You are here

  • Home
  • Archive
  • Volume 31, Issue 6
  • Three-dimensional virtual histology of benign and malignant endometrial stromal neoplasms: a new perspective on why morphology matters

Article Text

Article menu

Download PDFPDF

Video article
Three-dimensional virtual histology of benign and malignant endometrial stromal neoplasms: a new perspective on why morphology matters
  1. Felix KF Kommoss1,
  2. Jonas Albers2,
  3. Constantin Schwab1,
  4. Willi L Wagner3,4,
  5. Giuliana Tromba5 and
  6. Christian Dullin2,3,4
  1. 1 Institute of Pathology, University Hospital of Heidelberg, Heidelberg, Germany
  2. 2 Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
  3. 3 Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
  4. 4 Translational Lung Research Center Heidelberg, German Center for Lung Research, University of Heidelberg, Heidelberg, Germany
  5. 5 Elettra-Sincrotrone Trieste, Trieste, Italy
  1. Correspondence to Dr Felix KF Kommoss, Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; felix.kommoss{at}med.uni-heidelberg.de

https://doi.org/10.1136/ijgc-2020-002313

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    A perimenopausal woman presented with a history of hypermenorrhea and enlargement of uterine fibroids. Histopathological examination of curettage material showed fragments of a mesenchymal neoplasm consisting of small and monomorphic spindle cells with scant cytoplasm, reminiscent of non‐neoplastic proliferative phase endometrial stroma. The patient underwent hysterectomy to rule out malignancy. Gross examination revealed an intramural mass located within the uterine corpus. Histologically, characteristic finger-like projections of neoplastic stromal cells, infiltrating the myometrium, were seen. Based on the invasive nature of the neoplasm, a diagnosis of low grade endometrial stromal sarcoma (LGESS) was rendered, and the patient was scheduled for further tumor staging and regular follow-up cancer care, due to the metastatic potential of LGESS. Synchrotron phase contrast micro-CT (SRµCT) of formalin fixed, paraffin embedded tumor tissue provided a remarkably detailed three-dimensional view of the tumor’s distinctive invasive growth pattern (Video 1).1

    Video 1

    An invasive growth pattern and/or lymphovascular invasion are the only features reliably discriminating LGESS from endometrial stromal nodule (ESN), its benign and molecularly often indistinguishable (eg, identical JAZF1-SUZ12 gene fusion) counterpart.2 Therefore, the distinction between ESN and LGESS cannot be made with certainty on the basis of limited tissue samples, such as curettage, but requires evaluation of the entire tumor interface with adjacent myometrium, usually in hysterectomy specimens. Once clinically implemented, novel micro-radiological techniques, allowing for higher spatial resolution and superior soft tissue contrast in comparison with imaging techniques currently in clinical use, may facilitate clinical decision making by identifying patterns indicative of malignancy in cases of uterine stromal neoplasms where a fertility sparing surgical approach might be considered.3

    Data availability statement

    There are no data in this work.

    References

    1. ↵
      2. Saccomano M ,
      3. Albers J ,
      4. Tromba G , et al
      . Synchrotron inline phase contrast µCT enables detailed virtual histology of embedded soft-tissue samples with and without staining. J Synchrotron Radiat 2018;25:1153–61.doi:10.1107/S1600577518005489 pmid:http://www.ncbi.nlm.nih.gov/pubmed/29979177
      OpenUrlPubMed
    2. ↵
      2. Hoang L ,
      3. Chiang S ,
      4. Lee C-H
      . Endometrial stromal sarcomas and related neoplasms: new developments and diagnostic considerations. Pathology 2018;50:162–77.doi:10.1016/j.pathol.2017.11.086 pmid:http://www.ncbi.nlm.nih.gov/pubmed/29275929
      OpenUrlPubMed
    3. ↵
      2. Labriet H ,
      3. Nemoz C ,
      4. Renier M , et al
      . Significant dose reduction using synchrotron radiation computed tomography: first clinical case and application to high resolution CT exams. Sci Rep 2018:8.

    Footnotes

    • Contributors FK and CS performed the histological work-up. JA, WLW, GT, and CD performed synchrotron phase contrast micro-CT (SRµCT) imaging. FK wrote the manuscript, which was reviewed and approved by all of the authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.