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High-grade Endometrial Carcinoma With Serous and Colorectal Carcinoma-like Components: Unique Morphology in Correlation With Immunohistochemical and Molecular Findings. 具有浆液性和结肠直肠癌样成分的高级别子宫内膜癌:独特的形态与免疫组化和分子研究结果的相关性。
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-12 DOI: 10.1097/PGP.0000000000001067
Marie C Smithgall, Anna Yemelyanova, James Solomon, Eloise Chapman-Davis, Nina Schatz-Siemers

Endometrial carcinoma with intestinal differentiation/colorectal carcinoma-like (CRC-like) features is rare with few cases reported to date. Those described are mainly endometrioid carcinomas with intestinal differentiation. We report a case of high-grade endometrial carcinoma with serous and intestinal/CRC-like components. The gross, histologic, immunohistochemical, and molecular features are described for both components of the tumor in the initial diagnostic biopsy and subsequent resection specimen. The diagnosis of primary endometrial carcinoma with serous and CRC-like components is supported by immunohistochemical and molecular findings, as well as clinical workup. The rarity of this phenomenon poses diagnostic challenges. In addition, the literature is reviewed with specific emphasis on the molecular and pathologic features of mixed endometrial carcinomas, including those with intestinal/CRC-like features.

具有肠道分化/结直肠癌样(CRC-like)特征的子宫内膜癌非常罕见,迄今鲜有报道。所描述的主要是具有肠道分化的子宫内膜样癌。我们报告了一例具有浆液性和肠/CRC样成分的高级别子宫内膜癌。我们描述了最初诊断活检和随后切除标本中两种肿瘤成分的大体、组织学、免疫组化和分子特征。原发性子宫内膜癌伴有浆液性和 CRC 样成分的诊断得到了免疫组化和分子研究结果以及临床检查的支持。这种现象的罕见性为诊断带来了挑战。此外,本文还回顾了相关文献,特别强调了混合型子宫内膜癌(包括具有肠/CRC样特征的子宫内膜癌)的分子和病理特征。
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引用次数: 0
β-catenin, PAX2, and PTEN Aberrancy Across the Spectrum of Endometrioid Ovarian Lesions. 子宫内膜样卵巢病变范围内的β-catenin、PAX2 和 PTEN 畸变
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-31 DOI: 10.1097/PGP.0000000000001046
Maria M Del Mundo, Mitzi Aguilar, Hao Chen, Shuang Niu, Subhransu S Sahoo, Sambit Roy, Wenxin Zheng, Elena Lucas, Diego H Castrillon

Endometriosis is a common condition, with the ovary being the most common anatomic site. Endometriosis-particularly in the ovary-is associated with a risk of malignant progression, with a histologic spectrum of lesions from benign to malignant. Recently, a panel of 3 markers consisting of β-catenin, PAX2, and PTEN has been described as a potentially useful diagnostic adjunct in the diagnosis of intrauterine endometrioid neoplasia, where aberrancy for one or more of the markers is strongly associated with neoplasia. Here, we applied the panel to ovarian endometrioid lesions, including endometriosis, endometriosis with flat cytologic atypia, endometrioid borderline tumors, and endometrioid adenocarcinoma (n=85 cases in total). The incidence of aberrancy for the 3 markers increased along this putative neoplastic spectrum, arguing for a role of each of the markers in the neoplastic transformation of ovarian endometriosis. Just 1/32 (3%) of cases of nonatypical endometriosis was marker-aberrant, and this case was aberrant only for PAX2. One of 5 cases (20%) of endometriosis with atypia was marker-aberrant (both PAX2 and PTEN), supporting prior findings that some cases of flat atypia may represent bona fide precursor lesions. Of 19 endometrioid borderline tumors, 10 (53%) were aberrant for one or more markers, with PAX2 being the most frequently aberrant. Of 29 endometrioid adenocarcinomas, 28 (96.6%) were aberrant for at least 1 marker, with PAX2 again the most frequently aberrant. Patterns of aberrancy were well-preserved in areas of nonatypical endometriosis adjacent to borderline tumor or adenocarcinoma, supporting a biological origin in a common marker-aberrant precursor. The findings show that the biomarker panel could be of some diagnostic utility in the characterization of ovarian endometrioid neoplasia, such as in the diagnosis of endometrioid borderline tumor, distinguishing endometrioid from nonendometrioid lesions, or in identifying other types of early precursors at a higher risk of malignant transformation.

