1
|
Travaglino A, Raffone A, Gencarelli A, Neola D, Oliviero DA, Alfano R, Campanino MR, Cariati F, Zullo F, Mollo A, Insabato L. p53, p16 and ki67 as immunohistochemical prognostic markers in uterine smooth muscle tumors of uncertain malignant potential (STUMP). Pathol Res Pract 2021; 226:153592. [PMID: 34481212 DOI: 10.1016/j.prp.2021.153592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 01/20/2023]
Abstract
The risk stratification in gynecologic smooth muscle tumors of uncertain malignant potential (STUMP) is a crucial issue, but at present there are no validated prognostic markers. We aimed to assess p53, p16 and ki67 as immunohistochemical prognostic markers in STUMP through a systematic review and meta-analysis. Electronic databases were searched from their inception to July 2020. All studies assessing p53, p16 and/or ki67 immunohistochemistry in gynecologic STUMP series were included. Immunohistochemical patterns were categorized as "abnormal" vs "wild-type" for p53, "diffuse" vs "focal/negative" for p16, ≥ 10% vs 10% for ki67. The prognostic value for recurrence was assessed through Cox regression analysis; a p-value 0.05 was considered significant. Markers that resulted significant were assessed for prognostic accuracy with calculation of area under the curve (AUC) and post-test probability of recurrence. Seven studies with 171 patients were included. Significant association with disease-free survival was found for p53 (p 0.0001) and p16 (p 0.0001), but not for ki67 (p = 0.911). p53 showed sensitivity= 83%, specificity= 86%, AUC= 0.89, and post-test recurrence probabilities of 54% and 7% in the case of abnormal and wild-type expression, respectively. p16 showed sensitivity= 84%, specificity= 88%, AUC= 0.91 and post-test recurrence probabilities of 56% and 7% in the case of diffuse and focal/negative expression, respectively. In conclusion, p53 and p16 might be useful in the risk assessment of STUMP, despite not being suitable as stand-alone prognostic markers.
Collapse
Affiliation(s)
- Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy; Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Ospedale Maggiore Policlinico Milano, Milan, Italy.
| | - Annarita Gencarelli
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy; Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Domenico Alessandro Oliviero
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Rosa Alfano
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy; Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Maria Raffaela Campanino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy; Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Federica Cariati
- Ospedale Maggiore Policlinico Milano, Milan, Italy; CEINGE-Biotecnologie Avanzate, Naples, Italy; Fertility Unit, Maternal-Child Department, AOU Policlinico Federico II, Naples, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Antonio Mollo
- Ospedale Maggiore Policlinico Milano, Milan, Italy; Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
| | - Luigi Insabato
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy; Ospedale Maggiore Policlinico Milano, Milan, Italy
| |
Collapse
|
2
|
Cazzato F, D'Ercole A, De Luca G, Aiello FB, Croce A. Neck subcutaneous nodule as first metastasis from broad ligament leiomyosarcoma: a case report and review of literature. BMC Surg 2020; 20:297. [PMID: 33238975 PMCID: PMC7687730 DOI: 10.1186/s12893-020-00951-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Leiomyosarcoma usually develops in the myometrium and is characterized by a high recurrence rate, frequent hematogenous dissemination, and poor prognosis. Metastasis is usually to lungs, liver, and bone, and occasionally to the brain, but seldom to the head and neck region. Primary leiomyosarcoma very rarely arises in the broad ligament. Case presentation A 54-year old woman presented to the otolaryngology department with a mass in the right posterior region of the neck 4 years after surgery for a primary leiomyosarcoma of the right broad ligament. The neck mass was removed and found to be a metastatic leiomyosarcoma. Leiomyosarcoma localizations in lungs and liver were absent. Morphological examination showed both the primary and the secondary leiomyosarcomas to have features of low-grade tumors. One year after excision of the neck mass, the patient presented with tachycardia. Echocardiography detected two intracardiac nodules suggestive of metastatic tumors. Chemotherapy was administered; the disease has been stable since then. Conclusions We report the first case of broad ligament leiomyosarcoma with the neck subcutaneous region being the first site of secondary involvement. We speculate that the Batson venous plexus might have been the pathway of dissemination.
Collapse
Affiliation(s)
- Fiorella Cazzato
- Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Angela D'Ercole
- Surgical Pathology Unit, Santissima Annunziata Hospital, Chieti, Italy
| | - Graziano De Luca
- Clinical Pathology Unit, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Francesca B Aiello
- Department of Medicine and Aging Sciences, University G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - Adelchi Croce
- Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy.
