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Hafiani H, Bouknani N, Oqbani K, Rami A. Low-grade endometrial stromal sarcoma, a rare uterine tumor: Case report. Radiol Case Rep 2024; 19:1823-1826. [PMID: 38420342 PMCID: PMC10899045 DOI: 10.1016/j.radcr.2024.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/20/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
This case report describes a 45-year-old woman presenting with abnormal uterine bleeding and a cervical mass. Imaging and biopsy revealed low-grade endometrial stromal sarcoma (LGESS), emphasizing the importance of comprehensive evaluation for uterine masses. The report underscores the role of MRI and pathology in diagnosis, with immunohistochemical analysis helping confirmation. A multidisciplinary approach and vigilant follow-up are crucial for optimal management. The rarity of LGESS and its challenging diagnosis highlight the need for continued research to improve diagnostic and therapeutic strategies. Surgical intervention remains primary, but the optimal management approach is debated. This report indicates the necessity of a comprehensive approach to uterine mass evaluation and ongoing research for enhanced patient care.
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Affiliation(s)
- Hamza Hafiani
- Mohammed VI University of Health Sciences Faculty of Medicine, Cheikh Khalifa Hospital, Casablanca-Settat
| | - Nawal Bouknani
- Mohammed VI University of Health Sciences Faculty of Medicine, Cheikh Khalifa Hospital, Casablanca-Settat
| | - Kenza Oqbani
- Mohammed VI University of Health Sciences Faculty of Medicine, Cheikh Khalifa Hospital, Casablanca-Settat
| | - Amal Rami
- Mohammed VI University of Health Sciences Faculty of Medicine, Cheikh Khalifa Hospital, Casablanca-Settat
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2
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Pinto A. Uterine Smooth Muscle Tumors: An Overview. Adv Anat Pathol 2024:00125480-990000000-00103. [PMID: 38647238 DOI: 10.1097/pap.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Uterine smooth muscle tumors are a heterogeneous group of mesenchymal neoplasms with multiple histologic variants and distinct biological behaviors. Pathologic classification (benign, uncertain malignant potential, malignant) relies on the evaluation of mitotic index, necrosis, and degree of cytologic atypia, with different thresholds based on each subtype. Immunohistochemistry and other ancillary studies may be necessary to establish the diagnosis in a subset of cases, given the morphologic overlap with other mesenchymal neoplasms, including low-grade and high-grade endometrial stromal tumors, inflammatory myofibroblastic tumors, and PEComa. Recent advances in molecular diagnostics have refined the classification of smooth muscle tumors, but most cases are diagnosed purely on histologic grounds.
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Affiliation(s)
- Andre Pinto
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL
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3
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Bhatt A, Mishra S, Glehen O. Histopathological Evaluation and Molecular Diagnostic Tests for Peritoneal Metastases with Unknown Primary Site-a Review. Indian J Surg Oncol 2023; 14:15-29. [PMID: 37359927 PMCID: PMC10284789 DOI: 10.1007/s13193-022-01612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
Cancer of unknown primary (CUP) is a well-studied entity with guidelines available for the management of patients with CUP. The peritoneum represents one of the metastatic sites in CUP, and peritoneal metastases (PM) could present as CUP. PM of unknown origin remains a poorly studied clinical entity. There is only one series of 15 cases, one population-based study, and few other case reports on this subject. Studies on CUP, in general, cover some common tumour histological types like adenocarcinomas and squamous carcinomas. Some of these tumours may have a good prognosis though majority have high-grade disease with a poor long-term outcome. Some of the histological tumour types commonly seen in the clinical scenario of PM like mucinous carcinoma have not been studied. In this review, we divide PM into five histological types-adenocarcinomas, serous carcinomas, mucinous carcinomas, sarcomas and other rare varieties. We provide algorithms to identify the primary tumour site using immunohistochemistry when imaging, and endoscopy fails to establish the primary tumour site. The role of molecular diagnostic tests for PM or unknown origin is also discussed. Current literature on site-specific systemic therapy based on gene expression profiling does not show a clear benefit of this approach over empirical systemic therapies.
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Affiliation(s)
- Aditi Bhatt
- Dept. of Surgical Oncology, Zydus Hospital, Thaltej, Ahmedabad 380054 India
| | - Suniti Mishra
- Dept. of Pathology, Sparsh Hospital, Bangalore, India
| | - Olivier Glehen
- Dept. of Surgical Oncology, Centre Hospitalier Lyon-Sud, Lyon, France
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4
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Devins KM, Attygalle AD, Croce S, Vroobel K, Oliva E, McCluggage WG. Uterine Endometrial Stromal Tumors With Pure Low-Grade Morphology Harboring YWHAE::NUTM2 Fusions: Report of a Case Series Emphasizing Potential for High-Grade Transformation and Aggressive Behavior. Am J Surg Pathol 2023; 47:717-724. [PMID: 37032555 DOI: 10.1097/pas.0000000000002041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Uterine endometrial stromal sarcomas (ESS) with YWHAE::NUTM2 gene fusions are typically morphologically high-grade tumors composed of atypical round cells, sometimes associated with a low-grade fibromyxoid component; they are currently included in the category of high-grade ESS (HGESS). We report 5 morphologically pure low-grade endometrial stromal tumors harboring YWHAE::NUTM2 fusions, including 1 endometrial stromal nodule (ESN) and 4 low-grade endometrial stromal sarcomas (LGESS), an association only occasionally reported previously. Patients ranged from 30 to 51 (mean=43) years and tumors from 4.5 to 7.5 cm (mean=5.7). All were stage I at diagnosis (confined to the uterus). Microscopically, the 4 LGESS showed extensive "tongue-like" invasion of the myometrium, and the ESN was entirely confined to the endometrium with no myometrial invasion. All tumors were composed entirely of morphologically uniform bland ovoid cells resembling proliferative endometrial stroma. A fibromyxoid component was seen in 1 LGESS and the ESN; in the LGESS, this was the sole component. Atypical round cells characteristic of YWHAE::NUTM2 HGESS were not identified. Mitotic count ranged from <1 to 13 per 10 high-power fields (mean: 3). CD10 was positive in 2/4 (focal), estrogen receptor in 5/5 (focal=1; diffuse=4), progesterone receptor in 5/5 (focal=1; diffuse=4) and cyclin D1 was diffusely positive in 3/4. Follow-up was available in all 5 patients and ranged from 6 to 159 months (mean=72). Two patients with LGESS had recurrent disease at 15 and 155 months; 1 showed predominantly LGESS with rare round cells in the initial recurrence and pure HGESS in a subsequent recurrence, while the other patient's recurrent tumor was predominantly HGESS (90%) in a background of focal fibromyxoid LGESS (10%). Both patients rapidly progressed and died of disease within 5 months of high-grade recurrence. We show that rare cases of morphologically pure low-grade endometrial stromal tumors, some but not all with a fibromyxoid component, harbor YWHAE::NUTM2 fusions and may recur rapidly, with transformation to HGESS and aggressive behavior. Our findings suggest that at least a subset of YWHAE::NUTM2 HGESS evolves from LGESS. We suggest that cyclin D1 and CD10 staining should be performed in all LGESS. Diffuse staining for cyclin D1 and/or negative or focal staining for CD10 should suggest the possibility of a YWHAE::NUTM2 fusion, and appropriate molecular testing should be undertaken. Since no single morphological or immunohistochemical parameter is entirely sensitive for fusion status, we also suggest that testing for a YWHAE::NUTM2 gene fusion should be considered in all cases of LGESS and, if a fusion is present, this should raise the possibility of subsequent high-grade transformation and aggressive behavior, even though such cases should still be categorized as LGESS. Although seemingly rare, ESN and LGESS with YWHAE::NUTM2 fusions may be under-recognized due to a lack of routine fusion testing.
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Affiliation(s)
- Kyle M Devins
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Esther Oliva
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
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5
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Dermawan JK, Dashti N, Chiang S, Turashvili G, Dickson BC, Ellenson LH, Kirchner M, Stenzinger A, Mechtersheimer G, Agaimy A, Antonescu CR. Expanding the molecular spectrum of gene fusions in endometrial stromal sarcoma: Novel subunits of the chromatin remodeling complexes PRC2 and NuA4/TIP60 as alternative fusion partners. Genes Chromosomes Cancer 2023; 62:152-160. [PMID: 36445224 PMCID: PMC9825654 DOI: 10.1002/gcc.23109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/12/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022] Open
Abstract
Endometrial stromal sarcomas (ESS) are morphologically and molecularly heterogeneous. We report novel gene fusions (EPC1::EED, EPC1::EZH2, ING3::PHF1) identified by targeted RNA sequencing in five cases. The ING3::PHF1-fusion positive ESS presented in a 58-year-old female as extrauterine mesocolonic, ovarian masses, and displayed large, monomorphic ovoid-to-epithelioid cells arranged in solid sheets. The patient remained alive with disease 13 months after surgery. The three ESS with EPC1::EED occurred in the uterine corpus in patients with a median age of 58 years (range 27-62 years). One tumor showed a uniform epithelioid nested morphology, while the other two were composed of monomorphic spindle cells in fascicles with elevated mitotic figures, focal tumor cell necrosis, and lymphovascular invasion. At a median follow-up of 20 months, two patients developed local recurrence, including one with concomitant distant metastasis, while one patient remained free of disease. All three patients were alive at the last follow-up. The EPC1::EZH2-fusion positive ESS presented in a 52-year-old female in the uterus, and displayed uniform spindled cells arranged in short fascicles, with focally elevated mitotic activity but without necrosis. The patient remained free of disease 3 months after surgery. All cases were diffusely positive for CD10; four diffusely express estrogen and progesterone receptors. Our study expands the molecular spectrum of EPC1 and PHF1-related gene fusions in ESS to include additional novel subunits of the PRC2 and/or NuA4/TIP60 complexes. These cases displayed a monomorphic epithelioid or spindled phenotype, spanning low-grade and high-grade cytomorphology, all expressing CD10 and commonly ER and PR, and are prone to local and/or distant spread.
