Nucci M R, O'Connell J T, Huettner P C, Cviko A, Sun D, Quade B J
Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Am J Surg Pathol. 2001 Apr;25(4):455-63. doi: 10.1097/00000478-200104000-00004.
Distinction of endometrial stromal neoplasms from cellular smooth muscle tumors of the uterus is sometimes difficult. Immunohistochemistry is often not helpful because muscle actins and desmin are expressed in both neoplasms. This study's goal was to determine whether h-caldesmon, a smooth muscle-specific isoform of a calcium, calmodulin, and actin binding protein, could effectively distinguish endometrial stromal tumors from uterine smooth muscle tumors. The authors analyzed immunohistochemical expression in 24 endometrial stromal neoplasms (21 sarcomas and three nodules), 29 leiomyosarcomas, 32 leiomyomas (10 "usual," 14 cellular leiomyoma, and eight "highly cellular" types), 40 myometria, and 25 endometria. h-Caldesmon was diffusely positive in all myometria, leiomyomata, and leiomyosarcomas. Of note, 16 leiomyosarcomas (55%) were positive for h-caldesmon in more than 50% of tumor cells. In five "highly cellular" leiomyomas, h-caldesmon expression was markedly decreased or absent in areas morphologically resembling endometrial stromal tumors, raising the possibility that these tumors may be mixed smooth muscle-endometrial stromal neoplasms. In contrast, h-caldesmon expression was absent in all endometria and endometrial stromal neoplasms apart from accompanying small vessels. Desmin was diffusely positive in all myometria and leiomyomata. The fraction of cells expressing desmin was greater than that of h-caldesmon in only 10% of leiomyosarcomas. Focal desmin expression was also present in eight of 25 (32%) endometria and 12 of 24 (50%) endometrial stromal neoplasms. h-Caldesmon appears to be a more sensitive and specific marker of smooth muscle differentiation in the uterus than desmin and may be a useful tool for distinguishing and classifying uterine mesenchymal tumors.
子宫内膜间质肿瘤与子宫细胞性平滑肌瘤的鉴别有时存在困难。免疫组织化学通常并无帮助，因为两种肿瘤均表达肌动蛋白和结蛋白。本研究的目的是确定h -钙调蛋白（一种钙、钙调蛋白和肌动蛋白结合蛋白的平滑肌特异性异构体）是否能有效区分子宫内膜间质肿瘤与子宫平滑肌瘤。作者分析了24例子宫内膜间质肿瘤（21例肉瘤和3例结节）、29例平滑肌肉瘤、32例平滑肌瘤（10例“普通型”、14例细胞性平滑肌瘤和8例“高细胞型”）、40例子宫肌层组织以及25例子宫内膜组织中的免疫组织化学表达情况。h -钙调蛋白在所有子宫肌层组织、平滑肌瘤和平滑肌肉瘤中均呈弥漫性阳性。值得注意的是，16例（55%）平滑肌肉瘤中超过50%的肿瘤细胞h -钙调蛋白呈阳性。在5例“高细胞型”平滑肌瘤中，在形态上类似子宫内膜间质肿瘤的区域，h -钙调蛋白表达明显减少或缺失，提示这些肿瘤可能是平滑肌 - 子宫内膜间质混合性肿瘤。相比之下，除了伴行的小血管外，所有子宫内膜组织和子宫内膜间质肿瘤中h -钙调蛋白均无表达。结蛋白在所有子宫肌层组织和平滑肌瘤中均呈弥漫性阳性。仅10%的平滑肌肉瘤中表达结蛋白的细胞比例高于h -钙调蛋白。25例子宫内膜组织中的8例（32%）以及24例子宫内膜间质肿瘤中的12例（50%）也存在局灶性结蛋白表达。h -钙调蛋白似乎是子宫平滑肌分化比结蛋白更敏感和特异的标志物，可能是区分和分类子宫间叶性肿瘤的有用工具。
