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Garzon S, Caliò A, Ferrari FA, Iannicello CQ, Zorzato PC, Bosco M, Piazzola E, Martignoni G, Laganà AS, Mariani A, Uccella S. Uterine perivascular epithelioid cell tumors (PEComa) and the accuracy of proposed classification systems in predicting the malignant versus non-malignant behavior. Gynecol Oncol 2024; 188:35-43. [PMID: 38905754 DOI: 10.1016/j.ygyno.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To compare the accuracy of available classification systems (Folpe, modified Folpe, Bennet, and Schoolmester) in predicting the behavior of uterine Perivascular Epithelioid Cell tumors (PEComas). METHODS We reviewed the pathology registry to identify all uterine PEComas treated at our center. We conducted a systematic literature review searching electronic databases from inception to November 2023. We included all references reporting at least one case of uterine PEComa; cases associated with tuberous sclerosis complex were excluded. Patient-level data were extracted by identified records. Survival analysis was used to assess the accuracy of all proposed classification systems to classify uterine PEComas as malignant versus non-malignant. RESULTS Six uterine PEComas were treated at our center. The literature search identified 101 uterine PEComas from 32 studies. Eighty-five out of 107 PEComas (28 studies and our series) reported enough follow-up data and details to apply all four classifications. The modified Folpe classification demonstrated the highest hazard ratio (HR) for relapse (HR:8.63; 95% confidence interval [CI] 2.06-36.1) and death due to PEComa (HR:6.8, 95%CI:0.89-51.6) for malignant versus non-malignant PEComas. Changing the cut-off of PEComa size to ≥8 cm and mitotic figures per 50 high power fields to ≥5, the HR for recurrence lowered (HR:6.26; 95% CI 2.20-17.80), but HR for death increased (HR:10.3; 95% CI 1.35-77.80). CONCLUSIONS The modified Folpe classification was the most accurate in predicting the PEComa behavior. Changing the cut-off of PEComa size and number of mitotic figures may improve the accuracy in predicting death due to disease.
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Affiliation(s)
- Simone Garzon
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
| | - Anna Caliò
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Filippo Alberto Ferrari
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Cesare Quintino Iannicello
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Pier Carlo Zorzato
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Elena Piazzola
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Guido Martignoni
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy; Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Andrea Mariani
- Department of Gynecology and Obstetrics, Mayo Clinic, Rochester, MN, USA
| | - Stefano Uccella
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
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Zagardo V, Ferini G. Is there any role for radiotherapy in the management of uterine perivascular epithelioid cell tumors (PEComas)? Arch Gynecol Obstet 2024; 310:1789-1791. [PMID: 38850284 DOI: 10.1007/s00404-024-07578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Affiliation(s)
- Valentina Zagardo
- Radiation Oncology Unit, REM Radioterapia, 95100, Viagrande, CT, Italy
| | - Gianluca Ferini
- Radiation Oncology Unit, REM Radioterapia, 95100, Viagrande, CT, Italy.
- Department of Medicine and Surgery, University Kore of Enna, 94100, Enna, Italy.
- REM Radioterapia srl, Via Penninazzo 11, 95029, Viagrande, CT, Italy.
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Hu D, Miao M, Zhou H, Gu X, Wang X, Teichmann AT, Wang Q, Yang Y. A Case Report of Malignant Perivascular Epithelioid Cell Tumors of the Uterus and Literature Review. Int J Womens Health 2024; 16:619-628. [PMID: 38645980 PMCID: PMC11027917 DOI: 10.2147/ijwh.s453226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/09/2024] [Indexed: 04/23/2024] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors originating from perivascular epithelioid cells. In gynecological system, the uterus is one of the most common sites affected by PEComas. Most PEComas are benign, and patients usually have a good prognosis. However, malignant uterus PEComa is rare, and better comprehensive epidemiological investigations are needed. To date, there are a few reported cases of uterus PEComa. We herein report a rare case of malignant PEComa occurred in the uterine corpus and cervix, possibly accompanied by pulmonary lymphangioleiomyomatosis (PLAM). In addition, 55 cases of malignant uterus PEComa were picked out and collected in the data base of PubMed and Medline. On the one hand, the age of onset, population distribution, clinical manifestations, metastatic sites and routes of metastasis were analysed. On the other hand, a summary of the epidemiology, pathogenesis, diagnosis, and treatments of uterus PEComa was given.
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Affiliation(s)
- Daifeng Hu
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Mengyue Miao
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Hui Zhou
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Xia Gu
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, People’s Republic of China
| | - Xuedan Wang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Alexander Tobias Teichmann
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Qin Wang
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Youzhe Yang
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, People’s Republic of China
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Cui Q, Li C, Huang T, Huang J, Chen M. Systematic analysis of perivascular epithelioid cell neoplasms in the female reproductive tract: a comprehensive review. Future Oncol 2024; 20:283-295. [PMID: 38426361 DOI: 10.2217/fon-2023-0778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Perivascular epithelioid cell neoplasms (PEComas) are rare mesenchymal lesions, with gynecological PEComas accounting for just over a quarter of cases. Limited reports exist on gynecological PEComa, primarily treated with surgery; adjuvant therapy is considered in high-risk cases. This systematic review aims to summarize the origin and clinical, pathological and molecular characteristics of uterine PEComa, focusing on treatment options for gynecological PEComa. A comprehensive PubMed review of gynecological PEComa reports was conducted. A detailed examination of the literature ensured a thorough understanding. Gynecological PEComa diagnosis relies on histology and immunology. Despite therapy controversies, surgery remains the mainstay. Adjuvant therapy efficacy in high-risk cases is uncertain. mTOR inhibitors are the first line; alternative treatments, including angiogenesis and aromatase inhibitors, should be considered.
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Affiliation(s)
- Qiulin Cui
- Department of Gynecology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cheng Li
- Department of Gynecology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tongyi Huang
- Department of Clinical Medical Ultrasonics, Division of Interventional Ultrasound, Institute of Diagnostic & Interventional Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaming Huang
- Department of Gynecology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Chen
- Department of Gynecology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Mah SJ, Hoang L, Lee S, Finlayson S, Carey MS. Cervical PEComa: Challenges in diagnosis and prognosis of a rare neoplasm. Gynecol Oncol Rep 2023; 48:101238. [PMID: 37502444 PMCID: PMC10368816 DOI: 10.1016/j.gore.2023.101238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023] Open
Abstract
•Cervical PEComas are rare neoplasms which present a diagnostic challenge.•Large tumour size is an important clinical prognosticator in cervical PEComa.•All reported cases of cervical PEComa classified as benign by Folpe criteria behaved in benign fashion clinically.•Tumours ≤ 4 cm may be assessed with cone biopsy, and simple hysterectomy considered if no adverse pathologic features.•Molecular characterization and linkage with coordinated rare tumour registries may identify novel treatments.
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Affiliation(s)
- Sarah J. Mah
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Lien Hoang
- Department of Anatomical Pathology, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Shaina Lee
- Department of Gynecology, University of Saskatchewan, Regina, SK, Canada
| | - Sarah Finlayson
- Department of Obstetrics and Gynecology, University of British Columbia, BC Cancer Agency and Vancouver General Hospital, Vancouver, BC, Canada
| | - Mark S. Carey
- Department of Obstetrics and Gynecology, University of British Columbia, BC Cancer Agency and Vancouver General Hospital, Vancouver, BC, Canada
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Battistella E, Pomba L, Mirabella M, Gregianin M, Scapinello A, Volante M, Toniato A. Metastatic Adrenal PEComa: Case Report and Short Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010149. [PMID: 36676773 PMCID: PMC9866888 DOI: 10.3390/medicina59010149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/14/2023]
Abstract
PEComa has become a widely accepted entity, and increased recognition has led to descriptions of this tumor in a wide variety of anatomic sites, including the adrenal gland. PEComa (perivascular epithelioid cell tumor) is a mesenchymal tumor composed of perivascular cells, and the most frequent sites of PEComas are the uterus and retroperitoneum. The incidence is <1 per 1,000,000 people. We report a case of adrenal metastatic PEComa in a 63-year-old man discovered by a spontaneous hematoma of the rectus abdominis. In our case, PEComa of the adrenal gland was a significant diagnostic dilemma as the morphologic and immunophenotypic features of this neoplasm may easily be confused with those of other more commonly encountered lesions.
