Primary squamous cell carcinoma with its spindle cell variant in the endometrium. A case report and review of literature

Yamashina, Motoaki; Kobara, Thomas Y.

doi:10.1002/1097-0142(19860115)57:2<340::aid-cncr2820570225>3.0.co;2-z

Cited by 29 publications

(5 citation statements)

References 16 publications

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“…This is the basis for the recommendation that gland crowding assessments used to diagnose EIN (area of glands must exceed that of stroma) must be performed to the exclusion of squamous components(2). Malignancies which follow morule-containing EIN lesions are usually pure adenocarcinomas rather than squamous carcinomas(15). Other investigators have previously shown coordinate loss of estrogen and progesterone receptors, and reduction of Ki-67 staining specifically in the squamous but not glandular elements of endometrial adenocarcinomas(16;17).…”

Section: Discussionmentioning

confidence: 99%

Squamous morules are functionally inert elements of premalignant endometrial neoplasia

et al. 2009

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Squamous morules are a common component of premalignant glandular lesions that are followed by glandular, rather than squamous, carcinomas. We tested the hypothesis that the appearance of glands associated with morules predicts cancer risk, and undertook molecular testing to determine the clonal and hormonal response properties of admixed squamous and glandular elements. A total of 66 patients with squamous morules in an index endometrial biopsy had follow-up clinical data (average follow-up: interval 31 months, 2.5 biopsies) showing development of carcinoma in 11% (7/66) of cases. The histological appearance of morule-associated glands in the index biopsy was significantly associated with this clinical outcome, with the majority (71%, 5/7) of cancer occurrences following an overtly premalignant lesion (endometrial intraepithelial neoplasia) with squamous morules. Eight endometrial intraepithelial neoplasias with squamous morules were examined by immunohistochemistry for estrogen and progesterone receptors and mitotic activity (Ki-67 antigen percent stained). Glandular components had abundant estrogen and progesterone receptors, and high levels of mitotic activity in all cases. In sharp contrast, all squamous morules were devoid of sex hormone receptors and had undetectable or extremely low-proliferation rates. When mutated, the same specific PTEN mutation was detected in squamous and glandular elements, indicating that both are of common lineage. The clinical and laboratory data are consistent with a model of morule biology in which squamous morules are a hormonally incompetent subpopulation of endometrial glandular lesions. Isolated morules might result from artifactual displacement from their native glandular context, or selective hormonally induced regression of the glandular but not squamous components over time. Subsequent cancer risk, as promoted by estrogens, is greatest when the glandular component has the appearance of endometrial intraepithelial neoplasia. Even isolated morules should be carefully followed, however, to exclude a coexisting undersampled, or occult, glandular lesion. Modern Pathology ( Keywords: endometrial hyperplasia; endometrial intraepithelial neoplasia; metaplasia; sex hormones; squamous morules Endometrial adenocarcinomas are readily classified into 'endometrioid (type I)' and 'non-endometrioid (type II)' subsets based on differing clinicopathologic and molecular features. 1 Endometrioid endometrial cancers, comprising over 90% of all endometrial glandular neoplasms, are distinguished by inactivation of the PTEN tumor suppressor pathway and a prodrome of long-term estrogen exposure unopposed by progestins. The indolent beginnings of endometrioid endometrial adenocarcinomas may be manifest by emergence of a premalignant glandular lesion (endometrial intraepithelial neoplasia (EIN) or atypical endometrial hyperplasia), 2 several years in advance. The non-endometrioid class,

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Section: Discussionmentioning

confidence: 99%

Squamous morules are functionally inert elements of premalignant endometrial neoplasia

et al. 2009

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“…9 Positive labeling of neoplastic cells with cytokeratin and EMA was particularly helpful when the tumor harbored a sarcomatoid pattern. 10 This squamous cell carcinoma developed primarily in the endometrium, as the cervix was tumor-free. [11][12][13] In our patient, the features of the tumor were similar to those of any squamous cell carcinoma of other sites, especially the cervix; however, we were unable to precisely indicate its origin preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Primary squamous cell carcinoma of the endometrium: Case history, pathologic findings, and discussion

