High‐grade endometrial stromal sarcoma with smooth muscle and skeletal muscle differentiation: Report of a case with cytomorphologic and immunocytologic analysis

Abstract

We report a case of high-grade endometrial stromal sarcoma with cytological and immunocytochemical findings. Cytologically, major tumor cells showed round-to-short spindle shapes with round- to oval-shaped nuclei and moderately abundant delicate cytoplasm. Tumor cells with tapered shapes and eccentric nuclei were also observed. A few spindle cells having enlarged cigar-shaped nuclei with conspicuous nucleoli and delicate wispy cytoplasm, which resembled leiomyosarcoma, were intermingled. One rhabdomyoblast cell with both α-sarcomeric muscle actin and myoglobin was also observed. Most of the tumor cells, including the leiomyosarcomatous spindle cells, were positive for CD10, and negative for desmin and h-caldesmon. Accordingly, when relatively monotonous round-to-short spindle tumor cells and taper-shaped tumor cells are observed in the female genital tract, high-grade endometrial stromal sarcoma should be considered in the differential diagnosis. Immunocytochemistry contributed to the correct diagnosis. This case was high-grade endometrial stromal sarcoma with smooth muscle and skeletal muscle differentiation.

Recent developments in uterine mesenchymal neoplasms

“…The presence of permeative, tongue‐like myometrial and/or vascular invasion distinguishes ESSs from their much less frequent benign counterpart, ESNs. Both tumour types can display variant histological features such as smooth muscle, glandular, sex cord, rhabdomyoblastic or adipocytic differentiation; fibrous, myxoid, rhabdoid, epithelioid, clear or granular change; the presence of bizarre, foamy or osteoclast‐like giant cells; and true papillae or pseudopapillae …”

Unusual morphologic features of low‐grade endometrial stromal sarcoma: A case report

“…8 In our case, the preoperative diagnosis [9][10][11] Other reported variants (rhabdomyoblastic and adipocytic differentiation) are extremely rare. 12,13 The various differentiated tissues show different immunohistochemical staining results and may be positive for h-caldesmon, inhibin, calretinin, etc. These morphologic features are mainly focal.…”

“…Endometrioid‐type gland appearance and clear cell change are uncommon 9–11 . Other reported variants (rhabdomyoblastic and adipocytic differentiation) are extremely rare 12,13 . The various differentiated tissues show different immunohistochemical staining results and may be positive for h‐caldesmon, inhibin, calretinin, etc.…”