title: Pulmonary metastatic nodules of uterine low-grade endometrial stromal sarcoma: histopathological and immunohistochemical analysis of 10 cases.
abstract: OBJECTIVE
  To identify histopathological and immunohistochemical findings that aid diagnosis of metastatic endometrial stromal sarcoma (ESS) in small biopsy specimens of the lung.
  
  
  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 CD10 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 CD10.
  
  
  CONCLUSIONS
  Combined staining for ER and CD10 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.
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Park
authors.forename: Chang Ohk
authors.initials: CO
authors.lastname: Sung
authors.forename: Se-Jin
authors.initials: SJ
authors.lastname: Jang
authors.forename: Sang Yong
authors.initials: SY
authors.lastname: Song
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Kyu-Rae
authors.initials: KR
authors.lastname: Kim
mesh_terms: D000199:Actins / Q000378:metabolism; D000328:Adult; D016889:Endometrial Neoplasms / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008168:Lung / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D008175:Lung Neoplasms / Q000378:metabolism / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D015260:Neprilysin / Q000378:metabolism; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D018203:Sarcoma, Endometrial Stromal / Q000378:metabolism / Q000473:pathology / Q000556:secondary*
chemical_list: C541116:ACTA2 protein, human; D000199:Actins; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D011960:Receptors, Estrogen; D015260:Neprilysin
keywords: bronchial artery; endometrial stromal sarcoma; histological change; lung; metastasis