Low-grade endometrial stromal sarcoma (LG-ESS) can present diagnostic challenges, due to its overlapping morphological features with other uterine mesenchymal tumors. Misdiagnosis rates remain significant, and immunohistochemical data for LG-ESS are limited to small series and inconsistent antibody panels. This study aimed to refine the IHC profile of LG-ESS by analyzing a large, molecularly confirmed series of 147 cases using a panel of 24 antibodies, including newer markers like transgelin and smoothelin. CD10 and IFITM1, key endometrial stromal markers, were expressed in 86% (92% of those extensively) and 69% (60% of those extensively) of cases, with fusion-positive tumors showing significantly higher expression. Smooth muscle markers (α-SMA, desmin, h-caldesmon, calponin, transgelin) were variably expressed, predominantly in focal or low-intensity patterns, with α-SMA reaching the highest frequency of expression (44%). However, the intensity of smooth muscle marker expression was usually very low. Smoothelin was rarely expressed. Hormone receptors were frequently positive, with PR showing a higher frequency (92% vs. 83%) and intensity than ER. Markers like S-100, HMB45, and CD117 were largely negative; all tumors were p53 wild-type, with preserved SMARCB1/SMARCA4 expression and ALK and ROS1 negativity. This work represents the largest molecularly validated IHC study on LG-ESS, providing a robust diagnostic profile for routine pathology. By addressing key diagnostic limitations and examining newer markers, our study supports a more standardized approach to diagnosing LG-ESS and underscores the value of immunohistochemical panels, particularly in fusion-negative tumors where diagnosis relies on morphological and immunohistochemical interpretation. These findings contribute critical data for improving diagnostic accuracy.

Biopticka laboratory University Hospital in Pilsen Czech Republic Pilsen Czech Republic

Caucasus Medical Centre Megalab Tbilisi Georgia

Caucasus Medical Centre Onco gynecological Department Tbilisi Georgia

Chair and Department of Obstetrics Gynaecology and Gynaecological Oncology Medical Univerity of Warsaw Warsaw Poland

Chair and Department of Oncologic Gynecology and Gynecology Medical University of Lublin Lublin Poland

Chair and Department of Toxicology Medical University of Lublin Lublin Poland

Department of Clinical and Molecular Pathology and Medical Genetics University Hospital and Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Gynaecology Obstetrics and Neonatology 1st Faculty of Medicine Charles University and General University Hospital in Praque Prague Czech Republic

Department of Gynecologic Oncology Khmelnytskyi regional anti tumor center Khmelnytskyi Ukraine

Department of Gynecologic Oncology National Oncology Institute Bratislava Slovakia

Department of Gynecological Oncology Pomeranian Hospitals Gdynia Poland

Department of Gynecological Oncology Wroclaw Medical University Wroclaw Poland

Department of Gynecology and Obstetrics Charles University 1st Faculty of Medicine and University Hospital Bulovka Prague Czech Republic

Department of Gynecology and Obstetrics Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

Department of Gynecology and Obstetrics Faculty of Medicine University of Debrecen Debrecen Hungary

Department of Gynecology and Obstetrics Tomas Bata Regional Hospital Zlín Czech Republic

Department of Gynecology and Obstetrics University Hospital Brno and Faculty of Medicine Masaryk University Brno Czech Republic

Department of Gynecology University of Medicine Pharmacy Sciences and Technology GE Palade Targu Mures Romania

Department of Obstetric and Gynecology University Hospital and Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Obstetrics and Gynecology 3rd Medical Faculty Charles University Prague and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Obstetrics and Gynecology Department of Oncology and Radiotherapy Charles University Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Obstetrics and Gynecology Faculty of Medicine and Dentistry Palacky University University Hospital Olomouc Olomouc Czech Republic

Department of Oncological Gynecology Lower Silesian Oncology Pulmonology and Hematology Center Wroclaw Poland

Department of Oncology and Nuclear Medicine Sestre milosrdnice University Hospital Centre Zagreb Croatia

Department of Pathology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Department of Pathology 3rd Medical Faculty Charles University Prague and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Pathology Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

Department of Pathology National Oncology Institute Bratislava Slovakia

Department of Pathology University Hospital Brno and Medical Faculty Masaryk University Brno Czech Republic

