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Clinicopathologic Parameters and Immunohistochemical Study of Endometrial Stromal Sarcomas

Wu, Tzu-I. M.D.; Chou, Hung-Hsueh M.D.; Yeh, Chi-Ju M.D.; Hsueh, Swei M.D.; Yang, Jung-Erh M.S., B.S.; Jao, Mei-Shan M.D.; Chang, Ting-Chang M.D., M.P.H.; Hsu, Chun-Sen M.D.; Lin, Kwang-Huei Ph.D.; Lai, Chyong-Huey M.D.

International Journal of Gynecological Pathology: September 2013 - Volume 32 - Issue 5 - p 482–492
doi: 10.1097/PGP.0b013e3182729131

We aimed to investigate the clinicopathologic features, immunohistochemical studies, and prognosis in patients with endometrial stromal sarcoma (ESS). Clinical information was reviewed retrospectively for cases of ESS (1985–2009). A histologic review and immunohistochemical staining for the estrogen receptor, progesterone receptor, c-Kit, CD-10, Ki-67, and m-TOR were performed. Sixty-one patients (median age, 44 y; range, 22–71) were eligible for analysis (1988 International Federation of Gynecology and Obstetrics Stage I, 43; Stage II, 2; Stage III, 11; Sage IV, 4; unstaged, 1). The median follow-up period for survivors was 73 mo. Of those, the patients who underwent an adnexectomy and a pelvic lymphadenectomy, 15% and 13%, respectively, revealed metastasis. There were 20 relapses/persistence, including 13 (65%) in the pelvis and abdomen and 7 (35%) in distant sites. Eight patients died from ESS at a median duration of 14.5 mo (range, 2–50 mo) after relapse. Five- and 10-yr cancer-specific survival (CSS) rates were 88% and 85%, respectively; and 5- and 10-yr progression-free survival rates were 69% and 57%, respectively. Stage, residual disease, and high proliferative index of Ki-67 were significant prognostic factors for both progression-free survival and CSS in a univariate analysis, in addition to mitotic index for CSS. Multivariate analysis selected only residual disease as an independent variable for progression-free survival and stage and residual disease for CSS. Our results support using clinical Stage I, no residual disease, low proliferative index of Ki-67, and estrogen receptor/progesterone receptor overexpression as potential biomarkers to select patients with ESS for fertility-preservation surgery (5 such patients were alive and free).

Department of Obstetrics and Gynecology (T.-I.W., C.-S.H.), Wan Fang Hospital, Taipei Medical University, Taipei

Department of Obstetrics and Gynecology (H.-H.C., J.-E.Y., M.-S.J., T.-C.C., C.-H.L.), Chang Gung Memorial Hospital, Chang Gung University College of Medicine

Department of Pathology (C.-J.Y., S.H.), Chang Gung Memorial Hospital and Chang Gung University College of Medicine

Department of Biochemistry (T.-I.W., K.-H.L.), Chang-Gung University, Taoyuan, Taiwan

Tzu-I Wu and Hung-Hsueh Chou have contributed equally being first authors.

Supported by Grants (CMRPG 340082 and CMRPG 340773) from Chang Gung Medical Foundation and the Department of Health, Taiwan (DOH99-TD-B-111-005 and DOH99-TD-C-111-006).

The authors declare no conflict of interest.

Address correspondence and reprint requests to Chyong-Huey Lai, MD, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Shin St. Kueishan, Taoyuan 333, Taiwan. E-mail:

©2013International Society of Gynecological Pathologists