子宫内膜异位症是一种常见病,卵巢是最常见的解剖部位。子宫内膜异位症(尤其是卵巢子宫内膜异位症)与恶性进展的风险有关,病变的组织学类型从良性到恶性不等。最近,由β-catenin、PAX2和PTEN组成的3个标记物面板被描述为诊断子宫内膜样肿瘤的一种潜在有用的辅助诊断方法,其中一个或多个标记物的异常与肿瘤密切相关。在此,我们将该小组应用于卵巢子宫内膜样病变,包括子宫内膜异位症、扁平细胞学不典型性子宫内膜异位症、子宫内膜样边缘瘤和子宫内膜样腺癌(共 85 例)。在这一假定的肿瘤谱系中,3 种标记物的异常发生率均有所上升,这表明每种标记物在卵巢子宫内膜异位症的肿瘤转化过程中都发挥了作用。在非典型子宫内膜异位症病例中,仅有 1/32(3%)的病例存在标记物异常,而该病例仅 PAX2 存在异常。在 5 例(20%)不典型子宫内膜异位症病例中,有 1 例(20%)存在标记物异常(PAX2 和 PTEN),这支持了之前的研究结果,即一些扁平不典型病例可能是真正的前驱病变。在 19 例子宫内膜样边缘性肿瘤中,10 例(53%)存在一种或多种标记物异常,其中 PAX2 最常出现异常。在 29 个子宫内膜样腺癌中,28 个(96.6%)至少有一个标记物异常,其中 PAX2 又是最常见的异常标记物。与边缘瘤或腺癌相邻的非典型子宫内膜异位症区域保留了良好的异常模式,支持生物起源于共同的标记物异常前体。研究结果表明,该生物标记物面板可用于卵巢子宫内膜样肿瘤的特征诊断,如诊断子宫内膜样边缘瘤、区分子宫内膜样与非子宫内膜样病变,或识别恶性转化风险较高的其他类型早期前体。
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引用次数: 0
HER2 Status in Low-grade Serous Ovarian Tumors. 低级别浆液性卵巢肿瘤的 HER2 状态
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-30 DOI: 10.1097/PGP.0000000000001059
Kristýna Němejcová, Adam Šafanda, Michaela Kendall Bártů, Nikola Hájková, Jana Drozenová, Pavel Fabian, Jan Laco, Radoslav Matěj, Gábor Méhes, Petr Škapa, Ivana Stružinská, Pavel Dundr

Using immunohistochemistry, we examined a large cohort of 135 ovarian tumors, made up of 96 low-grade serous carcinomas (LGSCs) and 39 serous borderline tumors (micropapillary variant, mSBT), with the aim of exploring their HER2 status (overexpression). We followed with comprehensive genomic analyses on this sample set from our previous study, which revealed HER2 mutation in 5% (4/75) of LGSC and 10% (3/29) of mSBT. No cases were evaluated as HER2-positive, but 6 LGSCs and 1 mSBT were scored as HER2 1+, and 2 LGSCs and 1 mSBT showed the so-called HER2 "ultra-low" phenotype. This could be of clinical value as a potential therapeutical target concerning emerging therapeutic treatments (antibody conjugates). However, the clinical significance of this expression still needs to be established.