Department of Pathology University Hospital Bulovka Prague Czech Republic

Department of Pathology University Hospital Crosshouse Kilmarnock Scotland

Department of Pathology University of Medicine Pharmacy Sciences and Technology GE Palade Targu Mures Romania

Department of Tumor Pathology Maria Sklodowska Curie National Reaserch Institute of Oncology Cracow Branch Cracow Poland

Faculty of Humanities Tomas Bata University in Zlín Zlín Czech Republic

Gynecologic Oncology Unit Department of Woman and Child Health and Public Health Fondazione Policlinico Universitario 'A Gemelli' IRCCS Rome Italy

Gynecologic Oncology Unit La Paz University Hospital Madrid Spain

Ljudevit Jurak Department of Pathology and Cytology Sestre milosrdnice University Hospital Centre Zagreb Croatia

LUX MED Oncology Hospital Warsaw Poland

Lviv Regional Oncological Center Department of Oncology and Radiology Danylo Halytsky Lviv national medical university Lviv Ukraine

Pathological and Anatomical Department Tomas Bata Regional Hospital Zlín Czech Republic

Pathology Department La Paz University Hospital Madrid Spain

Section of Obstetrics and Gynecology University Department of Life Sciences and Public Health Università Cattolica del Sacro Cuore Rome Italy

Surgical Oncology Clinic Medical University in Gdansk Gdansk Poland

The Fingerland Department of Pathology Charles University Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove Hradec Kralove Czech Republic

University Hospital in Pilsen Pilsen Czech Republic

Zobrazit více v PubMed

WHO Classification of Tumours Editorial Board (2020) Female genital tumours. Lyon (France): International Agency for Research on Cancer. (WHO classification of tumours series, 5th ed.; vol. 4). https://publications.iarc.fr/592

Amant F, Floquet A, Friedlander M, Kristensen G, Mahner S, Nam EJ, Powell MA, Ray-Coquard I, Siddiqui N, Sykes P, Westermann AM, Seddon B (2014) Gynecologic Cancer InterGroup (GCIG) consensus review for endometrial stromal sarcoma. Int J Gynecol Cancer 24:S67-72. https://doi.org/10.1097/IGC.0000000000000205 PubMed DOI

Mayr D, Horn LC, Hiller GGR, Hohn AK, Schmoeckel E (2022) Endometrial and other rare uterine sarcomas : diagnostic aspects in the context of the 2020 WHO classification. Pathologe 43:183–195. https://doi.org/10.1007/s00292-022-01072-6 PubMed DOI

Amador-Ortiz C, Roma AA, Huettner PC, Becker N, Pfeifer JD (2011) JAZF1 and JJAZ1 gene fusion in primary extrauterine endometrial stromal sarcoma. Hum Pathol 42:939–946. https://doi.org/10.1016/j.humpath.2010.11.001 PubMed DOI

Zhu TH, Zhang FB, Yan H, Yu WY, Chen M, Guan YT (2022) A novel CDKN1A-JAZF1 gene fusion in low-grade endometrial stromal sarcoma arising from endometriosis in abdominal wall cesarean section scar: a case report and literature review. Taiwan J Obstet Gynecol 61:1082–1085. https://doi.org/10.1016/j.tjog.2022.04.010 PubMed DOI

Dickson BC (2019) Beyond smooth muscle-other mesenchymal neoplasms of the uterus. Surg Pathol Clin 12:107–137. https://doi.org/10.1016/j.path.2018.10.005 PubMed DOI

Akaev I, Yeoh CC, Rahimi S (2021) Update on endometrial stromal tumours of the uterus diagnostics (Basel) 11. https://doi.org/10.3390/diagnostics11030429

Conklin CM, Longacre TA (2014) Endometrial stromal tumors: the new WHO classification. Adv Anat Pathol 21:383–393. https://doi.org/10.1097/pap.0000000000000046 PubMed DOI

Nucci MR (2016) Practical issues related to uterine pathology: endometrial stromal tumors. Mod Pathol 29(Suppl 1):S92-103. https://doi.org/10.1038/modpathol.2015.140 PubMed DOI

Oliva E, Young RH, Amin MB, Clement PB (2002) An immunohistochemical analysis of endometrial stromal and smooth muscle tumors of the uterus: a study of 54 cases emphasizing the importance of using a panel because of overlap in immunoreactivity for individual antibodies. Am J Surg Pathol 26:403–412. https://doi.org/10.1097/00000478-200204000-00001 PubMed DOI

