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However, a small subset of tumors harbor gene fusions, but their molecular spectrum and clinicopathological correlations have not been defined. We identified 12 uAS-like neoplasms in our files carrying\n                    <jats:italic>ESR1<\/jats:italic>\n                    gene fusions and reviewed 4 previously reported cases (total: 16). Patient\u2019s age range was 34 \u2013 76\u00a0years (median, 54). The tumors originated in the uterus body (5), unspecified uterus segment (5), cervix (1) and isthmus (1). Follow-up was available for 6 patients (median 44\u00a0months, range 9\u00a0months\u201420\u00a0years). One patient developed lung metastasis 52\u00a0months later and one had an abdominopelvic recurrence\u2009&gt;\u200920\u00a0years later. Four patients were disease-free at 9\u201455\u00a0months. All tumors harbored in-frame\n                    <jats:italic>ESR1<\/jats:italic>\n                    fusions (10 with\n                    <jats:italic>ESR1::NCOA3<\/jats:italic>\n                    , 1\n                    <jats:italic>ESR1:NCOA2<\/jats:italic>\n                    and 1\n                    <jats:italic>ESR1::MAMLD1<\/jats:italic>\n                    ). Nine tumors were low-grade and 3 high-grade. All lacked heterologous elements. Stromal overgrowth was recorded in three (all high-grade) and sex cord-like elements in 4 tumors. Phyllodiform architecture, admixed Mullerian glands, and periglandular stromal condensation distinguished the 4 tumors with sex cord-like elements from conventional uterine tumors resembling ovarian sex cord tumor (UTROSCT). This study expands the overlapping morphologic and molecular spectrum of uterine neoplasms resembling uAS showing recurrent fusions (mostly\n                    <jats:italic>ESR1::NCOA3\/2<\/jats:italic>\n                    ), associated with mostly low-grade histology, lack of heterologous elements and paucity of stromal overgrowth. The nosological relationship of these uAS-like tumors to UTROSCT (driven similarly by\n                    <jats:italic>ESR1::NCOA3\/2<\/jats:italic>\n                    fusions) and to fusion-negative\u00a0high-grade uAS\u00a0remains to be verified in future studies utilizing epigenetics and other tools.\n                  <\/jats:p>","DOI":"10.1007\/s00428-026-04403-7","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T02:42:48Z","timestamp":1768876968000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["ESR1::NCOA2\/3 fusions in uterine neoplasms with adenosarcoma-like morphology: clinicopathologic and molecular features of 12 cases and review of the literature"],"prefix":"10.1007","author":[{"given":"Abbas","family":"Agaimy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Chiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Michal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine K.","family":"Dermawan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blaise A.","family":"Clarke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Emons","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Stoehr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias W.","family":"Beckmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arndt","family":"Hartmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjelica","family":"Hodgson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Matias-Guiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina R.","family":"Antonescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan C.","family":"Dickson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"4403_CR1","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1007\/s00428-018-2470-6","volume":"473","author":"J Ferreira","year":"2018","unstructured":"Ferreira J, F\u00e9lix A, Lennerz JK, Oliva E (2018) Recent advances in the histological and molecular classification of endometrial stromal neoplasms. 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MM, JKD, XMG, CRA and BCD serve on the editorial board of Virchows Archiv. The authors have no financial or non-financial conflicts of interest to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}