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Affiliation(s)
- Enrico Battistella
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
- Correspondence:
| | - Luca Pomba
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Marica Mirabella
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Michele Gregianin
- Department of Nuclear Medicine, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Antonio Scapinello
- Pathology Unit, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Marco Volante
- Department of Oncology, University of Turin, Via Giuseppe Verdi 8, 10124 Turin, Italy
| | - Antonio Toniato
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
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Cao B, Huang Y. Malignant perivascular epithelioid cell tumor (PEComa) of the uterus. BMC Womens Health 2022; 22:523. [PMID: 36522714 PMCID: PMC9756506 DOI: 10.1186/s12905-022-02119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumors (PEComas) of the uterus is a rare type of mesenchymal tumors associated with myelomelanocytic differentiation and distinctive histological appearances. So far, the reported cases of uterine PEComas are usually benign. Documented malignant cases with aggressive behavior appear to be less common. CASE PRESENTATION We report a 37-year-old female who received abdominal hysterectomy for uterine tumor in a local hospital. She was diagnosed with uterine leiomyosarcoma and referred to Hubei Cancer Hospital. Her histological slides were reviewed and immunohistochemical staining for specific markers of epithelial, melanocytic, myoid and some others were analyzed. The pathologic diagnosis was malignant uterine PEComa. Systematic imaging of the patient further revealed an abdominal para-aortic mass. She received pelvic and para-aortic lymph node dissection. Postoperative histology revealed para-aortic lymph nodal metastasis of malignant uterine PEComa. She received 8 cycles of chemotherapy after surgery. The chemotherapy regiment was epirubicin plus ifosfamide The patient is free of recurrence and metastasis 6 years after surgical resection. CONCLUSION Uterine PEComas are indistinguishable from other uterine tumors such as leiomyoma and leiomyosarcoma before pathologic diagnosis could be made. For patients with malignant uterine PEComas, removal of both primary lesions and metastatic foci, if any, needs to be attempted. Postoperative chemotherapy or radiotherapy should also be considered in patients with distant metastases or positive lymph nodes.
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Affiliation(s)
- Bo Cao
- grid.33199.310000 0004 0368 7223Department of Gynecology Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Yi Huang
- grid.33199.310000 0004 0368 7223Department of Gynecology Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
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Bourgmayer A, Nannini S, Bonjean P, Kurtz JE, Malouf GG, Gantzer J. Natural History and Treatment Strategies of Advanced PEComas: A Systematic Review. Cancers (Basel) 2021; 13:cancers13205227. [PMID: 34680376 PMCID: PMC8533842 DOI: 10.3390/cancers13205227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 01/11/2023] Open
Abstract
Simple Summary In this article, we review the clinical features of advanced PEComas and show the diversity of reported data among authors, emphasizing the heterogeneity of molecular characterization and treatment strategy. Based on clinical data collected from 124 case reports, metastatic disease at diagnosis and a grouped version of the Bleeker’s risk category were the only factors significantly associated with death. Due to a significant number of missing data or short follow-ups, results regarding prognostic factors should, however, be interpreted with caution. Abstract PEComas is a family of rare mesenchymal tumors. This systematic review aims to better understand the natural history of advanced PEComas. After a search on the PubMed database and main oncology meeting libraries according to the PRISMA guidelines, 88 articles reported in the English literature were included. Data on clinical and histological features, treatments and outcomes were collected. To identify risk factors, univariate and multivariate analyses were performed. Seven cohorts of patients and 124 individual patients were identified. Focusing on case reports, most patients were metastatic, and the median overall survival (OS) of the entire cohort was 60 months (95%CI 33; NA). Risk factors significantly associated with OS in the multivariate analysis were the presence of metastasis at diagnosis (HR: 2.59, 95%CI 1.06; 6.33, p = 0.036) and the grouped-Bleeker’s risk category (HR: 4.66; 95%CI 1.07; 20.19; p = 0.039). In the metastatic population, only the presence of lymph node metastasis was associated with OS (HR: 3.11; 95%CI 1.13; 8.60, p < 0.05). Due to a lack of events, it was not possible to conclude on other factors. This review of the literature highlights the heterogeneity of literature data and shows the great diversity of clinical management strategies.
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Affiliation(s)
- Agathe Bourgmayer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France; (A.B.); (S.N.); (J.-E.K.); (G.G.M.)
| | - Simon Nannini
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France; (A.B.); (S.N.); (J.-E.K.); (G.G.M.)
| | - Paul Bonjean
- Department of Clinical Research and Pharmacology Innovation Unit, CHU de Saint-Etienne, Hôpital Nord, 42270 Saint-Priest en Jarez, France;
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France; (A.B.); (S.N.); (J.-E.K.); (G.G.M.)
| | - Gabriel G. Malouf
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France; (A.B.); (S.N.); (J.-E.K.); (G.G.M.)
- Davidson Team, Department of Cancer and Functional Genomics, INSERM UMR_S1258, Institute of Genetics and Molecular and Cellular Biology, 67400 Illkirch, France
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France; (A.B.); (S.N.); (J.-E.K.); (G.G.M.)
- Davidson Team, Department of Cancer and Functional Genomics, INSERM UMR_S1258, Institute of Genetics and Molecular and Cellular Biology, 67400 Illkirch, France
- Correspondence:
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Yang Y, Yu X, Lu B, Shao Z. Perivascular epithelioid cell tumor (PEComa) of the kidney: an overview of its management and outcomes. J Int Med Res 2021; 48:300060520961223. [PMID: 33070694 PMCID: PMC7592318 DOI: 10.1177/0300060520961223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor with unique histological and immunohistochemical characteristics. Malignant renal cell carcinoma is even rarer and its biological behavior is still not clear. We report here a case of malignant PEComa in a male patient. The first symptom of the patient was intermittent hematuria. Ultrasound and computed tomography scan showed a solid mass in the left kidney. Fibrosarcoma was initially diagnosed after radical resection of the tumor. Six years later, the patient had a tumor recurrence and underwent a second operation, through which the diagnosis of renal malignant PEComa was made. Since then, the patient received chemotherapy, a third operation, and interventional treatment because of recurrence and metastasis of the tumor, which prolonged the life of the patient for another 6 years. Malignant PEComa involving the kidney is very rare; it seems to develop slowly but will recur and metastasize. At present, surgical resection remains the best treatment.
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Affiliation(s)
- Yu Yang
- Department of Urology, the Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaohong Yu
- Department of Urology, the Linyi People's Hospital, Linyi, Shandong Province, China
| | - Bo Lu
- Department of Surgery, the Maternal and Child Health Hospital of Pingyi County, Linyi, Shandong Province, China
| | - Zhiqiang Shao
- Department of Urology, the Linyi People's Hospital, Linyi, Shandong Province, China
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Gu J, Wang W, Wang S. A Retrospective Case Study of 13 Uterine Perivascular Epithelioid Cell Neoplasm (PEComa) Patients. Onco Targets Ther 2021; 14:1783-1790. [PMID: 33727828 PMCID: PMC7955772 DOI: 10.2147/ott.s300523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction and Hypothesis Perivascular epithelioid cell neoplasms (PEComas) are rare mesenchymal tumors that originate from perivascular epithelioid cells. The uterus is the second most common organ to be affected by PEComa. Most PEComas are benign and the prognosis is usually good. Surgery is the main treatment at present, and adjuvant therapy is mainly used for malignant cases. However, because of the lack of described cases, the best diagnosis and treatment of these tumors cannot be determined. Methods From 2009 to 2020, 13 patients from Shengjing Hospital (China Medical University), with uterine PEComa, who met the inclusion criteria and appropriate pathological diagnosis were enrolled in this study. Clinical, pathological, and therapeutic features were retrospectively analyzed to determine the best approach towards diagnosis and treatment. Results All the enrolled patients underwent surgical treatment; four of them had a malignant PEComa. Three of the malignant patients received chemotherapy after surgery; among them, one died, another showed no obvious recurrence after regular re-examination, and the third did not undergo any further treatment despite short-term recurrence. However, upon regular re-examination, no progress was observed. The fourth malignant patient did not receive chemotherapy after surgery and showed no obvious recurrence during regular reviews. Conclusion The preoperative diagnosis of uterine PEComa lacks specificity and therefore is often confused with uterine leiomyoma or leiomyosarcoma. We conclude that uterine PEComa can be diagnosed by combined analysis of immunohistochemistry and post-operative pathology. Though surgical resection is still the main treatment, high-risk patients can be given adjuvant treatment to strengthen disease control.