Richmond AM, Rohrer AJ, Davidson SA, Post MD (2017) Low-grade endometrial stromal sarcoma with extensive sex cord differentiation, heterologous elements, and complex atypical hyperplasia: Case report and review of literature Gynecol. Oncol Rep 19:34–38. https://doi.org/10.1016/j.gore.2016.12.002 DOI

Agoff SN, Grieco VS, Garcia R, Gown AM (2001) Immunohistochemical distinction of endometrial stromal sarcoma and cellular leiomyoma. Appl Immunohistochem Mol Morphol 9:164–169. https://doi.org/10.1097/00129039-200106000-00009 PubMed DOI

Dundr P, Gregova M, Hojny J, Krkavcova E, Michalkova R, Nemejcova K, Bartu M, Hajkova N, Laco J, Mara M, Richtarova A, Zima T, Struzinska I (2022) Uterine cellular leiomyomas are characterized by common HMGA2 aberrations, followed by chromosome 1p deletion and MED12 mutation: morphological, molecular, and immunohistochemical study of 52 cases. Virchows Arch 480:281–291. https://doi.org/10.1007/s00428-021-03217-z PubMed DOI

Flidrova M, Hajkova N, Hojny J, Dvorak J, Michalkova R, Krkavcova E, Laco J, McCluggage WG, Giordano G, Silini EM, Michalova K, Bizon M, Nemejcova K, Dundr P, Kendall Bartu M (2024) Unraveling the molecular landscape of uterine tumor resembling ovarian sex cord tumor: insights from a clinicopathological, morphologic, immunohistochemical, and molecular analysis of 35 cases. Mod Pathol 37:100611. https://doi.org/10.1016/j.modpat.2024.100611 PubMed DOI

Hwang H, Matsuo K, Duncan K, Pakzamir E, Pham HQ, Correa A, Fedenko A, Mhawech-Fauceglia P (2015) Immunohistochemical panel to differentiate endometrial stromal sarcoma, uterine leiomyosarcoma and leiomyoma: something old and something new. J Clin Pathol 68:710–717. https://doi.org/10.1136/jclinpath-2015-202915 PubMed DOI

Agaimy A, Clarke BA, Kolin DL, Lee CH, Lee JC, McCluggage WG, Poschke P, Stoehr R, Swanson D, Turashvili G, Beckmann MW, Hartmann A, Antonescu CR, Dickson BC (2022) Recurrent KAT6B/A::KANSL1 fusions characterize a potentially aggressive uterine sarcoma morphologically overlapping with low-grade endometrial stromal sarcoma. Am J Surg Pathol 46:1298–1308. https://doi.org/10.1097/PAS.0000000000001915 PubMed DOI PMC

Trecourt A, Azmani R, Hostein I, Blanchard L, Le Loarer F, Bourdon A, Alame M, Nadaud B, Mayer L, Rebier F, Larmonier C, Moura MS, Soubeyran I, Hartog C, Ray-Coquard I, Treilleux I, Devouassoux-Shisheboran M, Croce S (2023) The KAT6B::KANSL1 fusion defines a new uterine sarcoma with hybrid endometrial stromal tumor and smooth muscle tumor features. Mod Pathol 36:100243. https://doi.org/10.1016/j.modpat.2023.100243 PubMed DOI

Kommoss FKF, Charbel A, Kolin DL, Howitt BE, Kobel M, Lee JC, McCluggage WG, Agaimy A, Dickson BC, von Deimling A, Lee CH (2024) Uterine mesenchymal tumours harboring the KAT6B/A::KANSL1 gene fusion represent a distinct type of uterine sarcoma based on DNA methylation profiles. Virchows Arch 485:793–803. https://doi.org/10.1007/s00428-024-03935-0 PubMed DOI PMC

Dundr P, Dvorak J, Krausova M, Hojny J, Hajkova N, Struzinska I, Nemejcova K, Ondic O, Michal M, Michalova K, Berjon A, Jedryka M, Ksiazek M, Poprawski T, Rys J, Volodko N, Zapardiel I, Zima T, Cibula D, Poncova R, Matej R, Kendall Bartu M (2024) Uterine sarcoma with KAT6B/A::KANSL1 fusion: a molecular and clinicopathological study on 9 cases. Virchows Arch. https://doi.org/10.1007/s00428-024-03994-3

