case_images: PMC8478548_01
case_images: Histology image of the ordinary endometrioid carcinoma component. (a) Endometrioid glands were observed. (b) Higher magnification of the endometrioid carcinoma component. (c) PAX8 was positive. (d) p16 immunostaining was patchy. (e) p53 was wild type. (f) WT-1 was negative. (A, B: H&E staining, A: x10, B: x20, Immunostaining C, D: x10, E,F: x20).
case_images: CRIPA2021-5868818.001.jpg
case_images: PMC8478548_01_CRIPA2021-5868818.001.jpg
case_images: fig1
case_images: Histologically, the tumor was a high-grade endometrioid carcinoma that exhibited growth of irregularly shaped glands, which contained cells with eosinophilic cytoplasm and high-grade nuclei (Figures 1(a), (b)). Table 2. The ordinary endometrioid carcinoma element showed positive staining for cytokeratin (AE1/AE3), EMA, vimentin, ER, PAX8 (Figure 1(c)), and CD99. p16 staining was patchy (Figure 1(d)), and p53 staining was indicative of the wild-type gene (Figure 1(e)). WT-1 (Figure 1(f)) and GATA3 were both negative.
case_images: Histology image of the sertoliform endometrioid carcinoma component. (a) Sertoliform element in the glandular area. (b) Sertoliform element in the solid area. (c) AE1/AE3 was negative. (d) EMA staining was patchy. (e) alpha-inhibin showed positive staining. (f) Calretinin was also positive. (A, B: H&E staining, A, B: x20, Immunostaining C-F: x20).
case_images: CRIPA2021-5868818.002.jpg
case_images: PMC8478548_01_CRIPA2021-5868818.002.jpg
case_images: fig2
case_images: Cells in the small hollow tubules had small, atypical nuclei with vesicular chromatin and pale cytoplasm (Figure 2(a)). The solid area contained small, atypical cells with dark oval vesicular nuclei and scant cytoplasm (Figure 2(b)). Tightly packed solid nests of sex cord-like elements were positively stained for EMA (Figure 2(d)), vimentin, CD99, calretinin (Figure 2(f)), CD56 (Figure 4(e)), synaptophysin, and chromogranin A, which was similar to the glandular area. In contrast to the glandular area, alpha-inhibin (Figure 2(e)) was positive in the solid area.
case_images: Histology image of the sarcomatous component. (a) Heterologous element with chondroid differentiation. (b) Chondroid stroma showed positive staining with Alcian blue. (c) Proliferation of spindle and polygonal stromal cells. (d) Epithelial cells were stained for AE1/AE3. (e) Vimentin was positive both in epithelial and stromal cells. (f) CD10 was positive in the sarcomatous cells. (A: H&E staining, x20, B: Alcian blue x20, Immunostaining C-F: x20).
case_images: CRIPA2021-5868818.003.jpg
case_images: PMC8478548_01_CRIPA2021-5868818.003.jpg
case_images: fig3
case_images: In some areas, atypical cell nests with chondroid differentiation (Figure 3(a)) and diffusely distributed spindle to polygonal atypical stromal cells were observed (Figure 3(c)). ER (Figure 3(d)), PgR, alpha-inhibin, PAX8 (Figure 3(c)), WT-1, Melan A, CD10, SMA, and myogenin were negative, while MLH1, MSH2, MSH6, and PMS2 were positive. Diffuse staining for p16 (Figure 4(a)) and p53 (Figure 4(b)) was observed, and beta-catenin showed diminished membranous staining and positive cytoplasmic staining (Figure 3(f)). Alcian blue (Figure 3(b)). Atypical spindle and polygonal stromal cells (Figure 3(c)) were positive for vimentin (Figure 3(e)) and CD10 (Figure 3(f)), although those cells were negative for SMA and myogenin, which indicates endometrial stromal cell differentiation.
case_images: Immunohistochemistry image of the sertoliform endometrioid carcinoma component. (a) p16 showed diffuse staining in the solid area of the sertoliform element. (b) p53 also showed diffuse staining in the solid area. (c) PAX8 was negative. (d) ER was also negative. (e) CD56 was positive. (f) Membranous staining of beta-catenin was diminished, while the cytoplasm was positively stained. (A, C: x10, B, D, E: x20, F: x40).
case_images: CRIPA2021-5868818.004.jpg
case_images: PMC8478548_01_CRIPA2021-5868818.004.jpg
case_images: fig4
case_images: Tightly packed solid nests of sex cord-like elements were positively stained for EMA (Figure 2(d)), vimentin, CD99, calretinin (Figure 2(f)), CD56 (Figure 4(e)), synaptophysin, and chromogranin A, which was similar to the glandular area. Diffuse staining for p16 (Figure 4(a)) and p53 (Figure 4(b)) was observed, and beta-catenin showed diminished membranous staining and positive cytoplasmic staining (Figure 3(f)).