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Affiliation(s)
- Josephine K. Dermawan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nooshin Dashti
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sarah Chiang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Brendan C. Dickson
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada
| | - Lora H. Ellenson
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martina Kirchner
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Abbas Agaimy
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Cristina R. Antonescu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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6
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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 2022; 61:1082-1085. [DOI: 10.1016/j.tjog.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
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7
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Devins KM, Young RH, Croce S, Burandt E, Bennett JA, Pesci A, Zannoni GF, Ip PPC, Nielsen GP, Oliva E. Solitary Fibrous Tumors of the Female Genital Tract: A Study of 27 Cases Emphasizing Nonvulvar Locations, Variant Histology, and Prognostic Factors. Am J Surg Pathol 2022; 46:363-375. [PMID: 34739418 DOI: 10.1097/pas.0000000000001829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report 27 solitary fibrous tumors of the female genital tract emphasizing nonvulvar locations, variant histology, and prognostic factors. The patients ranged from 25 to 78 years (most were over 40), and tumors occurred in the vulva (7), vagina (2), cervix (2), corpus (6), fallopian tube/paratubal soft tissue (5), and ovary (5). They ranged from 1.5 to 39 (mean=10.5) cm and were typically solid, but 4 were predominantly cystic. All had a haphazard arrangement of spindled to ovoid cells, with most demonstrating alternating cellular and hypocellular areas and prominent vessels, but 13 lacked hypocellular areas, and 7 had focal diffuse growth with inconspicuous vasculature. Other patterns included corded (8), fascicular (5), trabecular (1), and nested (1). Microcysts (6), myxoid background (8), hyalinization (8), lipomatous differentiation (2), and multinucleated cells (6) were also present, and 10 tumors had necrosis. Vasculature included thin-walled branching "staghorn" (27), thick-walled (7), and hyalinized vessels (5) or dilated anastomosing vascular channels (3). Nuclear atypia ranged from mild (19), moderate (7), to severe (1), and mitoses from 0 to 24/10 HPF (mean=4). STAT6 was positive in all 25 tumors tested. One tumor showed dedifferentiation; the remainder were classified as benign (19) or malignant (7) based on mitotic rate (univariate stratification model) and as low risk (14), intermediate risk (8), or high risk (4) based on the Demicco multivariate risk stratification score. Follow-up (median=23 mo) was available for 16 patients. Six tumors recurred (2 intermediate risk, 3 high risk, and the dedifferentiated tumor), 5 in the abdomen; the dedifferentiated tumor metastasized to the lung. Multivariate risk stratification was superior to univariate classification, as 5 "benign" tumors were reclassified as intermediate risk using the multivariate model; of these, 2 recurred, and 1 patient died of disease. Upper female genital tract tumors occurred in older patients, were larger, and more frequently classified as high risk compared with those of the lower tract. A trend toward increased cellularity was also seen in the upper tract tumors. Only size (P=0.04), necrosis (P=0.04), and Demicco score (P=0.01) independently correlated with recurrence. Female genital tract solitary fibrous tumors demonstrate a wide range of variant morphologies and occur in diverse sites in addition to the vulva. Tumors were often misdiagnosed as other neoplasms; thus, awareness of solitary fibrous tumors occurring at these sites is crucial in prompting staining for STAT6 to establish this diagnosis. The Demicco risk stratification system effectively predicts behavior.
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Affiliation(s)
- Kyle M Devins
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert H Young
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sabrina Croce
- Department of Pathology, Bergonié Institute, Bordeaux, France
| | - Eike Burandt
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Anna Pesci
- Department of Pathology, IRCCS Sacred Heart Hospital, Negrar-Verona
| | - Gian F Zannoni
- Department of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Philip P C Ip
- Department of Pathology, University of Hong Kong, Pokfulam, Hong Kong
| | - G Petur Nielsen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Esther Oliva
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
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8
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Dermawan JK, Zhang L, Singer S, Chi P, Antonescu CR. Low-grade endometrial stromal sarcoma-like tumors in male with JAZF1 gene fusions. Genes Chromosomes Cancer 2022; 61:63-70. [PMID: 34651371 PMCID: PMC8811592 DOI: 10.1002/gcc.23003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023] Open
Abstract
Low-grade endometrial stromal sarcoma (ESS) is a hormone-responsive low-grade sarcoma typically occurring in the uterine corpus in women. Their genetic hallmarks are recurrent gene fusions involving JAZF1, partnering with either SUZ12 gene or less commonly with PHF1. Low-grade ESS-like sarcoma, or endometrioid stromal sarcoma, is exceptionally rare in males and has been reported to date only in two cases, one in the paratesticular area and the other of prostatic stromal origin. We report herein two new cases of low-grade ESS-like sarcoma in male patients, one presenting as a periprostatic/peri-rectal mass with a JAZF1-GLI3 fusion, while the other as a paratesticular mass with a JAZF1-PHF1 fusion. As the GLI3 fusion appeared novel, we searched the transcriptional signature of 35 low-grade ESS from our archives and found a similar JAZF1-GLI3 fusion in a low-grade ESS arising from the uterine corpus, supporting a common pathogenesis. Histopathologically, both cases demonstrate cellular, monotonous proliferation of ovoid to fusiform cells with a background of arteriolar vascular network. Immunohistochemically, the neoplastic cells express ER, PR, and CD10, similar to ESS. One case also expresses diffuse and strong AR. On follow-up, the patient with the periprostatic mass recurred 2 years after initial surgery with peritoneal "sarcomatosis." We describe the salient diagnostic morphologic, immunohistochemical, and molecular features and discuss the differential diagnosis and possible pathogenesis of this unusual entity.
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Affiliation(s)
| | - Lei Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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9
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Bai H, Yuan F, Liang B, Sun H, Gao Y, Jin M, Xing X. Clinicopathological characteristics and treatment of patients with high-grade endometrial stromal sarcoma: A retrospective study of 40 cases. Medicine (Baltimore) 2022; 101:e28490. [PMID: 35029198 PMCID: PMC8758035 DOI: 10.1097/md.0000000000028490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
To investigate the clinicopathological characteristics of patients with high-grade endometrial stromal sarcoma (HG-ESS).The clinicopathological characteristics, treatments, and prognostic information of consecutive HG-ESS patients were collected from medical records and then evaluated.A total of 40 women were included in the analysis. The immunohistochemical profiles indicated that HG-ESS tumors tend to be locally or weakly positive for vimentin (100%) and CD10 (72.0%) but mostly negative for desmin (7.7%) and AE1/AE3 (9.1%). The progression-free survival intervals and the clinical benefit rates of patients receiving radiotherapy and/or chemotherapy were slightly longer and higher than those receiving simple observation (progression-free survival: 6 and 5 months vs 2 months; clinical benefit rate: 83.3% and 75.0% vs 28.6%). The 1-year disease-specific survival (DSS) rate was 62.7%. Tumor size, myometrial invasion, lymphovascular space invasion, cervical involvement, Federation International of Gynecology and Obstetrics (FIGO) stage, and residual disease all significantly affected the DSS rate (P < .001, =.002, <.001, =.004, <.001, and <.001, respectively). For patients with stage I disease, the 1-year DSS rate was as high as 91.7%, in contrast to 66.7%, 26.7%, and 0% for those with stage II, III, and IV disease, respectively.HG-ESS is associated with an adverse prognosis. FIGO stage could effectively predict the prognosis of patients with this lethal disease. Immunohistochemical markers, vimentin+/CD10+ (local or very weak), in combination with desmin-/AE1/AE3-, may be helpful for improving the diagnostic accuracy of this lethal condition. The therapeutic roles of adjuvant chemotherapy and radiotherapy warrant further investigation.
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Affiliation(s)
- Huimin Bai
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fang Yuan
- Department of Obstetrics and Gynecology, the Affiliated Hospital Qingdao University, Qingdao, China
| | - Bing Liang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hengzi Sun
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yutao Gao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Mulan Jin
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Xing
- Department of Pathology, the Affiliated Hospital Qingdao University, Qingdao, China
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10
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Sharma A, Bal M, Menon S. Extragenital endometrial stromal sarcoma of transverse mesocolon: A diagnostic conundrum. Int J Surg Pathol 2021; 30:551-556. [PMID: 34970922 DOI: 10.1177/10668969211070485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endometrial stromal sarcoma (ESS) is a rare uterine neoplasm infrequently arising in extra-genital sites. Herein, we report an extremely rare case of primary extra-genital ESS of transverse mesocolon occurring in a 51-year-old female presenting with gradually increasing abdominal mass. The clinical diagnosis considered was a gastrointestinal stromal tumor. Intra-operatively, the mass was confined exclusively to the transverse mesocolon. Microscopy revealed a cellular tumor composed of oval to elongate neoplastic cells with hyperchromatic nuclei, inconspicuous nucleoli and were immunoreactive for CD10, progesterone receptor (PR), estrogen receptor (ER), and PAX8; negative for KIT, CD34, SMA, S100, synaptophysin, chromogranin, WT-1, and calretinin. A distinct arborizing network of arterioles along with foci of endometriosis was also seen. We present this case for its extreme rarity and the challenges entailed in its diagnosis.
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Affiliation(s)
- Aishwarya Sharma
- Tata Memorial Hospital, Homi Bhabha National institute, Mumbai 400012, Maharashtra, India
| | - Munita Bal
- Tata Memorial Hospital, Homi Bhabha National institute, Mumbai 400012, Maharashtra, India
| | - Santosh Menon
- Tata Memorial Hospital, Homi Bhabha National institute, Mumbai 400012, Maharashtra, India
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11
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Bergman-Larsson J, Gustafsson S, Méar L, Huvila J, Tolf A, Olovsson M, Pontén F, Edqvist PHD. Combined expression of HOXA11 and CD10 identifies endometriosis versus normal tissue and tumors. Ann Diagn Pathol 2021; 56:151870. [PMID: 34844098 DOI: 10.1016/j.anndiagpath.2021.151870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 01/23/2023]
Abstract
The gold standard for diagnosing endometriosis is by laparoscopic visual demonstration of ectopic endometrial lesions outside the uterus, preferably verified by biopsy and microscopical examination. Molecular markers to facilitate the microscopical diagnosis of endometriosis and for distinguishing endometriosis from other benign and malignant lesions are lacking. Our aim was to test and validate an immunohistochemical antibody panel for improved diagnostic accuracy of endometriosis. Both CD10 and HOXA11 have been implicated in regulation of endometrial homeostasis. Here we have analyzed the expression pattern of these two proteins using immunohistochemistry on human tissues in a tissue microarray format. CD10 and HOXA11 expression in endometriosis lesions were compared to expression patterns in a range of normal tissues and in primary- and metastatic lesions of endometrial-, cervical- and ovarian cancer. HOXA11 and CD10 were expressed in 98% and 91% of endometriosis lesions and the combined double-positive expression profile of both HOXA11 and CD10 was highly sensitive for ectopic endometrial tissue (90%). The specificity and sensitivity for this double-positive signature in endometriosis was significantly different from all investigated tissues, cancers and metastases except normal, eutopic endometrial- and cervical mucosa. The combination of HOXA11 and CD10 expression profiles provides a useful tool to identify ectopic endometrial tissue and for distinguishing endometriosis from various types of gynecological malignancies and metastases.
