title: Cystic pulmonary metastases of endometrial stromal sarcoma of the uterus, mimicking lymphangiomyomatosis: a case report with immunohistochemistry of HMB45.
abstract: A case of endometrial stromal sarcoma (ESS) showed cystic pulmonary metastases mimicking lymphangiomyomatosis (LAM). A 58-year-old female, who had undergone total hysterectomy for low-grade ESS 16 years previously, had repeated bouts of pneumothorax. Multiple thin-walled cysts in the peripheral lung were revealed by radiological examinations. In an open-lung biopsy specimen, cystic lesions were surrounded by layers of spindle-shaped cells of varying thickness that resembled LAM. However, in addition to subtle histologic differences from LAM, HMB45 (antimelanoma antibody) showed positive in LAM (n = 3), but was negative in ESS (n = 2) and the cystic lesions of this case. Using myogenic markers (desmin and alpha-smooth muscle actin), metastatic ESS could be immunohistochemically differentiated from mesenchymal cystic hamartoma (n = 1). HMB45 immunohistochemistry is useful in the differential diagnosis of cystic pulmonary lesions.
authors.affiliation: Department of Diagnostic Pathology, Kanto Teishin Hospital, Tokyo, Japan. tomooitoh@jsn.justnet.or.jp
authors.forename: T
authors.initials: T
authors.lastname: Itoh
authors.forename: M
authors.initials: M
authors.lastname: Mochizuki
authors.forename: S
authors.initials: S
authors.lastname: Kumazaki
authors.forename: T
authors.initials: T
authors.lastname: Ishihara
authors.forename: M
authors.initials: M
authors.lastname: Fukayama
mesh_terms: D000199:Actins / Q000032:analysis; D000951:Antigens, Neoplasm / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D003893:Desmin / Q000032:analysis; D003937:Diagnosis, Differential; D016889:Endometrial Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000737:chemistry* / Q000000981:diagnostic imaging / Q000556:secondary; D018192:Lymphangioleiomyomatosis / Q000000981:diagnostic imaging / Q000473:pathology*; D058950:Melanoma-Specific Antigens; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000032:analysis; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000737:chemistry* / Q000000981:diagnostic imaging / Q000556:secondary; D012509:Sarcoma / Q000737:chemistry* / Q000000981:diagnostic imaging / Q000556:secondary; D014057:Tomography, X-Ray Computed
chemical_list: D000199:Actins; D000951:Antigens, Neoplasm; D015415:Biomarkers; D003893:Desmin; D058950:Melanoma-Specific Antigens; D009363:Neoplasm Proteins