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Blogger's Note: of interest to those with dual malignancies and possibly Lynch Syndrome patients
Abstract
Endometrial
carcinomas are known to have the potential for recurrences that are
distinctly discordant at the morphologic and immunophenotypic levels
from their antecedent primary tumors. This report describes 3 patients
with stage I, low or intermediate grade, conventional endometrioid
carcinomas that recurred at the vaginal apex as notably clear cell-rich,
higher grade, histotypically ambiguous neoplasms. Comparative
immunohistochemical analyses were performed on all cases on both the
original and the recurrent tumors using a panel of 8 biomarkers,
including estrogen receptor, progesterone receptor, vimentin, p53, p16,
hepatocyte nuclear factor 1β, BAF250a (ARID1A), and stathmin or
oncoprotein-18 (STMN1). Notable immunophenotypic differences (relative
to the original tumor) in case 1 included the relative loss of vimentin
and estrogen receptor and the acquisition of p53, p16, and STMN1
expression in the recurrence. In case 2, significant p16 and STMN1
expression were identified only in the recurrence. In case 3, there were
no significant immunophenotypic differences between the original tumor
and the recurrence. In all 3 cases, the recurrent and original tumors
showed no significant differences in BAF250a, hepatocyte nuclear factor 1β,
and progesterone receptor expression. In summary, our cases confirm
that endometrioid carcinomas can recur as clear cell-rich tumors. The
relative acquisition of STMN1 expression in 2 of the 3 recurrences and
p53 overexpression in 1 of 3 recurrences suggests that this phenomenon
represents a form of tumor evolution, and this may be a potential
contributor to tumor progression in these patients.
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