Definition/General
Clinical Features
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Gross Description
Microscopic Description
Immunohistochemistry
Molecular/Genetic
Differential Diagnosis
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Patient Information
Name: [Patient Name]\nAge: [X] years\nMRN: [Medical Record Number]\nDate of Procedure: [Date]
Clinical History
Clinical indication: [Abnormal uterine bleeding/Pelvic mass/Enlarged uterus/Recurrent disease]\nSymptoms: [Menorrhagia/Pelvic pain/Pressure symptoms/Weight loss]\nImaging: [Ultrasound/CT/MRI findings showing polypoid masses/vascular invasion]\nPrevious pathology: [Prior endometrial biopsy results if available]\nProcedure: [Total hysterectomy +/- staging procedures]
Specimen Received
Specimen type: [Total hysterectomy/Radical hysterectomy] +/- [bilateral salpingo-oophorectomy/pelvic lymph nodes]\nUterine weight: [X] grams\nTumor size: [X] cm\nAdditional specimens: [Omentum/Lymph nodes/Peritoneal biopsies] if submitted\nFixative: 10% neutral buffered formalin
Gross Examination
The uterus weighs [X] grams and measures [X] x [X] x [X] cm. [Polypoid masses/Infiltrative tumor] measuring up to [X] cm [protrude into the endometrial cavity/infiltrate the myometrium]. The tumor has a [tan-yellow/soft] appearance with [ill-defined/infiltrative] borders. Characteristic [worm-like extensions into vascular channels/serpentine growth pattern] are [identified/suspected]. Cut surface shows [soft, fleshy tissue with areas of hemorrhage/yellow-tan tissue]. The tumor [extends to the serosal surface/is confined to the myometrium/involves the cervix]. [Extrauterine extension/vascular invasion] is [grossly evident/not apparent]. Representative sections: [X] sections of tumor, [X] sections showing vascular invasion, [X] sections of uninvolved tissue.
Microscopic Examination
Sections show a malignant mesenchymal tumor composed of uniform small cells resembling endometrial stromal cells. The cells have [oval to spindle-shaped nuclei with fine chromatin/enlarged pleomorphic nuclei] and [scant/moderate] cytoplasm. The tumor demonstrates [characteristic spiral artery-like vasculature/prominent vascular pattern]. Growth pattern shows [diffuse infiltration with tongue-like extensions/sheet-like arrangement]. Mitotic activity is [low with X mitoses per 10 HPF/<5/10 HPF for low-grade][high with X mitoses per 10 HPF/>10/10 HPF for high-grade]. [Nuclear atypia is minimal/significant nuclear pleomorphism is present]. [Prominent lymphovascular invasion with serpentine growth pattern/vascular invasion] is present. [Sex cord-like areas/smooth muscle differentiation/glandular differentiation] are [present/absent].
Immunohistochemistry
CD10: [Diffusely positive] (characteristic of endometrial stroma)\nEstrogen Receptor: [Positive/Negative]\nProgesterone Receptor: [Positive/Negative]\nWT1: [Positive/Negative]\nCyclin D1: [Positive/Negative]\nInhibin: [Focal positive/Negative]\nSmooth Muscle Actin: [Focal positive/Negative]\nDesmin: [Negative]\nh-Caldesmon: [Negative]\nKi-67 proliferation index: [X]% ([low <10%/high >10%])
Molecular Studies (if performed)
JAZF1 rearrangement: [Positive/Negative/Not performed]\nPHF1 rearrangement: [Positive/Negative/Not performed]\nOther fusion studies: [Specify if performed]\nFISH analysis: [Results if available]\nNext-generation sequencing: [Results if available]
Staging Assessment
Tumor confined to uterus: [Yes/No]\nMyometrial invasion: [<50%/>50%]\nCervical involvement: [Present/Absent]\nExtrauterine extension: [Present/Absent - specify sites]\nLymphovascular invasion: [Present/Absent/Prominent]\nLymph node involvement: [Present/Absent/Not assessed]\nDistant metastases: [Present/Absent/Clinical correlation needed]\nFIGO Stage: [I/II/III/IV]
Final Diagnosis
[LOW-GRADE/HIGH-GRADE] ENDOMETRIAL STROMAL SARCOMA\n\nGrade: [Low-grade/High-grade] (WHO 2020)\nSize: [X] cm\nFIGO Stage: [I/II/III/IV]\nMitotic count: [X] per 10 HPF\nVascular invasion: [Present/Absent/Prominent]\nHormone receptors: ER [Pos/Neg], PR [Pos/Neg]\nCD10: [Positive]\nMolecular findings: [JAZF1/PHF1/Other rearrangement if detected]
Comments and Prognosis
• [Low-grade ESS: Indolent course with tendency for late recurrences. Generally hormone-sensitive. 5-year survival 80-90%.]\n• [High-grade ESS: More aggressive behavior with higher metastatic potential. 5-year survival approximately 50%.]\n• CD10 positivity confirms endometrial stromal differentiation.\n• Characteristic spiral artery-like vasculature and lymphovascular invasion pattern.\n• [Hormone receptor positivity suggests potential benefit from hormonal therapy (low-grade).]\n• Complete surgical staging and multidisciplinary team discussion recommended.\n• Long-term surveillance required due to potential for late recurrences.\n• [Consider molecular testing for treatment stratification and prognostication.]
Reported By
Dr. [Pathologist Name], MD\nConsultant Pathologist\nDate: [Report Date]\n\nReviewed by: Dr. [Senior Pathologist], MD (if applicable)