Mesenchymal tumours of the uterus: Selected topics emphasizing diagnostic pitfalls

Current Diagnostic Pathology

Volumn 8, Issue 4, 2002, Pages 268-282

  Oliva, E ^a   Clement, P B ^b   Young, R H ^a  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b UNIVERSITY OF BRITISH COLUMBIA   (Canada)

Author keywords

Endometrial stromal tumours; Immunochemistry; Leiomyoma variants; Leiomyosarcoma; Leiomyosarcoma variants; Uterine tumours resembling ovarian sex cord tumours

Indexed keywords

CLINICAL FEATURE; DIAGNOSTIC PROCEDURE; ENDOMETRIUM SARCOMA; HUMAN; IMMUNOHISTOCHEMISTRY; LEIOMYOBLASTOMA; LEIOMYOMA; LEIOMYOSARCOMA; MESENCHYMOMA; MITOSIS RATE; MORPHOLOGY; MUSCLE TUMOR; REVIEW; UTERUS TUMOR;

EID: 0036698622     PISSN: 09686053     EISSN: None     Source Type: Journal    
DOI: 10.1054/cdip.2002.0126     Document Type: Review

References (81)

1. Scully R E, Bonfiglio T A, Kurman R J, Silverberg S G, Wilkinson EJ. Histologic Typing of Female Genital Tract Tumours. Berlin: Springer-Verlag, 1994; 19.
2. Oliva E, Young R H, Clement P B, Bhan A K, Scully R E. Cellular benign mesenchymal tumours of the uterus. A comparative morphologic and immunohistochemical analysis of 33 highly cellular leiomyomas and six endometrial stromal nodules, two frequently confused tumours. Am J Surg Pathol 1995; 19: 757-768.
3. Dionigi A, Oliva E, Clement P B, Young R H. Endometrial stromal nodules and endometrial stromal tumours with limited infiltration: a clinicopathologic analysis of 50 cases. Am J Surg Pathol 2002; 26: 567-581.
4. Lillemoe T J, Perrone T, Norris H J, Dehner L P. Myogenous phenotype of epithelial-like areas in endometrial stromal sarcomas. Arch Pathol Lab Med 1991; 115: 215-219.
5. Abrams J, Talcott J, Corson J M. Pulmonary metastases in patients with low-grade endometrial stromal sarcoma. Clinicopathologic findings with immunohistochemical characterization. Am J Surg Pathol 1989; 13: 133-140.
6. Farhood A I, Abrams J. Immunohistochemistry of endometrial stromal sarcoma. Hum Pathol 1991; 22: 224-230.
7. Franquemont D W, Frierson H F, Mills S E. An immunohistochemical study of normal endometrial stroma and endometrial stromal neoplasms. Evidence for smooth muscle differentiation. Am J Surg Pathol 1991; 15: 861-870.
8. Devaney K, Tavassoli F A. Immunohistochemistry as a diagnostic aid in the interpretation of unusual mesenchymal tumours of the uterus. Mod Pathol 1991; 4: 225-231.
9. Oliva E, Young R H, Amin M B, Clement P B. An immunohistochemical analysis of endometrial stromal and smooth muscle tumours of the uterus: a study of 54 cases emphasizing the crucial importance of using a panel because of overlap in immunoreactivity for individual antibodies. Am J Surg Pathol 2002; 26: 403-412.
10. Nucci M R, O'Connell J T, Huettner P C et al. h-Caldesmon expression effectively distinguishes endometrial stromal tumours from uterine smooth muscle tumours. Am J Surg Pathol 2001; 25: 455-463.
11. Rush D S, Tan J, Baergen R N, Soslow R A. h-Caldesmon, a novel smooth muscle-specific antibody, distinguishes between cellular leiomyoma and endometrial stromal sarcoma. Am J Surg Pathol 200; 25: 253-258.
12. Chu P G, Arber D A, Weiss L M, Chang K L. Utility of CD10 in distinguishing between endometrial stromal sarcoma and uterine smooth muscle tumours: an immunohistochemical comparison of 34 cases. Mod Pathol 2001; 14: 465-471.
13. Wang L, Felix J C, Amezcua C A. The pattern of expression of c-kit and CD10 may aid in the diagnostic distinction among uterine mesenchymal neoplasms. Mod Pathol 2002; 15: 213A.
14. Srodon M, Kurman R J. CD10, desmin, and caldesmon in differentiating uterine stromal from smooth muscle tumours. Mod Pathol 2002; 15: 211A.