我们使用免疫组化方法检查了一大批 135 例卵巢肿瘤,其中包括 96 例低级别浆液性癌(LGSCs)和 39 例浆液性边界肿瘤(微乳头状变异,mSBT),目的是探索它们的 HER2 状态(过表达)。我们随后对之前研究中的这组样本进行了全面的基因组分析,结果发现5%的LGSC(4/75)和10%的mSBT(3/29)存在HER2突变。没有病例被评估为HER2阳性,但有6例LGSCs和1例mSBT被评为HER2 1+,2例LGSCs和1例mSBT显示出所谓的HER2 "超低 "表型。这可能具有临床价值,因为它是新出现的治疗方法(抗体共轭物)的潜在治疗靶点。然而,这种表达的临床意义仍有待确定。
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引用次数: 0
Metastatic Leiomyoma With Malignant Transformation Harboring RAB2A-PLAG1 Fusion-A Case Report and Review With Molecular Analysis. 携带 RAB2A-PLAG1 融合基因的恶性转化转移性子宫肌瘤--病例报告和分子分析综述
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-29 DOI: 10.1097/PGP.0000000000001058
Hiu Yeung Lau, Mingjie Huang, Kenneth Tou En Chang, Chik Hong Kuick, Angela Takano

Metastasizing leiomyoma is a rare condition characterized by the development of benign-appearing smooth muscle neoplasms at extrauterine sites in patients with a history of uterine leiomyoma. These lesions occur most commonly in the lung, with the abdominopelvic and mediastinal lymph nodes being other reported sites. Malignant transformation of metastasizing leiomyoma is extremely rare, with only a few cases described in the literature. We describe a case of metastasizing leiomyoma with malignant transformation in a middle-aged Asian lady, who developed pulmonary metastatic foci 12 years after surgical excision of the original uterine leiomyomata. Molecular analysis showed a common RAB2A-PLAG1 fusion gene and identical single nucleotide variants in both tumor foci, with significantly more pronounced segmental chromosomal copy number variations in one focus showing high-grade features. A comprehensive review of the literature lends support to the hypothesis that the original leiomyomata and the metastatic foci are clonally related, with high-grade features being associated with more complex genomic signatures.

转移性子宫平滑肌瘤是一种罕见的疾病,其特点是有子宫平滑肌瘤病史的患者在子宫外部位发生外观为良性的平滑肌瘤。这些病变最常发生在肺部,腹盆腔淋巴结和纵隔淋巴结也是其他报道的部位。转移性子宫肌瘤的恶性转化极为罕见,文献中仅有几例描述。我们描述了一例转移性子宫纵膈肌瘤恶变病例,患者是一名中年亚洲女性,在手术切除原发子宫纵膈肌瘤 12 年后出现肺转移灶。分子分析显示,两个肿瘤病灶中均存在一个共同的 RAB2A-PLAG1 融合基因和相同的单核苷酸变异,其中一个病灶的染色体拷贝数片段变异更为明显,显示出高级别特征。对文献的全面回顾支持了这样的假设,即原始的白肌瘤和转移灶是克隆相关的,高级别特征与更复杂的基因组特征有关。
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引用次数: 0
Association of Local and Distant Organ Metastases With MELF Pattern in Endometrial Cancer. 子宫内膜癌的局部和远处器官转移与 MELF 模式的关系
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-29 DOI: 10.1097/PGP.0000000000001056
Varol Gülseren, Ertuğrul Şen, Mehmet Dolanbay, Fulya Çağli, Nahit Topaloğlu, Figen Öztürk, Bülent Özçelik, Serdar Serin, Kemal Güngördük

