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Alodaini AA. Uterine Mesenchymal Tumors: Updates on Pathology, Molecular Landscape, and Therapeutics. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1085. [PMID: 39064514 PMCID: PMC11278911 DOI: 10.3390/medicina60071085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
Background: Mesenchymal uterine tumors are a diverse group of neoplasms with varying biological potential. Many of these neoplasms can have overlapping morphologic similarities, which, in some instances, render their diagnosis and categorization thorough histomorphologic examination inconclusive. In the last decade, an exponential amount of molecular data aiming to more accurately characterize and, consequently, treat these tumors have accumulated. Objective: The goal of this narrative review is to provide a pathologic review, a genetic update, and to know the new therapeutic avenues of primary uterine mesenchymal neoplasms.
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Affiliation(s)
- Amal A Alodaini
- Pathology Department, King Fahd University Hospital, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
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Michal M, Agaimy A, Croce S, Mechtersheimer G, Gross JM, Xing D, Bell DA, Gupta S, Mosaieby E, Martínek P, Klubíčková N, Michalová K, Bouda J, Fínek J, Hernandez T, Michal M, Schoolmeester JK, Ondič O. PLAG1-Rearranged Uterine Sarcomas: A Study of 11 Cases Showing a Wide Phenotypical Spectrum Not Limited to Myxoid Leiomyosarcoma-like Morphology. Mod Pathol 2024; 37:100552. [PMID: 38942115 DOI: 10.1016/j.modpat.2024.100552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/07/2024] [Accepted: 06/20/2024] [Indexed: 06/30/2024]
Abstract
PLAG1 gene fusions were recently identified in a subset of uterine myxoid leiomyosarcomas (M-LMS). However, we have encountered cases of PLAG1-rearranged uterine sarcomas lacking M-LMS-like morphology and/or any expression of smooth muscle markers. To better characterize their clinicopathologic features, we performed a multiinstitutional search that yielded 11 cases. The patients ranged in age from 34 to 72 years (mean, 57 years). All tumors arose in the uterine corpus, ranging in size from 6.5 to 32 cm (mean, 15 cm). The most common stage at presentation was pT1b (n = 6), and 3 cases had stage pT1 (unspecified), and 1 case each presented in stages pT2a and pT3b. Most were treated only with hysterectomy and adnexectomy. The follow-up (range, 7-71 months; median, 39 months) was available for 7 patients. Three cases (7-21 months of follow-up) had no evidence of disease. Three of the 4 remaining patients died of disease within 55 to 71 months, while peritoneal spread developed in the last patient, and the patient was transferred for palliative care at 39 months. Morphologically, the tumors showed a high intertumoral and intratumoral heterogeneity. M-LMS-like and epithelioid leiomyosarcoma-like morphology were present in 3 and 5 primary tumors, respectively, the remaining mostly presented as nondescript ovoid or spindle cell sarcomas. Unusual morphologic findings included prominently hyalinized stroma (n = 3), adipocytic differentiation with areas mimicking myxoid liposarcoma (n = 2), osteosarcomatous differentiation (n = 1), and undifferentiated pleomorphic sarcoma-like areas (n = 1). The mitotic activity ranged from 3 to 24 mitoses per 10 high-power fields (mean, 9); 3 of 10 cases showed necrosis. In 3 of 11 cases, no expression of smooth muscle actin, h-caldesmon, or desmin was noted, whereas 5 of 5 cases expressed PLAG1. By RNA sequencing, the following fusion partners were identified: PUM1, CHCHD7 (each n = 2), C15orf29, CD44, MYOCD, FRMD6, PTK2, and TRPS1 (each n = 1). One case only showed PLAG1 gene break by fluorescence in situ hybridization. Our study documents a much broader morphologic spectrum of PLAG1-rearranged uterine sarcomas than previously reported, encompassing but not limited to M-LMS-like morphology with occasional heterologous (particularly adipocytic) differentiation. As it is currently difficult to precisely define their line of differentiation, for the time being, we suggest using a descriptive name "PLAG1-rearranged uterine sarcoma."
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Affiliation(s)
- Michael Michal
- Bioptical Laboratory, Ltd, Pilsen, Czech Republic; Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic.
| | - Abbas Agaimy
- Institute of Pathology, Friedrich Alexander University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Sabrina Croce
- Department of BioPathology, Anticancer Center, Institut Bergonié, Bordeaux, France
| | | | - John M Gross
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Deyin Xing
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Debra A Bell
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Elaheh Mosaieby
- Bioptical Laboratory, Ltd, Pilsen, Czech Republic; Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | | | - Natálie Klubíčková
- Bioptical Laboratory, Ltd, Pilsen, Czech Republic; Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Květoslava Michalová
- Bioptical Laboratory, Ltd, Pilsen, Czech Republic; Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Jiří Bouda
- Department of Gynecology and Obstetrics, Charles University, Faculty of Medicine in Pilsen and Charles University Hospital Pilsen, Pilsen, Czech Republic
| | - Jindřich Fínek
- Department of Oncology and Radiotherapeutics, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Tahyna Hernandez
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Michal Michal
- Bioptical Laboratory, Ltd, Pilsen, Czech Republic; Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | | | - Ondrej Ondič
- Bioptical Laboratory, Ltd, Pilsen, Czech Republic; Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
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Affiliation(s)
- Wen-Ling Lee
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
| | - Fa-Kung Lee
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
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