3. What's your final diagnosis?
A: Endocervical adenocarcinoma
B: Endometrioid carcinoma, FIGO 3
C: Mesonephric-like adenocarcinoma
D: Mucinous carcinoma of gastrointestinal type
Answer
What is the molecular alterations of mesonephric-like adenocarcinoma?
A: PTEN loss
B: P53
C: CTNNB1
D: KRAS
Answer
Bonus homework: Why there is mesonephric adenocarcinoma and mesonephric-like adenocarcinoma? What is the difference?
References:
Shen F, Gao Y, Ding J, Chen Q. Is the positivity of estrogen receptor or progesterone receptor different between type 1 and type 2 endometrial cancer? Oncotarget. 2017 Jan 3;8(1):506-511. doi: 10.18632/oncotarget.13471. PMID: 27888807; PMCID: PMC5352172.
Case credit: UCSD Pathology
Author: Wangpan Jackson Shi, MD
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