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Affiliation(s)
- Julia Bergman-Larsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck Laboratory, Dag Hammarskjölds väg 20, SE-75185 Uppsala, Sweden
| | - Sofie Gustafsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck Laboratory, Dag Hammarskjölds väg 20, SE-75185 Uppsala, Sweden
| | - Loren Méar
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck Laboratory, Dag Hammarskjölds väg 20, SE-75185 Uppsala, Sweden
| | - Jutta Huvila
- Department of Pathology and Forensic Medicine, University of Turku, Turku University Hospital, Turku, Finland.
| | - Anna Tolf
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck Laboratory, Dag Hammarskjölds väg 20, SE-75185 Uppsala, Sweden.
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Fredrik Pontén
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck Laboratory, Dag Hammarskjölds väg 20, SE-75185 Uppsala, Sweden.
| | - Per-Henrik D Edqvist
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck Laboratory, Dag Hammarskjölds väg 20, SE-75185 Uppsala, Sweden.
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12
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Gu C, Duluc D, Wiest M, Xue Y, Yi J, Gorvel JP, Joo H, Oh S. Cell type-specific expression of estrogen and progesterone receptors in the human vaginal mucosa. Clin Immunol 2021; 232:108874. [PMID: 34740841 DOI: 10.1016/j.clim.2021.108874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/30/2022]
Abstract
Female sex hormones affect the immune response in the lower female genital tract. To understand their mechanisms of action, it is essential to define cell types expressing estrogen receptor (ER) and/or progesterone receptor (PR) in the human vaginal mucosa (VM). Here, we report that none of the dendritic cell (DC) subsets in the human VM expressed ERα or PR in situ. However, they were capable of expressing ERα, but not PR, after in vitro culture of the whole VM tissues. Similarly, ERα and/or PR expression by T cells in the VM tissues was also inducible rather than constitutive. In contrast, ERα and/or PR were constitutively expressed in HLA-DR- non-immune cell types (vimentin+, desmin+, or CD10+). These new findings will help us understand the mechanisms of action of female sex hormones in the modulation of immune response in the human VM and lower female genital tract.
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Affiliation(s)
- Chao Gu
- Department of Immunology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA
| | - Dorothee Duluc
- Immunoconcept, CNRS UMR 5164, Bordeaux University, Bordeaux, France
| | - Matthew Wiest
- Department of Immunology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA
| | - Yaming Xue
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Johnny Yi
- Department of Medical and Surgery Gynecology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, USA
| | - Jean-Pierre Gorvel
- Centre d'Immunologie de Marseille-Luminy, CIML, Aix Marseille Université, INSERM, CNRS, Marseille, France
| | - HyeMee Joo
- Department of Immunology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA.
| | - SangKon Oh
- Department of Immunology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA.
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Dundr P, Gregová M, Hojný J, Krkavcová E, Michálková R, Němejcová K, Bártů M, Hájková N, Laco J, Mára M, Richtárová A, Zima T, Stružinská I. 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 2021; 480:281-291. [PMID: 34626221 DOI: 10.1007/s00428-021-03217-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022]
Abstract
Cellular leiomyoma (CL) represents an uncommon variant of uterine leiomyoma with limited data concerning its immunohistochemical and molecular profile. We performed a comprehensive analysis of 52 CL cases all of which were analyzed immunohistochemically. Molecular analysis was possible in 32 cases with sufficient DNA, and 38 cases with sufficient RNA. The immunohistochemical results showed a high expression of smooth muscle markers (calponin (100%), desmin (100%), smooth muscle actin (98.1%), caldesmon (96.1%), transgelin (96.1%), smooth muscle myosin heavy chain (86.5%), and smoothelin (61.5%)). Concerning markers of endometrial stromal differentiation, the expression of CD10 was observed in 65.4% cases (42.2% with H-score > 50), and IFITM1 in 36.5% cases (1.9% with H-score > 50). 36.5% showed HMGA2 overexpression at the IHC level, associated with increased mRNA expression in 14/14 cases. The rearrangement of the HMGA2 gene was detected in 13.2%. Chromosome 1p deletion was found in 19.3%, while 9.4% of tumors showed a pathogenic mutation in the MED12 gene. In conclusion, CL is immunohistochemically characterized by a high expression of "smooth muscle" markers commonly associated with a co-expression of "endometrial stromal" markers, where IFITM1 shows superior performance compared to CD10 regarding its specificity for differentiation from endometrial stromal tumors. The sensitivity of smoothelin in CL seems rather low, but no data is available to assess its specificity. On a molecular level, the most common mutually exclusive aberration in CL affects HMGA2, followed by chromosome 1p deletions and MED12 mutations.
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Affiliation(s)
- Pavel Dundr
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 2, 12800, Prague 2, Czech Republic.
| | - Mária Gregová
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 2, 12800, Prague 2, Czech Republic
| | - Jan Hojný
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 2, 12800, Prague 2, Czech Republic
| | - Eva Krkavcová
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 2, 12800, Prague 2, Czech Republic
| | - Romana Michálková
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 2, 12800, Prague 2, Czech Republic
| | - Kristýna Němejcová
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 2, 12800, Prague 2, Czech Republic
| | - Michaela Bártů
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 2, 12800, Prague 2, Czech Republic
| | - Nikola Hájková
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 2, 12800, Prague 2, Czech Republic
| | - Jan Laco
- The Fingerland Department of Pathology, Faculty of Medicine in Hradec Králové, University Hospital in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Michal Mára
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Adéla Richtárová
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tomáš Zima
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Ivana Stružinská
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 2, 12800, Prague 2, Czech Republic
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14
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Zhao W, Cui M, Zhang R, Shen X, Xiong X, Ji X, Tao L, Jia W, Pang L, Sun Z, Wang C, Zou H. IFITM1, CD10, SMA, and h-caldesmon as a helpful combination in differential diagnosis between endometrial stromal tumor and cellular leiomyoma. BMC Cancer 2021; 21:1047. [PMID: 34556086 PMCID: PMC8461929 DOI: 10.1186/s12885-021-08781-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background The differential diagnosis of endometrial stromal tumor (EST) and uterine cellular leiomyoma (CL) remains a challenge in clinical practice, especially low grade endometrial stromal sarcoma (ESS) and CL, suggesting the need for novel immunomarkers panels for differential diagnosis. Interferon-induced transmembrane protein 1 (IFITM1) is a novel immunomarker for endometrial stromal cells, h-caldesmon is an immunomarker for smooth muscle cells and has a higher specificity than smooth muscle actin (SMA). So this study aimed to evaluate whether IFITM1, cluster of differentiation 10(CD10), SMA, and h-caldesmon are useful biomarker combinations for the differential diagnosis of EST and CL. Methods Tissue microarrays were used to detect IFITM1, CD10, SMA, and h-caldesmon immunohistochemical staining in 30 EST and 33 CL cases. Results The expressions of IFITM1 and CD10 were high in EST (86.7 and 63.3%, respectively) but low in CL (18.2 and 21.2%), whereas those of h-caldesmon and SMA were high in CL (87.9 and 100%) and low in EST (6.9 and 40%). In diagnosing EST, IFITM1 shows better sensitivity and specificity (86.7 and 81.8%, respectively) than CD10 (63.3 and 78.8%). The specificity of h-caldesmon in diagnosing CL was significantly higher (93.1%) than that of SMA (60%). When all four antibodies were combined for the differential diagnosis, the area-under-the-curve (AUC) predictive value was 0.995. The best combination for diagnosing EST was IFITM1 (+) or CD10 (+) and h-caldesmon (−) (sensitivity 86.7%, specificity 93.9%). Conclusion The best combination for diagnosing CL were h-caldesmon (+) and SMA (+) (sensitivity 87.9%, specificity 100%). IFITM1, CD10, SMA, and h-caldesmon are a good combination for the differential diagnosis of EST and CL.
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Affiliation(s)
- Weilin Zhao
- Department of Pathology, The First Affiliated Hospital, Shihezi University School of Medicine, Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education of China, NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Xinjiang, 832002, China.,Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Mei Cui
- Department of Pathology, Xinjiang Uygur Autonomous Region People's Hospital, Xinjiang, 830001, China
| | - Ruiqi Zhang
- Department of Pathology, The First Affiliated Hospital, Shihezi University School of Medicine, Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education of China, NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Xinjiang, 832002, China
| | - Xihua Shen
- Department of Pathology, The First Affiliated Hospital, Shihezi University School of Medicine, Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education of China, NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Xinjiang, 832002, China
| | - Xin Xiong
- Department of Pathology, The First Affiliated Hospital, Shihezi University School of Medicine, Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education of China, NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Xinjiang, 832002, China
| | - Xinhua Ji
- Department of Pathology, The First Affiliated Hospital, Shihezi University School of Medicine, Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education of China, NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Xinjiang, 832002, China
| | - Lin Tao
- Department of Pathology, The First Affiliated Hospital, Shihezi University School of Medicine, Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education of China, NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Xinjiang, 832002, China
| | - Wei Jia
- Department of Pathology, The First Affiliated Hospital, Shihezi University School of Medicine, Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education of China, NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Xinjiang, 832002, China
| | - Lijuan Pang
- Department of Pathology, The First Affiliated Hospital, Shihezi University School of Medicine, Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education of China, NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Xinjiang, 832002, China
| | - Zhenzhu Sun
- Department of Pathology, Xinjiang Uygur Autonomous Region People's Hospital, Xinjiang, 830001, China
| | - Chun Wang
- Department of Pathology, Xinjiang Uygur Autonomous Region People's Hospital, Xinjiang, 830001, China.
| | - Hong Zou
- Department of Pathology, The First Affiliated Hospital, Shihezi University School of Medicine, Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education of China, NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Xinjiang, 832002, China. .,Department of Pathology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, 310009, China.
