Uterine mesenchymal tumours: recent advances
Amir Momeni-Boroujeni
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Search for more papers by this authorCorresponding Author
Sarah Chiang
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Address for correspondence: S Chiang, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10044, USA. e-mail [email protected]
Search for more papers by this authorAmir Momeni-Boroujeni
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Search for more papers by this authorCorresponding Author
Sarah Chiang
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Address for correspondence: S Chiang, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10044, USA. e-mail [email protected]
Search for more papers by this authorAbstract
Almost all uterine mesenchymal tumours have been historically classified as either smooth muscle or endometrial stromal neoplasms. Recent application of molecular techniques has identified numerous lesions with distinctive genetic abnormalities and clinicopathological characteristics. Newly discovered uterine sarcoma subtypes include high-grade endometrial stromal sarcomas with BCOR genetic abnormalities, fibrosarcoma-like uterine sarcomas with NTRK rearrangements and COL1A–PDGFRB fusions, as well as undifferentiated uterine sarcomas with SMARCA4 mutations. Novel PLAG1 and PGR fusions have been identified in subsets of myxoid and epithelioid leiomyosarcomas. Some uterine tumours resembling ovarian sex-cord tumour harbour GREB1 and ESR1 rearrangements. Histological and immunophenotypical features as well as underlying genetic abnormalities defining these lesions are discussed.
Conflict of interest
The authors have no conflicts of interest to disclose.
References
- 1Fan Z, Yamaza T, Lee JS et al. BCOR regulates mesenchymal stem cell function by epigenetic mechanisms. Nat. Cell Biol. 2009; 11; 1002–1009.
- 2Lewis N, Soslow RA, Delair DF et al. ZC3H7B–BCOR high-grade endometrial stromal sarcomas: a report of 17 cases of a newly defined entity. Mod. Pathol. 2018; 31; 674–684.
- 3Hoang LN, Aneja A, Conlon N et al. Novel high-grade endometrial stromal sarcoma: a morphologic mimicker of myxoid leiomyosarcoma. Am. J. Surg. Pathol. 2017; 41; 12–24.
- 4Marino-Enriquez A, Lauria A, Przybyl J et al. BCOR internal tandem duplication in high-grade uterine sarcomas. Am. J. Surg. Pathol. 2018; 42; 335–341.
- 5Chiang S, Lee CH, Stewart CJR et al. BCOR is a robust diagnostic immunohistochemical marker of genetically diverse high-grade endometrial stromal sarcoma, including tumors exhibiting variant morphology. Mod. Pathol. 2017; 30; 1251–1261.
- 6Juckett LT, Lin DI, Madison R et al. A pan-cancer landscape analysis reveals a subset of endometrial stromal and pediatric tumors defined by internal tandem duplications of BCOR. Oncology 2019; 96; 101–109.
- 7Lee CH, Ali RH, Rouzbahman M et al. Cyclin D1 as a diagnostic immunomarker for endometrial stromal sarcoma with YWHAE–FAM22 rearrangement. Am. J. Surg. Pathol. 2012; 36; 1562–1570.
- 8Shah VI, McCluggage WG. Cyclin D1 does not distinguish YWHAE–NUTM2 high-grade endometrial stromal sarcoma from undifferentiated endometrial carcinoma. Am. J. Surg. Pathol. 2015; 39; 722–724.
- 9Parra-Herran C, Quick CM, Howitt BE et al. Inflammatory myofibroblastic tumor of the uterus: clinical and pathologic review of 10 cases including a subset with aggressive clinical course. Am. J. Surg. Pathol. 2015; 39; 157–168.
- 10Lee CH, Marino-Enriquez A, Ou W et al. The clinicopathologic features of YWHAE–FAM22 endometrial stromal sarcomas: a histologically high-grade and clinically aggressive tumor. Am. J. Surg. Pathol. 2012; 36; 641–653.
- 11Lee CH, Ou WB, Marino-Enriquez A et al. 14-3-3 fusion oncogenes in high-grade endometrial stromal sarcoma. Proc. Natl Acad. Sci. USA 2012; 109; 929–934.
- 12Croce S, Hostein I, Ribeiro A et al. YWHAE rearrangement identified by FISH and RT-PCR in endometrial stromal sarcomas: genetic and pathological correlations. Mod. Pathol. 2013; 26; 1390–1400.
- 13Pinto A, Howitt B. Uterine adenosarcoma. Arch. Pathol. Lab. Med. 2016; 140; 286–290.
- 14Cotzia P, Benayed R, Mullaney K et al. Undifferentiated uterine sarcomas represent under-recognized high-grade endometrial stromal sarcomas. Am. J. Surg. Pathol. 2019; 43; 662–669.
- 15Dos Santos LA, Garg K, Diaz JP et al. Incidence of lymph node and adnexal metastasis in endometrial stromal sarcoma. Gynecol. Oncol. 2011; 121; 319–322.
