Join us   Log in  


Pages: 1214-1218
Print Article   Download XML  Download PDF

A p16 positive pleomorphic Endometrial Stromal Sarcoma: An Unusual Case Scenario

Author: Sarika Gupta, Anshul Singh, Vatsala Misra

Category: JMSR Pathology


Endometrial stromal sarcomas are rare uterine malignancies, particularly in young women,and are divided into four types- Endometrial Stromal Nodules [ESN], Low Grade ESS [LGESS], High Grade ESS [HGESS] and Undifferentiated Uterine Sarcomas [UUS]. A fifth category of Endometrial Stromal Sarcomas – Not Otherwise Specified [ESS-NOS] has also been kept for tumours with a predominantly high grade morphology showing significant LG ESS areas as well. Herein, we report a case of a 26 year old woman who presented with an abdominal mass and bleeding per vaginum. Abdomino pelvic ultrasound revealed a neoplastic polypoidal lesion. Post hysterectomy, histopathological examination revealed a tumour mass with features of a highly pleomorphic high grade endometrial stromal sarcoma[HGESS] along with concomitant features of low grade endometrial stromal sarcoma[LGESS] as well. Application of IHC panel further revealed that the tumorcame out to be immuno reactive for vimentin, cyclin D1, INI1 and p-16 with focal positivity for Calretinin, Glypican 3 and CD99, the demonstration of p16 positivity being highly unusual for a HGESS. As the patient’s condition deteriorated rapidly and she expired soon after the initial examination started, molecular profiling could not be done

Keywords: p16 positive, Endometrial sarcomas, stromal neoplasms of uterus, high grade endometrial stromal sarcomas, undifferentiated endometrial sarcomas


  1. Shekhar S, Sharma C, Elhence P, Bansal S & Garg N. A case of high-grade endometrial stromal sarcoma: A poignant allegory; Journal of Midlife health 2019;10(4): 209-212
  2. Cree IA, White VA, Indave BI, Lokuhetty D. Revising the WHO classification: female genital tract tumours. Histopathology 2020;76(1):151-156. doi: 10.1111/his.13977.
  3. Akaev I, Yeoh CC, Rahimi S. Update on Endometrial Stromal Tumours of the Uterus. Diagnostics (Basel). 2021; 11(3): 429. doi: 10.3390/diagnostics11030429
  4. Robert J. Kurman, Lora Hedrick Ellenson and Brigitte M. Ronnett [eds]. Blaustein’s Pathology of the Female Genital Tract 2019; 7th edition: Page- 486-487 [ISBN : 978-3-319-46333-9]
  5. Iwasaki S, Sudo T, Miwa M, Ukita M, Morimoto A, Tamada M, Ueno S, Wakahashi S, Yamaguchi S, Fujiwara K, Sakuma Y, Mikami Y, Nishimura R. “Endometrial stromal sarcoma: clinicopathological and immunophenotypic study of 16 cases. Arch Gynecol Obstet 2013; 288(2): 385-91. doi: 10.1007/s00404-013-2766-3
  6. Rekhi B, Motghare P. Cyclin D1 and p16INK4 positive endometrial stromal sarcoma: A case report with new insights. Indian J Pathol Microbiol 2014; 57: 606-8. doi: 10.4103/0377-4929.142689.
  7. Yoon G, Koh CW, Yoon N, Kim JY, Kim HS. Stromal p16 expression is significantly increased in endometrial carcinoma. Oncotarget. 2017;8(3):4826-36. doi: 10.18632/oncotarget.13594.
  8. Serra S, Chetty R. p16. J Clin Pathol. 2018; 71(10):853-858. doi:10.1136/jclinpath-2018-205216
  9. Goldblum JR, Lamps LW, Mc Kenny J et al. [eds]. Rosai and Ackerman’s Surgical Pathology. 11th ed. Elsevier publication, Cambridge;2018: 1317-1318
  10. Lenhard S., Untch M., Himsl, I. et al. The high-grade endometrial sarcoma: a rare entity. Arch Gynecol Obstet 2006; 274:56–59