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Pulmonary metastatic nodules of uterine low‐grade endometrial stromal sarcoma: histopathological and immunohistochemical analysis of 10 cases
Author(s) -
Park Ji Young,
Sung Chang Ohk,
Jang SeJin,
Song Sang Yong,
Han Jung Ho,
Kim KyuRae
Publication year - 2013
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.12232
Subject(s) - pathology , immunohistochemistry , medicine , stromal cell , lung , biopsy , lymphatic system , sarcoma
Aims To identify histopathological and immunohistochemical findings that aid diagnosis of metastatic endometrial stromal sarcoma ( ESS ) in small biopsy specimens of the lung. Methods and results We reviewed the histology of 46 lung nodules from 10 cases of pulmonary metastatic ESS . Biopsy sections were analysed by immunohistochemistry to highlight blood and lymphatic vasculature, and for expression of CD 10 and oestrogen receptor ( ER ). Various histological changes were identified that could mislead in making a diagnosis on small biopsy samples: haemangiopericytomatous blood vessels (39%), absence of characteristic spiral arteriole‐like vasculature (26%), intratumoral cysts formed by dilatation of airways (22%) or intratumoral myxoid change (11%), prominent interstitial collagen deposits (48%), foam cell infiltration (4%) and smooth muscle differentiation (2%). Peribronchial/peribronchiolar distribution of tumour cells with juxtaepithelial growth was a frequent feature, observed in 59% of nodules. In two very small nodules the lesion was barely recognizable histologically; tumour cells were detected only by expression of ER and CD 10. Conclusions Combined staining for ER and CD 10 can be helpful in avoiding an erroneous diagnosis. As lymphatics are not normally present in the juxtaepithelial bronchial/bronchiolar wall, juxtaepithelial tumour growth beneath the bronchial epithelium in early metastatic lesions indicates a haematogenous metastastic route through the bronchial artery.