Immunohistochemical analysis of 147 cases of low-grade endometrial stromal sarcoma: refining the immunohistochemical profile of LG-ESS on a large, molecularly confirmed series

• DOI: 10.1007/s00428-025-04026-4
• Publication Date: 2025-01-21T06:08:38Z
• Authors: Miroslava Flídrová; Pavel Dundr; Romana Vránková; Kristýna Němejcová; David Cibula; Renata Poncová; Květoslava Michalová; Jiří Bouda; Jan Laco; Munachiso Ndukwe; Janusz Ryś; Mariusz Książek; Alberto Berjon; Ignacio Zapardiel; Ivan Franin; Antonela Njavro; Jitka Hausnerová; Petra Bretová; Vladimír Židlík; Jaroslav Klát; Zoard Tibor Krasznai; Robert Poka; Nataliya Volodko; Iryna Yezhova; Radovan Pilka; Radim Marek; Georgina Kolnikova; Milan Krkoška; Michael Halaška; Jana Drozenová; Dagmar Dolinská; Vladimír Kalist; Marcin Bobiński; Marta Ostrowska-L...; Magdalena Bizoń; Włodzimierz Sawicki; Maciej Stukan; Karolina Grabowska; Marcin Jędryka; Tymoteusz Poprawski; Simona Stolnicu; Mihai Emil Căpîlna; Zuzana Špůrková; Michal Zikán; Francesca Ciccarone; Giovanni Scambia; Archil Sharashenidze; Miranda Gudadze; Tetiana Piatnytska; Ihor Varchak; Michaela Kendall ...
• Keywords: CD117; Desmin; Smooth Muscle Tumor

Abstract Low-grade endometrial stromal sarcoma (LG-ESS) can present diagnostic challenges, due to its overlapping morphological features with other uterine mesenchymal tumors. Misdiagnosis rates remain significant, and immunohistochemical data for LG-ESS are limited small series inconsistent antibody panels. This study aimed refine the IHC profile of by analyzing a large, molecularly confirmed 147 cases using panel 24 antibodies, including newer markers like transgelin smoothelin. CD10 IFITM1, key markers, were expressed in 86% (92% those extensively) 69% (60% cases, fusion-positive tumors showing significantly higher expression. Smooth muscle (α-SMA, desmin, h-caldesmon, calponin, transgelin) variably expressed, predominantly focal or low-intensity patterns, α-SMA reaching highest frequency expression (44%). However, intensity smooth marker was usually very low. Smoothelin rarely expressed. Hormone receptors frequently positive, PR vs. 83%) than ER. Markers S-100, HMB45, CD117 largely negative; all p53 wild-type, preserved SMARCB1/SMARCA4 ALK ROS1 negativity. work represents largest validated on LG-ESS, providing robust routine pathology. By addressing limitations examining our supports more standardized approach diagnosing underscores value panels, particularly fusion-negative where diagnosis relies interpretation. These findings contribute critical improving accuracy.