- 16Vaishnavi A, Le AT, Doebele RC. TRKing down an old oncogene in a new era of targeted therapy. Cancer Discov. 2015; 5; 25–34.
- 17Cocco E, Scaltriti M, Drilon A. NTRK fusion-positive cancers and TRK inhibitor therapy. Nat. Rev. Clin. Oncol. 2018; 15; 731–747.
- 18Kheder ES, Hong DS. Emerging targeted therapy for tumors with NTRK fusion proteins. Clin. Cancer Res. 2018; 24; 5807–5814.
- 19Papadopoulos N, Lennartsson J. The PDGF/PDGFR pathway as a drug target. Mol. Aspects Med. 2018; 62; 75–88.
- 20Hung YP, Fletcher CDM, Hornick JL. Evaluation of pan-TRK immunohistochemistry in infantile fibrosarcoma, lipofibromatosis-like neural tumour and histological mimics. Histopathology 2018; 73; 634–644.
- 21Solomon JP, Hechtman JF. Detection of NTRK fusions: merits and limitations of current diagnostic platforms. Cancer Res. 2019; 79; 3163–3168.
- 22Croce S, Hostein I, Longacre TA et al. Uterine and vaginal sarcomas resembling fibrosarcoma: a clinicopathological and molecular analysis of 13 cases showing common NTRK-rearrangements and the description of a COL1A1–PDGFB fusion novel to uterine neoplasms. Mod. Pathol. 2019; 32; 1008–1022.
- 23Solomon JP, Linkov I, Rosado A et al. NTRK fusion detection across multiple assays and 33,997 cases: diagnostic implications and pitfalls. Mod. Pathol. 2019. https://doi.org/10.1038/s41379-019-0324-7
10.1038/s41379-019-0324-7 Google Scholar
- 24Chiang S, Cotzia P, Hyman DM et al. NTRK fusions define a novel uterine sarcoma subtype with features of fibrosarcoma. Am. J. Surg. Pathol. 2018; 42; 791–798.
- 25Hechtman JF, Benayed R, Hyman DM et al. Pan-Trk immunohistochemistry is an efficient and reliable screen for the detection of NTRK fusions. Am. J. Surg. Pathol. 2017; 41; 1547–1551.
- 26O'Brien KP, Seroussi E, Dal Cin P et al. Various regions within the alpha-helical domain of the COL1A1 gene are fused to the second exon of the PDGFB gene in dermatofibrosarcomas and giant-cell fibroblastomas. Genes Chromosomes Cancer 1998; 23; 187–193.
10.1002/(SICI)1098-2264(199810)23:2<187::AID-GCC13>3.0.CO;2-L CAS PubMed Web of Science® Google Scholar
- 27Nakamura I, Kariya Y, Okada E et al. A novel chromosomal translocation associated with COL1A2–PDGFB gene fusion in dermatofibrosarcoma protuberans: PDGF expression as a new diagnostic tool. JAMA Dermatol. 2015; 151; 1330–1337.
- 28Strickland KC, Nucci MR, Esselen KM et al. Solitary fibrous tumor of the uterus presenting with lung metastases: a case report. Int. J. Gynecol. Pathol. 2016; 35; 25–29.
- 29Robinson DR, Wu YM, Kalyana-Sundaram S et al. Identification of recurrent NAB2-STAT6 gene fusions in solitary fibrous tumor by integrative sequencing. Nat. Genet. 2013; 45; 180–185.
- 30Stacchiotti S, Pantaleo MA, Negri T et al. Efficacy and biological activity of imatinib in metastatic dermatofibrosarcoma protuberans (DFSP). Clin. Cancer Res. 2016; 22; 837–846.
- 31Parra-Herran C, Howitt BE. Uterine mesenchymal tumors: update on classification, staging, and molecular features. Surg. Pathol. Clin. 2019; 12; 363–396.
- 32Binzer-Panchal A, Hardell E, Viklund B et al. Integrated molecular analysis of undifferentiated uterine sarcomas reveals clinically relevant molecular subtypes. Clin. Cancer Res. 2019; 25; 2155–2165.
- 33Kolin DL, Dong F, Baltay M et al. SMARCA4-deficient undifferentiated uterine sarcoma (malignant rhabdoid tumor of the uterus): a clinicopathologic entity distinct from undifferentiated carcinoma. Mod. Pathol. 2018; 31; 1442–1456.
- 34Lin DI, Allen JM, Hecht JL et al. SMARCA4 inactivation defines a subset of undifferentiated uterine sarcomas with rhabdoid and small cell features and germline mutation association. Mod. Pathol. 2019. https://doi.org/10.1038/s41379-019-0303-z
- 35Yoshida A, Kobayashi E, Kubo T et al. Clinicopathological and molecular characterization of SMARCA4-deficient thoracic sarcomas with comparison to potentially related entities. Mod. Pathol. 2017; 30; 797–809.
