Sarcomatoid squamous cell carcinoma of the uterine cervix

Abstract

Sarcomatoid squamous cell carcinoma (SSCC) is composed of squamous cell carcinoma element and spindle cell sarcoma element derived from squamous cell carcinoma element. SSCC is very rare and can occur in any organ, but is relatively common in the lung, esophagus, and skin. Most of the carcinoma of uterine cervix is squamous cell carcinoma (SCC), though adenocarcinoma is also common. However, SSCC in uterine cervix is very rare. The author reports here a case of SSCC of the uterine cervix. A 68-year-old Japanese woman was admitted to our hospital because of uterine bleeding. A colposcopic examination revealed an exophytic polypoid tumor (approximately 7 £ 7 £ 7 mm) in the cervix, and an incisional biopsy was performed. Histologically, it was composed of moderately diVerentiated SCC and spindle or round cell sarcomatous elements (Fig. 1a, b). Both elements had signiWcant nuclear atypia regarded as malignant (Fig. 1a–c). Gradual merges between the both elements were recognized in many areas (Fig. 1c). The histological diagnosis was SSCC. Immunohistochemically, the sarcomatous element was positive for pancytokeratin (AE1/3, WSS, KLM), cytokeratin (CK) 5/6, CK 34BE12, CK14, vimentin, p53, p63, and Ki67 (labeling = 36%), but negative for CK CAM5.2, CK 7, CK 18, CK 19, CK 20, CD34, S100 protein, CA125, epithelial membrane antigen, -smooth muscle antigen, neuron speciWc enolase, desmin, synaptophysin, and CD56. The SCC element was positive for pancytokeratin (AE1/3, WSS, KLM), CK 5/6, CK 34BE12, CK14, p53, p63, and Ki67 (labeling = 49%) but negative for vimentin, CK CAM5.2, CK 7, CK 18, CK 19, CK 20, epithelial membrane antigen, CA125, CD34, S100 protein, smooth muscle antigen, neuron-speciWc enolase, desmin, synaptophysin, and CD56. Thus, the immunohistochemical Wndings were similar between the SCC and sarcomatoid elements, except for vimentin. The histological and immunohistochemical diagnosis was SSCC. No metastasis was found by various imaging modalities. The clinical study revealed that the patient was FIGO stage IB1, and hysterectomy, bilateral salpingo-oophorectomy and lymph nodes dissection are now planed. The SCC and sarcomatous elements in the present case are histologically malignant. In addition, positive expression of p53 and high Ki67 labeling indicate the malignant nature of the both elements. Both elements were histologically merged, and gradual transitions were present between the both elements, suggesting that the sarcomatous element was derived from the SCC element. In addition, both the elements were positive for p63 and CK5/6, markers of squamous cells. The sarcomatous element expressed CK in addition to vimentin. The immunophenotype of both elements were similar except for vimentin. These observations suggest that the sarcomatous element was derived from the SCC element. The present case is not carcinosarcoma (malignant mixed Mullerian tumor, homologous), because the sarcomatous element showed epithelioid phenotypes and appears to be derived from the SCC element. Moreover, the carcinomatous component of malignant mixed Mullerian tumor is usually of the adenocarcinomatous or undiVerentiated type. The SSCC of the uterine cervix is very rare [1–7]. Actually, Li et al. [6] aYrmed in 2006 that less than 20 cases T. Terada (&) Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231, Shimizu-ku, Shizuoka 424-8636, Japan e-mail: piyo0111jp@yahoo.co.jp