Immunohistochemical expression and clinicopathological features of high-grade endometrial stromal sarcoma with ZC3H7B-BCOR gene fusion accompanied by MDM2 and CDK4 gene amplification

① In the sparse area, the tumor cells were spindle-shaped, light-moderate atypia, and interstitial mucoid transformation② The tumor cells in the dense area were fat fusiform or oval, and the mucoid transformation was not obvious③ Necrosis is common④ Most of the CD10 was amplified by the 2+ expression Envision method by immunohistochemistry⑤ Immunohistochemical staining of BCOR showed 1+ expression in Envision method⑥ Immunohistochemical staining of CyclinD1 showed 2+ expression and magnification in Envision method⑦ Immunohistochemical staining of SATB2 diffuse 3+ expression was amplified by Envision method⑧ Immunohistochemical staining of MDM2 diffuse 3+ expression was amplified by Envision method⑨ Immunohistochemical staining of CDK4 diffuse 3+ expression was amplified by Envision methodNote: The staining intensity is judged by the tan depth of the positive area, 0 (negative), 1+ (light yellow), 2+ (light brown), 3+ (dark brown).Figure 1-3 FISH results of MDM2, CDK4 and BCOR genesTable 1 Summary of clinicopathologic features of high-grade endometrial stromal sarcoma with ZC3H7B-BCOR gene fusion reported in this case and in the literatureTable 1 deals with the list of referencesLiterature [5]Mansor, S., Kuick, C. H., Lim, S. L., et al. ZC3H7B-BCOR-Rearranged Endometrial Stromal Sarcomas: A Distinct Subset Merits its Own Classification?. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists, 38(5), 420–425. https://doi.org/10.1097/PGP.0000000000000523Literature [7]Zhao, L., Cheng, Y. W., & Policarpio-Nicolas, et al. ZC3H7B-BCOR Fusion High-grade Endometrial Stromal Sarcoma With Morphologic Features of Low-grade Endometrial Stromal Sarcoma. A Case Report and Review of Literature. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists, 42(6), 597–601. https://doi.org/10.1097/PGP.0000000000000917Literature [8]Ondič, O., Bednářová, B., Ptáková, N., et al. ZC3H7B-BCOR high-grade endometrial stromal sarcoma may present as myoma nascens with cytoplasmic signet ring cell change. Virchows Archiv : an international journal of pathology, 476(4), 615–619. https://doi.org/10.1007/s00428-020-02744-5Literature [9]Lu, B., Chen, J., Shao, Y., et al. Two cases of ZC3H7B-BCOR high grade endometrial stromal sarcoma with an extension on its morphological features. Pathology, 52(6), 708–712. https://doi.org/10.1016/j.pathol.2020.05.007Literature [10]Zhi, W., Zheng, X., & Jin, Y. ZC3H7B-BCOR High-Grade Endometrial Stromal Sarcoma with a Mucoid Grossly Feature: A Case Report and Literature Review. International journal of women's health, 14, 1701–1708. https://doi.org/10.2147/IJWH.S390042Literature [11]Nagaputra J , Goh R , Kuick C ,et al.ZC3H7B-BCOR high-grade endometrial stromal sarcoma with osseous metaplasia: Unique feature in a recently defined entity[J].Human Pathology: Case Reports, 2019.https://doi.org/10.1016/j.ehpc.2018.11.002Table 2 Immunohistochemical expression of 24 cases in the literature and this case; The horizontal coordinate is immunohistochemical antibody; The ordinate is the number of cases