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Alwafai Z, Reichert VMC, Spring P, Zygmunt M, Köhler G. Results of Endometrial Biopsy and Its Impact on Survival Data in Patients with High-Risk Uterine Sarcoma. J Clin Med 2024; 13:4048. [PMID: 39064089 PMCID: PMC11278278 DOI: 10.3390/jcm13144048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/09/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Background: There are conflicting data regarding the detection rate of high-risk uterine sarcoma (HRUS) by endometrial biopsy. In addition, there are no studies in the literature on its impact on the chosen surgical approach and survival. Methods: This study includes 415 patients with HRUS. Of these, 178 (42.9%) patients had undergone endometrial biopsy. We analyzed the detection rate of endometrial biopsy and its impact on surgical approach and survival data. Results: Correct specific histologic diagnosis was achieved in only 30.0% of LMS and 33.3% of HGESS/UUS. Other uterine sarcoma, unspecified malignant mesenchymal tumor, carcinosarcoma or carcinoma were found in 45% of LMS and 78.2% of HGESS/UUS. As a result of the histologic findings, the rate of inadequate surgery was reduced by up to 19.9%. As tumor morcellation was performed significantly less often with biopsy (32.5% with vs. 55.4% without biopsy, p < 0.001), the locoregional recurrence-free interval remained unaffected between the two groups (p = 0.81). This is obviously an advantage of biopsy, although it does not affect the local recurrence rate in morcellated patients. Conclusions: Indicated endometrial biopsy is an important step in the diagnosis of HRUS, despite its low detection rate. It helps to avoid inappropriate surgical procedures but does not affect OS.
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Affiliation(s)
- Zaher Alwafai
- Correspondence: ; Tel.: +49-3834-866508; Fax: +49-3834-866501
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Gambella A, Senetta R, Falco EC, Ricci AA, Mangherini L, Tampieri C, Fissore J, Orlando G, Manetta T, Mengozzi G, Mistrangelo M, Bertero L, Cassoni P. Prognostic and predictive role of YKL-40 in anal squamous cell carcinoma: a serological and tissue-based analysis in a multicentric cohort. Front Med (Lausanne) 2024; 11:1372195. [PMID: 39045410 PMCID: PMC11263350 DOI: 10.3389/fmed.2024.1372195] [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: 01/17/2024] [Accepted: 06/03/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction Anal squamous cell carcinoma (ASC) is a rare gastrointestinal malignancy showing an increased incidence over the past decades. YKL-40 is an immune modulator and pro-angiogenetic factor that showed a promising prognostic and predictive potential in several malignancies, but limited data are available for ASC. This study aims to provide an extensive evaluation of the prognostic and predictive role of YKL-40 in a multicenter cohort of ASC patients. Methods We retrospectively retrieved 72 consecutive cases of ASC diagnosed between February 2011 and March 2021. Both serum and tissue protein expression of YKL-40 were assessed, the latter in ASC tumor cells and peritumor immune cells. Results Increased YKL-40 serum levels at the time of diagnosis were associated with older age (p = 0.035), presence of cardiovascular/metabolic comorbidities (p = 0.007), and death for any cause (p = 0.011). In addition, high serum levels of YKL-40 were associated with a poor prognosis (HR: 2.82, 95% CI: 1.01-7.84; p = 0.047). Protein expression of YKL-40 in ASC tumor cells was significantly associated with low tumor grade (p = 0.031), while the increased expression in peritumor immune cells was associated with a worse response of patients to chemoradiotherapy (p = 0.007). However, YKL-40 protein expression in ASC tumor cells or peritumor immune cells did not significantly impact patient overall survival. Discussion In conclusion, YKL-40 resulted a relevant prognostic (serum level) and predictive (tissue protein expression in peritumor immune cells) biomarker and can considerably improve ASC patient clinical management.
