GATA3-Positive Adnexal Adenocarcinoma: Report of a Confusing
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A 54 year-old Japanese male suffered from urothelial carcinoma (UC) of the right urothelium, which was completely excised. Three years later, a metastasis to the lower lobe of the right lung arose, and was treated by resection and chemotherapy. At the age of 62 years, the patient presented with a subcutaneous nodule around the surgical scar on the right lower abdomen, measuring 20 mm in diameter. One year after performng an excisional biopsy, lymph node dissection (LND) of the right inguinal lymph node (LN), which was swollen was performed. The next year, a LND of the swollen left inguinal LN was performed.

(H&E)-stained specimen of the nodule from the right lower abdomen demonstrated an expansive nodule from the dermis to the subcutis, not involving the epidermis. The neoplastic cells possessed oval nuclei and ample eosinophilic cytoplasm, and were densely grouped. Clear cells were mixed in part. Although decapitation secretion could not be seen, intracytoplasmic lumens were partially detected. Cell atypia was severe, with some giant cells and occasional atypical mitoses. In some areas, there was a significant deposit of pale-staining mucin in the stroma.

An H&E-stained specimen of the right urinary tract showed a nodule radially proliferating from the urothelial epithelium. The neoplastic cells possessed oval nuclei and ample eosinophilic cytoplasm, and were densely grouped. Cell atypia was severe, with occasional atypical mitoses. Mucin deposition was not significant in the stroma. The neoplastic cells of the resected specimen in the lower lobe of the right lung were the same as those of the urothelium.

Neoplastic cells in the subcutis and LNs were positive for CK7, GATA-binding protein 3 (GATA3), and GCDFP15 expression, and negative for CK5/6, CK20, p63, CD10, PAX8, HER-2, and uroplakin-II expression. Neoplastic cells in the urothelium and the lung were positive for CK7, CK5/6, and GATA3 expression, and negative for CK20, p63, GCDFP15, and TTF-1 expression. The differential diagnosis could include EMPSGC and AC. However, EMPSGC typically has solid papillary pattern and prominent mucin deposit. And, AC could be accompanied by decapitation secretion.

The final diagnoses were confirmed as adnexal adenocarcinoma NOS metastasizing to the bilateral inguinal LNs and UC metastasizing to the lung, respectively. Fluorodeoxyglucose-positron emission tomography/ computed tomography (FDG-PET/CT) after excision demonstrated no other hot spots. Neither local recurrence nor distant metastasis has appeared during 12 months of follow-up after the last LND.

Source: https://anndermatol.org/search.php?where=aview&id=10.5021/ad.2020.32.5.417&code=0140AD&vmode=FULL
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