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Affiliation(s)
- Jiahui Gu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110001, People's Republic of China
| | - Wantong Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110001, People's Republic of China
| | - Shizhuo Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110001, People's Republic of China
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Perivascular Epithelioid Cell Tumour of the Uterus: a Case Report. Indian J Surg Oncol 2020; 11:196-198. [PMID: 33364697 DOI: 10.1007/s13193-020-01130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022] Open
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Libertini M, Hallin M, Thway K, Noujaim J, Benson C, van der Graaf W, Jones RL. Gynecological Sarcomas: Molecular Characteristics, Behavior, and Histology-Driven Therapy. Int J Surg Pathol 2020; 29:4-20. [PMID: 32909482 DOI: 10.1177/1066896920958120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gynecological sarcomas represent 3% to 4% of all gynecological malignancies and 13% of all sarcomas. The uterus is the most frequent primary site (83%); less frequently sarcomas are diagnosed originating from the ovary (8%), vulva and vagina (5%), and other gynecologic organs (2%). As the classification of gynecologic sarcomas continues to diversify, so does the management. Accurate histopathologic diagnosis, utilizing appropriate ancillary immunohistochemical and molecular analysis, could lead to a more personalized approach. However, there are subtypes that require further definition, with regard to putative predictive markers and optimal management. The aim of this review is to highlight the importance of accurate diagnosis and classification of gynecologic sarcoma subtypes by the surgical pathologist in order to provide more tailored systemic treatment, and to highlight the increasing importance of close collaboration between the pathologist and the oncologist.
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Affiliation(s)
| | - Magnus Hallin
- Royal Marsden Hospital/Institute of Cancer Research, London, UK
| | - Khin Thway
- Royal Marsden Hospital/Institute of Cancer Research, London, UK
| | | | | | | | - Robin L Jones
- Royal Marsden Hospital/Institute of Cancer Research, London, UK
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Gadducci A, Zannoni GF. Perivascular epithelioid cell tumors (PEComa) of the female genital tract: A challenging question for gynaecologic oncologist and pathologist. Gynecol Oncol Rep 2020; 33:100603. [PMID: 32685651 PMCID: PMC7356199 DOI: 10.1016/j.gore.2020.100603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
Perivascular epithelioid cell tumors (PEComa)s are mesenchymal neoplasms composed of perivascular epithelioid cells, which express both melanocytic and myogenic markers. These neoplastic cells are thought to arise from undifferentiated cells of the neural crest, or from myoblastic cells harbouring a molecular alteration leading to expression of melanocytic markers, or from pericytic cells. The majority of cases are benign, but a small subset behaves in a malignant fashion. Unfortunately, given their rarity, reliable criteria for predicting malignancy have yet to be established. PEComas of the female genital tract account for nearly 25% of PEComas of all body sites, and the most common site of occurrence is the uterine corpus; less common sites include the cervix, adnexa, vagina/vulva or broad or round ligament exceptionally. The present review aims to elucidate the clinical, pathological and molecular features of gynecological PEComas. Moreover, prognostic and therapeutic implications are also discussed.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - Gian Franco Zannoni
- Division of Anatomic Pathology and Histology - Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
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Nitahara K, Sasaki M, Ichikawa S, Tsuji K, Yoshida Y. Rupture of perivascular epithelioid cell neoplasm at 34 weeks’ gestation: A nonendometriosis case of spontaneous hemoperitoneum in pregnancy. J Obstet Gynaecol Res 2018; 45:709-713. [DOI: 10.1111/jog.13870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Kenta Nitahara
- Department of Obstetrics and GynecologyJapanese Red Cross Ishinomaki Hospital Ishinomaki Japan
| | - Megumi Sasaki
- Department of Obstetrics and GynecologyJapanese Red Cross Ishinomaki Hospital Ishinomaki Japan
| | - Saori Ichikawa
- Department of Obstetrics and GynecologyJapanese Red Cross Ishinomaki Hospital Ishinomaki Japan
| | - Keita Tsuji
- Department of Obstetrics and GynecologyJapanese Red Cross Ishinomaki Hospital Ishinomaki Japan
| | - Yuji Yoshida
- Department of Obstetrics and GynecologyJapanese Red Cross Ishinomaki Hospital Ishinomaki Japan
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15
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Shan W, Shi Y, Zhu Q, Yang B, Xie L, Li B, Ning C, Lv Q, Cheng Y, Xie B, Bai M, Xu Y, Chen X, Luo X. Five cases of uterine perivascular epithelioid cell tumors (PEComas) and review of literature. Arch Gynecol Obstet 2018; 299:185-190. [PMID: 30317387 DOI: 10.1007/s00404-018-4920-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 09/27/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Perivascular epithelioid cell tumor (PEComa) is a rare condition and the recognition of this condition is limited. Here we report five cases of uterine PEComa to add to the limited understanding of this rare condition. METHODS Five cases from Obstetrics and Gynecology Hospital of Fudan University were diagnosed as uterine PEComas. We collected the patients' clinical and pathological data as well as their outcomes. RESULTS All the five cases were diagnosed post-operationally. Fertility-sparing surgery was done for the first case and had a mass resection only. She delivered a healthy boy through the cesarean section in November 2016 and neither recurrence nor metastasis was found for 71 months. Hysterectomy was done for the other four cases. Adjuvant chemotherapy was also given for case 2 and case 4. Case 2 had combined endometrial cancer, which could be associated with tuberous sclerosis complex (TSC). She was followed up for 22 months and neither recurrence nor metastasis was detected. Neither recurrence nor metastasis was found in case 3 for 33 months. However, the patient in case 4 died of multiple dissemination and multiple organs failures, 10 months after the second surgery. The patient in case 5 had the hysterectomy and left adnexal resection and in this case we had no data about her long-term outcomes. CONCLUSION It is still challenging to detect and diagnose uterine PEComa clinically and no consensus or guidelines have been established regarding the treatment of this condition. More case studies are needed to enlighten the underlying mechanism and help optimize the therapies for this condition.
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Affiliation(s)
- Weiwei Shan
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Yue Shi
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Qin Zhu
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China.,Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, People's Republic of China
| | - Bingyi Yang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Liying Xie
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Bing Li
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Chengcheng Ning
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Qiaoying Lv
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Yali Cheng
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Bingying Xie
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Mingzhu Bai
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Yuhui Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China. .,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China.
| | - Xuezhen Luo
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China. .,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China.
