Uterine tumors resembling ovarian sex cord tumors (UTROSCT) - popis případu s metastázou do lymfatické uzliny

Popisujeme vzácný nádor dělohy odpovídající ovariálnímu sex cord nádoru (UTROSCT), který má nejistou histogenezi. Ačkoliv je obecně považovaný za benigní, v některých případech metastazuje. V našem případě šlo o 53letou ženu, která přišla do nemocnice s vaginálním krvácením. Klinické vyšetření ukázalo nádor velikosti v průměru 1,5cm, který byl lokalizovaný subendometriálně ve stěně dělohy. Histologicky byl nádor tvořený epiteloidními oválnými buňkami, které tvořily solidní hnízda, trabekuly a pruhy. V imunohistologickém vyšetření bylo přibližně 1 % nádorových buněk výrazně pozitivní s protilátkou proti desminu, kalponinu u 10 % buněk, WT1 u 80 % buněk a Ki-67 bylo pozitivní asi u 5 % nádorových buněk. Ostatní protilátky včetně protilátek proti cytokeratinům byly negativní. Metoda RT-PCR identifikující fúzní transkript JAZF1-JJAZ1 byla negativní. V jedné lymfatické uzlině v oblasti pravé ilické arterie byla zjištěna metastáza UTROSCT. Tento nález můžeme přiřadit k některým dříve popsaným UTROSCT, u kterých se objevily metastázy.

Klíčová slova:
nádor dělohy odpovídající ovariálnímu sex cord tumoru ovaria – UTROSCT – metastáza – lymfatická uzlina

Autoři: Jirka Mačák ¹; Pavel Dundr ²; Jana Dvořáčková ^1,3; Jaroslav Klát ⁴
Působiště autorů: Department of Pathology, University Hospital and Faculty of Medicine, University of Ostrava, Czech Republic ¹; Department of Pathology, First Faculty of Medicine and General University Hospital, Charles University in Prague, Czech Republic ²; CGB laboratory Inc. Ostrava, Czech Republic ³; Department of Gynecology and Obstetrics, University Hospital Ostrava, Czech Republic ⁴
Vyšlo v časopise: Čes.-slov. Patol., 50, 2014, No. 1, p. 46-49
Kategorie: Původní práce

Souhrn

Klíčová slova:
nádor dělohy odpovídající ovariálnímu sex cord tumoru ovaria – UTROSCT – metastáza – lymfatická uzlina

Zdroje

1. Morehead RP, Bowman MC. Heterologous mesodermal tumors of the uterus: report of a neoplasm resembling a granulosa cell tumor. Am J Pathol 1945; 21: 53-61.

2. Clement PB, Scully RE. Uterine tumors resembling ovarian sex-cord tumors. A clinicopathologic analysis of fourteen cases. Am J Clin Pathol 1976; 66: 512-525.

3. Abdullazade S, Kosemehmetoglu K, Adanir I, Kutluay L, Usubtun A. Uterine tumors resembling ovarian sex cord-stromal tumors: synchronous uterine tumors resembling ovarian sex cord-stromal tumors and ovarian sex cord tumor. Ann Diagn Pathol 2010; 14: 432-437.

4. Kantelip B, Cloup N, Dechelotte P. Uterine tumor resembling ovarian sex cord tumors: report of a case with ultrastructural study. Hum Pathol 1986; 17: 91-94.

5. Biermann K, Heukamp LC, Büttner R, Zhuo H. Uterine tumor resembling an ovarian sex cord tumor associated with metastasis. Int J Gynecol Pathol 2008; 27: 58-60.

6. Leiser AL, Hamid AM, Blanchard R. Recurrence of prolactin-producing endometrial stromal sarcoma with sex-cord stromal component treated with progestin and aromatase inhibitor. Gynecol Oncol 2004; 94: 567-571.

7. O’Meara AC, Giger OT, Kurrer M, Schaer G. Case report: Recurrence of a uterine tumor resembling ovarian sex-cord tumor. Gynecol Oncol 2009; 114: 140-142.

8. Viswanatha DS, Foucar K, Berry BR. Blastic mantle cell leukemia: an unusual presentation of blastic mantle cell lymphoma. Mod Pathol 2000;13: 825-833.

9. Gaffney R, Chakerian A, O’Connell JX. Novel fluorescent ligase detection reaction and flow cytometric analysis of SYT-SSX fusion in synovial sarcoma. J Mol Diagn 2003; 5: 127-135.

10. Antonescu CR, Kawai A, Leung DH. Strong association of SYT-SSX fusion type and morphologic epithelial differentiation in synovial sarcomas. Diagn Mol Pathol 2000; 9: 1-8.

11. Hrzenjak A, Moinfar F, Tavassoli FA. JAZF1/JJAZ1 gene fusion in endometrial stromal sarcomas: molecular analysis by reverse transcriptase-polymerase chain reaction optimized for paraffin-embedded tissue. J Mol Diagn 2005; 7: 388-395.

12. Czernobilsky B. Uterine tumors resembling ovarian sex cord tumors: an update. Int J Gynecol Pathol 2008; 27: 229-235.

