Diagnostic Value of Combined BCOR, Cyclin D1, and CD10 in Differentiating Endometrial Stromal Sarcoma From Other Uterine Spindle Cell Lesions

Mariam B Abouelkhair, Abouelkhair MB, Shakweer MM, Marwa M Shakweer, Malames M Faisal, Faisal MM, Magda H Nasreldin, Nasreldin MH, Farid LM, Laila M Farid
Applied immunohistochemistry & molecular morphology : AIMM · 2024 · vol. 32(7) , pp. 326–335 · doi:10.1097/PAI.0000000000001213 · PMID:38961542
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

A combined BCOR, Cyclin D1, and CD10 IHC panel differentiated high-grade endometrial stromal sarcoma from other uterine spindle cell lesions with 100% specificity.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This study evaluated the diagnostic value of a combined immunohistochemistry panel using BCOR, Cyclin D1, and CD10 to differentiate endometrial stromal sarcoma (ESS) from other uterine spindle cell lesions. Using 60 uterine lesion cases, the authors reported that BCOR diffuse positivity occurred in all high-grade ESS (12/12) but in none of low-grade ESS, malignant mesenchymal lesions (including leiomyosarcoma, adenosarcoma, and carcinosarcoma), or benign lesions, while Cyclin D1 positivity was observed only in high-grade ESS and paralleled BCOR. CD10 was negative in all high-grade ESS but positive in all low-grade ESS, endometrial stromal nodules, and adenomyosis; with the combined criteria BCOR diffuse+, Cyclin D1+, and CD10−, the panel showed 100% specificity and 75% sensitivity for high-grade ESS versus malignant mesenchymal lesions, and 100% specificity versus low-grade ESS. This paper is centrally about endometriosis — it includes adenomyosis among benign comparator lesions and uses it in an immunohistochemical differentiation context relevant to endometriosis spectrum disease.

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Abstract

Uterine spindle cell lesions share a dilemmatic overlapped features that needed to be addressed by the pathologist to reach a conclusive accurate diagnosis for its prognostic value and different management decisions. Usage of combined IHC panel can be an aiding guiding tool in this context. The aim of this study is to evaluate the diagnostic value of combined BCOR, Cyclin D1, and CD10 IHC panel in differentiating endometrial stromal sarcoma from other uterine spindle cell lesions. This study included 60 cases categorized into endometrial stromal sarcoma group (ESS) (12 cases high-grade endometrial stromal sarcoma [HGESS] and 18 cases low-grade endometrial stromal sarcoma [LGESS]), malignant uterine spindle cell lesions group (5 cases adenosarcoma [AS], 6 cases leiomyosarcoma [LS], 4 cases carcinosarcoma [CS]), and benign uterine lesions group (5 cases endometrial stromal nodule [ESN], 5 cases leiomyoma, and 5 cases adenomyosis). IHC staining procedure and evaluation for BCOR, Cyclin D1, and CD10 was performed on all studied cases. BCOR IHC staining was positive in all HGESS (12/12) of ESS group cases, with diffuse pattern in 75% of cases. BCOR-diffuse staining pattern was not recorded in any of LGESS (0/18), malignant mesenchymal lesions group (0/15), and also benign lesions group (0/15). Cyclin D1 positivity was observed only in HGESS cases, in parallel with positive-BCOR expression. On the contrary, CD10 was negatively expressed in all HGESS and positive in all LGESS, ESN, and adenomyosis cases. A specificity of 100% and sensitivity of 75% were recorded in differentiating HGESS from malignant mesenchymal lesions (including LMS, AS, and CS) and also HGESS from LGESS when using the combined panel BCOR +ve D /Cyclin D1 +ve / CD10 -ve , considering only the BCOR-diffuse staining pattern. In conclusion, BCOR +ve D /Cyclin D1 +ve /CD10 -ve as a combined panel is 100% specific and with lesser sensitivity in diagnosing HGESS as well as differentiating it from LGESS and other malignant uterine spindle cell lesions.
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Uterine spindle cell lesions share a dilemmatic overlapped features that needed to be addressed by the pathologist to reach a conclusive accurate diagnosis for its prognostic value and different management decisions. Usage of combined IHC panel can be an aiding guiding tool in this context. The aim of this study is to evaluate the diagnostic value of combined BCOR, Cyclin D1, and CD10 IHC panel in differentiating endometrial stromal sarcoma from other uterine spindle cell lesions. This study included 60 cases categorized into endometrial stromal sarcoma group (ESS) (12 cases high-grade endometrial stromal sarcoma [HGESS] and 18 cases low-grade endometrial stromal sarcoma [LGESS]), malignant uterine spindle cell lesions group (5 cases adenosarcoma [AS], 6 cases leiomyosarcoma [LS], 4 cases carcinosarcoma [CS]), and benign uterine lesions group (5 cases endometrial stromal nodule [ESN], 5 cases leiomyoma, and 5 cases adenomyosis). IHC staining procedure and evaluation for BCOR, Cyclin D1, and CD10 was performed on all studied cases. BCOR IHC staining was positive in all HGESS (12/12) of ESS group cases, with diffuse pattern in 75% of cases. BCOR-diffuse staining pattern was not recorded in any of LGESS (0/18), malignant mesenchymal lesions group (0/15), and also benign lesions group (0/15). Cyclin D1 positivity was observed only in HGESS cases, in parallel with positive-BCOR expression. On the contrary, CD10 was negatively expressed in all HGESS and positive in all LGESS, ESN, and adenomyosis cases. A specificity of 100% and sensitivity of 75% were recorded in differentiating HGESS from malignant mesenchymal lesions (including LMS, AS, and CS) and also HGESS from LGESS when using the combined panel BCOR+ve D/Cyclin D1+ve / CD10−ve, considering only the BCOR-diffuse staining pattern. In conclusion, BCOR+ve D/Cyclin D1+ve/CD10−ve as a combined panel is 100% specific and with lesser sensitivity in diagnosing HGESS as well as differentiating it from LGESS and other malignant uterine spindle cell lesions Research Articles Applied Immunohistochemistry & Molecular Morphology 32(7):p 326-335, August 2024. | DOI: 10.1097/PAI.0000000000001213 Readers Of this Article Also Read - The Diagnostic Utility of PAX8 for Neuroendocrine Tumors: An... - Immunohistochemical Distinction of Renal Cell Carcinoma from Other Carcinomas... - Role of PAX-8, CD5, and CD117 in Distinguishing Thymic Carcinoma From Poorly... - Immunohistochemical Overexpression of the p53 Protein and Ki-67 (MIB-1) Antigen ... - Primary Signet-ring Cell Carcinoma of the Urinary Bladder: A Clinicopathologic...

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Condition tags

adenomyosis

MeSH descriptors

Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1 Cyclin D1

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