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Greco S, Pinheiro J, Cardoso-Carneiro D, Giantomassi F, Pellegrino P, Scaglione G, Delli Carpini G, Ciavattini A, Zannoni GF, Goteri G, Martinho O, Ciarmela P. Raf kinase inhibitor protein expression in smooth muscle tumours of the uterus: a diagnostic marker for leiomyosarcoma? Reprod Biomed Online 2024; 48:103816. [PMID: 38608337 DOI: 10.1016/j.rbmo.2024.103816] [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: 07/25/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 04/14/2024]
Abstract
RESEARCH QUESTION What is the expression pattern of Raf kinase inhibitory protein (RKIP) in different subtypes of leiomyoma (usual type, cellular, apoplectic or haemorrhagic leiomyoma, leiomyoma with bizarre nuclei and lipoleiomyoma) and leiomyosarcoma specimens, and what is its biological role in leiomyosarcoma cells? DESIGN Leiomyoma and leiomyosarcoma specimens underwent immunohistochemistry staining. Leiomyosarcoma SK-LMS-1 cell line was RKIP knocked down and RKIP overexpressed, and cell viability, wound healing migration and clonogenicity assays were carried out. RESULTS A higher immunohistochemical expression of RKIP was observed in bizarre leiomyomas, than in usual-type leiomyomas. Decreased expression was also found in cellular leiomyoma, with generally absent staining in leiomyosarcomas. Upon RKIP expression manipulation in SK-LMS-1 cell line, no major differences were observed in cell viability and migration capacity over time. RKIP knockout, however, resulted in a significant increase in the cell's ability to form colonies (P = 0.011). CONCLUSION RKIP distinct expression pattern among leiomyoma histotype and leiomyosarcoma, and its effect on leiomyosarcoma cells on colony formation, encourages further studies of RKIP in uterine smooth muscle disorders.
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Affiliation(s)
- Stefania Greco
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Joana Pinheiro
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, Braga, Portugal.; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Diana Cardoso-Carneiro
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, Braga, Portugal.; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Federica Giantomassi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Pamela Pellegrino
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Giulia Scaglione
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Delli Carpini
- Department of Specialist and Odontostomatological Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Ciavattini
- Department of Specialist and Odontostomatological Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Gian Franco Zannoni
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaia Goteri
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Olga Martinho
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, Braga, Portugal.; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy..
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Hadi B, Nori W, Ibrahem H, Helmi ZR. A Case Report of a Uterine Smooth Muscle Tumor of Undetermined Malignant Potential (STUMP): A Diagnostic Dilemma and Management Challenges. Cureus 2024; 16:e58067. [PMID: 38738100 PMCID: PMC11088454 DOI: 10.7759/cureus.58067] [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] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Uterine smooth muscle tumors of undetermined malignant potential (STUMPs) are an uncommon kind of uterine smooth muscle tumor. It is distinguished by histopathologic and morphologic characteristics that are in between those of a benign leiomyoma and a malignant leiomyosarcoma. From a clinical standpoint, the clinical presentation of STUMP is similar to that of a fibroid. The diagnosis is usually confirmed after surgery. Here, we report the case of a 39-year-old woman who experienced increased menorrhagia, back pain, and pressure sensations during the past six months. She had a well-defined, freely movable lump in her lower abdomen, measuring the size of a 22-cm uterus. The patient exhibited pallor, and her imaging scan showed the presence of an intramural posterior uterine solid mass indistinguishable from fibroid measuring 8.5 × 9 cm. Goserelin acetate (Zoladex 3.6 mg implant) was recommended for a duration of six months. The patient experienced a significant amelioration in menorrhagia and discomfort. However, no reduction in the size of the mass was observed. Myomectomy was made for the suspicion of a malignant transformation. The histology examination confirmed the diagnosis of a STUMP; a hysterectomy was undergone, and the procedure went smoothly. The patient was discharged home in good condition with instructions for long-term follow-up due to a risk of recurrence of about 7%. The lack of standardized and clear clinical and diagnostic criteria for STUMP adds challenges to their management.