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16
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Ben-Ami E, Hornick JL, Wagner AJ. The potential of emerging new therapeutics for the treatment of perivascular epithelioid cell tumors (PEComa). Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1493376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Eytan Ben-Ami
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jason L. Hornick
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Andrew J. Wagner
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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17
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Kirste S, Kayser G, Zipfel A, Grosu AL, Brunner T. Unresectable hepatic PEComa: a rare malignancy treated with stereotactic body radiation therapy (SBRT) followed by complete resection. Radiat Oncol 2018; 13:28. [PMID: 29463266 PMCID: PMC5819697 DOI: 10.1186/s13014-018-0974-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/11/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors occurring in various anatomic regions. Although diagnostic criteria and treatment management are not established, current treatment options consist of surgery and chemotherapy including mTOR inhibitors. Stereotactic body radiation therapy (SBRT) is a non-invasive ablative treatment which has shown excellent control rates for more common types of unresectable liver tumors and metastases. In this report we present a rare case of PEComa of the liver that was treated by stereotactic radiotherapy followed by resection. Staging and evaluation of treatment response was done by FDG-PET/CT. This case highlights the potential of SBRT as a neoadjuvant treatment even for rare liver malignancies. It is the first case of liver PEComa treated by SBRT and resection. CASE PRESENTATION A 52-year-old woman presented at an external hospital with abdominal pressure and pain in the right upper abdominal quadrant. A CT scan showed a 700 cm3 liver lesion in segment IV. In repeated biopsy in July 2015 histopathological workup showed a pleomorphic epitheloid tumor with small to medium sized cells expressing vimentin and melan-A while being negative for cytokeratin establishing the diagnosis of PEComa of the liver. To achieve high, ablative doses a stereotactic body radiotherapy (SBRT) technique was chosen consisting of 60Gy (biologically effective dose 105Gy) in 8 fractions of 7.5Gy. Radiotherapy planning was based on MRI resulting in a planning target volume (PTV) of 1944 cm3. Treatment toxicity was limited to a slight elevation of transaminases (grade 1 and 3). A complete resection was performed 21 weeks after radiotherapy confirmed by negative surgical margins. At last follow-up 21 months after therapy, MRI showed neither local nor distant tumor recurrence. The patient was in stable condition (ECOG 1) and without late radiation toxicity. CONCLUSIONS This is the first documented case of liver PEComa treated by SBRT and resection. A favorable post-treatment course demonstrates that SBRT is a potential neoadjuvant treatment that is capable of reducing an inoperable rare liver tumor to a resectable lesion.
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Affiliation(s)
- Simon Kirste
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
| | - Gian Kayser
- Department of Surgical Pathology, University Medical Center Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Anne Zipfel
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
| | - Thomas Brunner
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
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18
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Acosta AM, Adley BP. Predicting the Behavior of Perivascular Epithelioid Cell Tumors of the Uterine Corpus. Arch Pathol Lab Med 2017; 141:463-469. [PMID: 28234575 DOI: 10.5858/arpa.2016-0092-rs] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Perivascular epithelioid cell tumors (PEComas) are rare neoplasms that share phenotypic features with angiomyolipomas, clear cell sugar tumors, and lymphangioleiomyomatosis. They presumably represent the neoplastic counterpart of a yet-unidentified perivascular epithelioid cell that expresses smooth muscle and melanocytic immunomarkers. The uterus is the second most common site of origin for perivascular epithelioid cell tumors, after the retroperitoneum. Although most uterine perivascular epithelioid cell tumors are clinically benign and can be cured by a complete surgical excision, there is a subset characterized by both local and distant dissemination. Unfortunately, no single histopathologic or immunohistochemical parameter can accurately predict the clinical behavior of these tumors, which is why the 2012 World Health Organization classification of tumors of the female reproductive organs suggests the use of several criteria to predict the risk of aggressive clinical behavior. Here we review those perivascular epithelioid cell tumors of the uterine corpus with aggressive clinical behavior reported in the literature, and we discuss their most relevant clinical and histopathologic features.
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Affiliation(s)
| | - Brian P Adley
- From the Department of Anatomic/Clinical Pathology, University of Illinois at Chicago Hospital and Health Sciences System (Dr Acosta); and the Department of Pathology, Advocate Lutheran General Hospital, Park Ridge, Illinois (Dr Adley)
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19
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Liang W, Xu C, Chen F. Primary retroperitoneal perivascular epithelioid cell neoplasm: A case report. Oncol Lett 2015; 10:469-472. [PMID: 26171053 DOI: 10.3892/ol.2015.3210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 04/27/2015] [Indexed: 12/21/2022] Open
Abstract
Perivascular epithelioid cell neoplasm (PEComa) is a rare type of tumor, and primary retroperitoneal PEComa is rarer still. The present report discusses the case of a 51-year-old woman who was admitted to hospital following stiffness and discomfort in the upper right abdomen for longer than one month. Computed tomography identified a soft tissue mass in the rear right kidney, accompanied by clear cystic degeneration and bleeding. The borderline between the mass and the right kidney was not distinct. An enhanced scan revealed that the solid section of the mass was progressively enhanced. Following excision of the mass and the affected right kidney, the patient was pathologically diagnosed with retroperitoneal PEComa involving the right kidney. Short-term reexamination did not detect any recurrence.
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Affiliation(s)
- Wenjie Liang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Chang Xu
- Department of Radiology, Hospital Affiliated to Binzhou Medical University, Binzhou, Shandong 256603, P.R. China
| | - Feng Chen
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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20
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Perivascular epithelioid cell neoplasm (PEComa) of the uterus: A systematic review. Int J Surg 2015; 19:1-5. [PMID: 25981307 DOI: 10.1016/j.ijsu.2015.05.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 04/23/2015] [Accepted: 05/04/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Perivascular epithelioid cell neoplasm (PEComa) is a rare mesenchymal tumor. Gynecological PEComas account for just over one-fourth of the overall PEComa cases reported in the literature. Surgery is the most recommended primary treatment while adjuvant therapy is generally reserved for high-risk cases. However, the best management of this neoplasia has not been well established, primarily because of the paucity of cases described to date. OBJECTIVES The aim of this systematic review is to summarize what is known thus far regarding the etiopathogenesis, clinical and pathologic features of PEComas, focusing also on the most valid treatment options for uterine cases. DATA SOURCES Pubmed articles on PEComas published in various journals over the past 70 years were analyzed. CONCLUSIONS AND KEY FINDINGS Although the optimal treatment of gynecological PEComas is controversial, surgical resection remains the cornerstone. The use of adjuvant treatment is warranted in high risk patients to increase disease control. A multidisciplinary approach should be key in treatment decision-making regarding gynecological PEComas.
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21
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Conlon N, Soslow RA, Murali R. Perivascular epithelioid tumours (PEComas) of the gynaecological tract. J Clin Pathol 2015; 68:418-26. [PMID: 25750268 DOI: 10.1136/jclinpath-2015-202945] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 12/11/2022]
Abstract
Perivascular epithelioid tumours (PEComas) of the gynaecological tract are rare tumours which were first recognised and diagnosed within the last 20 years. They represent a unique diagnostic challenge with regard to their accurate and reproducible distinction from more common entities such as smooth muscle tumours of the uterine corpus. In this review article, we trace the development of the concept of the PEComa tumour family, highlight what is known about extra-gynaecological tract PEComa at an immunohistochemical, molecular and therapeutic level and then present a summary of all reported cases of gynaecological tract PEComa to date. In the summary, we highlight rare subtypes of gynaecological tract PEComa and compare the performances of extant prognostic classification systems for malignancy in these tumours.
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Affiliation(s)
- Niamh Conlon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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22
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Forty-three-year-old woman with mediastinal PEComa treated with chemoradiation therapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396913000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe rarity of PEComa tumours has precluded any clinical trials, but surgery remains the most commonly reported treatment modality with just a few reports on treatment plans involving chemoradiation. We describe a patient with a mediastinal PEComa who presented with symptoms concerning for superior vena cava syndrome. She was deemed inoperable and was thus treated exclusively with chemoradiation therapy. The use of chemoradiation in the treatment of PEComa tumours is reviewed.