Houissa-Vuong

Catanzano‐Laroudie

Baviera

et al. 2002

Diagnostic Cytopathology

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Primary squamous cell carcinoma of the endometrium (PSCCE) is an exceedingly rare tumor. Rarely are cytological criteria discussed. We report our experience in the cytological diagnosis of a case. A postmenopausal, 64-yr-old woman suffered from pyometria. An endometrial Pap smear displayed some malignant squamous cells. Curettage of the cervix and the uterine cavity only recovered some fragments of atypical squamous epithelium whose origin could not be precisely identified. A hysterectomy with bilateral adnexectomy was decided upon. Pathological study evidenced a primary squamous cell carcinoma in the uterine cavity while the cervix was tumor-free and the lymph nodes were devoid of metastases (pT1, pN0, pM0). The patient died 46 mo PO with multiple pulmonary and renal metastases. The histological feature of PSCCE is identical to that of any tumor of a similar nature, whatever the site, especially the cervix. Confirmation of the primary endometrial nature is only possible on the hysterectomy specimen.

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“…Sarcomatous change in a carcinoma is a relatively rare event but has been reported by many investigators in various anatomic sites12, 13 such as the skin,14 head and neck,15–17 thyroid gland,18, 19 gastrointestinal tract,20–24 liver,25 gallbladder,26 pancreas,27, 28 mammary gland,29–31 urinary tract,32–36 genital tract,37–39 and lung 1–9…”

Section: Discussionmentioning

confidence: 99%

Sarcomatoid carcinoma of the lung

Nakajima

Kasai

Hashimoto

et al. 1999

Cancer

111

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BACKGROUND Spindle and giant cell carcinomas of the lung are rare subtypes and are regarded as one type of lung carcinoma, termed pleomorphic carcinoma in the Armed Forces Institute of Pathology classification. This classification is different from the World Health Organization classification. METHODS Thirty‐seven cases of sarcomatoid (spindle and/or giant cell) carcinoma of the lung were studied by light microscopy, conventional histochemistry, and immunohistochemistry to establish their clinical and histologic characteristics. RESULTS The patient population was comprised of 29 men and 8 women ages 33–81 years. Seventeen patients died of their disease and there was no statistically significant difference in patient prognosis between sarcomatoid carcinoma and nonsarcomatoid carcinoma of the lung. Using light microscopy, 5 cases (13.5%) comprised entirely of sarcomatoid components without carcinomatous elements were classified as Group A. In the remaining 32 cases (86.5%), classified as Group B, carcinomatous components were present (adenocarcinoma [18 cases; 48.7%], squamous cell carcinoma [8 cases; 21.6%], and large cell carcinoma [6 cases; 16.2%]). Sarcomatoid components were divided further into three categories: spindle cell type, giant cell type, and mixed spindle and giant cell type. Immunohistochemically, the sarcomatoid components of all 37 cases were positive for cytokeratins. Statistically, there was no significant prognostic difference between the 37 cases of sarcomatoid carcinoma and 647 cases of nonsarcomatoid, nonsmall cell carcinoma of the lung (P = 0.8537). CONCLUSIONS The sarcomatoid portions in all sarcomatoid carcinomas in the current study showed an epithelial differentiation, and there was no apparent difference in biologic behavior between sarcomatoid carcinoma and ordinary lung carcinoma. Cancer 1999;86:608–16. © 1999 American Cancer Society.

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Primary squamous cell carcinoma with its spindle cell variant in the endometrium. A case report and review of literature

Cited by 29 publications

References 16 publications

Squamous morules are functionally inert elements of premalignant endometrial neoplasia

Squamous morules are functionally inert elements of premalignant endometrial neoplasia

Primary squamous cell carcinoma of the endometrium: Case history, pathologic findings, and discussion

Sarcomatoid carcinoma of the lung

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