Abstract：
Uterine spindle cell lesions share a dilemmatic overlapped features that needed to be addressed by the pathologist to reach a conclusive accurate diagnosis for its prognostic value and different management decisions. Usage of combined IHC panel can be an aiding guiding tool in this context. The aim of this study is to evaluate the diagnostic value of combined BCOR, Cyclin D1, and CD10 IHC panel in differentiating endometrial stromal sarcoma from other uterine spindle cell lesions. This study included 60 cases categorized into endometrial stromal sarcoma group (ESS) (12 cases high-grade endometrial stromal sarcoma [HGESS] and 18 cases low-grade endometrial stromal sarcoma [LGESS]), malignant uterine spindle cell lesions group (5 cases adenosarcoma [AS], 6 cases leiomyosarcoma [LS], 4 cases carcinosarcoma [CS]), and benign uterine lesions group (5 cases endometrial stromal nodule [ESN], 5 cases leiomyoma, and 5 cases adenomyosis). IHC staining procedure and evaluation for BCOR, Cyclin D1, and CD10 was performed on all studied cases. BCOR IHC staining was positive in all HGESS (12/12) of ESS group cases, with diffuse pattern in 75% of cases. BCOR-diffuse staining pattern was not recorded in any of LGESS (0/18), malignant mesenchymal lesions group (0/15), and also benign lesions group (0/15). Cyclin D1 positivity was observed only in HGESS cases, in parallel with positive-BCOR expression. On the contrary, CD10 was negatively expressed in all HGESS and positive in all LGESS, ESN, and adenomyosis cases. A specificity of 100% and sensitivity of 75% were recorded in differentiating HGESS from malignant mesenchymal lesions (including LMS, AS, and CS) and also HGESS from LGESS when using the combined panel BCOR +ve D /Cyclin D1 +ve / CD10 -ve , considering only the BCOR-diffuse staining pattern. In conclusion, BCOR +ve D /Cyclin D1 +ve /CD10 -ve as a combined panel is 100% specific and with lesser sensitivity in diagnosing HGESS as well as differentiating it from LGESS and other malignant uterine spindle cell lesions.
摘要：
子宫梭形细胞病变具有两难选择的重叠特征，病理学家需要解决这些问题，以就其预后价值和不同的管理决策达成结论性的准确诊断。在这种情况下，使用组合的IHC面板可以是一种辅助引导工具。这项研究的目的是评估联合BCOR的诊断价值，细胞周期蛋白D1和CD10IHC图在区分子宫内膜间质肉瘤与其他子宫梭形细胞病变中的作用。本研究纳入60例，分为子宫内膜间质肉瘤组（ESS）（高级别子宫内膜间质肉瘤[HGESS]12例，低级别子宫内膜间质肉瘤[LGESS]18例）。恶性子宫梭形细胞病变组(5例腺肉瘤[AS],平滑肌肉瘤[LS]6例,4例癌肉瘤[CS]），子宫良性病变组(5例子宫内膜间质结节[ESN],5例平滑肌瘤，子宫腺肌病5例)。IHC染色程序和BCOR的评估，对所有研究病例进行细胞周期蛋白D1和CD10。所有HGESS(12/12)病例的BCOR免疫组化染色均为阳性，75%的病例有弥漫性。在任何LGESS（0/18）中未记录BCOR扩散染色模式，恶性间质病变组（0/15），良性病变组(0/15)。仅在HGESS病例中观察到细胞周期蛋白D1阳性，与BCOR阳性表达平行。相反,CD10在所有HGESS中呈阴性表达，在所有LGESS中呈阳性表达，ESN,和子宫腺肌病病例。在区分HGESS和恶性间质病变（包括LMS，AS,和CS)以及LGESS的HGESS，当使用组合面板BCOR+veD/CyclinD1+ve/CD10-ve时，仅考虑BCOR扩散染色模式。总之,BCORveD/CyclinD1ve/CD10-ve作为组合面板在诊断HGESS以及将其与LGESS和其他恶性子宫梭形细胞病变区分开方面具有100％的特异性和较低的敏感性。