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23
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Imaging features of primary and metastatic malignant perivascular epithelioid cell tumors. AJR Am J Roentgenol 2014; 202:252-8. [PMID: 24450662 DOI: 10.2214/ajr.13.10909] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of our study was to describe the imaging features of primary and metastatic malignant perivascular epithelioid cell tumors (PEComas). MATERIALS AND METHODS In this retrospective study, 36 patients (26 women, 10 men; mean age, 53.1 years; age range, 35-77 years) with a histopathologically confirmed diagnosis of malignant PEComa who were seen at our institute between January 2007 and December 2012 were included. Pretreatment imaging of the primary tumor in 17 patients (CT, n = 13; MRI, n = 9; ultrasound, n = 5) and follow-up imaging in all 36 patients (CT, n = 36; MRI, n = 7) were reviewed by three radiologists in consensus. RESULTS The most common site of presentation of malignant PEComas was the retroperitoneum (38.9%) followed by the female genital tract (27.8%). Kidneys (8/36) and uterus (8/36) were the organs most frequently involved. The mean largest dimension was 11.01 cm (range, 4.5-25 cm). Primary tumors were well-circumscribed masses (16/17), were heteroechoic on ultrasound (5/5), were hypodense (2/6) to isodense (4/6) enhanced significantly (11/12) and compared with the paraspinal muscles on CT, were hypointense to isointense compared with skeletal muscle on T1-weighted imaging (8/9), were heterogeneously hyperintense compared with skeletal muscle on T2-weighted imaging (9/9), and showed significant post-gadolinium enhancement (7/7) on MRI. Of the 17 primary tumors, necrosis was seen in seven tumors, hemorrhage in three tumors, and calcification in three tumors. Twenty-six of 36 (72%) patients developed metastases, most commonly to the lung (21.6%), liver (17.6%), and peritoneum (10.8%). CONCLUSION Malignant PEComas in our study were large tumors that most often arise in the kidneys and uterus and metastasize to lungs, liver, or peritoneum. In our experience malignant PEComas should be considered in the differential diagnosis of large well-circumscribed renal and uterine tumors.
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24
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Xi S, Chen H, Wu X, Jiang H, Liu J, Wu Q, Zeng J. Malignant renal angiomyolipoma with metastases in a child. Int J Surg Pathol 2013; 22:160-6. [PMID: 23975831 DOI: 10.1177/1066896913497395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The biological character of epithelioid angiomyolipoma (EAML) remains controversial and little is known about EAML in children. We present a case of a 7-year-old boy with abdominal distention, diagnosed as EAML. Under microscopy, epithelioid cells were observed, with eosinophilic or slightly eosinophilic cytoplasm and nuclear pleomorphism, thick-walled blood vessels, and some cells that were differentiated to smooth muscle cells or fat cells were easily observed. Immunochemical staining showed that Melan-A and HMB45 were positive. The tumor presented highly aggressive biobehavior. Furthermore, we reviewed and analyzed cases of diagnosed EAML in our hospital and those reported in the literature. Renal EAML (10/17) was most common, and the EAML of 3 of 17 patients metastasized to other organs.
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Affiliation(s)
- Shaoyan Xi
- 1Sun Yat-sen University Cancer Center, Guangzhou, China
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25
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Cheung TT, Trendell-Smith N, Poon RTP. Primary perivascular epithelioid cell tumour (PEComa) of the liver. BMJ Case Rep 2013; 2013:bcr-2013-008706. [PMID: 23845671 DOI: 10.1136/bcr-2013-008706] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We present a case of a 53-year-old woman with abdominal discomfort for 6 months. The liver was enlarged. Contrast CT scan of the abdomen revealed a 10 cm hypervascular tumour at the right lobe of the liver. Right hepatectomy with complete excision of the tumour was achieved. Histological and immunohistochemical findings were consistent with perivascular epithelioid cell tumour. She is regularly followed up with contrast CT assessment. There is no tumour recurrence 12 months after the operation.
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Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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26
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Abstract
Many soft tissue tumors of childhood lack obvious differentiation toward a defined mesenchymal tissue type or have a phenotype that does not correspond to any defined normal tissue. These challenging tumors are currently regarded as neoplasms of uncertain differentiation. Nonetheless, there have been great strides in the understanding of their pathologic and genetic features and biologic underpinnings. The application of new genetic information to the pathologic diagnosis among this group of tumors is an emerging area in diagnostic pediatric pathology. This article reviews the clinicopathologic features of tumors of uncertain and/or miscellaneous origin, with an emphasis on the unique aspects of these neoplasms in children and adolescents, use of diagnostic adjuncts, and differential diagnosis.
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Affiliation(s)
- Rita Alaggio
- Department of Pathology, University of Padova, Padova, Italy.
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27
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Alaggio R, Cecchetto G, Martignoni G, Bisogno G, Cheng L, Sperlì D, d'Amore ESG, Dall'Igna P. Malignant perivascular epithelioid cell tumor in children: description of a case and review of the literature. J Pediatr Surg 2012; 47:e31-40. [PMID: 22703822 DOI: 10.1016/j.jpedsurg.2012.02.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 01/09/2012] [Accepted: 02/02/2012] [Indexed: 01/05/2023]
Abstract
Perivascular epithelioid cell tumors (PEComas) include different morphological entities originating from perivascular epithelioid cells. Their clinical behavior is not predictable, and there are no strict histologic criteria for malignancy, although larger tumors with infiltrative growth, hypercellularity, cellular atypia, atypical mitoses, and necrosis generally have a malignant course. Pediatric PEComas are rare, with less than 40 cases reported, mostly in children older than 5 years. We describe a case of malignant PEComa of the ligamentum teres in a 2-year-old girl, characterized by the occurrence of local relapse after primary treatment with chemotherapy and surgery and poor response to imatinib mesilate and temsirolimus used after further analyses confirmed p70S6K expression involved in the mTOR pathway. The girl was eventually treated with a debulking surgical procedure and is now alive with disease 6 years after diagnosis. Literature data of children affected by PEComas were also analyzed, trying to identify pathologic characteristics that could predict their course and therapeutic options. Histologically, they may be differentiated in 3 prognostic categories: (1) benign, lacking unfavorable morphological markers; (2) with uncertain malignant potential, carrying 1 unfavorable marker; and (3) malignant, with at least 2 unfavorable markers. In the literature, 9% of cases occurred as a second malignancy probably because of genomic instability related to treatment. Their different biology and the potential value of targeted therapies remain to be explored. The indolent evolution in our patient was similar to that reported in some other cases in the literature. In terms of treatment, the present case suggests a minor response to temsirolimus compared with the adult population.
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Affiliation(s)
- Rita Alaggio
- Pathology Department, University of Padua, Padua, Italy
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28
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"Malignant" perivascular epithelioid cell neoplasm: risk stratification and treatment strategies. Sarcoma 2012; 2012:541626. [PMID: 22619565 PMCID: PMC3350998 DOI: 10.1155/2012/541626] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/08/2012] [Indexed: 02/07/2023] Open
Abstract
Purpose. Perivascular epithelioid cell tumors (PEComas) are a rare collection of tumors characterized by a myomelanocytic phenotype, and PEComas occurring in “nonclassic” anatomic distributions are known as perivascular epithelioid cell tumor not otherwise specified (PEComa-NOS). This review aims to compile and analyze cases of PEComa-NOS in an effort to better define their natural history.
Design. We evaluated all 234 cases of PEComa-NOS reported in the English literature, extracting information regarding diagnostic features, treatment approaches, and outcomes. Multivariate analysis of a number of variables evaluable on pathologic review was performed to refine preexisting risk stratification criteria. Outcomes for patients receiving nonsurgical treatment are also reported.
Results. Primary tumor size ≥5 cm (P = 0.02) and a high (1/50 HPF) mitotic rate (P < 0.0001) were the only factors significantly associated with recurrence following surgical resection. Cytotoxic chemotherapy and radiation therapy have shown little benefit in treating PEComa-NOS; mTOR inhibition is emerging as a treatment option.
Conclusion. Progress has been made in understanding the natural history and molecular biology of PEComa-NOS. This review further clarifies risk of recurrence in this disease, allowing clinicians to better risk stratify patients. Further work should focus on applying this knowledge to making treatment decisions for patients with this disease.
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29
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Bleeker JS, Quevedo JF, Folpe AL. Malignant perivascular epithelioid cell tumor of the uterus. Rare Tumors 2012; 4:e14. [PMID: 22532912 PMCID: PMC3325741 DOI: 10.4081/rt.2012.e14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/03/2012] [Accepted: 01/06/2012] [Indexed: 01/04/2023] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are a rare collection of tumors arising in a wide array of anatomic locations and characterized by a myomelanocytic phenotype. PEComas which occur in non-classic anatomic distributions are known as perivascular epithelioid cell tumor-not otherwise specified (PEComa-NOS), and one of the most common primary sites for PEComa-NOS is the uterus. The risk of aggressive behavior of these tumors has been linked to a number of factors evaluable on pathologic review following initial surgical resection. We report a case of PEComa-NOS of the uterus with multiple high-risk features, including frank vascular invasion, with no evidence of recurrent disease 18 months following initial surgical resection.