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Affiliation(s)
- Alessandro Gambella
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Rebecca Senetta
- Pathology Unit, Department of Oncology, University of Turin, Turin, Italy
| | | | - Alessia Andrea Ricci
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Mangherini
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Cristian Tampieri
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jessica Fissore
- Pathology Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Giulia Orlando
- Pathology Unit, Department of Oncology, University of Turin, Turin, Italy
| | - Tilde Manetta
- Department of Laboratory Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Giulio Mengozzi
- Department of Laboratory Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy
| | | | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
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El Hassouni F, Tligui S, Lakhdissi A, Rouas L, El Youssfi M. Uterine smooth muscle tumors of uncertain malignant potential (STUMP): A case report. Int J Surg Case Rep 2024; 118:109607. [PMID: 38608517 PMCID: PMC11024644 DOI: 10.1016/j.ijscr.2024.109607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are extremely rare, defined as a uterine smooth muscle tumors that cannot be diagnosed as benign or malignant and does not satisfy all the criteria for leiomyosarcoma or leiomyoma. CASE REPRESENTATION A 48-year-old woman who presented with a history of heavy menstrual bleeding and pelvic pain. Physical examination revealed an enlarged uterus. Ultrasonography showed lobular and enlarged uterus containing multiples leiomyomas. A subtotal hysterectomy was performed. A Pathological analysis revealed a uterine mass diagnosed as a smooth muscle tumor of uncertain malignant. DISCUSSION Uterine STUMPs are rare and are commonly diagnosed by histopathological evaluation following myomectomy or hysterectomy. The most common clinical manifestations of uterine STUMP are the same as leiomyomas. Prognosis for the patient is unclear and there is a risk of recurrence with the tumors. However, considering their potential risk of recurrence and metastasis, it is advisable to maintain six-monthly controls for 5 years and then annual controls for 5 years more. CONCLUSION Due to the rarity of uterine STUMP, there are no specific guidelines for their treatment and control. The scientific literature needs to be constantly updated in order to identify masses suspected of malignancy before surgery and improve patient management and follow-up.
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Affiliation(s)
- Fatima El Hassouni
- Department of Obstetrics and Gynecology, Oncology and High-Risk Pregnancies, Maternity Hospital Souissi, Ibn Sina university Hospital, Rabat, Morocco; Mohamed V University, Rabat, Morocco.
| | - Samia Tligui
- Department of Obstetrics and Gynecology, Oncology and High-Risk Pregnancies, Maternity Hospital Souissi, Ibn Sina university Hospital, Rabat, Morocco; Mohamed V University, Rabat, Morocco
| | - Asmaa Lakhdissi
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
| | - Lamiaa Rouas
- Mohamed V University, Rabat, Morocco; Department of Pathology, Ibn Sina university Hospital, Rabat, Morocco
| | - Mounia El Youssfi
- Department of Obstetrics and Gynecology, Oncology and High-Risk Pregnancies, Maternity Hospital Souissi, Ibn Sina university Hospital, Rabat, Morocco; Mohamed V University, Rabat, Morocco
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Belloni A, Notarstefano V, Greco S, Pellegrino P, Giorgini E, Ciarmela P. FTIR Microspectroscopy as a new probe to study human uterine lesions: Characterization of tumor cell lines from uterine smooth muscle cells and evaluation of EPA and DHA in vitro treatments. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166873. [PMID: 37666437 DOI: 10.1016/j.bbadis.2023.166873] [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: 05/30/2023] [Revised: 08/05/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
During their life, women are likely to develop uterine diseases, which often compromise their fertile and perimenopausal age. Besides benign lesions like leiomyomas, several malignant neoplasms can occur, such as the uterine leiomyosarcoma, which represents the most frequent malignancy among the rarest uterine cancers. It presents several variants similar to both benign and malignant neoplasms, and sometimes it shares symptoms with the benign counterpart. In this scenario, for a correct diagnosis and a successful prognosis, it is mandatory to detect new reliable markers which strengthen histopathological outcomes and let define a more appropriate and less harmful therapy. Based on this concerning evidence, in the present study, Fourier Transform Infrared Microspectroscopy has been exploited at a cellular level on uterine leiomyoma and leiomyosarcoma cell lines to (1) identify specific spectral biomarkers able to distinguish between benign and malignant lesions, and (2) evaluate the efficacy of eicosapentaenoic and docosahexaenoic acids (respectively EPA and DHA), already successfully tested. Results evidenced reliable differences in the spectral signature of benign and malignant cells, mainly in terms of lipids and nucleic acids composition. Moreover, even if EPA and DHA seemed to exert different effects on the tested cell lines, no cytotoxic and/or anti-apoptotic actions were observed after omega-3 based treatments.