Dundr P, Matej R, Hojny J, Hajkova N, Nemejcova K, Kendall Bartu M (2024) The spectrum of fusions occurring in non-smooth muscle mesenchymal uterine tumors: a review of the current knowledge. Arch Pathol Lab Med. https://doi.org/10.5858/arpa.2023-0324-RA DOI

Hirsch FR, Varella-Garcia M, Bunn PA Jr, Di Maria MV, Veve R, Bremmes RM, Baron AE, Zeng C, Franklin WA (2003) Epidermal growth factor receptor in non-small-cell lung carcinomas: correlation between gene copy number and protein expression and impact on prognosis. J Clin Oncol 21:3798–3807. https://doi.org/10.1200/JCO.2003.11.069 PubMed DOI

Yoshida H, Kikuchi A, Tsuda H, Sakamoto A, Fukunaga M, Kaku T, Yoshida M, Shikama A, Kogata Y, Terao Y, Tanikawa M, Yasuoka T, Chiyoda T, Miyamoto T, Okadome M, Nakamura T, Enomoto T, Konno Y, Yahata H, Hirata Y, Aoki Y, Tokunaga H, Usui H, Yaegashi N (2022) Discrepancies in pathological diagnosis of endometrial stromal sarcoma: a multi-institutional retrospective study from the Japanese clinical oncology group. Hum Pathol 124:24–35. https://doi.org/10.1016/j.humpath.2022.03.007 PubMed DOI

Kolin DL, Nucci MR, Turashvili G, Song SJ, Corbett-Burns S, Cesari M, Chang MC, Clarke B, Demicco E, Dube V, Lee CH, Rouzbahman M, Shaw P, Cin PD, Swanson D, Dickson BC (2024) Targeted RNA sequencing highlights a diverse genomic and morphologic landscape in low-grade endometrial stromal sarcoma, including novel fusion genes. Am J Surg Pathol 48:36–45. https://doi.org/10.1097/PAS.0000000000002142 PubMed DOI

Park HJ, Kuk IS, Kim JH, Kim JH, Song SJ, Choi BC, Kim B, Kim NH, Song H (2011) Characterisation of mouse interferon-induced transmembrane protein-1 gene expression in the mouse uterus during the oestrous cycle and pregnancy. Reprod Fertil Dev 23:798–808. https://doi.org/10.1071/RD10086 PubMed DOI

Parra-Herran CE, Yuan L, Nucci MR, Quade BJ (2014) Targeted development of specific biomarkers of endometrial stromal cell differentiation using bioinformatics: the IFITM1 model. Mod Pathol 27:569–579. https://doi.org/10.1038/modpathol.2013.123 PubMed DOI

Tang Y, Chen Y, Tian L, Chen J, Yang P, Zhang D, Cui Q, Zhao L, Li L (2020) Vaginal low-grade endometrial stromal sarcoma: an extremely rare case report and review of the literature. Int J Gynecol Pathol 39:447–451. https://doi.org/10.1097/PGP.0000000000000626 PubMed DOI

Abeler VM, Nenodovic M (2011) Diagnostic immunohistochemistry in uterine sarcomas: a study of 397 cases. Int J Gynecol Pathol 30:236–243. https://doi.org/10.1097/PGP.0b013e318200caff PubMed DOI

Baker P, Oliva E (2007) Endometrial stromal tumours of the uterus: a practical approach using conventional morphology and ancillary techniques. J Clin Pathol 60:235–243. https://doi.org/10.1136/jcp.2005.031203 PubMed DOI PMC

Mittal K, Soslow R, McCluggage WG (2008) Application of immunohistochemistry to gynecologic pathology. Arch Pathol Lab Med 132:402–423. https://doi.org/10.5858/2008-132-402-AOITGP PubMed DOI

Rush DS, Tan J, Baergen RN, Soslow RA (2001) h-Caldesmon, a novel smooth muscle-specific antibody, distinguishes between cellular leiomyoma and endometrial stromal sarcoma. Am J Surg Pathol 25:253–258. https://doi.org/10.1097/00000478-200102000-00014 PubMed DOI

Busca A, Gulavita P, Parra-Herran C, Islam S (2017) IFITM1 outperforms CD10 in differentiating low-grade endometrial stromal sarcomas from smooth muscle neoplasms of the uterus. Int J Gynecol Pathol. https://doi.org/10.1097/PGP.0000000000000424 DOI