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Heterologous and rare homologous sarcomas of the uterine corpus: a clinicopathologic review. Adv Anat Pathol 2011; 18:60-74. [PMID: 21169739 DOI: 10.1097/pap.0b013e3182026be7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pure sarcomas of the uterine corpus are uncommon, constituting less than 3% of all malignancies at this site, and most of them are leiomyosarcomas and endometrial stromal sarcomas. Rare histotypes of homologous sarcomas and heterologous sarcomas are occasionally encountered, and the absence of significant accumulated experience with these histotypes at this location may potentially raise diagnostic and patient management difficulties. In this article, the clinicopathologic attributes of all earlier reported sarcomas of the uterine corpus other than leiomyosarcomas and endometrial stromal sarcomas are summarized. Included are embryonal rhabdomyosarcoma, pleomorphic rhabdomyosarcoma, angiosarcoma, alveolar soft part sarcoma, malignant perivascular epithelioid cell tumors (PEComas), osteosarcoma, chondrosarcoma, liposarcomatous tumors, malignant extrarenal rhabdoid tumors, Ewing sarcoma/primitive neuroectodermal tumor, and other rare histotypes. Embryonal rhabdomyosarcoma (20%), Ewing sarcoma/primitive neuroectodermal tumor (17%), angiosarcoma (14%), and pleomorphic rhabdomyosarcoma (13%) appeared to be more common than the others, although there was no single overwhelmingly prevalent histotype in the group. A subset, including embryonal rhabdomyosarcoma, alveolar soft part sarcoma, and PEComas, peak in the premenopausal years, but most of the others were observed in postmenopausal women. Favorable outcomes have been reported for the patients diagnosed with alveolar soft part sarcoma, and the prognosis for their counterparts with PEComa remains a matter of debate. Multimodal therapeutic approaches to contemporary patients with embryonal rhabdomyosarcomas have resulted in significantly improved outcomes. Unfortunately, most of the other sarcomas have been associated with rapid tumor progression and unfavorable patient outcomes. The differential diagnosis for these sarcomas is often extensive and varies by histotype, but their accurate diagnosis fundamentally requires the careful exclusion of biphasic malignancies.
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de León DC, Pérez-Montiel D, Bandera A, Villegas C, Gonzalez-Conde E, Vilchis JC. Perivascular epithelioid cell tumor of abdominal origin. Ann Diagn Pathol 2010; 14:173-7. [PMID: 20471562 DOI: 10.1016/j.anndiagpath.2010.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 02/18/2010] [Indexed: 12/14/2022]
Abstract
Perivascular epithelioid tumor is not a common disease; therefore, large series are not available in the literature, and most are case reports. Histologic characteristics of these neoplasms are positivity to melanogenic (HMB-45) and muscle stains. All these neoplasms have the characteristic perivascular epithelioid cell or "PEC," but the term myomelanocyte tumor has been proposed because of the immunohistochemistry expression. Females are affected more commonly than males. The uterus seems to be one of the most common organs affected. Its clinical behavior is uncertain, and standard treatment has not been established as well as criteria for malignancy. We report 3 cases of abdominal PEComa, 1 of them with benign clinical outcome and 2 with an aggressive behavior.
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Affiliation(s)
- David Cantú de León
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, México City, México.
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An unresectable malignant perivascular epithelioid cell tumor resistant to multiple combined chemotherapies: a unique case report. J Pediatr Hematol Oncol 2010; 32:e136-8. [PMID: 20051914 DOI: 10.1097/mph.0b013e3181b8700b] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Malignant perivascular epithelioid cell tumor (PEComa) was a kind of rare disease with malignant behavior and poor prognosis. Nearly all PEComas show immunoactivity for HMB45. The treatment strategy for malignant PEComa is still of controversy, especially in advanced or unresectable disease. We reported a 14-year-old patient of unresectable malignant PEComa, who was treated with multiple combined chemotherapies. The patient died of tumor 9 months after surgery, although 3 different combined chemotherapeutic regimens and antiangiogenic drug were used. Our case suggested that empirical chemotherapeutic regimens for soft tissue sarcomas might not be suitable for PEComa.
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Abstract
The connection between angiomyolipoma (AML) of the kidney, clear cell sugar tumor (CCST) of the lung, and pulmonary lymphangioleiomyoma (LAM), was progressively discovered because of the histologic and immunophenotypic similarities between the three tumors and their frequent association with tuberous sclerosis complex (TSC). Morphologically, analogous lesions found in other locations are composed of the unifying cell, the perivascular epithelioid cell (PEC). PEC tumors (or PEComas), other than AML, CCST, and LAM, are not associated with TSC and typically occur in middle-aged adult females. These neoplasms are composed of nests and fascicles of clear to granular epithelioid and/or spindled cells with a consistent arrangement around blood vessels. Characteristically, the cells express both melanocytic (usually HMB45) and myogenic (typically actin) markers. Although the most common sites are the gastrointestinal and genitourinary tracts, approximately 23 cases, to date, of PEComas arising in the skin have been reported. Primary cutaneous PEComas also have a predilection for adult females and most often present as a painless mass on the extremities. In contrast to other sites, the myogenic marker most commonly expressed in PEComas of the skin is desmin. Most reported cutaneous PEComas follow a benign course, however, a malignant case has been reported. Surgical excision is currently the mainstay of treatment.
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Affiliation(s)
- Sarah N Walsh
- Cutaneous Pathology, WCP Laboratories, Inc, 2326 Millpark Dr., St. Louis, MO 63043, USA.
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Strzelczyk JM, Durczynski A, Szymanski D, Jablkowski M, Dworniak D, Sporny S. Primary perivascular epithelioid cell tumor (PEComa) of the liver: report of a case. Surg Today 2009; 39:916-21. [PMID: 19784736 DOI: 10.1007/s00595-009-3945-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 01/07/2009] [Indexed: 12/30/2022]
Abstract
PEComa is very rare mesenchymal neoplasm which is formed by perivascular epithelioid cells and is characterized by dual melanocytic and myoid differentiation. Up to now only a very few cases of PEComa of the liver have been described worldwide. We herein present a patient who underwent a right hemihepatectomy for a huge tumor which could not be identified by imaging investigations. A final histopathologic examination revealed a benign epithelioid tumor with a solid growth pattern, abundant vascularity, and frequently dilated vascular channels. Immunohistochemically, the tumor cells were strongly positive for HMB-45, moderately positive for actin, and faintly positive for S-100, respectively. Based on the above findings, a diagnosis of a primary clear cell "sugar" tumor was established. Because the natural history of PEComas is mostly unpredictable, the patient has been closely followed up; however, no recurrence has so far been observed. Immunohistochemical findings play a crucial role in avoiding a misdiagnosis, and a surgical resection with an adequate margin of healthy tissue remains the gold standard of treatment. A long-term periodic follow-up is reasonable in all cases presenting with PEComa.
