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<p>Pilomatrix-like high-grade endometrioid carcinoma (PiMHEC) is characterized by solid basaloid morphology, geographic necrosis, and shadow cells, often associated with CTNNB1 mutations and aberrant β-catenin expression, exhibiting aggressive behavior. However, high-grade endometrial carcinomas with similar solid basaloid/geographic necrosis (SB-GN) features may overlap diagnostically with PiMHEC. This study aimed to investigate the clinicopathological and molecular characteristics of endometrial carcinomas with SB-GN and compare them with PiMHEC. Eighteen endometrial carcinomas with SB-GN (including 6 PiMHECs) were diagnosed in Fudan University Shanghai Cancer Center. Histopathological, immunohistochemical, and molecular features based on next-generation sequencing were reviewed. In our cohort, recurrence/metastasis occurred early (median: 5&#xa0;months; range: 0–21). Most cases had classic basaloid tumor cells with solid growth pattern. Spindle-shaped cells or tumor cells with more cytoplasm were occasionally observed. Twenty-eight percent of patients had squamous differentiation and 33% had shadow cells. In solid components, aberrant β-catenin expression was observed in 77.8% of cases. Eighty-three percent harbored <i>CTNNB1</i> exon 3 mutations (frequent co-mutations: <i>PTEN</i>, <i>ARID1A</i>, <i>PIK3CA</i>). Molecular classification revealed 28% MMR-deficient, 22% <i>POLE</i>-mutated, 6% p53-abnormal, and 44% no specific molecular profile (NSMP). Endometrial carcinomas with SB-GN showed no significant differences compared to PiMHECs, except for higher PR positivity in solid components (58.3% vs. 0%, <i>p</i> = 0.046). Endometrial carcinomas with SB-GN represent a distinct and aggressive tumor group characterized by solid growth pattern, prominent necrosis, frequent basaloid morphology, high rates of <i>CTNNB1</i> mutations, and aberrant β-catenin staining. Our results demonstrate that endometrial carcinomas with SB-GN and PiMHECs share similar clinicopathologic and molecular profiles, supporting a unified biological spectrum.</p>

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Endometrial carcinomas with solid basaloid morphology and geographic necrosis: clinicopathological and molecular features of 18 cases

  • 期刊论文

  • 发表日期：

    2025年12月4日

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  • Mengyuan Cai,
  • Tian Tang,
  • Rui Bi,
  • Huijuan Ge,
  • Xiaoyu Tu,
  • Ke Zuo,
  • Ziling Huang,
  • Xiaoyan Zhou,
  • Wentao Yang

摘要

Pilomatrix-like high-grade endometrioid carcinoma (PiMHEC) is characterized by solid basaloid morphology, geographic necrosis, and shadow cells, often associated with CTNNB1 mutations and aberrant β-catenin expression, exhibiting aggressive behavior. However, high-grade endometrial carcinomas with similar solid basaloid/geographic necrosis (SB-GN) features may overlap diagnostically with PiMHEC. This study aimed to investigate the clinicopathological and molecular characteristics of endometrial carcinomas with SB-GN and compare them with PiMHEC. Eighteen endometrial carcinomas with SB-GN (including 6 PiMHECs) were diagnosed in Fudan University Shanghai Cancer Center. Histopathological, immunohistochemical, and molecular features based on next-generation sequencing were reviewed. In our cohort, recurrence/metastasis occurred early (median: 5 months; range: 0–21). Most cases had classic basaloid tumor cells with solid growth pattern. Spindle-shaped cells or tumor cells with more cytoplasm were occasionally observed. Twenty-eight percent of patients had squamous differentiation and 33% had shadow cells. In solid components, aberrant β-catenin expression was observed in 77.8% of cases. Eighty-three percent harbored CTNNB1 exon 3 mutations (frequent co-mutations: PTEN, ARID1A, PIK3CA). Molecular classification revealed 28% MMR-deficient, 22% POLE-mutated, 6% p53-abnormal, and 44% no specific molecular profile (NSMP). Endometrial carcinomas with SB-GN showed no significant differences compared to PiMHECs, except for higher PR positivity in solid components (58.3% vs. 0%, p = 0.046). Endometrial carcinomas with SB-GN represent a distinct and aggressive tumor group characterized by solid growth pattern, prominent necrosis, frequent basaloid morphology, high rates of CTNNB1 mutations, and aberrant β-catenin staining. Our results demonstrate that endometrial carcinomas with SB-GN and PiMHECs share similar clinicopathologic and molecular profiles, supporting a unified biological spectrum.