Department of Pathology, Shanxi Medical University, Taiyuan City, Shanxi province, China.
Int J Gynecol Pathol. 2010 Jan;29(1):55-62. doi: 10.1097/PGP.0b013e3181b1cdb0.
It can sometimes be difficult to distinguish between the 2 main types of uterine mesenchymal neoplasms; uterine smooth muscle tumors (SMTs) and endometrial stromal sarcomas (ESSs), particularly when the ESSs show smooth muscle differentiation or the SMTs are highly cellular. The aim of this study was to investigate myocardin expression in normal uterus myometrium, in SMTs, and in ESSs and to determine whether myocardin can be used as a useful diagnostic tool in the classification of problematic uterine mesenchymal tumors. Immunohistochemical staining was performed in each group. Besides myocardin, all cases were also stained for other smooth muscle markers (h-caldesmon, desmin, smooth muscle actin) and for CD10. All tested markers were analyzed in 21 conventional leiomyomas (LMs), 21 highly cellular leiomyomas (HCLs), 12 leiomyosarcomas (LMSs), 3 endometrial stromal nodules (ESNs), 11 ESSs, and 15 normal uterus myometrium. Myocardin was expressed in all normal uterine myometrium and in SMTs (even in the regions with epithelioid features) moderately or strongly, at least topically, whereas in endometrium, in ESNs and in ESSs, except in the regions of smooth muscle differentiation, it was negative. All ESNs, 11 of 11 ESSs and 14 of 15 endometrium were negative for h-caldesmon, but all SMTs and normal uterine myometrium were positive for h-caldesmon except for 2 LMSs, 2 HCLs, and for the regions with epithelioid features in 2 LMs. Desmin was stained in all normal uterine myometrium and in SMTs (except those of the regions with epithelioid features), but it was negative in 1 HCL and 1 LMS. One of 3 ESNs and 2 of 11 ESSs were expressed in desmin. Smooth muscle actin was negative in all ESNs, 2 LMSs, and 2 HCLs, and positive in all myometriums, LMs (except for the regions with epithelioid features), 1 ESSs, and 1 proliferative phase endometrium. Eight of 11 ESSs and all ESNs were positive for CD10, as was 1 HCL, and 2 LMSs. All uterine myometrium, 3 ESSs, and 3 endometriums were negative for CD10. Our study indicates that the myocardin is expressed in normal and neoplastic uterine smooth muscle cells sensitively and that the evaluation of myocardin expression is useful in distinguishing SMTs from ESSs.
有时很难区分 2 种主要的子宫间质肿瘤；子宫平滑肌肿瘤（SMT）和子宫内膜间质肉瘤（ESS），特别是当 ESS 显示平滑肌分化或 SMT 高度细胞化时。本研究旨在研究心肌球蛋白在正常子宫平滑肌、SMT 和 ESS 中的表达，并确定心肌球蛋白是否可作为分类有问题的子宫间质肿瘤的有用诊断工具。在每组中进行了免疫组织化学染色。除了心肌球蛋白外，所有病例还被染色用于其他平滑肌标志物（h-钙调蛋白、结蛋白、平滑肌肌动蛋白）和 CD10。在 21 例常规平滑肌瘤（LM）、21 例高细胞性平滑肌瘤（HCL）、12 例平滑肌肉瘤（LMS）、3 例子宫内膜间质结节（ESN）、11 例 ESS 和 15 例正常子宫平滑肌中分析了所有测试的标志物。心肌球蛋白在所有正常子宫平滑肌和 SMT 中（甚至在具有上皮样特征的区域）中度或强表达，至少在局部表达，而在子宫内膜、ESN 和 ESS 中，除了平滑肌分化区域外，它呈阴性。所有 ESN、11 例 ESS 和 15 例子宫内膜中 h-钙调蛋白均为阴性，但所有 SMT 和正常子宫平滑肌均为阳性，除了 2 例 LMS、2 例 HCL 和 2 例 LM 的上皮样特征区域。结蛋白染色在所有正常子宫平滑肌和 SMT 中（除具有上皮样特征的区域外），但在 1 例 HCL 和 1 例 LMS 中为阴性。3 例 ESN 中有 1 例和 11 例 ESS 中有 2 例表达结蛋白。3 例 ESN 中有 1 例和 11 例 ESS 中有 2 例表达结蛋白。3 例 ESN 中有 1 例和 11 例 ESS 中有 2 例表达结蛋白。在所有的子宫平滑肌、平滑肌瘤（除上皮样特征区域外）、1 例 ESS 和 1 例增殖期子宫内膜中，平滑肌肌动蛋白均为阴性。在 11 例 ESS 中有 8 例和所有 ESN 中、1 例 HCL 和 2 例 LMS 中 CD10 为阳性。所有的子宫平滑肌、3 例 ESS 和 3 例子宫内膜均为 CD10 阴性。我们的研究表明，心肌球蛋白在正常和肿瘤性子宫平滑肌细胞中敏感表达，评估心肌球蛋白的表达有助于区分 SMT 和 ESS。