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Affiliation(s)
- Janusz M Strzelczyk
- Department of General and Transplant Surgery, Medical University of Lodz, Norbert Barlicki Memorial Teaching Hospital, Kopcinskiego Street 22, Lodz 90-153, Poland
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Rettenmaier MA, Zekry N, Chang M, Palmer A, Brown JV, Micha JP, Goldstein BH. A heavily pigmented vaginal perivascular epithelioid cell neoplasm. J OBSTET GYNAECOL 2009; 29:676-7. [DOI: 10.1080/01443610903118247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zekry N, Rettenmaier MA, Abaid LN, John CR, Micha JP, Brown JV, Goldstein BH. Perivascular epithelioid cell neoplasms: a systematic review of prognostic factors. J Minim Invasive Gynecol 2009; 16:527-32. [PMID: 19596216 DOI: 10.1016/j.jmig.2009.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/22/2009] [Accepted: 04/30/2009] [Indexed: 10/20/2022]
Abstract
Perivascular epithelioid cell tumors (PEComas) are rare, soft tissue tumors characterized by epithelioid cells with clear or eosinophilic cytoplasm and a perivascular disbursement. We compiled the treatment and follow-up results from an extensive collection of reported gynecologic PEComa cases and statistically analyzed their respective therapy modalities and corresponding patient outcomes. In the group of patients with PEComa who received surgical management alone, there was a tendency for them to exhibit a lower disease recurrence rate. Conversely, patients with PEComa who initially received surgery and chemotherapy or radiation therapy were associated with a higher disease recurrence rate (P =.024). Metastatic involvement was related to higher patient mortality rates (P =.0001), although this finding was unrelated to treatment type. Surgical management alone may suffice for nonaggressive lesions, but chemotherapy and radiotherapy appear necessary for patients who present with high-risk histologic condition or metastatic disease. Because PEComas exhibit varying biologic behavior and an ill-defined presentation, the treatment for these lesions necessitates further evaluation.
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Affiliation(s)
- Nazila Zekry
- Hoag Memorial Hospital, Department of Pathology, Newport Beach, CA, USA
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37
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Perivascular epithelioid cell tumor (PEComa) of the uterus with aggressive behavior at presentation. Hematol Oncol Stem Cell Ther 2009; 2:426-30. [DOI: 10.1016/s1658-3876(09)50013-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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38
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Armah HB, Parwani AV. Perivascular epithelioid cell tumor. Arch Pathol Lab Med 2009; 133:648-54. [PMID: 19391667 DOI: 10.5858/133.4.648] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2008] [Indexed: 11/06/2022]
Abstract
Perivascular epithelioid cell tumors are mesenchymal neoplasms defined by the presence of histologically and immunohistochemically distinctive perivascular epithelioid cells. The perivascular epithelioid cell has no known normal tissue counterpart and coexpresses myoid and melanocytic markers. This tumor family shows marked female predominance and includes angiomyolipoma, clear cell sugar tumor, lymphangioleiomyomatosis, and a group of rare, morphologically and immunophenotypically similar tumors arising at a variety of visceral and soft tissue sites. This latter subset has been collectively termed perivascular epithelioid cell tumors-not otherwise specified. They are usually composed of epithelioid, but occasionally spindled, cells with clear to granular eosinophilic cytoplasm and focal perivascular accentuation. The mainstay of treatment is wide excision. Although most cases are benign, a subset behaves in a malignant fashion. Since few malignant cases have been reported, firm criteria for malignancy have yet to be established. This review focuses on the perivascular epithelioid cell tumors-not otherwise specified subset.
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Affiliation(s)
- Henry B Armah
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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39
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Polypoid PEComa in the rectum of a 15-year-old girl: case report and review of PEComa in the gastrointestinal tract. Am J Surg Pathol 2009; 33:475-82. [PMID: 19092636 DOI: 10.1097/pas.0b013e31819003d1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PEComa of the gastrointestinal tract, composed of perivascular epithelioid cells with myomelanocytic differentiation, is rare with previous literature limited to 16 case reports. There is a marked female preponderance and approximately one-third of the cases occur in the pediatric age group. We report PEComa with lymph node involvement occurring in the rectum of a 15-year-old girl, treated by surgical resection and adjuvant chemotherapy. The patient is well at 9 months follow-up with neither radiologic nor endoscopic evidence of recurrence. We review the differential diagnosis of intestinal PEComa, which includes malignant melanoma, epithelioid gastrointestinal stromal tumors, clear cell sarcoma of soft parts, alveolar soft part sarcoma, leiomyosarcoma with HMB45 expression, and paraganglioma. Immunohistochemistry can rule out many of these morphologically similar tumors but differentiation from clear cell sarcoma may require reverse transcription-polymerase chain reaction. We discuss the determination of pathologic features indicative of malignancy in PEComa, which is complicated in the gastrointestinal tract due to the small number of cases, variability of pathologic features reported, and inconsistent reporting of outcome. All 4 tumors reporting early recurrence or progression were greater than 5 cm in size and had areas of coagulative tumor necrosis. In addition, high nuclear grade and lymphovascular invasion were seen in 2 of these 4 cases. We propose that a minimum dataset for gastrointestinal PEComa should include these features along with mitotic count, infiltrative border, and tumor stage analogous to that used in colorectal carcinoma.
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40
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Jeon IS, Yi DY. Acute lymphoblastic leukemia secondary to chemoradiotherapy for perivascular epithelioid cell tumor of uterus. Pediatr Hematol Oncol 2009; 26:85-8. [PMID: 19322738 DOI: 10.1080/08880010902754859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute lymphoblastic leukemia (ALL), a primary hematologic malignancy that is especially common in childhood, occurs relatively rarely as a secondary malignant neoplasm. Available data indicate that ALL often follows chemoradiotherapy for soft tissue sarcoma. Perivascular epithelioid tumor (PEComa), a primitive mesenchymal tissue origin, can be classified as a soft tissue sarcoma. An 11-year-old girl was diagnosed with ALL secondary to chemoradiotherapy (vincristine, ifosfamide, and anthracycline) and radiotherapy comprising 45 Gy to the whole pelvis for PEComa. ALL, FAB L2, and immunophenotypically pro-B developed 16 months after the final chemotherapy treatment. Moreover, a cytogenetic study of lymphoblasts showed t(1;11)(p32;q23). Herein, the authors report a case of secondary ALL that might be related to a previously used intercalating DNA topoisomerase II inhibitor (anthracycline) for a very rare sarcoma, PEComa.
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Affiliation(s)
- In-sang Jeon
- Department of Pediatrics, Gil Medical Center, Gachon Medical School, Gachon University of Medicine and Science, Incheon 405-760, Korea.
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41
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Lans TE, van Ramshorst GH, Hermans JJ, den Bakker MA, Tran TCK, Kazemier G. Perivascular epithelioid cell tumor of the retroperitoneum in a young woman resulting in an abdominal chyloma. J Gastrointest Surg 2009; 13:389-92. [PMID: 18213505 DOI: 10.1007/s11605-007-0462-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 12/13/2007] [Indexed: 01/31/2023]
Abstract
Perivascular epithelioid cell tumor (PEComa) is an extremely rare neoplasm which appears to have predominancy for young, frequently Asian, women. The neoplasm is composed chiefly of HMB-45-positive epithelioid cells with clear to granular cytoplasm and usually showing a perivascular distribution. These tumors have been reported in various organs under a variety of designations. Malignant PEComas exist but are very rare. The difficulty in determining optimal therapy, owing to the sparse literature available, led us to present this case. We report a retroperitoneal PEComa discovered during emergency surgery for abdominal pain in a 28-year-old Asian woman. The postoperative period was complicated by chylous ascites that was initially controlled by a wait-and-see policy with total parenteral nutrition. However, the chyle production gradually increased to more than 4 l per day. The development of a bacterial peritonitis resulted in cessation of production of abdominal fluid permitting normal nutrition without chylous leakage. Effective treatment for this rare complication of PEComa is not yet known; therefore, we have chosen to engage in long-term clinical follow-up.
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Affiliation(s)
- T E Lans
- Department of Surgery, Erasmus MC-University Medical Center, 'sGravendijkwal 230, 3015 GD Rotterdam, The Netherlands.
