Anaplastic lymphoma kinase-negative uterine inflammatory myofibroblastic tumor containing the ETV6-NTRK3 fusion gene: a case report

Abstract

Inflammatory myofibroblastic tumors (IMTs) are neoplasms with low malignant potential, and the most common tumor in the lung and orbit. Their occurrence in the uterus is rare. Approximately 50% of IMT patients have anaplastic lymphoma kinase gene ( ALK) rearrangements. Recent studies described novel fusions involving ROS1, platelet-derived growth factor receptor beta ( PDGFR-β), and ETS translocation variant ( ETV6) genes in a subset of ALK-negative patients. We report a 44-year-old woman with anemia and uterine IMT. Ultrasonography and magnetic resonance imaging revealed a myxoid degenerative myoma-like mass, 7.4 cm in maximum diameter, on the left uterine side wall. Hysterectomy was performed as a definitive treatment. Microscopic examination revealed spindle cell proliferation with numerous lymphocytes and plasma cells. Immunohistochemically, the spindle cells were negative for ALK-1, desmin, and smooth muscle actin. The pathological diagnosis was IMT arising from the uterus. Fluorescence in situ hybridization demonstrated an ETV6-neurotrophic tyrosine kinase, receptor, type 3 gene ( NTRK3) translocation but no ALK, ROS1, or PDGFR-β translocations. Lung and abdomen computed tomography at 31 months postoperatively revealed no disease recurrence. This association of an ETV6-NTRK3 fusion oncogene with an ALK-negative uterine IMT increases our understanding of this neoplasm, which may help the development of specific therapies.

Keywords: ETV6–NTRK3 fusion gene; Inflammatory myofibroblastic tumor; anaplastic lymphoma kinase; crizotinib; fluorescence in situ hybridization; uterus.

Figure 1.

Axial MRI T2-weighted fat-suppressed sequence demonstrating the local lesion with an inhomogeneous hyperintensity on the left uterine side wall.

Figure 2.

Histopathological findings showing plump spindle and epithelioid cells admixed with lymphocytes and plasma cells in an abundant myxoid extracellular matrix. Cells were stained with hematoxylin and eosin (magnification, ×200).

Figure 3.

Fluorescent in situ hybridization analysis. Yellow arrow indicates ETV6 arrangement. The presence of the ETV6-NTRK3 fusion is demonstrated by the close proximity of a green signal (ETV6 from chromosome 12) with a red signal (NTRK3 from chromosome 15) in multiple tumor cells.