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15
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Alghamdi DA. Myometrial myxoidosis in a patient with systemic lupus erythematosus. Ann Saudi Med 2021; 41:121-126. [PMID: 33818144 PMCID: PMC8020647 DOI: 10.5144/0256-4947.2021.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Myometrium myxoidosis is new terminology to describe a non-neo-plastic process of extracellular mucinous accumulation in the myometrium wall of the uterus. We report a rare association of myometrial myxoidosis with lupus erythematosus in a 35-year old woman with a history of leiomyoma. At presentation, this case was diagnosed as a pelvic abscess and treated with specific antibiotherapy, and then discharged after clinical improvement. One week later, after recurrence of the symptoms, the patient underwent hysterectomy with bilateral salpingo-oophorectomy and appendectomy with anterior abdominal soft tissue part resection. Pathological analysis revealed diffuse hypo-cellular myxoid areas intersecting the smooth muscle layer of the uterus and cervix in addition to a focal area in the interstitium of smooth muscles of the appendix and soft tissue of the anterior abdominal wall. This case emphasizes the importance of distinguishing between myxoid neoplastic and non-neoplastic lesions with myxoid changes. SIMILAR CASES PUBLISHED: To our knowledge, there are only two similar cases reported.
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Affiliation(s)
- Doaa Ali Alghamdi
- From the Department of Pathology, King Abdulaziz University, Jeddah, Saudi Arabia
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16
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Yao YB, Xiao CF, Lu JG, Wang C. Caldesmon: Biochemical and Clinical Implications in Cancer. Front Cell Dev Biol 2021; 9:634759. [PMID: 33681215 PMCID: PMC7930484 DOI: 10.3389/fcell.2021.634759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
Caldesmon, an actin-binding protein, can inhibit myosin binding to actin and regulate smooth muscle contraction and relaxation. However, caldesmon has recently attracted attention due to its importance in cancer. The upregulation of caldesmon in several solid cancer tissues has been reported. Caldesmon, as well as its two isoforms, is considered as a biomarker for cancer and a potent suppressor of cancer cell invasion by regulating podosome/invadopodium formation. Therefore, caldesmon may be a promising therapeutic target for diseases such as cancer. Here, we review new studies on the gene transcription, isoform structure, expression, and phosphorylation regulation of caldesmon and discuss its clinical implications in cancer.
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Affiliation(s)
- Yi-Bo Yao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chang-Fang Xiao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jin-Gen Lu
- Longhua Hospital, Institute of Chinese Traditional Surgery, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Wang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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17
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Rekhi B. Role of immunohistochemistry in gynec oncopathology including specific diagnostic scenarios with associated treatment implications. INDIAN J PATHOL MICR 2020; 63:S70-S80. [PMID: 32108634 DOI: 10.4103/ijpm.ijpm_832_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Over the years, immunohistochemistry has emerged as a powerful tool for a more precise diagnosis of certain tumors in gynecologic oncopathology and resolving certain diagnostic dilemmas with significant treatment implications. Certain specific immunohistochemical (IHC) markers have been useful in the more correct identification of rare tumors, characterized by specific molecular signatures. Immunohistochemistry has also been useful in the identification of underlying genetic events, characterizing various tumors, as well as precancerous lesions. This review will focus upon the judicious application of various IHC antibody markers in gynec oncopathology, including authors' experience during "sign-outs" and especially during interaction with other oncology colleagues within the institutional disease management group. The updated references were retrieved from PubMed.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Centre, HBNI University, Mumbai, Maharashtra, India
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18
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Hodgson A, Swanson D, Tang S, Dickson BC, Turashvili G. Gene fusions characterize a subset of uterine cellular leiomyomas. Genes Chromosomes Cancer 2020; 59:688-696. [PMID: 32677742 DOI: 10.1002/gcc.22888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/03/2020] [Accepted: 07/14/2020] [Indexed: 01/12/2023] Open
Abstract
Uterine leiomyomas are the most common benign tumor of the female genital tract. Previous studies have shown that conventional leiomyomas often harbor-specific alterations including rearrangements involving HMGA2. Cellular leiomyomas are a variant of uterine leiomyoma that are less well-studied from a genomic point of view. Morphologically and immunohistochemically, cellular leiomyomas may be confused with low-grade endometrial stromal neoplasms, a group of tumors which frequently harbor a number of recurrent gene fusions. Ancillary molecular testing may be used to investigate tumors where low-grade endometrial stromal neoplasms enter into the differential diagnosis. At our institution, we identified a uterine cellular leiomyoma harboring a HMGA2-TRAF3IP2 fusion. After a retrospective review 11 additional tumors were identified. All included cases were reviewed and evaluated for immunohistochemical expression of smooth muscle actin, desmin, h-caldesmon, CD10, estrogen receptor, and progesterone receptor. RNA sequencing using the TruSight RNA Fusion Panel was performed on formalin-fixed paraffin-embedded tissue samples. In addition to the index case, two other cases harbored fusions: HMGA2-NAA11 and TPCN2-YAP1, of which the latter is novel and was confirmed with reverse transcriptase-polymerase chain reaction. In conclusion, a subset of cellular leiomyomas harbor rearrangements involving HMGA2, suggesting molecular kinship with conventional uterine leiomyomas. In addition, the prevalence of the novel TPCN2-YAP1 gene fusion in cellular leiomyomas requires further study. The fusions reported here, when identified, may be useful when the diagnosis of cellular leiomyoma is in question.
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Affiliation(s)
- Anjelica Hodgson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - David Swanson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Shangguo Tang
- Department of Pathology, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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19
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Alabiad MA, Harb OA, Abdelfattah MT, El-Shafaay BS, El-Taher AK, El-Hendawy EI. The values of Transgelin, Stathmin, BCOR and Cyclin-D1 expression in differentiation between Uterine Leiomyosarcoma (ULMS) and Endometrial Stromal Sarcoma (ESS); diagnostic and prognostic implications. SURGICAL AND EXPERIMENTAL PATHOLOGY 2020. [DOI: 10.1186/s42047-020-00065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Morphologic distinction between uterine leiomyosarcoma (ULMS) and endometrial stromal sarcoma (ESS) alone is not straightforward and has been shown to be challenging especially with poor differentiation, so immunohistochemistry (IHC) is often employed as an adjunct to morphology in uterine sarcoma.
Aim
We aimed to assess the diagnostic utility of Transgelin, Stathmin, BCOR and Cyclin-D1 separately and in-combinations in distinguishing ULMS from ESS, and to evaluate their prognostic value in patients with such sarcoma subtypes.
Material and Methods
We included 44 patients with uterine sarcoma. The diagnostic performances of Transgelin, Stathmin, BCOR and Cyclin-D1 were assessed in samples from all patients using immunohistochemistry.
Results
The combination of Stathmin and Transgelin expression has high sensitivity and specificity for diagnosis of LMS and differentiating it from ESS; 95.5% and associated with poor prognosis in LMS patients.
The combination of BCOR and Cyclin-D1 expression has high sensitivity and specificity for diagnosis of ESS and differentiating it from LMS; 90.9% and 95.5% respectively and associated with poor prognosis in ESS patients. The combination of Stathmin and Transgelin, BCOR and CyclinD1 expression has high sensitivity and specificity for diagnosis of LMS and differentiating it from ESS; 100%.
Conclusion
Combination of Stathmin, Transgelin, BCOR and Cycline-D1 raised the accuracy of differentiation between ULMS and ESS to 100% and has prognostic roles in such sarcomas.
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20
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Subbaraya S, Murthy SS, Devi G S. Immunohistochemical and Molecular Characterization of Endometrial Stromal Sarcomas. CLINICAL PATHOLOGY 2020; 13:2632010X20916736. [PMID: 32524088 PMCID: PMC7236392 DOI: 10.1177/2632010x20916736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
Introduction: Endometrial stromal sarcomas (ESSs) are rare and characterized by translocations t(7;17)(p15;q11.2) and t(10;17)(q22;p13), resulting in JAZF1-SUZ12 and YWHAE-FAM22 gene fusions used for defining low-grade (LG-ESS) and high-grade (HG-ESS) tumours. Aim: The objective of the study was to characterize ESSs using immunohistochemical and molecular markers. Material and Methods: Patients diagnosed as having ESSs between January 2014 and December 2018 were included in the study. The slides were reviewed along with a panel of immunohistochemical markers, CD10, cyclin D1, oestrogen receptor (ER) and progesterone receptor (PR), Ki67, and vimentin and classified according to World Health Organization (2014) criteria into LG-ESS, HG-ESS, and undifferentiated uterine sarcoma (UUS). Molecular characterization was performed by fluorescence in situ hybridization using relevant probes. Results: Over a 4-year period, 552 cases of endometrial malignancies were reported, 10 of which were ESS (1.8%). Of these, 5 were LG-ESS, 3 HG-ESS, and 2 UUS. CD10 was 100% sensitive and 75% specific for LG-ESS. Oestrogen receptor and PR were 100% specific but less sensitive (80%) for LG-ESS. Forty per cent (2/5) of LG-ESS demonstrated JAZF1-SUZ12 gene rearrangement. All 3 cases of HG-ESS showed diffuse strong cyclin D1 (>70% nuclei) positivity and were negative for cluster differentiation 10, ER, and PR and demonstrated YWHAE gene rearrangement. None of the UUS cases demonstrated this gene rearrangement. Conclusion: Endometrial stromal sarcomas are rare tumours (1.8% in this study). JAZF1-SUZ12 and YWHAE-FAM22 gene rearrangement helps in accurate characterization of ESS and can be used as diagnostic tools especially when the diagnosis is unclear or difficult. Cyclin D1 can be used as an adjuvant immunomarker for YWHAE gene–rearranged HG-ESS.
