Molecular and immunohistochemical evidence for the origin of uterine leiomyosarcomas from associated leiomyoma and symplastic leiomyoma-like areas
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Uterine Leiomyoma
Smooth Muscle Tumor
Ki-67
Uterine Leiomyoma
Smooth Muscle Tumor
Ki-67
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Smooth Muscle Tumor
Uterine Leiomyoma
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Despite well-established criteria, the distinction of uterine leiomyosarcoma from certain variants of benign leiomyoma, particularly bizarre leiomyoma, can be challenging morphologically. Recent studies reported the overexpression of p16 protein in uterine leiomyosarcoma. However, the potential role of immunohistochemistry of p16, p53, and Ki-67 in the differential diagnosis of leiomyosarcoma and bizarre leiomyoma has not been well assessed. We had immunohistochemically studied the expression of p16, p53, and Ki-67 proteins in 100 cases of uterine smooth muscle tumors, including 35 usual leiomyomas (LM), 13 cellular leiomyomas (CLM), 15 bizarre leiomyomas (BLM), 2 cases of smooth muscle tumor of uncertain malignant potential (STUMP), and 35 leiomyosarcoma (LMS). For p16 immunostain, strong and mediate-to-diffuse staining pattern (>25% cells positive) was seen in 100% of LMS and STUMP. There were 86.5% of BLM that showed positive for p16, which includes 60% of them showing mediate-to-diffuse p16 positivity. Although 38.5% of CLM and 14% of usual LM showed p16 positivity, the majority of those (70%) are focal with weak p16 staining pattern. The strong, mediate-to-diffuse p53 immunostain was seen in 91% of LMS, 60% of BLM, and 50% of STUMP, but none of usual LM and CLM. More than 10% of cells positive for Ki-67 were observed in 83% of LMS, 100% of STUMP, and 48% of BLM, but none of usual LM and CLM. Our study indicates that distinct expression patterns for p16, p53, and Ki-67 exist between leiomyosarcoma and usual LM and CLM (P<0.0001). Immunohistochemical study with a panel of antibodies to p16, p53, and Ki-67 is helpful in distinguishing LMS from CLM and usual LM. However, due to significant overlapping staining patterns between LSM and BLM (P=0.09), immunostains for p16, p53, and Ki-67 have limited role in differentiating LMS from BLM.
Smooth Muscle Tumor
Immunostaining
Uterine Leiomyoma
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Background: Cutaneous smooth muscle tumors are rare and sometimes the differential diagnosis between leiomyoma and leiomyosarcoma is difficult and based in very subtle criteria. We therefore tried to investigate the use of p53 in such a conundrum. This marker has rarely been reported in cutaneous leiomyomas and even in more rare occasions, in cutaneous leiomyomas. Material and Methods: We studied 30 benign cutaneous smooth muscle tumors, including angioleiomyomas, common leiomyomas and a symplastic leiomyoma, as well as four leiomyosarcomas and one cutaneous metastasis of leiomyosarcoma. All cases were reviewed in order to confirm the diagnosis, before the cases were included in the study. In all cases, we performed an immunohistochemical study in all cases with p53 and the percentage of positive cells was estimate counting a total of 1000 cells per case. Results: Six cases from the 31 (19.35%) benign cutaneous smooth muscle tumors showed some expression of p53. The expression of it varied from only occasional cells to 1% of the cells. On the contrary, all leiomyosarcomas investigated showed expression of p53, and in three of the four cases (75%), the marker was expressed by at least 80% of the tumoral cells. Only in one leiomyosarcoma, the marker was expressed by a low percentage (0.5%) of cells. No expression of p53 was found in the only case of symplastic leiomyoma, which was investigated. The case of a cutaneous metastasis of leiomyosarcoma showed expression of p53 by 20% of cells. Conclusions: We conclude that expression of p53 by a high percentage of cells in a cutaneous smooth muscle cell tumor should be considered as highly suspicious for malignancy.
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Objective To investigate the clinical and endoscopic features of smooth muscle tumors in upper gastrointestinal tract and evaluate the diagnostic and therapeutic methods of leiomyoma and leiomyosarcoma.MethodsThe documents of 156 cases with smooth muscle tumors in upper gastrointestinal tract proved by surgery and histopathology in past 25 years were retrospectively reviewed and analysed.Results156 cases of smooth muscle tumors in upper gastrointe stinal tract included leiomyoma 126 cases and leiomyosarcoma 30 cases. Leiomyoma were found mainly in esophagus, Most of them (78.2%) were small ones with diameter≤2 cm. The incidence of tumors with ulceration were found higher in leiomyosarcoma (73.3%) than in leiomyoma(14.3%)(P0.01). 75.4% leiomyoma appeared ≤2 cm in diameter, 76.7% of leiomyosarcoma exceeded 5 cm in diameter. 95 cases of leiomyoma with diameter ≤2 cm were resected by push snare cauterization.Conclusion Leiomyomas in upper gastrointestinal tract were found mainly in esophagus. The size and ulceration of tumors can be considered as an important evidence of distinguishing leiomyoma from leiomyosarcoma .The satisfactory results suggested that the method of push snare cauterization was safe and effective in dealing with leiomyoma ≤2 cm in diameter.
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Smooth Muscle Tumor
Etiology
Histopathology
Smooth muscle tissue
Presentation (obstetrics)
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Aims: It has been suggested that p16 is overexpressed in uterine leiomyosarcomas in comparison with leiomyomas. In this study, p16 immunohistochemical expression was assessed in a variety of uterine smooth muscle tumours, including usual leiomyomas, leiomyoma variants, smooth muscle tumours of uncertain malignant potential (STUMPs) and leiomyosarcomas. The aim was to ascertain whether there are differences in p16 expression between these groups and whether p16 is of potential value in the assessment of problematic uterine smooth muscle neoplasms. p16 expression was also compared with that of p53 and MIB1. Methods and results: Cases of usual leiomyoma ( n = 10), leiomyoma variants ( n = 27), STUMP ( n = 4) and leiomyosarcoma ( n = 22) were subject to p16, p53 and MIB1 immunohistochemistry. For p16, cases were evaluated with respect to both staining distribution and intensity. There was a statistically significant difference in p16 distribution ( P < 0.001) and intensity ( P = 0.001) between leiomyosarcomas and the other groups. There was no difference in p16 expression between usual leiomyomas, leiomyoma variants and STUMPs. There were also statistically significant differences in p53 ( P = 0.014) and MIB1 ( P < 0.001) immunoreactivity between leiomyosarcomas and the other groups. Conclusions: p16 is overexpressed in uterine leiomyosarcomas compared with leiomyomas, benign leiomyoma variants and STUMPs, suggesting that p16 may be implicated in the pathogenesis of malignant uterine smooth muscle neoplasms. p16, in combination with p53 and MIB1, may be of value as an adjunct to morphological examination in the assessment of problematic uterine smooth muscle tumours, although further large‐scale studies with follow‐up are necessary to confirm this.
Smooth Muscle Tumor
Uterine Leiomyoma
Smooth muscle tissue
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Smooth Muscle Tumor
Gastric tumor
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Smooth Muscle Tumor
Malignant Transformation
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Surgical oncology
Colorectal Surgery
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