Several types of myometrial invasion in endometrioid-type endometrial adenocarcinoma (EEC) have been identified: adenomyosis-like changes; adenoma malignum; broad front, single-cell/cell clusters; and the microcystic elongated and fragmented (MELF) pattern. This study aims to investigate the effect of the MELF pattern on recurrence type and survival rate among patients with EEC. We retrospectively reviewed the records of patients diagnosed with EEC over a 10-year period from January 2011 to January 2021. Among 108 patients with EEC, 54 had recurrence (study group), and 54 did not (control group). The MELF pattern was more common in the group with recurrence than in the group without recurrence (40.7% vs. 14.8%; P=0.002). The MELF pattern was observed in 60.0% of patients with local recurrence and 29.4% of patients with extrapelvic or distant organ metastases (P=0.027). Evaluation of 5-year disease-free survival (P=0.003) and overall survival (P=0.001) rates showed that MELF positivity was associated with decreased survival. Among patients with grade I-II EEC lacking uterine-localized myometrial invasion, the MELF pattern was less common in the nonrelapsed group than in the local relapse group (10.0% vs. 60.0%; P<0.001). The MELF pattern (odds ratio=19.4, 95% CI=1.2-31.2) was a significant independent negative predictor for local recurrence. The MELF pattern was more common in patients with recurrence, especially local recurrence. This finding suggests that the MELF pattern primarily impacts direct local invasion rather than hematogenous or lymphatic spread.

子宫内膜样型子宫内膜腺癌(EEC)的子宫肌层侵袭有几种类型:子宫腺肌病样变;恶性腺瘤;宽阵线、单细胞/细胞簇;以及微囊拉长和破碎(MELF)模式。本研究旨在探讨 MELF 模式对 EEC 患者复发类型和存活率的影响。我们回顾性地查阅了从2011年1月至2021年1月这10年间确诊的EEC患者的病历。在108例EEC患者中,54例复发(研究组),54例未复发(对照组)。在复发组中,MELF模式比未复发组更常见(40.7% 对 14.8%;P=0.002)。60.0%的局部复发患者和29.4%的盆腔外或远处器官转移患者出现MELF模式(P=0.027)。对5年无病生存率(P=0.003)和总生存率(P=0.001)的评估显示,MELF阳性与生存率下降有关。在子宫肌层未受侵袭的 I-II 级 EEC 患者中,未复发组的 MELF 阳性率低于局部复发组(10.0% 对 60.0%;P=0.027)。
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引用次数: 0
Prognostic Significance of "High" Tumor Budding and "High" Poorly Differentiated Clusters in Endometrial Carcinomas: Independent Predictors of Lymphovascular Space Invasion and Lymph Node Metastasis. 子宫内膜癌中 "高 "肿瘤萌发和 "高 "分化差簇的预后意义:淋巴管间隙侵犯和淋巴结转移的独立预测因子
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-29 DOI: 10.1097/PGP.0000000000001061
Elina James, Gayatri Ravikumar, John Michael Raj A, Kiran Kulkarni

Tumor budding (TB) and poorly differentiated clusters (PDCs) are well-established prognostic factors in various cancers. This study aimed to assess the independent prognostic role of these markers in endometrial carcinomas. Retrospective analysis of endometrial carcinoma resection specimens by examining traditional histologic prognostic parameters. TB and PDC were observed at 20× magnification in ten fields at the invasive front and categorized as present or absent. In addition, a count of ≥5 was stratified as "high." Clinical and follow-up details were extracted from Gynecologic Oncology records. Sixty-five endometrial carcinomas were studied and were predominantly endometrioid (n=47, 72.3%). TB was identified in 52.3% of cases, with high TB observed in 38.5%. PDC was evident in 44.6%, with high PDC seen in 29.2%. Associations were significant between the presence of TB/high TB and higher tumor grade (P < 0.001), deep myometrial invasion (P = 0.006/P = 0.002), diffuse pattern of invasion (P = 0.007/P = 0.03), microcystic elongated and fragmented pattern (P < 0.001), lymphovascular space invasion, lymph node metastasis (P=<0.001) and International Federation of Gynecology and Obstetrics stage (P = 0.000/P = 0.002). PDC/high PDC showed similar associations, and, in addition, with nonendometrioid histologic type (P = 0.02) and tumor location in a lower uterine segment (high PDC, P = 0.009). After adjusting for other significant parameters, both high TB (P = 0.03) and high PDC (P = 0.031) emerged as independent prognostic parameters for lymphovascular space invasion or Lymph node metastasis. No recorded deaths or significant events occurred, precluding commentary on overall survival status. High TB and PDC are independent predictors of Lymph node metastasis in endometrial carcinomas. Their association with the microcystic elongated and fragmented pattern makes them histologic predictors of epithelial-mesenchymal transition. Their simple application underscores their potential as valuable additional prognostic indicators for endometrial carcinomas.