13. Zamecnik M, Michal M. Endometrial stromal nodule with retiform sex-cord-like differentiation. Pathol Res Pract 1998; 194: 449-453.

14. Giordano G, Lombardi M, Brigati F, Mancini C, Silini EM. Clinicopathologic features of 2 new cases of uterine tumors resembling ovarian sex cord tumors. Int J Gynecol Pathol 2010; 29: 459-467.

15. Hillard JB, Malpica A, Ramirez PT. Conservative management of a uterine tumor resembling an ovarian sex cord-stromal tumor. Gynecol Oncol 2004; 92: 347-352.

16. Irving JA, Carinelli S, Prat J. Uterine tumors resembling ovarian sex cord tumors are polyphenotypic neoplasms with true sex cord differentiation. Modern Pathol 2006; 19: 17-24.

17. Oliva E, Clement PB, Young RH. Endometrial stromal tumors: an update on a group of tumors with a protean phenotype. Adv Anat Pathol 2000; 7: 257-281.

18. Oliva E, Young RH, Amin MB, Clement PB. An immunohistochemical analysis of endometrial stromal and smooth muscle tumors of the uterus: a study of 54 cases emphasizing the importance of using a panel because of overlap in immunoreactivity for individual antibodies. Am J Surg Pathol 2002; 26: 403-412.

19. Zamecnik M, Staník M. Uterine tumor resembling ovarian sex cord tumor (UTROSCT). Report of case suggesting neoplastic origin of intratumoral myoid cells. Cesk Patol 2006; 42: 145-149.

20. Zamecnik M, Stanik M, Michal M. Smooth muscle/myoid differentiation in uterine tumour resembling ovarian sex-cord tumour (UTROSCT). Histopathology 2009; 55: 619-628.

21. Sutak J, Lazic D, Cullimore JE. Uterine tumour resembling an ovarian sex cord tumour. J Clin Pathol 2005; 58: 888-890.

22. Hurrell DP, McCluggage WG. Uterine tumour resembling ovarian sex cord tumour is an immunohistochemically polyphenotypic neoplasm which exhibits coexpression of epithelial, myoid and sex cord markers. J Clin Pathol 2007; 60: 1148-1154.

23. Staats PN, Garcia JJ, Dias-Santagata DC, et al. Uterine tumors resembling ovarian sex cord tumors (UTROSCT) lack the JAZF1-JJAZ1 translocation frequently seen in endometrial stromal tumors. Am J Surg Pathol 2009; 33: 1206-1212.

24. de Leval L, Lim GS, Waltregny D, Oliva E. Diverse phenotypic profile of uterine tumors resembling ovarian sex cord tumors: an immunohistochemical study of 12 cases. Am J Surg Pathol 2010; 34: 1749-1761.

25. Gupta M, de Leval L, Selig M, Oliva E, Nielsen GP. Uterine tumors resembling ovarian sex cord tumors: an ultrastructural analysis of 13 cases. Ultrastruct Pathol 2010; 34: 16-24.

26. Clement PB, Scully RE. Uterine tumors resembling ovarian sex-cord tumors. A clinicopathologic analysis of fourteen cases. Am J Clin Pathol 1976; 66: 512-525.

27. Fekete PS, Vllios F, Patterson BD. Uterine tumor resembling an ovarian sex-cord tumor: report of a case of an endometrial stromal tumor with foam cells and ultrastructural evidence of epithelial differentiation. Int J Gynecol Pathol 1985; 4: 378-387.

28. McCluggage WG, Burton J, Maxwell P, Sloan JM. Immunohistochemical staining of normal, hyperplastic, and neoplastic adrenal cortex with a monoclonal antibody against alpha inhibin. J Clin Pathol 1998; 51: 114-116.

29. Pusiol T, Parolari AM, Pisciolo F. Uterine leiomyoma with tubules. Int Semin Surg Oncol 2008; 5: 15. doi: 10.1186/1477-7800-5-15.

30. Murray SK, Clement PB, Young RH. Endometrioid carcinomas of the uterine corpus with sex cord-like formations, hyalinization, and other unusual morphologic features: a report of 31 cases of a neoplasm that may be confused with carcinosarcoma and other uterine neoplasms. Am J Surg Pathol 2005; 29: 157-166.

31. Simon RA, Sung CJ, Lawrence WD, Quddus MR. Vascular plexiform leiomyoma mimicking uterine tumor resembling ovarian sex cord tumor. Ann Diagn Pathol 2010; 14: 355-357.

32. Czernobilsky B, Mamet Y, David MB, Atlas I, Gitstein G, Lifschitz-Mercer B. Uterine retiform sertoli-leydig cell tumor: report of a case providing additional evidence that uterine tumors resembling ovarian sex cord tumors have a histologic and immunohistochemical phenotype of genuine sex cord tumors. Int J Gynecol Pathol 2005; 24: 335-340.

33. Garuti G, Gonfiantini C, Mirra M, Galli C, Luerti M. Uterine tumor resembling ovarian sex cord tumors treated by resectoscopic surgery. J Minim Invasive Gynecol 2009; 16: 236-240.