Aggressive behavior and poor prognosis of endometrial stromal sarcomas with YWHAE-FAM22 rearrangement indicate the clinical importance to recognize this subset

Int J Gynecol Cancer. 2014 Nov;24(9):1616-22. doi: 10.1097/IGC.0000000000000278.

Abstract

Objectives: Although the World Health Organization (WHO) in 2003 defined endometrial stromal sarcomas (ESSs) in general have a good prognosis, considerable differences in clinical behavior and prognosis may exist between different patients with ESS. The ESSs of the type associated with YWHAE-NUTM2 (previously named YWHAE-FAM22) fusion have a more aggressive clinical behavior and poorer prognosis than conventional ESS. Recently, the WHO 2014 classification recognizes this subset of ESS as a separate entity and classifies these as high-grade ESSs. Recognition of this subset has therefore an important clinical impact. We performed a review of the literature to delineate the clinicopathologic features of ESS patients with an YWHAE-NUTM2 rearrangement, with the goal to recognize this subset of ESS.

Methods: We report a case of a woman with WHO 2014-defined high-grade ESS. Furthermore, published English literature was reviewed for YWHAE-FAM22 ESS and uterus.

Results: Twenty patients were identified, with a median age of 50 (range, 28-67) years. There were no clinical features able to recognize YWHAE-NUTM2 ESS. However, they characteristically contain specific histopathological features. Furthermore, YWHAE-NUTM2 ESSs are strongly cyclin D1 positive in contrast to conventional low-grade ESSs.

Conclusions: YWHAE-NUTM2 ESSs represent a subset of ESSs with an aggressive clinical behavior and poor prognosis. Specific histopathological features may indicate the presence of YWHAE-NUTM2 rearrangement, which subsequently can be confirmed by cyclin D1 immunostaining.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Biomarkers, Tumor / genetics*
  • Endometrial Neoplasms / drug therapy
  • Endometrial Neoplasms / genetics*
  • Endometrial Neoplasms / pathology*
  • Female
  • Gene Rearrangement*
  • Humans
  • In Situ Hybridization, Fluorescence
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Oncogene Proteins, Fusion / genetics*
  • Prognosis
  • Review Literature as Topic
  • Sarcoma, Endometrial Stromal / drug therapy
  • Sarcoma, Endometrial Stromal / genetics*
  • Sarcoma, Endometrial Stromal / pathology*

Substances

  • Biomarkers, Tumor
  • Oncogene Proteins, Fusion
  • YWHAE-FAM22 fusion protein, human