Are Immunoprofile and JAZF1 Genetic Rearrangement of Low-Grade Endometrial Stromal Sarcomas Potential Markers of Aggressive Behaviour?
Kiran Jakate, Rola Ali, Cheng-Hen Lee, Blaise Clarke, Golnar Rasty, Patricia Shaw, Marjan Rouzbahman. University Health Network, Toronto, Canada; University of Toronto, ON, Canada; Vancouver General Hospital, BC, Canada
Background: Endometrial stromal tumors are uncommon mesenchymal tumors of the uterus. Apart from stage, prognostic factors for endometrial stromal sarcomas (ESS) are not well established. The relationship of tumor genotype (JAZF1-rearrangment) and immunoprofile to clincopathologic parameters is unclear. We compared morphological, immunhohistochemical and genetic profiles of stage 1 versus higher stage low-grade endometrial stromal sarcomas (LG-ESS).
Design: 23 consecutive LG-ESS cases from 23 patients with material available for study were retrieved from pathology files (1990- 2010). A tissue microarray (TMA) paraffin block of duplicate 0.6mm cores was prepared. Immunohistochemistry (IHC) for p53, estrogen receptor (ER), progesterone receptor (PR) and CD10 were done according to standard techniques and assigned an Allred score wherein a score >= 3 was considered positive. For Ki67 a percentage of >10% was considered as positive. All H&E stained slides and IHC stained sections of TMA were reviewed and scored by two pathologists. FISH analysis for the JAZF1 rearrangement was performed. For IHC variables and JAZF1 rearrangement, Fisher's exact test and for mitosis, Wilcoxon's rank-sum test was used to compare stage 1 versus higher stage ESS.
Results: The average age was 48.4 years and all patients were alive at the time of study except one. Follow-up was available in all but one case. Cases included 13 stage I, 3 stage II, 2 stage III, 1 stage IV, 2 primary ovary, 1 extra uterine pelvic mass. More frequent p53 positivity and more frequent JAZF1 rearrangement were seen in higher stage LG-ESS compared to stage 1 diseases. Other parameters showed very similar results in stage 1 versus higher stage disease (Table). None of parameters showed difference when group of patients without recurrence was compared to the patients who had disease recurrence, regardless of stage.
|p53||ER||PR||CD10||KI67||JazF1||Mean mitoses/10 hpf (STD)|
|Stage 1||31%||85%||85%||92%||15%||23%||5.06 (6.25)|
|Higher Stage||83%||100%||100%||100%||0%||66%||5.13 (7.56)|