A panel of antibodies to determine site of origin and malignancy in smooth muscle tumors
Por:
Lee, CH, Turbin, DA, Sung, YCV, Espinosa, I, Montgomery, K, van de Rijn, M, Gilks, CB
Publicada:
1 dic 2009
Resumen:
Leiomyosarcomas are malignant smooth muscle tumors that occur most commonly in the gynecologic tract and soft tissue. There are different diagnostic criteria of malignancy for smooth muscle tumors arising at gynecologic and soft tissue sites and they may be managed differently but determining the primary site of a smooth muscle tumor can be difficult in some cases. In addition, the distinction between malignant and benign gynecologic tract smooth muscle tumors on morphologic grounds can be challenging. Using a series of tissue microarrays that contain 245 cases of leiomyosarcomas (102 gynecologic) with survival data, and 49 cases of uterine leiomyoma, we examined the ability of selected immune-markers (estrogen receptor (ER) and WT1) to distinguish between leiomyosarcomas of gynecologic and nongynecologic origin. In addition, we examined whether immunostains for p16, p53 and Ki-67 could distinguish between malignant and benign gynecologic smooth muscle tumors. ER nuclear positivity was observed in 3 and 50% of the nongynecologic and gynecologic leiomyosarcomas, respectively (P<0.001). Nuclear WT1 positivity was seen in 0 and 8% of the nongynecologic and gynecologic leiomyosarcomas, respectively (P<0.001). 87% of primary gynecologic leiomyosarcomas and 2% of uterine leiomyomas showed diffuse (>= 50% of cells) p16 staining (P<0.001). 23% of gynecologic leiomyosarcomas showed p53 immunopositivity (>= 50% of cells) whereas none of the leiomyomas were positive for p53 (P<0.001). 65% of the gynecologic leiomyosarcomas and 0% of the leiomyomas exhibited 410% Ki-67 proliferation index (P<0.001). Diffuse p16 and p53 immunopositivity and high Ki-67 proliferation index, singly or in combination, yielded an overall sensitivity of 92% and specificity of 98% for distinguishing between gynecologic leiomyosarcomas and leiomyomas and can be used as indicators of malignancy for gynecologic smooth muscle tumors. Although ER positivity can be used to support the gynecologic origin of a leiomyosarcomas, nuclear WT1 immunostaining is of little use. Modern Pathology (2009) 22, 1519-1531; doi:10.1038/modpathol.2009.122; published online 4 September 2009
Filiaciones:
Lee, CH:
Univ British Columbia, Dept Pathol & Lab Med, Vancouver Gen Hosp, Vancouver, BC V5Z 1M9, Canada
Turbin, DA:
Univ British Columbia, Dept Pathol & Lab Med, Vancouver Gen Hosp, Vancouver, BC V5Z 1M9, Canada
Sung, YCV:
Univ British Columbia, Dept Pathol & Lab Med, Vancouver Gen Hosp, Vancouver, BC V5Z 1M9, Canada
Espinosa, I:
Hosp Santa Creu & Sant Pau, Dept Pathol, Barcelona, Spain
Montgomery, K:
Stanford Univ, Med Ctr, Dept Pathol, Stanford, CA 94305 USA
van de Rijn, M:
Stanford Univ, Med Ctr, Dept Pathol, Stanford, CA 94305 USA
Gilks, CB:
Univ British Columbia, Dept Pathol & Lab Med, Vancouver Gen Hosp, Vancouver, BC V5Z 1M9, Canada
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