肿瘤萌芽(TB)和分化不良簇(PDC)是各种癌症中公认的预后因素。本研究旨在评估这些标志物在子宫内膜癌中的独立预后作用。通过检查传统的组织学预后参数,对子宫内膜癌切除标本进行回顾性分析。以 20 倍放大率在十个视野中观察浸润前沿的 TB 和 PDC,并将其分为存在或不存在。此外,计数≥5分为 "高"。从妇科肿瘤学记录中提取临床和随访细节。共研究了 65 例子宫内膜癌,以子宫内膜样癌为主(47 例,72.3%)。52.3%的病例发现了结核,38.5%的病例发现了高结核。44.6%的病例存在明显的 PDC,其中 29.2% 的病例存在高 PDC。TB/高TB的存在与较高的肿瘤分级(P < 0.001)、子宫肌层深部浸润(P = 0.006/P = 0.002)、弥漫性浸润模式(P = 0.007/P = 0.03)、微囊拉长和碎裂模式(P < 0.001)、淋巴管间隙浸润、淋巴结转移(P = 0.006/P = 0.002)之间存在明显的相关性。
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引用次数: 0
How Can "No Specific Molecular Profile" Heterogeneity be Reduced in Molecularly Classified Endometrial Cancer?: Prognostic Significance of L1 Cell Adhesion Molecule. 如何降低分子分类子宫内膜癌的 "无特异性分子特征 "异质性?L1细胞粘附分子的预后意义。
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-29 DOI: 10.1097/PGP.0000000000001057
Cem Yagmur Ozdemir, Dagistan Tolga Arioz, Mine Kanat Pektaş, Cigdem Ozdemir, Nayif Cicekli, Filiz Bilir, Riza Dur, Ecenur Goztepe

This study aims to investigate the role of L1 cell adhesion molecule (L1CAM) in the prognostic assessment of endometrial cancers that have been depicted as having no specific molecular profile (NSMP) in molecular classification. This is a retrospective review of 150 patients who received the diagnosis of endometrial cancer and underwent surgery at the study center between January 2008 and January 2022. When evaluating L1CAM immunohistochemical staining, scoring was done according to the percentage of positivity in tumor cells. Accordingly, score 0 = 0%, score 1=1% to 10%, score 2 = >10% to 50% and score 3 = >50%. If the staining in tumor cells was ≥10% (scores 2 and 3), it was considered positive. The patients with L1CAM positivity had significantly more frequent lymphovascular space invasion and lymph node metastasis than patients with L1CAM negativity (P = 0.013 and P = 0.007). L1CAM expression was strongly associated with mutant p53 (P = 0.003). Recurrence was significantly higher (P = 0.001) and overall survival and progression-free survival were significantly lower in patients with L1CAM positivity (P = 0.001 for both). Seventy-nine patients (52.7%) were put into NSMP group. About 84.8% of them (n = 67) were L1CAM negative and 15.2% of them (n = 12) were L1CAM-positive. Recurrence was significantly higher (P = 0.001) and overall survival and progression-free survival were significantly lower in patients with NSMP who were positive for L1CAM (P = 0.002 and P = 0.001, respectively). This study demonstrates that L1CAM expression status may add prognostic information to endometrial cancer, particularly in the NSMP subgroup. Considering the prognostic importance of L1CAM, its use as a marker may make significant contributions to reducing prognostic heterogeneity, especially in the NSMP subgroup.