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Affiliation(s)
- Sneha Subbaraya
- Department of Pathology & Lab Medicine, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Sudha S Murthy
- Department of Pathology & Lab Medicine, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Sandhya Devi G
- Department of Pathology & Lab Medicine, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
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21
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Yang VS, Lim JQ, Tay TKY, Selvarajan S, Ng CCY, Farid M, Teh BT, Chan JY. Clinicopathologic Features and Whole Genome Sequencing of a Primary Osteosarcoma of the Uterus. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2020; 3:90-95. [PMID: 36751521 PMCID: PMC9179399 DOI: 10.36401/jipo-19-34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/06/2020] [Indexed: 12/18/2022]
Abstract
Primary osteosarcoma (OS) of the uterus is a distinctly rare and aggressive disease with fewer than 20 cases reported worldwide. We describe a case of primary uterine OS with rapid development of pulmonary and brain metastasis in a 50-year-old woman. Histopathologic examination of the uterine tumor showed atypical spindle cells producing an osteoid matrix with calcification in keeping with OS. Despite initial response to doxorubicin and ifosfamide, the patient succumbed to brain metastases just 8 months from diagnosis. Whole genome sequencing was performed on tumor and blood samples to analyze genetic alterations in this highly aggressive tumor. A pathogenic somatic missense mutation resulting in substitution of glutamate for lysine at position 653 within the protein kinase domain of the platelet-derived growth factor receptor beta (PDGFRB) was found. The PDGF pathway is involved in cell proliferation and angiogenesis, and it has been implicated in malignancy. Crucially, this pathogenic mutation may be amenable to PDGFR tyrosine kinase inhibition, representing a possible treatment approach in this rare sarcoma.
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Affiliation(s)
- Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
,Institute of Molecular and Cell Biology, Singapore
| | - Jing Quan Lim
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore
| | | | | | | | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Bin Tean Teh
- Institute of Molecular and Cell Biology, Singapore
,Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore
,Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
,Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
,Cancer Science Institute of Singapore, National University of Singapore, Singapore
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22
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Nasioudis D, Ko EM, Kolovos G, Vagios S, Kalliouris D, Giuntoli RL. Ovarian preservation for low-grade endometrial stromal sarcoma: a systematic review of the literature and meta-analysis. Int J Gynecol Cancer 2020; 29:126-132. [PMID: 30640694 DOI: 10.1136/ijgc-2018-000063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate the effect of ovarian preservation on oncologic outcomes for women with low-grade endometrial stromal sarcoma of the uterus. METHODS A systematic search of the Medline, Embase, Cohrane, and Web of Science databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies including patients with low-grade endometrial stromal sarcoma who had hysterectomy were identified. Data on tumor recurrence and death rate were pooled using a random effects model. RESULTS A total of 17 studies met the inclusion criteria and reported on 786 patients. Based on available information, ovarian preservation was noted in 190 patients while 501 had bilateral salpingo-oophorectomy. A significantly increased tumor recurrence rate was observed in the ovarian preservation group (89/190, 46.8%) compared with the bilateral salpingo-oophorectomy group (121/501, 24.2%) (OR 2.70, 95% CI 1.39 to 5.28). Based on data from 162 patients, no difference in death rate was noted between the ovarian preservation (2/34, 5.9%) and bilateral salpingo-oophorectomy (9/128, 7%) groups (OR 0.80, 95% CI 0.18 to 3.47). CONCLUSIONS Approximately one-quarter of patients with low-grade endometrial stromal sarcoma were managed with ovarian preservation. These women experienced a higher recurrence rate. Hormone exposure may be responsible for this elevated risk. Given the apparent high salvage rate, however, ovarian preservation may be an option only in a well-informed patient population.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA .,Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Emily M Ko
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Georgios Kolovos
- Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Stylianos Vagios
- Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Dimitrios Kalliouris
- Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Robert L Giuntoli
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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23
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Sohail R, Kanwal S, Murtaza A, Haq B. Endometrial stromal sarcoma in a 20-year-old woman. BMJ Case Rep 2019; 12:12/12/e228874. [PMID: 31818885 DOI: 10.1136/bcr-2018-228874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Endometrial stromal sarcoma (ESS) is an uncommon and challenging condition comprising 10% of all uterine sarcomas and found in women 42-58 years of age. ESS is difficult to diagnose in young women as it masquerades as a leiomyoma. We report this tumour in a 20-year-old woman presenting with heavy and prolonged menses and urinary retention. She was not sexually active and did not give consent for pelvic examination. A preoperative diagnosis of a submucous leiomyoma with an adnexal mass was made. At laparotomy, the leiomyoma was found to be wedged between the cervix and the vagina, and was removed vaginally. A 5-6 cm retroperitoneal mass was adherent to the right pelvic wall, which was also removed. Histopathology of both specimens revealed ESS. The final diagnosis according to the International Federation of Gynaecology and Obstetrics classification was stage IV ESS. After oncology consult, she was referred for chemotherapy. She is now on follow-up.
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Affiliation(s)
- Rubina Sohail
- Obstetrics and Gynaecology, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan .,Obstetrics and Gynaecology, Hameed Latif Hospital, Lahore, Punjab, Pakistan
| | - Shahlla Kanwal
- Obstetrics and Gynaecology, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Adnan Murtaza
- Obstetrics and Gynaecology, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Bushra Haq
- Obstetrics and Gynaecology, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
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24
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Abstract
The spectrum of mesenchymal neoplasia in the uterus has expanded in recent years. First, the identification of prevalent, recurrent molecular alterations has led to a more biologically and clinically congruent classification of endometrial stromal tumors. Likewise, the diagnostic criteria of several rare and miscellaneous tumor types have been refined in recent case series (Perivascular Epithelioid Cell tumor, inflammatory myofibroblastic tumor). Pure mesenchymal tumors are still broadly classified based on morphology according to the tumor cell phenotype. Smooth muscle tumors predominate in frequency, followed by tumors of endometrial stromal derivation; the latter are covered in depth in this article with an emphasis on defining molecular alterations and their morphologic and clinical correlates. The remaining entities comprise a miscellaneous group in which cell derivation does not have a normal counterpart in the uterus (eg, rhabdomyosarcoma) or is obscure (eg, undifferentiated uterine sarcoma). This article discusses their clinical relevance, recent insights into their molecular biology, and the most important differential diagnoses. Regarding the latter, immunohistochemistry and (increasingly) molecular diagnostics play a role in the diagnostic workup. We conclude with a few considerations on intraoperative consultation and macroscopic examination, as well as pathologic staging and grading of uterine sarcomas as per the most recent American Joint Cancer Commission and the Fédération Internationale de Gynécologie et d'Obstétrique staging systems.
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Borella F, Lucchino F, Bertero L, Ribotta M, Castellano I, Carosso A, Cosma S, Katsaros D, Benedetto C. Clinico-pathological features of gynecological myopericytoma: a challenging diagnosis in an exceptional location. Virchows Arch 2019; 475:763-770. [PMID: 31410559 DOI: 10.1007/s00428-019-02645-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/29/2019] [Accepted: 05/31/2019] [Indexed: 02/01/2023]
Abstract
Myopericytomas (MPC) are rare mesenchymal tumors, originating from the perivascular myoid cells. They predominantly occur in the skin and superficial soft tissues of the extremities, while visceral involvement is rare. Histological features and clinical course are usually benign. To the best of our knowledge, MPC is still an uncharacterized tumor entity of the female internal genital tract. We describe three MPC cases involving the female internal genital tract: (1) a uterine wall MPC arising in a 49-year-old woman with progressive pelvic/abdominal pain; (2) a cervix MPC of a 49-year-old woman who presented with metrorrhagia, and (3) a MPC presenting as a simple ovarian cyst in a 26-year-old woman with pain located in the left iliac fossa. All patients were surgically treated, and recurrence occurred in two cases. The histological and immunohistochemical findings, supporting the diagnosis of MPC, are presented; in particular, one case showed characteristics pointing towards an uncertain biological behavior/low-grade malignancy. A literature search was conducted to identify previous reports of gynecological MPC and for possible alternative diagnoses. Leiomyoma, epithelioid leiomyoma, angioleiomyoma, perivascular epithelioid cell tumor, solitary fibrous tumor, and low-grade endometrial stromal sarcoma should be considered in the differential diagnosis. Awareness of possible occurrence of this rare neoplasm in the female genital tract is important to reach a correct diagnosis in the spectrum of mesenchymal tumors. Considering the risk of recurrence, we recommend careful evaluation of surgical margins and complete surgical removal whenever possible.
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Affiliation(s)
- Fulvio Borella
- Obstetrics and Gynaecology Unit, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, Turin, 10126, Italy
| | - Fabiola Lucchino
- Obstetrics and Gynaecology Unit, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, Turin, 10126, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126, Turin, Italy.
| | - Marisa Ribotta
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126, Turin, Italy
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126, Turin, Italy
| | - Andrea Carosso
- Obstetrics and Gynaecology Unit, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, Turin, 10126, Italy
| | - Stefano Cosma
- Obstetrics and Gynaecology Unit, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, Turin, 10126, Italy
| | - Dionyssios Katsaros
- Obstetrics and Gynaecology Unit, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, Turin, 10126, Italy
| | - Chiara Benedetto
- Obstetrics and Gynaecology Unit, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, Turin, 10126, Italy
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The Usefulness of Immunohistochemistry in the Differential Diagnosis of Lesions Originating from the Myometrium. Int J Mol Sci 2019; 20:ijms20051136. [PMID: 30845657 PMCID: PMC6429074 DOI: 10.3390/ijms20051136] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/20/2019] [Accepted: 03/01/2019] [Indexed: 12/15/2022] Open
Abstract
Uterine leiomyomas (LMs), currently the most common gynecological complaint around the world, are a serious medical, social and economic problem. Accurate diagnosis is the necessary prerequisite of the diagnostic-therapeutic process. Statistically, mistakes may occur more often in case of disease entities with high prevalence rates. Histopathology, based on increasingly advanced immunohistochemistry methods, is routinely used in the diagnosis of neoplastic diseases. Markers of the highest sensitivity and specificity profiles are used in the process. As far as LMs are concerned, the crux of the matter is to identify patients with seemingly benign lesions which turn out to be suspicious (e.g., atypical LM) or malignant (e.g., leiomyosarcoma (LMS)), which is not uncommon. In this study, we present the current state of knowledge about the use of immunohistochemical markers in the differential diagnosis of LM, atypical LM, smooth muscle tumors of uncertain malignant potential (STUMP), and LMS, as well as their clinical predictive value.