15. Hirsch M S, Huettner P C, Cviko A, Quade B J, Nucci M R. CD10 (CALLA) positive/H-caldesmon negative immunophenotype effectively distinguishes endometrial stromal tumours from uterine smooth muscle tumours. Mod Pathol 2002; 15: 198A.
16. Ghofrani M, Jain S R, Hui P, Zheng W, Parkash V. Immunohistochemical markers for the diagnosis of uterine mesenchymal neoplasms. Mod Pathol 2002; 15: 197A.
17. McCluggage W G, Sumathi V P, Maxwell P. CD10 is a sensitive and diagnostically useful immunohistochemical marker of normal endometrial stroma and of endometrial stromal neoplasms. Histopathology 2001; 39: 273-278.
18. Chu P, Arber D A. Paraffin-section detection of CD10 in 505 nonhematopoietic neoplasms. Frequent expression in renal cell carcinoma and endometrial stromal sarcoma. Am J Clin Pathol 2000; 113: 374-382.
19. Nixon B, Agoff S, Grieco V, Garcia R, Gown A. The use of immunohistochemistry to distinguish endometrial stromal sarcoma from cellular leiomyoma. Mod Pathol 2001; 14: 142A.
20. Clement P B. The pathology of uterine smooth muscle tumours and mixed endometrial stromal-smooth muscle tumours: a selective review with emphasis on recent advances. Int J Gynecol Pathol 2000; 19: 39-55.
21. O'Connor D M, Norris H J. Mitotically active leiomyomas of the uterus. Hum Pathol 1990; 21: 223-227.
22. Perrone T, Dehner L P. Prognostically favorable 'mitotically active' smooth-muscle tumours of the uterus. A clinicopathologic study of ten cases. Am J Surg Pathol 1988; 12: 1-8.
23. Prayson R A, Hart W R. Mitotically active leiomyomas of the uterus. Am J Clin Pathol 1992; 97: 14-20.
24. Norris H J, Hilliard G D, Irey N S. Hemorrhagic cellular leiomyomas ('apoplectic leiomyoma') of the uterus associated with pregnancy and oral contraceptives. Int J Gynecol Pathol 1988; 7: 212-224.
25. Myles J L, Hart W R. Apoplectic leiomyomas of the uterus. A clinicopathologic study of five distinctive hemorrhagic leiomyomas associated with oral contraceptive usage. Am J Surg Pathol 1985; 9: 798-805.
26. Bell S W, Kempson R L, Hendrickson M R. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol 1994; 18: 535-558.
27. Evans N. Malignant myomata and related tumours of the uterus. Report of 72 cases occurring in a series of 4000 operations for uterine fibromyomata. Surg Gynecol Obstet 1920; 30: 225-239.
28. Kempson R L, Hendrickson M R. Smooth muscle, endometrial stromal, and mixed mullerian tumours of the uterus. Mod Pathol 2000; 13: 328-342.
29. Downes K A, Hart W R. Bizarre leiomyomas of the uterus: a comprehensive pathologic study of 24 cases with long-term follow-up. Am J Surg Pathol 1997; 21: 1261-1270.
30. Downes K A, Hart W R. Bizarre uterine leiomyomas: Ki-67 activity and DNA ploidy. Abstract. Mod Pathol 1999; 12: 116A.
31. Zhai Y L, Kobayashi Y, Mori A et al. Expression of steroid receptors, Ki-67, and p53 in uterine leiomyosarcomas. Int J Gynecol Pathol 1999; 18: 20-28.
32. Layfield L J, Liu K, Dodge R, Barsky S H. Uterine smooth muscle tumours: utility of classification by proliferation, ploidy, and prognostic markers versus traditional histopathology. Arch Pathol Lab Med 2000; 124: 221-227.
33. Ernst L M, Luo V, Parkash V, Zheng W. Increased global DNA methylation in symplastic leiomyomas. Mod Pathol 2002; 15: 196A.
34. Kelly H A, Cullen T S. Myomata of the Uterus. Philadelphia: WB Saunders, 1909.
35. Clement P B, Young R H, Scully R E. Diffuse, perinodular, and other patterns of hydropic degeneration within and adjacent to uterine leiomyomas. Problems in differential diagnosis. Am J Surg Pathol 1992; 16: 26-32.
36. Roth L M, Reed R J. Dissecting leiomyomas of the uterus other than cotyledonoid dissecting leiomyomas: a report of eight cases. Am J Surg Pathol 1999; 23: 1032-1039.
