Prognostic value of the diagnostic criteria distinguishing endometrial stromal sarcoma, low grade from undifferentiated endometrial sarcoma, 2 entities within the invasive endometrial stromal neoplasia family
Abstract
The World Health Organization (WHO 2003) recognizes 3 endometrial stromal neoplasms:
noninvasive endometrial stromal nodule and the 2 invasive neoplasms, endometrial stromal
sarcoma (ESS), low grade and undifferentiated endometrial sarcoma (UES). It is important
to note that the WHO 2003 does not define moderate atypia (an important differentiating
diagnostic criterion for ESS, low grade and UES), nor does it discuss its significance.
Moreover, studies on reproducibility and additional prognostic value of other diagnostic
features in large are lacking. Using strict definitions, we analyzed the agreement
between routine and expert-review necrosis and nuclear atypia in 91 invasive endometrial
stromal neoplasias (IESN). The overall 5-year and 10-year recurrence-free survival
rate estimates of the 91 IESN patients were 82% and 75%, respectively. Necrosis was
well reproducible, and nuclear atypia was reasonably well reproducible. The 10-year
recurrence-free survival rates for necrosis absent/inconspicuous versus prominent
were 89% and 45% (P<0.001) and those for review-confirmed none/mild, moderate, severe
atypia were 90%, 30%, and <20% (P<0.00001). Therefore, cases with moderate/severe
atypia should be grouped together. Nuclear atypia and necrosis had independent prognostic
values (Cox regression). Once these features were taken into account, no other feature
had an independent additional prognostic value, including mitotic count. Using "none/mild
atypia, necrosis absent/inconspicuous" as ESS, low grade versus "moderate/severe atypia
present or necrosis present" as UES resulted in 68 ESS, low grade and 23 UES cases
with disease-specific overall mortality-free survival of 99% versus 48% (P<0.00001,
hazard ratio=45.4). When strictly defined microscopic criteria are used, the WHO 2003
diagnoses of ESS, low grade and UES are well reproducible and prognostically strong.
© 2012 International Society of Gynecological Pathologists.
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https://hdl.handle.net/10161/12058Published Version (Please cite this version)
10.1097/PGP.0b013e318229adfbPublication Info
Feng, Weiwei; Malpica, Anais; Robboy, Stanley J; Gudlaugsson, Einar; Hua, Keqin; Zhou,
Xianrong; & Baak, Jan PA (2012). Prognostic value of the diagnostic criteria distinguishing endometrial stromal sarcoma,
low grade from undifferentiated endometrial sarcoma, 2 entities within the invasive
endometrial stromal neoplasia family. International Journal of Gynecological Pathology, 31(2). pp. 151-158. 10.1097/PGP.0b013e318229adfb. Retrieved from https://hdl.handle.net/10161/12058.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Stanley J. Robboy
Professor Emeritus of Pathology
My research program, largely histopathological, concerns definitions of criteria,
biological properties, differential diagnosis, and survival associated with pathological
lesions in the female genital tract. With the gynecologic oncologists at Duke, we
have reviewed the Institution's long term experience of endometrial cancer and with
the International Collaborative Group on Endometrium, we have developed a new classification
system for endometrial hyperplasia that better differentiates pr

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