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Nagaputra JC, Goh RCH, Kuick CH, Chang KTE, Sittampalam K. ZC3H7B-BCOR high-grade endometrial stromal sarcoma with osseous metaplasia: Unique feature in a recently defined entity. HUMAN PATHOLOGY: CASE REPORTS 2019. [DOI: 10.1016/j.ehpc.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Abstract
Mesenchymal tumors of the uterus comprise a heterogeneous group of neoplasms of varied biologic potential. In addition to being host to several anatomically unique entities, the uterus may contain mesenchymal neoplasms typically found elsewhere in the body. Although smooth muscle neoplasms are common, other mesenchymal neoplasms in this location are relatively rare. Many of these neoplasms exhibit morphologic overlap. In addition to a careful histomorphologic review, definitive classification frequently depends on the judicious application of ancillary immunohistochemical and molecular testing. The intent of this review is to offer a basic approach to the classification of primary uterine mesenchymal neoplasms.
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Affiliation(s)
- Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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Tran-Harding K, Nair RT, Dawkins A, Ayoob A, Owen J, Deraney S, Lee JT, Stevens S, Ganesh H. Endometriosis revisited: an imaging review of the usual and unusual manifestations with pathological correlation. Clin Imaging 2018; 52:163-171. [DOI: 10.1016/j.clinimag.2018.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 01/06/2023]
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Ferreira J, Félix A, Lennerz JK, Oliva E. Recent advances in the histological and molecular classification of endometrial stromal neoplasms. Virchows Arch 2018; 473:665-678. [DOI: 10.1007/s00428-018-2470-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/29/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022]
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31
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Arend RC, Toboni MD, Montgomery AM, Burger RA, Olawaiye AB, Monk BJ, Herzog TJ. Systemic Treatment of Metastatic/Recurrent Uterine Leiomyosarcoma: A Changing Paradigm. Oncologist 2018; 23:1533-1545. [PMID: 30139839 DOI: 10.1634/theoncologist.2018-0095] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/05/2018] [Indexed: 12/13/2022] Open
Abstract
The treatment of metastatic and recurrent uterine leoimyosarcoma (uLMS) has evolved rapidly in the past several years. Leoimyosarcoma is extremely aggressive and responds poorly to traditional chemotherapeutics. Recent regulatory approval of novel treatment options has significantly expanded the therapeutic armamentarium, and the addition of these therapies has challenged clinicians to select and optimally sequence these new compounds. Additionally, the potential role of immunotherapy is being assessed in current uLMS clinical trials. Given the increasing number of agents available both in the U.S. and globally, a treatment template that addresses optimal sequencing based upon expert consensus would be useful. Current guidelines, although listing various options, lack granularity by line of therapy. Most patients with leiomyosarcoma, even in early stage, are treated with surgery followed by adjuvant chemotherapy despite uLMS being relatively chemoresistant. Adjuvant chemotherapy often includes the combination of gemcitabine and docetaxel with or without doxorubicin in first-line systemic therapy, but these cytotoxic agents only provide patients with advanced disease a 5-year survival <30%. This review will focus on examination of current guidelines and consensus building for optimal sequencing of systemic therapies for advanced or recurrent uLMS. Critical ongoing studies investigating novel approaches including immunotherapeutics and genetic alterations also will be discussed. IMPLICATIONS FOR PRACTICE: Recent regulatory approval of novel treatment options has significantly expanded the therapeutic armamentarium, and the addition of these therapies has challenged clinicians to select and optimally sequence these compounds. This review will focus on examination of current guidelines and consensus building for optimal sequencing of systemic therapies for advanced or recurrent uterine leoimyosarcoma.
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Affiliation(s)
- Rebecca C Arend
- Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Michael D Toboni
- Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Allison M Montgomery
- Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Robert A Burger
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona and Creighton University, Phoenix, Arizona, USA
| | - Thomas J Herzog
- Department of Obstetrics and Gynecology, University of Cincinnati Cancer Institute and College of Medicine, Cincinnati, Ohio, USA
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Chambers JK, Shiga T, Takimoto H, Dohata A, Miwa Y, Nakayama H, Uchida K. Proliferative Lesions of the Endometrium of 50 Four-Toed Hedgehogs ( Atelerix albiventris). Vet Pathol 2018; 55:562-571. [PMID: 29448904 DOI: 10.1177/0300985818758467] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Uteri from 50 four-toed hedgehogs ( Atelerix albiventris) with clinical signs of uterine disease were histopathologically examined. Sixteen animals (32%) were diagnosed with endometrial hyperplasia, 7 animals (14%) were diagnosed with endometrial polyp, and 27 animals (54%) were diagnosed with endometrial neoplasia. The mean ages of the animals with endometrial hyperplasia, polyp, and neoplasia were 28.7 months, 29.4 months, and 25.2 months, respectively. The neoplasms were classified into 7 endometrial mixed tumors, 12 endometrial stromal nodules, and 8 endometrial stromal sarcomas. However, the endometrial stromal nodules and endometrial stromal sarcomas often developed within or were contiguous with an endometrial polyp or mixed tumor. Interestingly, the stromal tumors and the stromal components of the endometrial polyp and mixed tumor displayed extraendometrial differentiation (eg, into adipocytes, granular cells, smooth muscle cells, and osteoid tissue). The endometrial stromal sarcomas exhibited severe cellular atypia and invaded subendometrial tissue. Immunohistochemical examinations demonstrated that the stromal cells of the hyperplastic lesions as well as the neoplastic lesions were positive for CD10, the progesterone receptor, and Wilms tumor 1. The four-toed hedgehog develops unique uterine neoplasms that are mainly composed of endometrial stromal cells and probably arise from endometrial polyps and/or mixed tumors.
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Affiliation(s)
- James K Chambers
- 1 Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, the University of Tokyo, Tokyo, Japan
| | - Takanori Shiga
- 1 Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, the University of Tokyo, Tokyo, Japan
| | | | - Atsushi Dohata
- 1 Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, the University of Tokyo, Tokyo, Japan
| | | | - Hiroyuki Nakayama
- 1 Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, the University of Tokyo, Tokyo, Japan
| | - Kazuyuki Uchida
- 1 Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, the University of Tokyo, Tokyo, Japan
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Kumabe S, Sato J, Tomonari Y, Takahashi M, Inoue K, Yoshida M, Doi T, Wako Y, Tsuchitani M. Morphological and immunohistochemical diversity of endometrial stromal sarcoma in rats. J Toxicol Pathol 2018; 31:95-103. [PMID: 29749998 PMCID: PMC5938210 DOI: 10.1293/tox.2017-0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/06/2017] [Indexed: 11/19/2022] Open
Abstract
To clarify the histopathological characteristics of rat endometrial stromal sarcoma
(ESS), we morphologically reviewed 12 malignant uterine tumors protruding into the lumen
in previous rat carcinogenicity studies. The 12 cases were classified into the following 6
types based on their morphological features: spindle cell and collagen rich type,
pleomorphic/spindle cell and compact type, decidual alteration type, histiocytic and
multinucleated giant cell mixture type, Antoni A-type schwannoma type, and Antoni B-type
schwannoma type. Immunohistochemically, tumor cells in all cases exhibited focal or
diffuse positive reactions for vimentin, and 11 of the 12 cases were positive for S-100.
Interestingly, 9 cases were positive for desmin or αSMA, indicating tumor cells expressing
smooth muscle properties. Both Antoni A- and B-type schwannoma types showed low reactions
for both muscle markers. Positive results for estrogen receptor α in the 11 cases
suggested that they were derived from endometrial stromal cells. On the basis of their
immunohistochemical profiles, they were considered to be derived from endometrial stromal
cells while they showed morphological variation. The detection of a basement membrane
surrounding tumor cells might not be a definitive indicator for differential diagnosis of
ESS from malignant schwannoma. In conclusion, ESS could exhibit wide morphological and
immunohistochemical variation including features of schwannoma or smooth muscle tumor.
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Affiliation(s)
- Shino Kumabe
- Pathology Department, Nonclinical Research Center, LSI Medience Corporation, 14-1 Sunayama, Kamisu-shi, Ibaraki 314-0255, Japan
| | - Junko Sato
- Pathology Department, Nonclinical Research Center, LSI Medience Corporation, 14-1 Sunayama, Kamisu-shi, Ibaraki 314-0255, Japan
| | - Yuki Tomonari
- Pathology Department, Nonclinical Research Center, LSI Medience Corporation, 14-1 Sunayama, Kamisu-shi, Ibaraki 314-0255, Japan
| | - Miwa Takahashi
- Drug Safety Research Laboratories, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan
| | - Kaoru Inoue
- Food Safety Commission of Japan, 5-2-20 Akasaka, Minato-ku, Tokyo 107-6122, Japan
| | - Midori Yoshida
- Food Safety Commission of Japan, 5-2-20 Akasaka, Minato-ku, Tokyo 107-6122, Japan
| | - Takuya Doi
- Pathology Department, Nonclinical Research Center, LSI Medience Corporation, 14-1 Sunayama, Kamisu-shi, Ibaraki 314-0255, Japan
| | - Yumi Wako
- Pathology Department, Nonclinical Research Center, LSI Medience Corporation, 14-1 Sunayama, Kamisu-shi, Ibaraki 314-0255, Japan
| | - Minoru Tsuchitani
- Pathology Department, Nonclinical Research Center, LSI Medience Corporation, 14-1 Sunayama, Kamisu-shi, Ibaraki 314-0255, Japan
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Endometrial stromal sarcomas and related neoplasms: new developments and diagnostic considerations. Pathology 2018; 50:162-177. [DOI: 10.1016/j.pathol.2017.11.086] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/05/2017] [Indexed: 12/21/2022]
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35
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Chhabra S, Bhutani N, Singh S, Sangwan M, Sen R. Pulmonary metastases of uterine endometrial stromal sarcoma in a young patient: An extreme rarity. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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36
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Ahuja A, Agarwal P, Sardana R, Bhaskar S. Extensively Metastasizing Leiomyosarcoma: A Diagnostic Challenge. J Midlife Health 2017; 8:148-150. [PMID: 28983164 PMCID: PMC5625581 DOI: 10.4103/jmh.jmh_60_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Uterine leiomyosarcoma (ULMS) is a rare malignancy of the female genital tract and carries an extremely poor 5-year survival rate. It is known to metastasize early and to distant sites owing to a high propensity for hematogeneous spread. Lung, peritoneum, liver, and bone are relatively common sites of metastasis. Patient age, tumor size, FIGO stage, and grade of the tumor are important criteria for predicting metastasis. The incidence of ULMS is increasing, probably due to the use of improved imaging techniques and as a result of cancer patients' prolonged life expectancy. An early well thought diagnosis is only made possible if even in otherwise seemingly unsuspected cases, the histopathology slides are extensively screened and the treating clinician is alerted timely. We hereby report a case of an elderly female who underwent hysterectomy for resection of multiple fibroids in the uterus and later presented with distant metastasis to brain with the erosion of overlying skull bone, chest wall, and lungs. Microscopic features along with an extensive immunohistochemistry panel were used to ascertain tumor origin.