37. Roth L M, Reed R J, Sternberg W H. Cotyledonoid dissecting leiomyoma of the uterus. The Sternberg tumour. Am J Surg Pathol 1996; 20: 1455-1461.
38. Clement P B, Young R H. Atlas of Gynecologic Surgical Pathology. Philadelphia: W. B. Saunders Company; 2000; 177-210.
39. Atkins K, Bell S, Kempson R, Hendrickson M. Myxoid smooth muscle tumours of the uterus. Mod Pathol 2001; 14: 132A.
40. Wilkinson N, Rollason T P. Recent advances in the pathology of smooth muscle tumours of the uterus. Histopathology 2001; 39: 331-341.
41. King M E, Dickersin G R, Scully R E. Myxoid leiomyosarcoma of the uterus. A report of six cases. Am J Surg Pathol 1982; 6: 589-598.
42. Pounder D J, lyer P V. Uterine leiomyosarcoma with myxoid stroma. Arch Pathol Lab Med 1985; 109: 762-764.
43. Salm R, Evans DJ. Myxoid leiomyosarcoma. Histopathology 1985; 9: 159-169.
44. Oliva E, Young R H, Clement P B, Scully R E. Myxoid and fibrous variants of endometrial stromal tumours of the uterus: a report of 10 cases. Int J Gynecol Pathol 1999; 18: 310-319.
45. Kurman R J, Norris H J. Mesenchymal tumours of the uterus. VI. Epithelioid smooth muscle tumours including leiomyoblastoma and clear-cell leiomyoma: a clinical and pathologic analysis of 26 cases. Cancer 1976; 37: 1853-1865.
46. Iwata J, Fletcher C D. Immunohistochemical detection of cytokeratin and epithelial membrane antigen in leiomyosarcoma: a systematic study of 100 cases. Pathol Int 2000; 50: 7-14.
47. Prayson R A, Goldblum J R, Hart W R. Epithelioid smooth-muscle tumours of the uterus: a clinicopathologic study of 18 patients. Am J Surg Pathol 1997; 21: 383-391.
48. Oliva E, Nielsen P G, Clement P B, Young R H, Scully R E. Epithelioid smooth muscle tumours of the uterus. A clinicopathologic analysis of 80 cases. Mod Pathol 1997; 10: 107A.
49. Atkins K, Bell S, Kempson R, Hendrickson M. Epithelioid smooth muscle tumours of the uterus. Mod Pathol 2001; 14: 132A.
50. Young R H, Scully R E. Oxyphilic tumours of the female and male genital tracts. Semin Diagn Pathol 1999; 16: 146-161.
51. Young R H, Scully R E. Placental-site trophoblastic tumour: current status. Clin Obstet Gynecol 1984; 27: 248-257.
52. Shih I M, Kurman R J. Epithelioid trophoblastic tumour: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumour simulating carcinoma. Am J Surg Pathol 1998; 22: 1393-1403.
53. Vang R, Kempson R L. Perivascular epithelioid cell tumour ('PEComa') of the uterus: a subset of HMB-45-positive epithelioid mesenchymal neoplasms with an uncertain relationship to pure smooth muscle tumours. Am J Surg Pathol 2002; 26: 1-13.
54. Oliva E, Clement P B, Young R H. Endometrial stromal tumours: an update on a group of tumours with a protean phenotype. Adv Anat Pathol 2000; 7: 257-281.
55. Tavassoli F A, Norris H J. Mesenchymal tumours of the uterus. VII. A clinicopathological study of 60 endometrial stromal nodules. Histopathology 1981; 5: 1-10.
56. Fekete PS, Vellios F. The clinical and histologic spectrum of endometrial stromal neoplasms: a report of 41 cases. Int J Gynecol Pathol 1984; 3: 198-212.
57. Chang K L, Crabtree G S, Lim-Tan S K, Kempson R L, Hendrickson M R. Primary uterine endometrial stromal neoplasms. A clinicopathologic study of 117 cases. Am J Surg Pathol 1990; 14: 415-438.
58. Hart W R, Yoonessi M. Endometrial stromatosis of the uterus. Obstet Gynecol 1977; 49: 393-403.
59. Silverberg S G. Low-grade endometrial stromal sarcoma: a rare but often puzzling diagnostic problem. Pathol Case Reviews 2000; 5: 173-180.
60. Oliva E, Clement P B, Young R H, Scully R E. Mixed endometrial stromal and smooth muscle tumours of the uterus: a clinicopathologic study of 15 cases. Am J Surg Pathol 1998; 22: 997-1005.