Zhao W, Cui M, Zhang R, Shen X, Xiong X, Ji X, Tao L, Jia W, Pang L, Sun Z, Wang C, Zou H (2021) IFITM1, CD10, SMA, and h-caldesmon as a helpful combination in differential diagnosis between endometrial stromal tumor and cellular leiomyoma. BMC Cancer 21:1047. https://doi.org/10.1186/s12885-021-08781-w PubMed DOI PMC

Jakate K, Azimi F, Ali RH, Lee CH, Clarke BA, Rasty G, Shaw PA, Melnyk N, Huntsman DG, Laframboise S, Rouzbahman M (2013) Endometrial sarcomas: an immunohistochemical and JAZF1 re-arrangement study in low-grade and undifferentiated tumors. Mod Pathol 26:95–105. https://doi.org/10.1038/modpathol.2012.136 PubMed DOI

Kurihara S, Oda Y, Ohishi Y, Iwasa A, Takahira T, Kaneki E, Kobayashi H, Wake N, Tsuneyoshi M (2008) Endometrial stromal sarcomas and related high-grade sarcomas: immunohistochemical and molecular genetic study of 31 cases. Am J Surg Pathol 32:1228–1238. https://doi.org/10.1097/PAS.0b013e31816a3b42 PubMed DOI

Park JY, Baek MH, Park Y, Kim YT, Nam JH (2018) Investigation of hormone receptor expression and its prognostic value in endometrial stromal sarcoma. Virchows Arch 473:61–69. https://doi.org/10.1007/s00428-018-2358-5 PubMed DOI

Rahimi S, Akaev I, Marani C, Chopra M, Yeoh CC (2019) Immunohistochemical expression of different subtypes of cytokeratins by endometrial stromal sarcoma. Appl Immunohistochem Mol Morphol 27:466–470. https://doi.org/10.1097/PAI.0000000000000642 PubMed DOI

Vera AA, Guadarrama MB (2011) Endometrial stromal sarcoma: clinicopathological and immunophenotype study of 18 cases. Ann Diagn Pathol 15:312–317. https://doi.org/10.1016/j.anndiagpath.2011.01.008 PubMed DOI

Zhu XQ, Shi YF, Cheng XD, Zhao CL, Wu YZ (2004) Immunohistochemical markers in differential diagnosis of endometrial stromal sarcoma and cellular leiomyoma. Gynecol Oncol 92:71–79. https://doi.org/10.1016/j.ygyno.2003.08.038 PubMed DOI

Leunen M, Breugelmans M, De Sutter P, Bourgain C, Amy JJ (2004) Low-grade endometrial stromal sarcoma treated with the aromatase inhibitor letrozole. Gynecol Oncol 95:769–771. https://doi.org/10.1016/j.ygyno.2004.07.063 PubMed DOI

Maenohara S, Fujimoto T, Okadome M, Sonoda K, Taguchi K, Saito T (2020) Potential alternative progestin therapy for low-grade endometrial stromal sarcoma: a case report Gynecol. Oncol Rep 34:100634. https://doi.org/10.1016/j.gore.2020.100634 DOI

Thiel FC, Halmen S (2018) Low-grade endometrial stromal sarcoma-a review. Oncol Res Treat 41:687–692. https://doi.org/10.1159/000494225 PubMed DOI

Cui R, Cao G, Bai H, Zhang Z (2019) The clinical benefits of hormonal treatment for LG-ESS: a meta-analysis. Arch Gynecol Obstet 300:1167–1175. https://doi.org/10.1007/s00404-019-05308-4 PubMed DOI

Huang X, Peng P (2022) Hormone therapy reduces recurrence in stage ii-iv uterine low-grade endometrial stromal sarcomas: a retrospective cohort study. Front Oncol 12:922757. https://doi.org/10.3389/fonc.2022.922757 PubMed DOI PMC

Cade TJ, Quinn MA, Rome RM, Polyakov A (2014) Prognostic significance of steroid receptor positivity and adjuvant progestogen use in endometrial stromal sarcoma. Aust N Z J Obstet Gynaecol 54:453–456. https://doi.org/10.1111/ajo.12245 PubMed DOI

Chu PG, Arber DA, Weiss LM, Chang KL (2001) Utility of CD10 in distinguishing between endometrial stromal sarcoma and uterine smooth muscle tumors: an immunohistochemical comparison of 34 cases. Mod Pathol 14:465–471. https://doi.org/10.1038/modpathol.3880335 PubMed DOI

