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Metastatic prostate adenocarcinoma to the penis presenting as pagetoid carcinoma: a phenomenon not previously reported.

markers can be patchy and limited to a few tumor cells in UEC and may be negative in limited material such as an endometrial biopsy. Although cytokeratin positivity has not been reported in YWHAE-NUTM2 ESS, this has not been systematically investigated, and many sarcomas, including low-grade ESS, may be cytokeratin positive. Estrogen receptor and progesterone receptor are not useful in the distinction, as both tumor types are typically negative. It has recently been shown that cyclin D1 is strongly and diffusely positive (>70% tumor cells) in YWHAENUTM2 ESS, and this marker can be used to distinguish this neoplasm from other mesenchymal tumors, which are usually negative or only focally positive.1 In fact, a diagnosis of YWHAENUTM2 ESS can be strongly suspected and provisionally made on the basis of diffuse cyclin D1 staining in a tumor that is morphologically compatible with this diagnosis, although molecular conformation is desirable. We recently encountered 2 tumors in endometrial biopsies from 55and 78year-old women, which were composed of a diffuse monomorphic population of small round cells, which were broadspectrum cytokeratin, estrogen receptor and progesterone receptor negative, and diffusely and strongly cyclin D1 positive (Fig. 1), suggesting a diagnosis of YWHAE-NUTM2 ESS. However, resection specimens in both cases showed minor foci of low-grade endometrioid adenocarcinoma admixed with the diffuse population of small round cells; the latter, as well as exhibiting diffuse strong positive staining with cyclin D1, showed focal strong positive staining with broadspectrum cytokeratins and EMA, resulting in a final diagnosis of mixed UEC and low-grade endometrioid adenocarcinoma (dedifferentiated endometrioid adenocarcinoma). We subsequently performed cyclin D1 immunohistochemistry on 8 additional cases of UEC (4 pure, 4 dedifferentiated). All 8 tumors showed cyclin D1 expression, 4 diffuse and strong and 4 patchy. The low-grade endometrioid component also expressed cyclin D1 in all 6 cases where this was present (3 diffuse, 3 patchy). As YWHAE-NUTM2 ESS is typically negative for CD10 (except in the associated low-grade component, if present),4,5 we stained 7 of our 10 cases of UES with this marker. Four cases were negative, and 3 exhibited minor foci of positivity, illustrating that this marker is of little or no value in distinguishing YWHAE-NUTM2 ESS from UES. In summary, diffuse cyclin D1 staining is common in UEC and cannot be used to distinguish this from YWHAE-NUTM2 ESS. In cases in which these 2 tumors are in the differential diagnosis and in which there is diffuse strong positive staining with cyclin D1 and negative staining with cytokeratins and EMA, molecular studies are necessary for diagnosis.