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Affiliation(s)
- Arvind Ahuja
- Department of Pathology, Dr. RML Hospital, PGIMER, New Delhi, India
| | - Poojan Agarwal
- Department of Pathology, Dr. RML Hospital, PGIMER, New Delhi, India
| | - Rohan Sardana
- Department of Pathology, Dr. RML Hospital, PGIMER, New Delhi, India
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Abstract
The malignant transformation of endometriosis is very uncommon. Whereas 75% of tumors arising from endometriosis arise in the ovary, location in extra-genital organs is rare and mesenchymal neoplasms are exceptional. A 47 year-old woman who underwent hysterectomy with bilateral salpingo-ooforectomy due to endometriosis 13 years before presented with abdominal pain. The magnetic resonance imaging (MRI) showed a 9.7×7.5 cm solid-cystic supravesical mass and a recto-vaginal tumor, as well as endometriotic nodules in the sigma, right parametrium and peritoneum that had significantly increased in size over a six months period. The patient underwent surgical resection of the masses. The histological study showed a low-grade endometrial stromal sarcoma (ESS) arising from endometriosis located at recotovaginal septum and affecting colonic wall and multiple peritoneal and pelvic implants. The patient received radiotherapy and aromatase inhibitors and is free of disease after a follow up of 2 years. Only 15 cases of ESS arising in endometriosis of the bowel have been reported. Tumor dissemination at diagnosis is unusual but does not imply a poor prognosis, as only one patient has died due to progression of the tumor. ESS should be included in the differential diagnosis of mesenchymal neoplasms in the intestine.
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38
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Varied Presentations of Cellular Leiomyoma. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0083-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Low-Grade Endometrial Stromal Sarcoma with Intravenous and Intracardiac Extension: A Multidisciplinary Approach. Case Rep Obstet Gynecol 2016; 2016:3467849. [PMID: 27239357 PMCID: PMC4863127 DOI: 10.1155/2016/3467849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022] Open
Abstract
Background. A rare case of low-grade endometrial stromal sarcoma (LG-ESS) extending to inferior vena cava (IVC) and cardiac chambers. Case Report. A 40-year-old woman had IVC tumor, which was incidentally detected by abdominal ultrasonography during a routine medical checkup. CT scan revealed a tumor in IVC, right iliac and ovarian veins, which was derived from the uterus and extended into the right atrium and ventricle. The operation was performed, the heart and IVC were exposed, and cardiopulmonary bypass was initiated. A right atriotomy was performed, and the intracardiac mass was removed. Then the tumor in IVC and the right internal iliac vein were removed after longitudinal venotomies in the suprarenal and infrarenal vena cava, the right common iliac vein. Next the pelvis was explored. Tumors were found originating from the posterior wall of the uterus and continuing into both the right uterine and ovarian vein. The patient underwent total hysterectomy with bilateral salpingooophorectomy. Complete tumor resection was achieved. Histopathological analysis confirmed a diagnosis of LG-ESS. She showed no evidence of disease for 2 years and 3 months. Conclusions. Our case highlights the importance of a multidisciplinary approach in treating this rare cardiovascular pathological condition through preoperative assessment to final operation.
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Tariq MU, Haroon S, Kayani N. Role of CD10 Immunohistochemical Expression in Predicting Aggressive Behavior of Phylloides Tumors. Asian Pac J Cancer Prev 2016; 16:3147-52. [PMID: 25921112 DOI: 10.7314/apjcp.2015.16.8.3147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phylloides tumors are rare breast neoplasms with a variable clinical course depending on the tumor category. Along with histologic features, the role of immunohistochemical staining has been studied in predicting their behavior. OBJECTIVES Our aim was to evaluate the role of CD 10 immunohistochemical staining in predicting survival, recurrence and metastasis in phylloides tumor. We also evaluated correlations of other clinicopathological features with overall and disease-free survival. MATERIALS AND METHODS CD10 expression was studied in 82 phylloides tumors divided into recurrent/metastatic and non-recurrent/non-metastatic cohorts. The Chi-square test was applied to determine the significance of differences in CD10 expression between outcome cohorts. Uni and multivariate survival analyses were also performed using log-rank test and Cox regression hazard models. RESULTS All 3 metastatic cases, 5 out of 6 (83.3%) recurrent cases and 37out of 73 (50.7%) non-recurrent and non-metastatic cases expressed significant (2+ or 3+) staining for CD10. This expression significantly varied between outcome cohorts (p<0.03). Tumor category and histological features including mitotic count and necrosis correlated significantly with recurrence and metastasis. A significant decrease in overall and disease free survival was seen with CD10 positivity, malignant category, increased mitoses and necrosis. Neither CD10 expression nor any other clinicopathologic feature proved to be an independent prognostic indicator in multivariate analysis. CONCLUSIONS CD10 immunohistochemical staining can be used as a predictive tool for phylloides tumor but this expression should be interpreted in conjunction with tumor category.
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Affiliation(s)
- Muhammad Usman Tariq
- Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan E-mail : ,
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Fritsch M, Schmidt N, Gröticke I, Frisk AL, Keator CS, Koch M, Slayden OD. Application of a Patient Derived Xenograft Model for Predicative Study of Uterine Fibroid Disease. PLoS One 2015; 10:e0142429. [PMID: 26588841 PMCID: PMC4654507 DOI: 10.1371/journal.pone.0142429] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/21/2015] [Indexed: 12/13/2022] Open
Abstract
Human uterine fibroids, benign tumors derived from the smooth muscle layers of the uterus, impose a major health burden to up to 50% of premenopausal women in their daily life. To improve our understanding of this disease, we developed and characterized a patient-derived xenograft model by subcutaneous transplantation of pieces of human uterine fibroid tissue into three different strains of severe combined immunodeficient mice. Engrafted uterine fibroid tissue preserved the classical morphology with interwoven bundles of smooth muscle cells and an abundant deposition of collagenous matrix, similar to uterine fibroids in situ. The grafts expressed both estrogen receptor 1 and progesterone receptor. Additionally, both receptors were up-regulated by estrogen treatment. Growth of the fibroid grafts was dependent on 17β-estradiol and progesterone supplementation at levels similar to women with the disease and was studied for up to 60 days at maximum. Co-treatment with the antiprogestin mifepristone reduced graft growth (four independent donors, p<0.0001 two-sided t-test), as did treatment with the mTOR inhibitor rapamycin (three independent donors, p<0.0001 two-sided t-test). This in vivo animal model preserves the main histological and functional characteristics of human uterine fibroids, is amenable to intervention by pharmacological treatment, and can thus serve as an adequate model for the development of novel therapies.
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Affiliation(s)
- Martin Fritsch
- Bayer Pharma AG, Global Drug Discovery, Berlin, Germany
- * E-mail:
| | | | - Ina Gröticke
- Bayer Pharma AG, Global Drug Discovery, Berlin, Germany
| | | | - Christopher S. Keator
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States of America
| | - Markus Koch
- Bayer Pharma AG, Global Drug Discovery, Berlin, Germany
| | - Ov D. Slayden
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States of America
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Hwang H, Matsuo K, Duncan K, Pakzamir E, Pham HQ, Correa A, Fedenko A, Mhawech-Fauceglia P. Immunohistochemical panel to differentiate endometrial stromal sarcoma, uterine leiomyosarcoma and leiomyoma: something old and something new. J Clin Pathol 2015; 68:710-7. [PMID: 25991737 DOI: 10.1136/jclinpath-2015-202915] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/30/2015] [Indexed: 01/12/2023]
Abstract
AIMS To evaluate an immunohistochemical panel differentiating endometrial stromal sarcoma (ESS) from uterine leiomyosarcoma (ULMS) and leiomyoma (LM). METHODS 94 cases (28 ESS, 41 ULMS, 25 LM) were retrieved and arrayed. 10 immunomarkers (estrogen receptor (ER), progesterone receptor (PR), CD10, smooth muscle actin, desmin, h-caldesmon, transgelin, GEM, ASC1, stathmin1) were used. A predictive model was constructed and examined by receiver operating characteristics curve analysis to determine area under the curve (AUC). RESULTS The combination of ER(+)/PR(+)/CD10(+)/GEM(-)/h-caldesmon(-)/transgelin(-) can predict ESS versus ULMS with AUC predictive value of 0.872 (95% CI 0.784 to 0.961, p<0.0001). The combination of ER(+)/PR(+)/CD10(+)/h-caldesmon(-)/transgelin(-) can predict low grade (LG) ESS from 'LG' ULMS with AUC predictive value of 0.914 (95% CI 0.832 to 0.995, p<0.0001). Finally, ULMS and ESS, including the LGs, were more likely to be stathmin1(+) than LM. CONCLUSIONS Due to the different clinical course and management, adding novel antibodies (GEM, transgelin) to the well established immunohistochemistry panel seemed to be useful in distinguishing ESS from ULMS and LG ESS from 'LG' ULMS. Finally, stathmin1 expression could be of value in differentiating LM from uterine sarcomas.
