Mittal Khush R, Chen Fan, Wei Jian J, Rijhvani Kiran, Kurvathi Rohini, Streck Deanna, Dermody James, Toruner Gokce A
Department of Pathology, New York University School of Medicine, 462 First Avenue, New York, NY 10016, USA.
Mod Pathol. 2009 Oct;22(10):1303-11. doi: 10.1038/modpathol.2009.96. Epub 2009 Jul 24.
It is uncertain whether uterine leiomyosarcoma arises de novo or in preexisting leiomyoma. Leiomyoma-like areas can be seen associated with uterine leiomyosarcoma, raising the possibility of precursor lesions for uterine leiomyosarcoma. In this study, we examined cases of uterine leiomyosarcoma associated with leiomyoma-like areas at the histological, immunohistochemical and DNA level to further evaluate if benign-looking leiomyoma-like and uterine leiomyosarcoma areas are related. Cases of uterine leiomyosarcoma observed at the New York University Medical Center from 1994 to 2007 were reviewed for the presence of leiomyoma-like areas. Of the 26 cases of uterine leiomyosarcoma observed during this period, 18 cases had an associated leiomyoma-like area (five cellular leiomyoma, four symplastic leiomyoma, four cellular and symplastic leiomyoma and five usual type leiomyoma). Sixteen of the 18 cases were examined immunohistochemically for Ki-67, for estrogen receptor, progesterone receptor and for p53. Immunohistochemical profiles were as expected for leiomyoma-like (the mean expression of p53, ER, PR and Ki-67 at 0.3, 63, 75 and 0.6%, respectively), symplastic leiomyoma-like areas (the mean expression of p53, ER, PR and Ki-67 at 0.6, 85, 89 and 5.5%, respectively) and uterine leiomyosarcoma areas (the mean expression of p53, ER, PR and Ki-67 at 52, 38, 39 and 61%, respectively). In six cases, the leiomyoma-like and uterine leiomyosarcoma areas from each case were examined using high-density oligonucleotide array-CGH to determine genetic aberrations in the two areas. Nearly all the genetic aberrations found in leiomyoma-like areas were also found in the corresponding uterine leiomyosarcoma areas. In addition, uterine leiomyosarcoma areas had additional genetic aberrations. The immunohistochemical profiles and genetic aberrations of the examined cases suggest that uterine leiomyosarcoma could arise from the preexisting leiomyoma-like areas that often have a symplastic or cellular morphology.
子宫平滑肌肉瘤是新发还是起源于已存在的平滑肌瘤尚不确定。子宫平滑肌肉瘤可见到类似平滑肌瘤的区域，这增加了子宫平滑肌肉瘤存在前驱病变的可能性。在本研究中，我们从组织学、免疫组织化学和DNA水平检查了伴有类似平滑肌瘤区域的子宫平滑肌肉瘤病例，以进一步评估看似良性的类似平滑肌瘤区域与子宫平滑肌肉瘤区域是否相关。回顾了1994年至2007年在纽约大学医学中心观察到的子宫平滑肌肉瘤病例，以确定是否存在类似平滑肌瘤的区域。在此期间观察到的26例子宫平滑肌肉瘤病例中，18例伴有类似平滑肌瘤的区域（5例细胞性平滑肌瘤、4例奇异型平滑肌瘤、4例细胞性和奇异型平滑肌瘤以及5例普通型平滑肌瘤）。18例中的16例进行了Ki-67、雌激素受体、孕激素受体和p53的免疫组织化学检查。免疫组织化学特征与类似平滑肌瘤（p53、ER、PR和Ki-67的平均表达分别为0.3%、63%、75%和0.6%）、奇异型类似平滑肌瘤区域（p53、ER、PR和Ki-67的平均表达分别为0.6%、85%、89%和5.5%）以及子宫平滑肌肉瘤区域（p53、ER、PR和Ki-67的平均表达分别为52%、38%、39%和61%）预期的情况一致。在6例病例中，对每例病例的类似平滑肌瘤区域和子宫平滑肌肉瘤区域进行了高密度寡核苷酸阵列比较基因组杂交检测，以确定这两个区域的基因畸变情况。在类似平滑肌瘤区域发现的几乎所有基因畸变在相应的子宫平滑肌肉瘤区域也能发现。此外，子宫平滑肌肉瘤区域还有额外的基因畸变。所检查病例的免疫组织化学特征和基因畸变表明，子宫平滑肌肉瘤可能起源于通常具有奇异型或细胞形态的已存在的类似平滑肌瘤区域。
