High-grade endometrial stromal sarcoma with BCOR rearrangements: clinicopathological analysis of five cases and literature reviews - an extension in understanding of morphological characteristics.

Five cases of FISH verified BCOR rearranged high-grade endometrial stromal sarcoma were retrospectively analyzed. The patient age ranged from 33 to 65 years (median, 48.4 years). Most patients presented with irregular vaginal bleeding (3/5) and uterus mass (2/5). Only one patient developed an abdominal wall metastasis and other patients remained in good condition during the follow-up. Pathological findings revealed that the tumors exhibited morphological diversity in terms of cell shape, arrangement pattern and tumor stroma, compared to previous summarized histology of BCOR rearranged high-grade endometrial stromal sarcoma. Detailed description of such morphology changes expanded our understanding of the histology of BCOR rearranged high-grade endometrial stromal sarcoma. Due to the non-specificity of morphology in such malignancies, molecular testing is needed for confirmation in all patients.

Zuo X ，Jiang W ，He YM ，Kuang W ，Li L ... -  《International Journal of Clinical and Experimental Pathology》

[Clinicopathological study of BCOR rearrangement in high grade endometrial stromal sarcoma].

Cheng YF ，Bai QM ，Bi R ，Chang B ，Huang D ，Yu L ，Zhou XY ，Yang WT ，Tu XY ... -  《-》

BCOR is a robust diagnostic immunohistochemical marker of genetically diverse high-grade endometrial stromal sarcoma, including tumors exhibiting variant morphology.

Chiang S ，Lee CH ，Stewart CJR ，Oliva E ，Hoang LN ，Ali RH ，Hensley ML ，Arias-Stella JA 3rd ，Frosina D ，Jungbluth AA ，Benayed R ，Ladanyi M ，Hameed M ，Wang L ，Kao YC ，Antonescu CR ，Soslow RA ... -  《-》

Breast metastasis in high-grade endometrial stromal sarcoma (HG-ESS) with BCOR rearrangement: a case report of a novel metastatic site.

The ZC3H7B-BCOR fusion gene has recently been described in tumours with kinship to so-called high grade endometrial stromal sarcoma (HG-ESS). This subset of tumour behaves similarly to YWHAE-NUTM2A/B HG-ESS, however, they are both morphologically and immunophenotypically distinct neoplasms. The identified rearrangements in the BCOR gene have been accepted as both the driver and requisite feature in creating a novel sub-entity within the category of HG-ESS. Preliminary investigations into BCOR HG-ESS have shown similar outcomes to YWHAE-NUTM2A/B HG-ESS, with patients typically presenting with high stage disease. Clinical recurrences and metastases to lymph nodes, sacrum/bone, pelvis/peritoneum, lung, bowel and skin have been identified. In this report, we describe a case of BCOR HG-ESS, that is deeply myoinvasive and widely metastatic. Metastatic deposits include a mass in the breast discovered on self-examination; a metastatic site that has yet to be reported in the literature. A 59-year-old female underwent biopsy for post-menopausal bleeding, yielding a diagnosis of "low-grade spindle cell neoplasm with myxoid stroma and endometrial glands", favouring endometrial stromal sarcoma (ESS). She was then referred for total hysterectomy and bilateral salpingo-oophorectomy. The resected uterine neoplasm was both intracavitary and deeply myoinvasive with morphology consistent with that of the biopsy specimen. Characteristic immunohistochemistry (IHC) was noted, and fluorescence in situ hybridization confirmed BCOR rearrangement, supporting a diagnosis of BCOR HG-ESS. A few months postoperatively, the patient underwent needle core biopsy of the breast which revealed metastatic HG-ESS. This case highlights some of the diagnostic challenges posed by uterine mesenchymal neoplasms, and exemplifies the emerging histomorphologic, immunohistochemical, molecular and clinicopathologic features of the recently described HG-ESS with ZC3H7B-BCOR fusion. It adds to the body of evidence supporting the inclusion of BCOR HG-ESS as a sub-entity of HG-ESS within the endometrial stromal and related tumours subcategory of uterine mesenchymal tumors, as well as the poor prognosis and high metastatic potential of this tumor.

Fong A ，Offman S 《Diagnostic Pathology》

Undifferentiated Uterine Sarcomas Represent Under-Recognized High-grade Endometrial Stromal Sarcomas.

Cotzia P ，Benayed R ，Mullaney K ，Oliva E ，Felix A ，Ferreira J ，Soslow RA ，Antonescu CR ，Ladanyi M ，Chiang S ... -  《-》