SERTOLIFORM ENDOMETRIAL ADENOCARCINOMA - A STUDY OF 4 CASES

We studied four endometrial carcinomas with a conspicuous component th at resembled patterns in Sertoli cell tumors. The patients presented a t age 44-83 years (mean 65 years), with abnormal or postmenopausal vag inal bleeding in three and abnormal cervical cytology in one. All were multiparous, moderately to markedly obese, and hypertensive, and thre e patients had non-insulin-dependent diabetes mellitus. One tumor was suspected to be an endometrial stromal sarcoma with sex-cord-like diff erentiation on biopsy. Gross examination of the hysterectomy and bilat eral salpingo-oophorectomy specimens showed solid polypoid endometrial tumors in each case, Light microscopic examination showed three to be superficially invasive of the myometrium and one to be confined to th e endometrium; none of the tumors showed the tonguelike pattern of myo invasion or the angiolymphatic invasion characteristic of low-grade en dometrial stromal sarcomas. The sertoliform component, which predomina ted in one case and was only focal in the three others, was composed o f uniform small hollow tubules lined by columnar cells with apical cyt oplasm and of compact slender cords. The tubules and cords were often present between benign-appearing or carcinomatous glands. In the case with predominant sertoliform areas, the lesional cells had clear cytop lasm suggesting a lipid-rich variant; special stains of this case demo nstrated cytoplasmic glycogen but no fat. In none of the cases was cyt oplasmic mucin, argyrophil granules, or argentaffinity demonstrated. T he nonsertoliform areas of the tumors consisted of typical endometrioi d adenocarcinoma; concurrent endometrial hyperplasia was also present in each case. Squamous differentiation and minor foci of anaplastic ca rcinoma with bizarre tumor giant cells were present in three tumors. I mmunoperoxidase stains showed staining for two or more markers of epit helial or glandular differentiation in the sertoliform areas in all ca ses (keratin, epithelial membrane antigen, carcinoembryonic antigen, C A125, TAG72), with focal expression of vimentin in all cases. In none of the cases was desmin or actin staining observed. The evidence indic ates that tumors in this series are variants of endometrioid adenocarc inoma and are distinct from uterine tumors resembling ovarian sex-cord tumors and stromal sarcomas with sex-cord-like differentiation.