Malignant Mixed Mullerian Tumor: An Immunohistochemical Study

Zhanyong Bing,Paul J Zhang,Li-Ping Wang,Theresa Pasha

doi:10.1155/2012/569609

Zhanyong Bing, Paul J Zhang + Show 2 more

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https://doi.org/10.1155/2012/569609

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Abstract

Malignant mixed Mullerian tumor (MMMT) is an uncommon aggressive neoplasm composed of both malignant epithelial and mesenchymal components. In this study, immunohistochemical stains of germ cell markers, including SALL4, OCT3/4, glypican-3, and alpha-fetal protein (AFP), and CDX2 were performed in a series of MMMTs. SALL4 nuclear immunoreactivity was detected in 6 out of 19 cases (33%). The staining extent ranged from focal to extensive. The staining intensity was usually intermediate to strong (the score ranged from 1.5 to 3, and average score was 2.3 ± 0.5 in the positive cases). In addition, glypican-3 cytoplasmic reactivity was detected in 14 out of 16 cases (88%) with a mean score of 1.8 ± 0.7 (score ranging from 1 to 3). In contrast, OCT3/4 was only positive in 1 out of 19 cases and AFP in 2 out of 18 cases (11%). In summary, SALL4 and glypican-3 were frequently expressed in a subset of MMMTs. Their roles in the pathogenesis and biology of MMMT are yet to be determined. MMMT should be included in the differential diagnosis when a tumor is positive for SALL4 and/or glypican-3.

Highlights

Malignant mixed Mullerian tumor (MMMT) is an aggressive neoplasm that usually occurs in postmenopausal women and responds poorly to treatment [1]
We investigated the expression of germ cell markers including SALL4, OCT3/4, glypican-3, and alpha-fetal protein (AFP) in a group of MMMTs
The immunohistochemical results for SALL4, OCT3/4, glypican3, CDX2, and AFP were listed in Table 2 and as follows

Summary

Introduction

Malignant mixed Mullerian tumor (MMMT) is an aggressive neoplasm that usually occurs in postmenopausal women and responds poorly to treatment [1]. Uterus and ovary are common sites for MMMT, though it can occur anywhere along the female genital tract and in the peritoneum. It is composed of both epithelial and mesenchymal components. The epithelial component can be endometrioid, undifferentiated, clear cell, or serous [1, 2]. The diagnosis of MMMT is usually not difficult; occasionally differentiation from various biphasic tumors such as mixed germ cell tumor can be difficult if the tumor occurred in relative younger age. CDX2, a transcription factor regulating early enterogenic differentiation and found to express in some testicular germ cell tumor [3], was evaluated in this group of MMMTs

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