Immunohistochemical Characterization of Endometrial Stromal Sarcomas

Nisha Marwah; Monika Kalyan; Shivani Bhargava; Sunita Singh

doi:10.21276/apalm.3566

Authors

Nisha Marwah Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Monika Kalyan Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Shivani Bhargava Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Sunita Singh

DOI:

https://doi.org/10.21276/apalm.3566

Keywords:

endometrial stromal tumors, beta catenin, immunohistochemistry

Abstract

Endometrial stromal sarcomas (ESS) are rare uterine mesenchymal tumors with overlapping histological and immunohistochemical features. High-grade ESS (HG-ESS) is typically characterized by high mitotic activity, marked pleomorphism, strong cyclin D1 expression, and negativity for hormone receptors. Accurate diagnosis is critical for appropriate treatment and prognosis. We report a case of a 75-year-old postmenopausal female presenting with abnormal uterine bleeding. Histopathological examination revealed a pleomorphic, highly cellular tumor with elevated mitotic activity (8–10/HPF). Immunohistochemistry showed strong positivity for vimentin, panCK, cyclin D1, ER, and PR. Beta-catenin staining was cytoplasmic and membranous, with no nuclear localization. SMA and MyoD1 were negative. Despite ER/PR positivity and absence of nuclear beta-catenin, the overall findings favored a diagnosis of high-grade endometrial stromal sarcoma. This case highlights the importance of integrating histomorphological features with a comprehensive IHC panel. Strong cyclin D1 expression, high mitotic index, and exclusion of other differential diagnoses supported the diagnosis of HG-ESS, despite conflicting ER/PR and beta-catenin findings.

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