Diagnostic immunohistochemistry in uterine sarcomas: a case report

Abstract

We present the case of a 90-year-old female patient with abnormal uterine bleeding. Imaging studies showed a uterine mass that involved the body and cervix. The cervical biopsy was interpreted after performing the immunohistochemistry panel including positivity for Vimentin, Desmin, MYOD1, and negativity for Cytokeratin AE1/AE3, CD45, CD34 and smooth muscle actin interpreted as Rhabdomyosarcoma. After neoadjuvant surgery, a total hysterectomy was performed, observing the large intracavitary tumor. The histopathological study showed a tumor with pleomorphic cells of rhabdoid appearance intermixed with medium eosinophilic cytoplasmic cells with atypia and mitosis poorly differentiated. A second immunohistochemical study included estrogen receptors, progesterone receptors, CD10, cyclin D1, EMA, DESMIN, MYOGENIN, MYOD1, and smooth muscle actin; testing positive for Desmin, Myogenin, MYOD 1, AML, P53. Possible differential diagnoses were ruled out. Based on these results, the diagnosis of Undifferentiated Uterine Sarcoma with a heterologous rhabdomyoblastic component and P53 mutation was proposed. Uterine sarcomas are rare, aggressive tumors. Our patient is in good general condition, free of disease.