Nucci MR, O’Connell JT, Huettner PC, Cviko A, Sun D, Quade BJ (2001) h-Caldesmon expression effectively distinguishes endometrial stromal tumors from uterine smooth muscle tumors. Am J Surg Pathol 25:455–463. https://doi.org/10.1097/00000478-200104000-00004 PubMed DOI

Robin YM, Penel N, Perot G, Neuville A, Velasco V, Ranchere-Vince D, Terrier P, Coindre JM (2013) Transgelin is a novel marker of smooth muscle differentiation that improves diagnostic accuracy of leiomyosarcomas: a comparative immunohistochemical reappraisal of myogenic markers in 900 soft tissue tumors. Mod Pathol 26:502–510. https://doi.org/10.1038/modpathol.2012.192 PubMed DOI

D’Angelo E, Spagnoli LG, Prat J (2009) Comparative clinicopathologic and immunohistochemical analysis of uterine sarcomas diagnosed using the World Health Organization classification system. Hum Pathol 40:1571–1585. https://doi.org/10.1016/j.humpath.2009.03.018 PubMed DOI

Kim GW, Baek SK, Han JJ, Kim HJ, Sung JY, Maeng CH (2022) Pulmonary metastasizing low-grade endometrial stromal sarcoma: case report and review of diagnostic pitfalls diagnostics (Basel) 12. https://doi.org/10.3390/diagnostics12020271

Yano Y, Yamasaki Y, Yamanaka K, Nishimoto M, Nagamata S, Terai Y (2023) A case of a recurrent low-grade endometrial stromal sarcoma extending to the inferior vena cava (IVC) after the primary fertility-sparing surgery. Int J Surg Case Rep 111. https://doi.org/10.1016/j.ijscr.2023.108857 PubMed DOI PMC

Tawfik O, Rao D, Nothnick WB, Graham A, Mau B, Fan F (2014) Transgelin, a novel marker of smooth muscle differentiation, effectively distinguishes endometrial stromal tumors from uterine smooth muscle tumors. Int J Gynecol Obstet Reprod Med Res 1:26–31 PubMed PMC

Kramer J, Aguirre-Arteta AM, Thiel C, Gross CM, Dietz R, Cardoso MC, Leonhardt H (1999) A novel isoform of the smooth muscle cell differentiation marker smoothelin. J Mol Med (Berl) 77:294–298. https://doi.org/10.1007/s001090050352 PubMed DOI

van der Loop FT, Schaart G, Timmer ED, Ramaekers FC, van Eys GJ (1996) Smoothelin, a novel cytoskeletal protein specific for smooth muscle cells. J Cell Biol 134:401–411. https://doi.org/10.1083/jcb.134.2.401 PubMed DOI

Coco DP, Hirsch MS, Hornick JL (2009) Smoothelin is a specific marker for smooth muscle neoplasms of the gastrointestinal tract. Am J Surg Pathol 33:1795–1801. https://doi.org/10.1097/pas.0b013e3181b76477 PubMed DOI

Mayhall KG Jr, Oertling E, Lewin E, Schmieg J, LeBeau H, Wu T, Crawford B (2019) The use of smoothelin and other antibodies in the diagnosis of uterine and soft tissue smooth muscle tumors. Appl Immunohistochem Mol Morphol 27:386–391. https://doi.org/10.1097/PAI.0000000000000619 PubMed DOI

Ahn SR, Lee JH (2020) Low-grade endometrial stromal sarcoma presenting as a sigmoid mass. Korean J Gastroenterol 76:322–326. https://doi.org/10.4166/kjg.2020.114 PubMed DOI

Klein WM, Kurman RJ (2003) Lack of expression of c-kit protein (CD117) in mesenchymal tumors of the uterus and ovary. Int J Gynecol Pathol 22:181–184. https://doi.org/10.1097/00004347-200304000-00011 PubMed DOI

Nakayama M, Mitsuhashi T, Shimizu Y, Ban S, Ogawa F, Ishihara O, Shimizu M (2006) Immunohistochemical evaluation of KIT expression in sarcomas of the gynecologic region. Int J Gynecol Pathol 25:70–76. https://doi.org/10.1097/01.pgp.0000183047.45459.36 PubMed DOI