| |
Collapse
|
3
|
Huo L, Wang D, Wang W, Cao D, Yang J, Wu M, Yang J, Xiang Y. Oncologic and Reproductive Outcomes of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: A Single Center Retrospective Study of 67 Cases. Front Oncol 2020; 10:647. [PMID: 32477938 PMCID: PMC7240040 DOI: 10.3389/fonc.2020.00647] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/07/2020] [Indexed: 12/14/2022] Open
Abstract
Background: The term “uterine smooth muscle tumor of uncertain malignant potential” (STUMP) indicates a rare tumor that cannot be classified as a benign leiomyoma or malignant leiomyosarcoma. In this study, we assessed the clinical characteristics, fertility, and oncologic outcomes of patients diagnosed as STUMP in 14 years. In addition, we analyzed the risk factors for recurrence in patients with STUMP. Methods: Medical records of STUMP patients at Peking Union Medical College Hospital (PUMCH) between January 2005 and June 2019 were reviewed and analyzed. Disease-free survival, age of diagnosis, tumor size, surgical procedure, pathology and immunohistochemistry, clinical characteristics, recurrence rate, and reproductive outcomes in the follow-up period were assessed. Univariate and multivariate analyses were performed to determine the prognostic factors. Results: The median age was 42 years old (range: 21–63). Total hysterectomy with or without bilateral salpingo-oophorectomy was performed in 29/67 cases (43.3%), and myomectomy was performed in 38/67 cases (56.7%). Ten patients experienced recurrences, and all but two recurrences occurred within 5 years after the initial surgery. Only two of these recurrences were leiomyosarcoma. There were no deaths in the median follow-up period of 48.4 (range 2.6–170.2) months. There were no remarkable differences in location of tumor between the myomectomy and hysterectomy groups, but the patients in the myomectomy group were younger than those in the hysterectomy group. In univariate and multivariate analysis, mitosis on pathology was the only independent risk factor for recurrence. Expression of Ki-67, p53, and p16 was significantly higher in patients with recurrence. Seven of the 35 patients who attempted to conceive had successful pregnancies. Conclusions: The prognosis of STUMP was favorable and tumors with more than 10 mitoses per 10 high power field should be monitored closely. The surgical procedure was not an independent risk factor of recurrence, and myomectomy may be an acceptable option for patients wishing to preserve fertility.
Collapse
Affiliation(s)
- Lanqing Huo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenze Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junjun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
4
|
Gironi LC, Camillo L, Zottarelli F, Savoia P. Concordance of p16, FH, and alpha-SMA expression with the fumarate hydratase gene mutational status in sporadic and hereditary piloleiomyomas. Pathology 2019; 51:659-663. [PMID: 31481265 DOI: 10.1016/j.pathol.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Laura Cristina Gironi
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy.
| | - Lara Camillo
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Francesca Zottarelli
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | | | - Paola Savoia
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| |
Collapse
|
5
|
Şahin H, Karatas F, Coban G, Özen Ö, Erdem Ö, Onan MA, Ayhan A. Uterine smooth muscle tumor of uncertain malignant potential: fertility and clinical outcomes. J Gynecol Oncol 2019; 30:e54. [PMID: 31074239 PMCID: PMC6543118 DOI: 10.3802/jgo.2019.30.e54] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/01/2019] [Accepted: 01/09/2019] [Indexed: 12/27/2022] Open
Abstract
Objective In this study, we aimed to evaluate the clinicopathological features, obstetric, and oncological outcomes of patients diagnosed with a uterine smooth muscle tumors of uncertain malignant potential (STUMP). Methods A dual-institutional, database review was carried out to screen patients with STUMP who were treated with upfront surgery between January 2006 and December 2017. Data including age at the time of diagnosis, recurrence rate, disease-free survival, overall survival, and fertility outcomes were retrospectively analyzed. Results Fifty-seven patients with STUMPs were included in the study. The median age at the time of diagnosis was 42 (range, 16 to 75) years. The median follow-up was 57 (range, 16 to 125) months. Eight patients (14%) had recurrence during follow-up. Recurrent STUMPs were seen in seven patients and leiomyosarcoma after 14 months in one patient. Seven patients with a recurrent STUMP survived, while the remaining patient died. Recurrence rates were similar for women who underwent myomectomy and those who underwent hysterectomy. The presence of uterine localization of tumor (subserosal vs intramural-submucosal) statistically significantly affected recurrence rates (odds ratio=5.72; 95% confidence interval=1.349–24.290; p=0.018). Ten of 27 patients who underwent myomectomy for uterine myoma had fertility desire. Seven pregnancies were recorded. Conclusions Our study results suggest that fertility-sparing approaches are feasible in patients with STUMP, although recurrence may be seen.
Collapse
Affiliation(s)
- Hanifi Şahin
- Department of Gynecologic Oncology, Malatya Education and Research Hospital, Malatya, Turkey.
| | - Funda Karatas
- Department of Gynecologic Oncology, School of Medicine, Gazi University, Ankara, Turkey
| | - Gonca Coban
- Department of Obstetrics and Gynecology, School of Medicine, Baskent University, Ankara, Turkey
| | - Özlem Özen
- Department of Pathology, School of Medicine, Baskent University, Ankara, Turkey
| | - Özlem Erdem
- Department of Pathology, School of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Anıl Onan
- Department of Gynecologic Oncology, School of Medicine, Gazi University, Ankara, Turkey
| | - Ali Ayhan
- Department of Gynecologic Oncology, School of Medicine, Baskent University, Ankara, Turkey
| |
Collapse
|