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Fadare O, Liang SX. Epithelioid smooth muscle tumors of the uterus do not express CD1a: a potential immunohistochemical adjunct in their distinction from uterine perivascular epithelioid cell tumors. Ann Diagn Pathol 2008; 12:401-5. [DOI: 10.1016/j.anndiagpath.2008.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Fadare O. Uterine PEComa: appraisal of a controversial and increasingly reported mesenchymal neoplasm. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2008; 5:7. [PMID: 18325099 PMCID: PMC2278149 DOI: 10.1186/1477-7800-5-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 03/06/2008] [Indexed: 11/10/2022]
Abstract
In recent years, a group of tumors that have been designated "perivascular epithelioid cell tumors" (PEComa) have been reported with increasing frequency from a wide variety of anatomic locations. The uterus and retroperitoneum appear to be the most frequent sites of origin for these lesions. PEComas belong to an identically named family of tumors comprised of conventional angiomyolipomas, clear cell sugar tumors, lymphangiomyomatosis and clear cell myomelanocytic tumor of the falciform ligament/ligament teres, and are also known as PEComa-NOS. This article is a primer for clinicians on the most salient clinicopathologic features of uterine PEComas, as most of the debate and discussion have taken place in the pathologic literature. The author appraises in detail the current state of knowledge on PEComas of the uterus based on a review of published data on the 44 previously reported cases, and comments on areas of controversy. The latter are centered predominantly on the significant morphologic and immunophenotypic overlap that exists between uterine PEComa and some smooth muscle tumors of the uterus. The clinicopathologic features of cases reported as epithelioid smooth muscle tumors and cases reported as uterine PEComas are compared and contrasted, and a practical approach to their reporting is proposed.
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Affiliation(s)
- Oluwole Fadare
- Department of Pathology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX 78236, USA.
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Perivascular epithelioid cell tumor (PEComa) of the uterus: an outcome-based clinicopathologic analysis of 41 reported cases. Adv Anat Pathol 2008; 15:63-75. [PMID: 18418088 DOI: 10.1097/pap.0b013e31816613b0] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The uterus and retroperitoneum have emerged as the most frequently reported anatomic sites of origin of perivascular epithelioid cell tumors (PEComas), a poorly defined neoplasm that is characterized by varying amounts of spindle and epithelioid cells with clear to eosinophilic cytoplasm that display immunoreactivity for melanocytic markers, most frequently HMB-45. Published reports on 41 previously reported uterine PEComas are reviewed in this report. Of these 41 cases, 31 originating in the corpus and for which there was adequate follow-up information (or clinical malignancy) were categorized into 2 groups: (1) a malignant group that was comprised of cases associated with patient death of disease and/or clinical malignancy as evidenced by local and/or distant extension outside of the uterus (n=13, group 1) and (2) a "nonmalignant" group of cases in which neither of the above features were present (n=18, group 2). Groups 1 and 2 did not significantly differ regarding duration of follow-up (25 mo vs. 24.3 mo, respectively, P=0.9) or patient age (45.61 y vs. 43.46 y, respectively, P=0.7). Five of the group 1 patients experienced distant (extra-abdominal) metastases. The group 1 tumors were significantly larger than the group 2 tumors (averages 9.6 cm vs. 4.67 cm respectively, P=0.04); however, there were no size thresholds that, in of themselves, reliably classified 75% or more of the cases in both groups. Coagulative necrosis was highly associated with group 1, being present in 82% of cases as compared with only 11.8% of group 2 cases (P=0.0002). Eighty-eight percent of the group 2 cases had a mitotic rate of <or=1/10 high power fields (HPF) as compared with 40% of group 1 cases (P=0.01). However, the absence of mitotic activity did not rule out malignancy, as 2 of the group 1 cases lacked mitotic activity and displayed metastases. Twenty-five percent, 49%, 56%, 73%, and 100% of tested cases displayed immunoreactivity for CD10, desmin, vimentin, smooth muscle actin, and caldesmon, respectively. PEComas are tumors of uncertain histogenesis and malignant potential that seem to display some morphologic and immunophenotypic overlap with smooth muscle neoplasia. A mitotic count of >1/10 HPF and/or coagulative necrosis are features that, if present, raise the definite potential for aggressive behavior.
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"Malignant" Uterine Perivascular Epithelioid Cell Tumor, Pelvic Lymph Node Lymphangioleiomyomatosis, and Gynecological Pecomatosis in a Patient With Tuberous Sclerosis. Int J Gynecol Pathol 2008; 27:86-90. [DOI: 10.1097/pgp.0b013e318150df37] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Armah HB, Parwani AV. Malignant perivascular epithelioid cell tumor (PEComa) of the uterus with late renal and pulmonary metastases: a case report with review of the literature. Diagn Pathol 2007; 2:45. [PMID: 18053181 PMCID: PMC2213634 DOI: 10.1186/1746-1596-2-45] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 12/03/2007] [Indexed: 11/22/2022] Open
Abstract
Background Perivascular epithelioid cell tumor (PEComa), other than angiomyolipoma (AML), clear cell sugar tumor (CCST), and lymphangioleiomyomatosis (LAM), is a very rare mesenchymal tumor with an unpredictable natural history. The uterus is the most prevalent reported site of involvement of PEComa-not otherwise specified (PEComa-NOS). To the best of our knowledge, about 100 PEComa-NOS have been reported in the English Language medical literature, of which 38 were uterine PEComa-NOS. These reported cases of uterine PEComa-NOS have usually shown clinically benign behavior, but 13 tumors, three of them associated with tuberous sclerosis complex (TSC), exhibited local aggressive behavior and four of them showed distant metastases. Case presentation We report the case of a 59-year-old woman, who presented with renal and pulmonary lesions seven years after the initial diagnosis of uterine leiomyosarcoma. Left nephrectomy and right middle lobe wedge resection were performed. Histological and immunohistochemical analysis of the renal and pulmonary lesions, in addition to retrospective re-evaluation of the previous uterine tumor, led to the final diagnosis of malignant uterine PEComa with late renal and pulmonary metastases. All three lesions had the typical histological appearance of PEComa-NOS showing a biphasic growth pattern with continuous transition between spindle cells and epithelioid cells, often arranged around vascular spaces. Immunohistochemically, the tumor cells of both phenotypes in all three lesions stained for melanocytic (HMB-45 and Melan-A/MART-1) and myoid (desmin, smooth muscle actin, and muscle-specific actin/all muscle actin/HHF-35) markers. Conclusion The findings indicate that despite the small number of reported cases, PEComas-NOS should be considered tumors of uncertain malignant potential, and metastases to other organs might become evident even several years after the primary diagnosis.
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Affiliation(s)
- Henry B Armah
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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48
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Fadare O. Perivascular Epithelioid Cell Tumors (PEComas) and Smooth Muscle Tumors of the Uterus. Am J Surg Pathol 2007; 31:1454-5; author reply 1455-6. [PMID: 17721205 DOI: 10.1097/pas.0b013e318039b218] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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49
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Weinreb I, Howarth D, Latta E, Ghazarian D, Chetty R. Perivascular epithelioid cell neoplasms (PEComas): four malignant cases expanding the histopathological spectrum and a description of a unique finding. Virchows Arch 2007; 450:463-70. [PMID: 17377813 DOI: 10.1007/s00428-007-0378-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 01/24/2007] [Accepted: 01/26/2007] [Indexed: 10/23/2022]
Abstract
Four cases of malignant PEComas were stained with smooth muscle actin, muscle specific actin, desmin, human melanoma black-45, melan-A, microphthalmia transcription factor, S100 and cyclin D1. One case was studied by electron microscopy (EM). Tumour locations were the thigh, elbow, retroperitoneum and bladder in association with a urachal cyst. There were two men and two women; the average age was 51.3 years, and the size ranged from 5.0-23.0 cm. In three cases, 50-95% of the tumour was composed of pleomorphic sarcomatous areas. All cases had at least focal clear-cell areas. One case showed a continuous single layer of perivascular clear cells remote from the tumour, transitioning to invasive nests and to PEComa. EM demonstrated these cells in apposition to and in direct contact with the abluminal surface of the basal lamina of the capillaries. We suggest the term "pecosis" for these areas. All cases were positive for two or more melanocytic markers and for at least one actin. S100 and desmin were focally positive in one case. Cyclin D1 was positive in 3:4 cases. Four cases of malignant PEComa are described with the existence of a unique lesion (pecosis) in one case. These tumours may manifest largely as sarcomas appearing to be undifferentiated and should be considered in their differential diagnosis.
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Affiliation(s)
- Ilan Weinreb
- Department of Pathology, University Health Network, 200 Elizabeth Street, 11th Floor, Toronto, ON, M5G 2C4, Canada.
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