本研究旨在探讨 L1 细胞粘附分子(L1CAM)在分子分类中被描述为无特异性分子特征(NSMP)的子宫内膜癌预后评估中的作用。这是一项回顾性研究,研究对象是2008年1月至2022年1月期间在研究中心确诊为子宫内膜癌并接受手术的150名患者。在评估 L1CAM 免疫组化染色时,根据肿瘤细胞的阳性率进行评分。因此,0分=0%,1分=1%至10%,2分=>10%至50%,3分=>50%。如果肿瘤细胞中的染色≥10%(2分和3分),则被视为阳性。与 L1CAM 阴性患者相比,L1CAM 阳性患者淋巴管间隙侵犯和淋巴结转移的频率明显更高(P = 0.013 和 P = 0.007)。L1CAM的表达与突变p53密切相关(P = 0.003)。L1CAM阳性患者的复发率明显较高(P = 0.001),总生存期和无进展生存期明显较低(P = 0.001)。79名患者(52.7%)被归入NSMP组。其中约84.8%(n = 67)为L1CAM阴性,15.2%(n = 12)为L1CAM阳性。L1CAM阳性的NSMP患者复发率明显更高(P = 0.001),总生存期和无进展生存期明显更低(分别为P = 0.002和P = 0.001)。这项研究表明,L1CAM表达状态可能会增加子宫内膜癌的预后信息,尤其是在NSMP亚组中。考虑到L1CAM在预后方面的重要性,将其作为一种标记物可能会大大有助于减少预后异质性,尤其是在NSMP亚组中。
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引用次数: 0
Whole-exome Sequence Analysis of Gastric-type Adenocarcinoma of the Uterine Cervix and Adjacent Lobular Endocervical Glandular Hyperplasia in the Same Case. 全外显子组序列分析同一病例中的胃型宫颈腺癌和邻近的叶状宫颈内腺体增生症
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-29 DOI: 10.1097/PGP.0000000000001052
Tsutomu Miyamoto, Koichi Ida, Yasuhiro Tanaka, Shiho Asaka, Tanri Shiozawa

Lobular endocervical glandular hyperplasia (LEGH) may be a precursor lesion of gastric-type adenocarcinoma of the uterine cervix (GAS). However, the genetic mechanisms underlying its carcinogenesis remain unclear. To elucidate the oncogenic process from LEGH to GAS, we compared gene mutations in early-stage GAS and adjacent LEGH in the same case. Fresh-frozen tissue sections were obtained from a patient with Stage IB3 GAS and adjacent LEGH who had undergone hysterectomy. Using laser microdissection, we harvested the LEGH and GAS portions separately from these sections and extracted the genomic DNA. Somatic variant analysis using whole-exome sequencing used DNA from the normal myometrium as a reference sequence. Somatic variants involving amino acid substitutions were detected in 61 and 125 locations in LEGH and GAS, respectively. Seven variants were common in both lesions, of which the pathogenic variant was GNAS only (c.2531G>A, p.R844H), a mutation frequently reported in pancreatic and colorectal cancers. LEGH had no other pathogenic variants; another pathogenic variant in GAS was found only at the same amino acid site as GNAS (c.2530C>T, p.R844C). In the present case, LEGH and GAS shared the same pathogenic variant of GNAS, indicating that both lesions had a common origin. Furthermore, the current results showed that the second GNAS variant is associated with the progression of LEGH to GAS. Further studies are required to elucidate GAS's pathogenesis and biological characteristics.

