[Practical diagnostic aspects of uterine leiomyosarcoma in the context of the 2020 WHO classification]

Pathological characteristics and clinical prognostic analysis of intravenous leiomyomatosis: a retrospective study of 43 cases

Objective

To analyze the clinicopathological features and prognostic factors of intravenous Leiomyomatosis (IVL), a rare yet recurrent disease.

Methods

This retrospective observational study enrolled 43 patients with pathologically confirmed IVL. Clinicopathological data were collected and reviewed. Univariate analyses were performed to identify prognostic factors for IVL recurrence.

Results

Clinical manifestations included increased menstrual flow (12/43), prolonged menstrual periods (18/43), pelvic mass (15/43), abdominal pain (8/43), or no symptoms (9/43). Histopathologically, tumor cells were predominantly located in the blood vessels of the uterine muscle wall and surrounding blood vessels. The tumor were composed of benign smooth muscle cells arranged in strips or bundles. Immunohistochemistry revealed that tumor cells were positive for SMA (43/43), Desmin (42/43), and Caldesmon (40/43). Incomplete resection of the lesions was identified as a risk factor for postoperative recurrence of IVL (P < 0.05). Age, menopause status, gravidity, parity, maximum diameter of IVL, uterine leiomyomas, involvement of uterine/extrauterine blood vessels, surgical methods, Ki-67 index, and mitotic figures were not associated with postoperative recurrence of IVL (P > 0.05).

Conclusion

IVL is a rare form of leiomyoma with potential for malignancy. Complete resection of the lesion should be performed whenever possible to improve patient prognosis.

FOXO3a deregulation in uterine smooth muscle tumors

OBJECTIVE

The present study aimed to investigate FOXO3a deregulation in Uterine Smooth Muscle Tumors (USMT) and its potential association with cancer development and prognosis.

METHODS

The authors analyzed gene and protein expression profiles of FOXO3a in 56 uterine Leiomyosarcomas (LMS), 119 leiomyomas (comprising conventional and unusual leiomyomas), and 20 Myometrium (MM) samples. The authors used techniques such as Immunohistochemistry (IHC), FISH/CISH, and qRT-PCR for the present analyses. Additionally, the authors conducted an in-silico analysis to understand the interaction network involving FOXO3a and its correlated genes.

RESULTS

This investigation revealed distinct expression patterns of the FOXO3a gene and protein, including both normal and phosphorylated forms. Expression levels were notably elevated in LMS, and Unusual Leiomyomas (ULM) compared to conventional Leiomyomas (LM) and Myometrium (MM) samples. This upregulation was significantly associated with metastasis and Overall Survival (OS) in LMS patients. Intriguingly, FOXO3a deregulation did not seem to be influenced by EGF/HER-2 signaling, as there were minimal levels of EGF and VEGF expression detected, and HER-2 and EGFR were negative in the analyzed samples. In the examination of miRNAs, the authors observed upregulation of miR-96-5p and miR-155-5p, which are known negative regulators of FOXO3a, in LMS samples. Conversely, the tumor suppressor miR-let7c-5p was downregulated.

CONCLUSIONS

In summary, the outcomes of the present study suggest that the imbalance in FOXO3a within Uterine Smooth Muscle Tumors might arise from both protein phosphorylation and miRNA activity. FOXO3a could emerge as a promising therapeutic target for individuals with Unusual Leiomyomas and Leiomyosarcomas (ULM and LMS), offering novel directions for treatment strategies.