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Case 28

Updated: Jan 23

A 40-year-old female with significant uterine cancer history who presented with a large retroperitoneal mass.


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What is the morphology impression and the panel of stains?


IHC

  • Pan-keratin

  • Napsin A

  • CK7

  • CK20

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Answer

The patient has a history of uterine leiomysarcoma. Immunohistochemical studies demonstrate the tumor cells are negative for pankeratin, SOX-10, desmin, ALK, ALKD5F3 (weak and non-specific), DOG-1, CD117. ER shows weak positivity in a subset of cells, and SMA demonstrates focal positivity.

This case was likely represent the history of leiomysarcoma but since the stains for smooth muscle markers are not that convincing. additional molecular testing was recommended. Mutations are most common in TP53 (30%), ATRX (25%) and MED12 (20%) but none are specific.

Case credit: UCSD Pathology

Author: Wangpan Jackson Shi, MD

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