叶状宫颈内膜腺体增生(LEGH)可能是子宫颈胃型腺癌(GAS)的前驱病变。然而,其致癌的遗传机制仍不清楚。为了阐明从 LEGH 到 GAS 的致癌过程,我们比较了同一病例中早期 GAS 和邻近 LEGH 的基因突变情况。我们从一名接受子宫切除术的 IB3 期 GAS 和邻近 LEGH 患者身上获取了新鲜冷冻的组织切片。我们使用激光显微切割技术,从这些切片中分别提取了LEGH和GAS部分,并提取了基因组DNA。以正常子宫肌层的DNA为参考序列,利用全外显子测序技术进行体细胞变异分析。在LEGH和GAS中分别有61个和125个位置检测到涉及氨基酸置换的体细胞变异。两种病变中常见的变异有7个,其中致病变异只有GNAS(c.2531G>A,p.R844H),这是一种在胰腺癌和结直肠癌中经常报道的变异。LEGH没有其他致病变体;GAS的另一个致病变体仅在与GNAS相同的氨基酸位点上发现(c.2530C>T,p.R844C)。在本病例中,LEGH 和 GAS 具有相同的 GNAS 致病变体,表明这两种病变具有共同的起源。此外,目前的研究结果表明,第二个GNAS变体与LEGH发展为GAS有关。要阐明GAS的发病机制和生物学特征,还需要进一步的研究。
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引用次数: 0
Confusing Histopathological Features and HPV Testing Results in Vulvar Squamous Cell Carcinoma Arising in a Young Woman: A Case Solved Using Next-Generation Sequencing 一名年轻女性外阴鳞状细胞癌的组织病理学特征和 HPV 检测结果令人困惑:利用新一代测序技术解决的一个病例
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-24 DOI: 10.1097/pgp.0000000000001047
Lia Sisuashvili, A. Saco, Núria Carreras-Dieguez, Cristina Celada, L. Marimón, Carla Montironi, Jaume Ordi, N. Rakislova
Vulvar squamous cell carcinoma (VSCC) can be classified according to human papillomavirus (HPV) status as HPV-associated (HPV-A) and HPV-independent (HPV-I). However, a small subset of tumors may show overlapping features and become a serious diagnostic challenge for pathologists. We report an unusual case of VSCC arising in a 21-year-old patient with type 1 diabetes mellitus. The tumor had keratinizing histologic features, was associated with a premalignant lesion with features of a high-grade squamous intraepithelial lesion (HSIL), and showed consistent p53 immunohistochemical (IHC) overexpression, but variable results in the HPV testing and p16 IHC staining. Molecular analysis revealed mutation of TP53 and overexpression of cell cycle-regulating genes (including CCND1) and collagen-coding genes (such as COL6A1). These molecular findings in genes, previously reported as upregulated in HPV-I VSCC, supported an etiological origin independent of HPV for the tumor. In conclusion, molecular analysis may help to correctly classify challenging VSCC, showing puzzling clinical, morphologic, and IHC characteristics.
外阴鳞状细胞癌(VSCC)可根据人乳头状瘤病毒(HPV)状态分为HPV相关型(HPV-A)和HPV无关型(HPV-I)。然而,一小部分肿瘤可能会表现出重叠的特征,这对病理学家来说是一个严峻的诊断挑战。我们报告了一例不寻常的 VSCC 病例,患者 21 岁,患有 1 型糖尿病。该肿瘤具有角化组织学特征,与具有高级别鳞状上皮内病变(HSIL)特征的恶性前病变相关联,并显示出一致的p53免疫组化(IHC)过表达,但HPV检测和p16 IHC染色结果不一。分子分析显示 TP53 发生了突变,细胞周期调节基因(包括 CCND1)和胶原编码基因(如 COL6A1)过度表达。以前曾有报道称,这些基因在 HPV-I VSCC 中上调,这些分子研究结果支持该肿瘤的病因与 HPV 无关。总之,分子分析有助于对临床、形态和 IHC 特征令人费解的 VSCC 进行正确分类。
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引用次数: 0
Leiomyosarcomas of the Visceral Adnexal and Uterine Ligaments and Adnexal Connective Tissue: Immunohistochemical, Molecular Genetic, and MDM2 Fluorescence In Situ Hybridization Analysis. 内脏附件和子宫韧带及附件结缔组织的子宫肌瘤:免疫组化、分子遗传和 MDM2 荧光原位杂交分析。
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-23 DOI: 10.1097/PGP.0000000000001064
Nooshin K Dashti, Amy A Swanson, Vatsal Patel, Deyin Xing, Michael Feely, Gary L Keeney, Sounak Gupta, J Kenneth Schoolmeester
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引用次数: 0
期刊
International Journal of Gynecological Pathology
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