- 36Fuller CE. All things rhabdoid and SMARC: An enigmatic exploration with Dr. Louis P. Dehner. Semin. Diagn. Pathol. 2016; 33; 427–440.
- 37Lin DI, Chudnoversusky Y, Duggan B et al. Comprehensive genomic profiling reveals inactivating SMARCA4 mutations and low tumor mutational burden in small cell carcinoma of the ovary, hypercalcemic-type. Gynecol. Oncol. 2017; 147; 626–633.
- 38Schaefer IM, Agaimy A, Fletcher CD, Hornick JL. Claudin-4 expression distinguishes SWI/SNF complex-deficient undifferentiated carcinomas from sarcomas. Mod. Pathol. 2017; 30; 539–548.
- 39Karnezis AN, Hoang LN, Coatham M et al. Loss of switch/sucrose non-fermenting complex protein expression is associated with dedifferentiation in endometrial carcinomas. Mod. Pathol. 2016; 29; 302–314.
- 40Chan-Penebre E, Armstrong K, Drew A et al. Selective killing of SMARCA2- and SMARCA4-deficient small cell carcinoma of the ovary, hypercalcemic type cells by inhibition of EZH2: in vitro and in vivo preclinical models. Mol. Cancer Ther. 2017; 16; 850–860.
- 41Jelinic P, Ricca J, Van Oudenhove E et al. Immune-active microenvironment in small cell carcinoma of the ovary, hypercalcemic type: rationale for immune checkpoint blockade. J. Natl Cancer Inst. 2018; 110; 787–790.
- 42Hardell E, Josefson S, Ghaderi M et al. Validation of a mitotic index cutoff as a prognostic marker in undifferentiated uterine sarcomas. Am. J. Surg. Pathol. 2017; 41; 1231–1237.
- 43Hurrell 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.
- 44Croce S, Lesluyes T, Delespaul L et al. GREB1–CTNNB1 fusion transcript detected by RNA-sequencing in a uterine tumor resembling ovarian sex cord tumor (UTROSCT): a novel CTNNB1 rearrangement. Genes Chromosomes Cancer 2019; 58; 155–163.
- 45Dickson BC, Childs TJ, Colgan TJ et al. Uterine tumor resembling ovarian sex cord tumor: a distinct entity characterized by recurrent NCOA2/3 gene fusions. Am. J. Surg. Pathol. 2019; 43; 178–186.
- 46Lee CH, Kao YC, Lee WR et al. Clinicopathologic characterization of GREB1-rearranged uterine sarcomas with variable sex-cord differentiation. Am. J. Surg. Pathol. 2019; 43; 928–942.
- 47Cheng M, Michalski S, Kommagani R. Role for growth regulation by estrogen in breast cancer 1 (GREB1) in hormone-dependent cancers. Int. J. Mol. Sci. 2018; 19; 2543.
- 48Brunetti M, Panagopoulos I, Gorunova L et al. RNA-sequencing identifies novel GREB1–NCOA2 fusion gene in a uterine sarcoma with the chromosomal translocation t(2;8)(p25;q13). Genes Chromosomes Cancer 2018; 57; 176–181.
- 49Moore M, McCluggage WG. Uterine tumour resembling ovarian sex cord tumour: first report of a large series with follow-up. Histopathology 2017; 71; 751–759.
- 50Bean GR, Anderson J, Sangoi AR, Krings G, Garg K. DICER1 mutations are frequent in mullerian adenosarcomas and are independent of rhabdomyosarcomatous differentiation. Mod. Pathol. 2019; 32; 280–289.
- 51Piscuoglio S, Burke KA, Ng CK et al. Uterine adenosarcomas are mesenchymal neoplasms. J. Pathol. 2016; 238; 381–388.
- 52Chiang S, Samore W, Zhang L et al. PGR gene fusions identify a molecular subset of uterine epithelioid leiomyosarcoma with rhabdoid features. Am. J. Surg. Pathol. 2019; 43; 810–818.
- 53Bazer FW, Burghardt RC, Johnson GA, Spencer TE, Wu G. Interferons and progesterone for establishment and maintenance of pregnancy: interactions among novel cell signaling pathways. Reprod. Biol. 2008; 8; 179–211.
- 54Mertens F, Antonescu CR, Mitelman F. Gene fusions in soft tissue tumors: recurrent and overlapping pathogenetic themes. Genes Chromosomes Cancer 2016; 55; 291–310.
- 55Hibbard MK, Kozakewich HP, Dal Cin P et al. PLAG1 fusion oncogenes in lipoblastoma. Cancer Res. 2000; 60; 4869–4872.
- 56Arias-Stella JA III, Benayed R, Oliva E et al. Novel PLAG1 gene rearrangement distinguishes a subset of uterine myxoid leiomyosarcoma from other uterine myxoid mesenchymal tumors. Am. J. Surg. Pathol. 2019; 43; 382–388.