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Affiliation(s)
- Helena Hwang
- Department of Anatomic Pathology, University of Texas at Dallas, Dallas, Texas, USA
| | - Koji Matsuo
- Division of Gynecology Oncology, Departments of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Kara Duncan
- Department of Surgical Pathology, University of Southern California, Los Angeles, California, USA
| | - Elham Pakzamir
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Huyen Q Pham
- Division of Gynecology Oncology, Departments of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Adrian Correa
- Department of Surgical Pathology, University of Southern California, Los Angeles, California, USA
| | - Alexander Fedenko
- Department of Surgical Pathology, University of Southern California, Los Angeles, California, USA
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Pujani M, Jairajpuri ZS, Rana S, Jetley S, Hassan MJ, Jain R. Cellular leiomyoma versus endometrial stromal tumor: A pathologists' dilemma. J Midlife Health 2015; 6:31-4. [PMID: 25861206 PMCID: PMC4389382 DOI: 10.4103/0976-7800.153619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Uterine smooth muscle tumors and endometrial stromal tumors (ESTs) are the two major types of mesenchymal tumors of the uterus, the latter being fairly uncommon. Among these, endometrial stromal sarcoma (ESS) accounts for 0.2-1.5% of all uterine malignancies. Although routine histopathological examination is sufficient to distinguish between ESS and smooth muscle tumors in most of the cases, the distinction between ESTs and highly cellular leiomyomas (CMs), on several occasions becomes a great diagnostic challenge for the pathologist. The differentiation between EST and CM is necessary on account of the variable clinical course and slight variation in the therapy. However, this is difficult due to the tendency of endometrial stromal cells to differentiate into well-developed smooth muscle cells as well as overlapping immunohistochemical profile in some cases. We hereby report a series of cases which posed a diagnostic challenge to us as to whether they are CMs or ESTs. We therefore discuss the histological features which helped us resolve this dilemma as well as the utility of immunohistochemistry (IHC) as a diagnostic aid in arriving at a final diagnosis in such problematic cases.
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Affiliation(s)
- Mukta Pujani
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Zeeba S Jairajpuri
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Safia Rana
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sujata Jetley
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Mohd Jaseem Hassan
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Reena Jain
- Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Hood BL, Liu B, Alkhas A, Shoji Y, Challa R, Wang G, Ferguson S, Oliver J, Mitchell D, Bateman NW, Zahn CM, Hamilton CA, Payson M, Lessey B, Fazleabas AT, Maxwell GL, Conrads TP, Risinger JI. Proteomics of the Human Endometrial Glandular Epithelium and Stroma from the Proliferative and Secretory Phases of the Menstrual Cycle1. Biol Reprod 2015; 92:106. [DOI: 10.1095/biolreprod.114.127217] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/16/2015] [Indexed: 01/04/2023] Open
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Affiliation(s)
- Cheng-Han Lee
- Department of Laboratory Medicine and Pathology; Royal Alexandra Hospital; University of Alberta; Edmonton AB Canada
| | - Marisa R Nucci
- Department of Pathology; Brigham and Women's Hospital; Boston MA USA
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He L, Li JD, Xiong Y, Huang X, Huang L, Lin JX, Zhou Y, Zheng M. Clinicopathological and molecular markers associated with prognosis and treatment effectiveness of endometrial stromal sarcoma: a retrospective study in China. Arch Gynecol Obstet 2014; 289:383-91. [PMID: 23959089 PMCID: PMC3894427 DOI: 10.1007/s00404-013-2987-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 07/26/2013] [Indexed: 11/11/2022]
Abstract
Purpose
To evaluate the clinicopathological and immunophenotypic characteristics of endometrial stromal sarcoma (ESS) in China. Methods and materials Seventy-two consecutive ESS cases treated between 1995 and 2009 were retrospectively reviewed. Results Sixty-three patients received surgical treatment. Forty-one patients underwent pelvic lymphadenectomy. In paraffin-embedded specimens, expression of the following molecular markers was detected: CD10 (27/36), vimentin (37/38), HHF35 (3/32), S-100 (0/25), desmin (2/29), CD117 (0/23), CD34 (2/24), alpha-inhibin (0/17), CK (1/34), CD99 (4/9), smooth muscle actin (5/25), EMA (0/7), estrogen receptor (13/16) and progesterone receptor (13/16). CD10 and vimentin were expressed more frequently in these specimens. Tumor classification, CD10 and surgical procedures were significantly associated with disease-free survival (DFS). Surgical procedures were significantly associated with overall survival (OS). Tumor stage (P = 0.024) and surgical procedure (P = 0.042) were found to be significant independent prognostic factors for DFS. No complete or partial response was observed among patients who received radiotherapy or chemotherapy. Conclusions Our results indicate that total hysterectomy with bilateral salpingo-oophorectomy followed by pelvic lymphadenectomy is associated with an improved treatment outcome. CD10-negative expression may contribute to the malignant characteristics and recurrence associated with ESS.
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Abstract
Endometrial stromal tumors are rare uterine mesenchymal neoplasms that have intrigued pathologists for years, not only because they commonly pose diagnostic dilemmas, but also because the classification and pathogenesis of these tumors has been widely debated. The current World Health Organization recognizes 4 categories of endometrial stromal tumor: endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), and undifferentiated uterine sarcoma (UUS). uterine sarcoma. These categories are defined by the presence of distinct translocations as well as tumor morphology and prognosis. Specifically, the JAZF1-SUZ12 (formerly JAZF1-JJAZ1) fusion identifies a large proportion of ESN and LG-ESSs, whereas the YWHAE-FAM22 translocation identifies HG-ESSs. The latter tumors appear to have a prognosis intermediate between LG-ESS and UUS, which exhibits no specific translocation pattern. This review (1) presents the clinicopathologic features of endometrial stromal tumors; (2) discusses their immunophenotype; and (3) highlights the recent advances in molecular genetics which explain their pathogenesis and lend support for a new classification system.
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Ahmed ARH, Muhammad EMS. E-cadherin and CD10 expression in atypical hyperplastic and malignant endometrial lesions. J Egypt Natl Canc Inst 2014; 26:211-7. [PMID: 25282623 DOI: 10.1016/j.jnci.2014.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Loss of E-cadherin is a critical step for development and progression of malignant tumors. CD10; a marker of non-neoplastic and neoplastic endometrial stroma, is associated with aggressiveness of many epithelial malignancies. AIMS To evaluate expression and correlation of E-cadherin and CD10 in endometrial lesions and their possible role in differentiating atypical endometrial hyperplasia from endometrial carcinoma. The association of E-cadherin and CD10 expression with clinico-pathological parameters of endometrial carcinoma was also investigated. MATERIALS AND METHODS Fifty four cases including 28 endometrial carcinomas; 19 endometrial hyperplasia and 7 cases of normal endometrial changes were enrolled for this study. The expression of E-cadherin and CD10 was evaluated by immunohistochemistry using the streptavidin-biotin technique. RESULTS There was a strong association between malignant change of endometrial glands and membrano-cytoplasmic localization of E-cadherin (p<0.001). Expression of E-cadherin but not CD10 was significantly higher in endometrial carcinomas compared to atypical endometrial hyperplasia (p<0.01). Expression of E-cadherin was not associated with CD10 expression in different endometrial lesions. High grade tumors expressed low levels of both E-cadherin (p<0.01) and CD10 (p<0.05) and serous endometrial carcinoma had low E-cadherin and CD10 expression compared to endometrioid carcinoma (p<0.01 and <0.05, respectively). Expression of both molecules showed no association with depth of tumor invasion or FIGO stage. Tumors with lower E-cadherin or CD10 expression had higher rates of vascular tumor emboli (p<0.01 and <0.07, respectively). CONCLUSIONS Although expression of E-cadherin and CD10 in endometrial lesions was not correlated, reduced expression of both molecules could be critical for progression of endometrial carcinoma.
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Affiliation(s)
- Ahmed R H Ahmed
- Department of Pathology, Faculty of Medicine, Sohag University, Egypt.
| | - Eman M S Muhammad
- Department of Pathology, Faculty of Medicine, Sohag University, Egypt.
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High-Grade Undifferentiated Sarcomas of the Uterus: Diagnosis, Outcomes, and New Treatment Approaches. Curr Oncol Rep 2014; 16:405. [DOI: 10.1007/s11912-014-0405-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Sopha SC, Rosado FGN, Smith JJ, Merchant NB, Shi C. Hepatic Uterus-Like Mass Misdiagnosed as Hepatic Abscess. Int J Surg Pathol 2014; 23:134-9. [DOI: 10.1177/1066896914534465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Hepatic endometriosis/uterus-like mass is rare and may be overlooked during hepatic cyst workups. We report a case of uterus-like mass, misdiagnosed as hepatic abscess. Case Report: A 47-year-old woman developed abdominal pain and vomiting. Infectious colitis with hepatic abscess was diagnosed, and remained antibiotic-refractory. Fine-needle aspiration and core biopsies showed benign contents. The patient presented to our institution with symptoms and normal blood work. Laparoscopic excision demonstrated a 1.4-cm cyst composed of endometrial glands (estrogen receptor+ and progesterone receptor+) and stroma (CD10+) with smooth muscle actin (SMA+), arranged in an organoid fashion. The patient, status-post hysterectomy, had no history or symptoms of endometriosis. Conclusion. This rare case illustrates the merit of considering uterus-like mass/endometriosis in the differential diagnosis of antibiotic-refractory hepatic cysts. Cyst heterogeneity may confound needle biopsy. We report the first instance of a hepatic uterus-like mass, with a review of related entities, postulated histogenesis, and important clinical associations.
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Affiliation(s)
| | | | - J. J. Smith
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Chanjuan Shi
- Vanderbilt University Medical Center, Nashville, TN, USA
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