title: Sertoliform endometrioid carcinoma of the endometrium with dual immunophenotypes for epithelial membrane antigen and inhibin alpha: case report and literature review.
abstract: We report a rare case of sertoliform endometrioid carcinoma of the endometrium in a 71-year-old African American woman who presented with postmenopausal bleeding. Her medical condition was remarkable for hypertension, diabetes, and obesity. She underwent total hysterectomy, right salpingo-oophorectomy and lymph node sampling. The endometrium was occupied by a 4.5-cm solid polypoid tumor, which grossly invaded into the myometrium. Microscopically, the tumor consisted of small hollow tubules, anastomosing cords and trabeculae, and tightly packed nests. Microglandular areas mimicking adult granulosa cell tumors were also present. But true Call-Exner bodies were absent. Component of typical endometrioid carcinoma was noted only focally. The uninvolved endometrium demonstrated atypical complex hyperplasia. The tumor cells were diffusely immunoreactive for epithelial membrane antigen, estrogen receptor, and progesterone receptor (PR), and focally for vimentin. The tumor cells were also diffusely positive for inhibin alpha and CD99. Immunostains for other sex cord markers (calretinin, WT-1, and Melan-A) were also positive in approximately 30% to 40% of the tumor cells. Immunostains for CD10, smooth muscle actin, desmin, or HHF35 were negative. Two ovarian sertoliform endometrioid carcinomas from our archived tissue were, however, immunoreactive for epithelial membrane antigen but negative for inhibin alpha. Despite the prominent sertoliform features, both histologically and immunohistochemically, the tumor was of a high-grade endometrial carcinoma and will likely behave as such. As of today, dual differentiation of epithelium and sex cord by immunohistochemical staining has not been demonstrated in sertoliform endometrioid carcinomas of either endometrial or ovarian origin. Our case is the first documentation of such example and suggests that endometrial carcinoma can undergo true sex cord differentiation.
authors.affiliation: Department of Pathology, State University of New York at Stony Brook, Stony Brook, New York 11794-7025, USA. sxliang@notes.cc.sunysb.edu
authors.forename: Sharon X
authors.initials: SX
authors.lastname: Liang
authors.forename: Kausha
authors.initials: K
authors.lastname: Patel
authors.forename: Michael
authors.initials: M
authors.lastname: Pearl
authors.forename: Jingxuan
authors.initials: J
authors.lastname: Liu
authors.forename: Wenxin
authors.initials: W
authors.lastname: Zheng
authors.forename: Carmen
authors.initials: C
authors.lastname: Tornos
mesh_terms: D000368:Aged; D018269:Carcinoma, Endometrioid / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D007265:Inhibins / Q000378:metabolism*; D018396:Mucin-1 / Q000378:metabolism*; D012707:Sertoli Cell Tumor / Q000378:metabolism / Q000473:pathology* / Q000601:surgery
chemical_list: D018396:Mucin-1; C094377:inhibin-alpha subunit; D007265:Inhibins