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. 2025 Feb;486(2):355-363.
doi: 10.1007/s00428-024-03743-6. Epub 2024 Feb 29.

Ovarian endometrioid carcinoma with a sex cord-like pattern: a morphological, immunohistochemical, and molecular analysis

Antonio Travaglino  1   2 , Damiano Arciuolo  1   3 , Angela Santoro  1   3 , Caterina Fulgione  4 , Alessia Piermattei  1 , Manuela Martinelli  1 , Maria Elisabetta Onori  5 , Angelo Minucci  5 , Antonio Raffone  6 , Frediano Inzani  7 , Gian Franco Zannoni  8   9
Affiliations

Ovarian endometrioid carcinoma with a sex cord-like pattern: a morphological, immunohistochemical, and molecular analysis

Antonio Travaglino et al. Virchows Arch. 2025 Feb.

Abstract

Sex cord-like endometrioid carcinoma (SCLEC) is an uncommon entity which may constitute a diagnostic challenge. This study aimed to perform a clinicopathological, immunohistochemical, and molecular reappraisal of ovarian SCLEC. Consecutive ovarian SCLECs cases from a single institution were reviewed during a 13-year period. Twenty-three immunohistochemical markers were tested; 10 genes were analyzed by next-generation sequencing. Nine cases of ovarian SCLEC were identified. Mean patient age was 65.7 years; three cases showed extraovarian extension. Architectural pattern included sertoliform (n = 2), granulosa-like (n = 2), and mixed granulosa-like/sertoliform (n = 5). Eosinophilic changes accompanied by increased nuclear atypia were observed in four tumors. Endometrioid features (glands, squamous/morular differentiation) were observed in six cases. Most tumors were positive for cytokeratin-7 (8/9), EMA (9/9), estrogen and progesterone receptor (9/9), CD10 (7/9, including a luminal pattern reminiscent of mesonephric neoplasms), nuclear β-catenin (8/9), and CDX2 (8/9). A minority of cases showed block-type p16 pattern (2/9), PAX8-positivity (3/9), and non-diffuse positivity for WT1 (1/9), inhibin (1/9), chromogranin (1/9), and synaptophysin (2/9). All cases were negative for GATA3, TTF1, calretinin, and SF1. Ki67 range was 15-90%. Six cases showed CTNNB1 exon 3 mutation. Eight cases were of "no specific molecular profile" (NSMP) and one was p53-abnormal. In conclusion, SCLECs frequently exhibit a mixed sertoliform/granulosa-like architecture and express epithelial markers, hormone receptors, nuclear β-catenin, and CDX2, with luminal CD10 positivity and CTNNB1 mutations. PAX8 expression is often lost, while other mesonephric, sex cord, and neuroendocrine markers are negative.

Keywords: Endometrioid carcinoma; Genomic; Immunohistochemistry; Sertoliform; Sex cord; TCGA.

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Conflict of interest statement

Declarations. Ethics approval: This study was based on retrospective analyses of routine archival formalin-fixed, paraffin-embedded tissue. All patients provided a written consent for the use of their biological specimen for research purpose. The study was conducted in agreement with the Declaration of Helsinki and the indications of Italian Legislative Decrees no. 196/03 and 101/18. All data were anonymized. No external funds were received for this study. The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Morphological features of sex cord-like endometrioid carcinoma (SCLEC). a Sertoliform pattern consisting of anastomosing solid and hollow tubules. b Solid-trabecular architecture resembling granulosa cell tumor. c Microfollicular pattern. d Squamoid areas
Fig. 2
Fig. 2
Cytoplasmic eosinophilia and nuclear pleomorphism in sex cord-like endometrioid carcinoma (SCLEC). a Tumor cells resembling Hürthle cells. b Trabecular pattern. c Mucinous features. d Serous-like atypia
Fig. 3
Fig. 3
Immunohistochemical features of sex cord-like endometrioid carcinoma (SCLEC). a Diffuse positivity for EMA. b Diffuse positivity cytokeratin-7. c Luminal expression of CD10 resembling mesonephric neoplasms. d Diffuse nuclear accumulation of β-catenin. e Diffuse CDX2 expression. f One case was p53-abnormal
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