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Affiliation(s)
- Alessia Belloni
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - Valentina Notarstefano
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - Stefania Greco
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy.
| | - Pamela Pellegrino
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy.
| | - Elisabetta Giorgini
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy.
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Tinelli A, D’Oria O, Civino E, Morciano A, Hashmi AA, Baldini GM, Stefanovic R, Malvasi A, Pecorella G. Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Comprehensive Multidisciplinary Update. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1371. [PMID: 37629661 PMCID: PMC10456637 DOI: 10.3390/medicina59081371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The uterine smooth muscle tumors of uncertain malignant potential (STUMP) are tumors with pathological characteristics similar to leiomyosarcoma, but that do not satisfy histological criteria for leiomyoma. These are problematic lesions with intermediate morphologic features; thus, diagnosis and treatment are difficult. This narrative review aims to review data in the literature about STUMPs, particularly focusing on management and therapeutic options and strategies for women who desire to preserve fertility. Material and Methods: authors searched for "uterine smooth muscle tumor of uncertain malignant potential" in PubMed and Scopus databases, from 2000 to March 2023. Pertinent articles were obtained in full-text format and screened for additional references. Only articles in English language were included. Studies including full case description of patients with histopathological diagnosis of STUMP in accordance with Stanford criteria were included. Results: The median age was 43 years old. Symptoms are similar to those of leiomyomas, with a mean diameter of 8.0 cm. Total hysterectomy with or without bilateral salpingo-oophorectomy is the standard care for women if fertility desire is satisfied. Myomectomy alone can be considered for young patients. Although these tumors have not a high malignant potential, several studies described recurrence and metastases. Conclusions: STUMPs are complex uterine smooth muscle tumors, with a rare but reasoned clinical-diagnostic management. Considering the high clinical and histological complexity of these tumors, high level of expertise is mandatory.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), “Veris delli Ponti Hospital”, 73020 Scorrano, Italy
| | - Ottavia D’Oria
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University, 00185 Rome, Italy;
| | - Emanuela Civino
- Department of Biological and Environmental Science and Technology, University of Salento, 73100 Lecce, Italy;
| | - Andrea Morciano
- Department of Gynaecology and Obstetrics, Pia Fondazione “Card. G. Panico”, 73039 Tricase, Italy;
| | - Atif Ali Hashmi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi 74800, Pakistan;
| | | | - Radomir Stefanovic
- Department of Histopathology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy;
| | - Giovanni Pecorella
- Department of Obstetrics, Gynecology and Reproductive Medicine, Saarland University, 66421 Homburg, Germany;
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Borella F, Benedetto C, Cassoni P, Bertero L. ASO Author Reflections: Surgical Management and Histopathological Predictors of Recurrence in Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): New Insights. Ann Surg Oncol 2022; 29:8315-8316. [PMID: 35976463 DOI: 10.1245/s10434-022-12426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Fulvio Borella
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, 10126, Turin, Italy.
| | - Chiara Benedetto
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, 10126, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University and City of Health and Science, 10126, Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University and City of Health and Science, 10126, Turin, Italy
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