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Uterus

Stromal tumors

Sarcoma NOS


Reviewer: Mohamed Desouki, M.D. (see Reviewers page)
Revised: 29 December 2011, last major update September 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

General
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● Rare tumors that display pleomorphic cells with high mitotic index that show no evidence of stromal or smooth muscle derivation
● Considered to be variants of MMMT, but without an epithelial component and lacking endometrial stromal features
● Must sample thoroughly to rule out MMMT
● Poor prognosis

Terminology
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● Undifferentiated uterine or endometrial sarcoma

Epidemiology
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● Average age 45 years, present with vaginal bleeding

Case reports
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● 80 year old woman presenting with pathologic fracture of humerus (Mil Med 2010;175:691)

Treatment
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● No consistent data available

Gross description
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● Necrotic fleshy, bulky tumor fills uterine cavity with polypoid appearance usually with deep myometrial invasion

Micro description
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● Marked nuclear anaplasia, variable pleomorphism, 20+ mitotic figures/10 HPF
● Large round, spindle or bizzare cells; chromatin is coarse, clumped with large prominent nucleoli
● Extensive necrosis is a common feature
● Entrapped glands usually small, inconspicuous, not surrounded by condensed stroma as in adenosarcoma

Micro images
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Undifferentiated sarcoma of endometrium - poorly differentiated spindled cells, numerous mitoses, necrosis at lower right


Undifferentiated sarcoma of endometrium - pleomorphic giant and spindle cells

Negative stains
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● Keratin

Differential diagnosis
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Endometrial stromal sarcoma: high grade tumors resemble stromal component of MMMT
Leiomyosarcoma: spindle cells resemble smooth muscle with moderate to severe pleomorphism
● Rhadbdomyosarcoma

End of Uterus > Stromal tumors > Sarcoma NOS


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