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Affiliation(s)
- Ban Hadi
- Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad, IRQ
| | - Wasan Nori
- Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad, IRQ
| | - Hajer Ibrahem
- Oral Medicine, College of Dentistry, Ashur University, Baghdad, IRQ
| | - Zeena R Helmi
- Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad, IRQ
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Petrocelli R, Hindman N, Reinhold C. Current Concepts in the Imaging of Uterine Sarcomas. Radiol Clin North Am 2023; 61:627-638. [PMID: 37169428 DOI: 10.1016/j.rcl.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Uterine sarcomas are a group of rare uterine tumors comprised of multiple subtypes with different histologic characteristics, prognoses, and imaging appearances. Identification of uterine sarcomas and their differentiation from benign uterine disease on imaging is of critical importance for treatment planning to guide appropriate management and optimize patient outcomes. Herein, we review the spectrum of uterine sarcomas with a focus on the classification of primary sarcoma subtypes and presenting the typical MR imaging appearances.
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Horn LC, Hiller GGR, Mayr D, Schmoeckel E, Höhn AK. [Practical diagnostic aspects of uterine leiomyosarcoma in the context of the 2020 WHO classification]. DER PATHOLOGE 2022; 43:196-201. [PMID: 35412039 DOI: 10.1007/s00292-022-01064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
The 2020 WHO Classification defines the spindle cell, epithelioid, and myxoid variants as subtypes of uterine leiomyosarcomas (LMS). Presence of cellular atypia (size variation of polymorphic nuclei > 2-3:1), tumor cell necroses, and mitotic count (usually ≥ 10 MF/10 HPF) are still the key features for diagnostic separation from uterine leiomyomas. Preanalytic variables, staining quality, as well as intralesional geographic distribution may affect the mitotic count. Smooth muscle tumors of uncertain malignant potential (STUMP) still exist as a not yet well-characterized diagnostic entity. Immunohistochemical stains against p16, p53, Ki-67, and WT‑1 may aid differential diagnosis in selected cases. Diagnostic molecular pathology is not yet relevant for diagnosis.
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Affiliation(s)
- Lars-Christian Horn
- Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig AöR, Liebigstr. 26, 04103, Leipzig, Deutschland.
| | | | - Doris Mayr
- Pathologisches Institut, der Ludwig-Maximilians-Universität München, München, Deutschland
| | - Elisa Schmoeckel
- Pathologisches Institut, der Ludwig-Maximilians-Universität München, München, Deutschland
| | - Anne Kathrin Höhn
- Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig AöR, Liebigstr. 26, 04103, Leipzig, Deutschland
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Travaglino A, Raffone A, Santoro A, Raimondo D, Improda FP, Cariati F, De Marco M, Casadio P, Seracchioli R, Zullo F, Insabato L, Zannoni GF. Risk of Recurrence in Uterine Leiomyoma with Bizarre Nuclei: a Systematic Review and Meta-Analysis. Geburtshilfe Frauenheilkd 2021; 81:1217-1223. [PMID: 34754271 PMCID: PMC8568503 DOI: 10.1055/a-1533-1651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022] Open
Abstract
Objective
Leiomyoma with bizarre nuclei (LBN) is a variant of uterine leiomyoma, which has replaced the previous category of “atypical leiomyoma” and must be distinguished from smooth muscle tumors of uncertain malignant potential (STUMP). However, previously published series of “atypical leiomyoma” might have included both LBN and STUMP, due to the lack of strict diagnostic criteria. Based on such hypothesis, we aimed to define the risk of recurrence in LBN.
Study Design
A systematic review and meta-analysis was performed by searching 4 electronic databases for all studies assessing the outcome of patients with “atypical leiomyoma” or LBN. The pooled absolute risk of recurrence was calculated. The included studies were subdivided into two subgroups based on the criteria used: “LBN + STUMP” or “LBN-only”.
Results
Twelve studies with 433 patients were included. The pooled risk of recurrence was 5.5% overall. The funnel plot showed two cluster of studies which superimposed to the two subgroups. In the LBN + STUMP cluster/subgroup, the pooled risk of recurrence was 7.7%. In the LBN-only cluster/subgroup, the pooled risk of recurrence was 1.9%. Statistical heterogeneity was null in all analyses.
Conclusion
Our results show a risk of recurrence of 1.9% for LBN; higher recurrence rates in older studies are likely due to the inclusion of STUMPs.
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Affiliation(s)
- Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.,Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Angela Santoro
- Pathology Unit, Department of Woman and Child Health, Agostino Gemelli University Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Francesco Paolo Improda
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Federica Cariati
- CEINGE-Biotecnologie Avanzate, Naples, Italy.,Fertility Unit, Maternal-Child Department, AOU Policlinico Federico II, Naples, Italy
| | - Margot De Marco
- Department of Medicine, Surgery and Odontology Schola Medica Salernitana, University of Salerno, Baronissi, SA, Italy
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Insabato
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gian Franco Zannoni
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
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