61. Schammel D P, Silver S A, Tavassoli F A. Combined endometrial stromal/smooth muscle neoplasms of the uterus. A clinicopathologic study of 38 cases. Mod Pathol 1999; 12: 12A.
62. Oliva E, Clement P B, Young R H. Epithelioid endometrial stromal tumours: a report of three cases emphasizing their distinction from epithelioid smooth muscle tumours and other oxyphilic uterine tumours. Int J Gynecol Pathol 2002; 21: 48-55.
63. Young R H, Prat J, Scully R E. Endometrioid stromal sarcomas of the ovary. A clinicopathologic analysis of 23 cases. Cancer 1984; 53: 1143-1155.
64. Young R H, Scully R E. Sarcomas metastatic to the ovary: a report of 21 cases. Int J Gynecol Pathol 1990; 9: 231-252.
65. Yantiss R K, Clement P B, Young R H. Neoplastic and preneoplastic changes in gastrointestinal endometriosis: a study of 17 cases. Am J Surg Pathol 2000; 24: 513-524.
66. Klein W M, Kurman R J. The lack of expression of c-kit protein (CD117) in mesenchymal tumours of the uterus and ovary. Mod Pathol 2002; 15: 200A.
67. McCluggage W G, Date A, Bharucha H, Toner P G. Endometrial stromal sarcoma with sex cord-like areas and focal rhabdoid differentiation. Histopathology 1996; 29: 369-374.
68. Clement P B, Scully R E. Endometrial stromal sarcomas of the uterus with extensive endometrioid glandular differentiation: a report of three cases that caused problems in differential diagnosis. Int J Gynecol Pathol 1992; 11: 163-173.
69. Lifschitz-Mercer B, Czernobilsky B, Dgani R et al. Immunocytochemical study of an endometrial diffuse clear cell stromal sarcoma and other endometrial stromal sarcomas. Cancer 1987; 59: 1494-1499.
70. Lloreta J, Prat J. Endometrial stromal nodule with smooth and skeletal muscle components simulating stromal sarcoma. Int J Gynecol Pathol 1992; 11: 293-298.
71. Clement P B, Young R H, Scully R E. Intravenous leiomyomatosis of the uterus. A clinicopathological analysis of 16 cases with unusual histologic features. Am J Surg Pathol 1988; 12: 932-945.
72. Goldblum J R, Clement P B, Hart W R. Adenomyosis with sparse glands. A potential mimic of low-grade endometrial stromal sarcoma. Am J Clin Pathol 1995; 103: 218-223.
73. Sahin A A, Silva E G, Landon G, Ordoñez N G, Gershenson D M. Endometrial tissue in myometrial vessels not associated with menstruation. Int J Gynecol Pathol 1989; 8: 139-146.
74. Banks E R, Mills S E, Frierson Jr H F. Uterine intravascular menstrual endometrium simulating malignancy. Am J Surg Pathol 1991; 15: 407-412.
75. Hattab E M, Allam-Nandyala P, Rhatigan R M. The stromal component of large endometrial polyps. Int J Gynecol Pathol 1999; 18: 332-337.
76. Evans H L. Endometrial stromal sarcoma and poorly differentiated endometrial sarcoma. Cancer 1982; 50: 2170-2182.
77. Cheung A N, Ng W F, Chung L P, Khoo U S. Mixed low grade and high grade endometrial stromal sarcoma of uterus: differences on immunohistochemistry and chromosome in situ hybridisation. J Clin Pathol 1996; 49: 604-607.
78. Clement P B, Scully R E. Uterine tumours resembling ovarian sex-cord tumours. A clinicopathologic analysis of fourteen cases. Am J Clin Pathol 1976; 66: 512-525.
79. Krishnamurthy S, Jungbluth A A, Busam K J, Rosai J. Uterine tumours resembling ovarian sex-cord tumours have an immunophenotype consistent with true sex-cord differentiation. Am J Surg Pathol 1998; 22: 1078-1082.
80. Baker R J, Hildebrandt R H, Rouse R V, Hendrickson M R, Longacre T A. Inhibin and CD99 (MIC2) expression in uterine stromal neoplasms with sex-cord-like elements. Hum Pathol 1999; 30: 671-679.
81. Rizeq M N, van de Rijn M, Hendrickson M R, Rouse R V. A comparative immunohistochemical study of uterine smooth muscle neoplasms with emphasis on the epithelioid variant. Hum Pathol 1994; 25: 671-677.