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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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2
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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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Jog AP, Ronderos DM, Ali A, Niazi M, Diaz-Fuentes G. Malignant Epithelioid Neoplasm of the Brain. Cureus 2020; 12:e10079. [PMID: 33005505 PMCID: PMC7523542 DOI: 10.7759/cureus.10079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Malignant epithelioid tumors have been described in various organ systems, but are rarely seen in the brain. They are aggressive tumors and have high mortality. In certain cases, the immunohistochemistry (IHC) findings may not be sufficient to clarify the diagnosis. In these cases, next-generation genetic sequencing may play a role in clarifying the diagnosis. In addition to lab testing, a thorough history and physical exam are necessary to rule out other sources of the tumor such as melanoma. Patients presenting with neurological symptoms are cared for by a wide variety of physicians, hence it is important to raise awareness of rare tumors in order to provide timely and appropriate management and referral for these patients. We present the case of a middle-aged woman who was diagnosed with a ‘malignant epithelioid neoplasm’ of the brain, a rare variety of tumors. We also give the clinical course of this illness.
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Affiliation(s)
| | | | - Asghar Ali
- Pulmonology and Critical Care, BronxCare Health System, Bronx, USA
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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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Gao F, Huang C, Zhang Y, Sun R, Zhang Y, Wang H, Zhang S. Combination targeted therapy of VEGFR inhibitor, sorafenib, with an mTOR inhibitor, sirolimus induced a remakable response of rapid progressive Uterine PEComa. Cancer Biol Ther 2016; 17:595-8. [PMID: 27030639 DOI: 10.1080/15384047.2016.1167290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Perivascular epithelioid cell tumor is a rare tumor. To date, there is no consensus of therapy to be recommended for unresectable disease. For a low incidence and a rarely curable disease, the finding of new therapy is essential. Here we report the first case of a patient with perivascular epithelioid cell tumor whose disease had a rapid progression after surgery and had a rapid remarkable response of combination therapy of a VEGFR inhibitor, sorafenib, with an mTOR inhibitor, sirolimus. This result may have potential to deliver a new treatment option and inhibiting the mTOR pathway combined with inhibiting the VEGF pathways may be a useful strategy for malignant PEComas.
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Affiliation(s)
- Fang Gao
- a Department of Medical Oncology , Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan ; Shandong Province , China
| | - Chengsuo Huang
- a Department of Medical Oncology , Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan ; Shandong Province , China
| | - Yiping Zhang
- b Department of Medicine , Weihai Guoan Hospital , Weihai , Shandong Province , China
| | - Ruirui Sun
- c Department of Medicine , Weihai Children's Hospital ; Weihai , Shandong Province , China
| | - Yujie Zhang
- d Department of Oncology , Xinjiang Medical University Hospital , Wulumuqi , Xinjiang Province , China
| | - Huijun Wang
- a Department of Medical Oncology , Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan ; Shandong Province , China
| | - Shu Zhang
- a Department of Medical Oncology , Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan ; Shandong Province , China
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PEComa of the Uterus: A Rare Mesenchymal Tumor Displaying a ≪Snowstorm≫ Pattern at Magnetic Resonance Imaging. J Belg Soc Radiol 2016; 100:5. [PMID: 30038969 PMCID: PMC5855219 DOI: 10.5334/jbr-btr.926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Leow WQ, Selvarajan S. Uterine perivascular epithelioid cell tumour and assessment of its malignant potential. Singapore Med J 2015; 56:531. [PMID: 26451059 DOI: 10.11622/smedj.2015143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Wei Qiang Leow
- Department of Pathology, Singapore General Hospital, Singapore.
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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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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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Zhao L, Anders KH. Malignant perivascular epithelioid cell tumor of the gallbladder: a case report and review of literature. Arch Pathol Lab Med 2014; 138:1238-41. [PMID: 25171708 DOI: 10.5858/arpa.2013-0092-cr] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Perivascular epithelioid cell tumors are rare mesenchymal neoplasms composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. The perivascular epithelioid cell tumor family includes angiomyolipoma, clear cell sugar tumor of the lung, lymphangioleiomyomatosis, clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres, and rare clear cell tumors of other anatomic sites. Perivascular epithelioid cell tumors have been reported previously in various sites, but to our knowledge not in the gallbladder. We report here, for the first time, a malignant perivascular epithelioid cell tumor arising in the gallbladder.
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Affiliation(s)
- Liena Zhao
- From the Department of Pathology and Laboratory Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
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12
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PEComa: A Perivascular Epithelioid Cell Tumor in the Liver-A Case Report and Review of the Literature. Case Rep Med 2013; 2013:904126. [PMID: 24489554 PMCID: PMC3891746 DOI: 10.1155/2013/904126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/07/2013] [Accepted: 11/21/2013] [Indexed: 12/30/2022] Open
Abstract
Perivascular epithelioid cell tumors are soft tissue tumors that can occur in various locations in the body whose incidence is rising. Hepatic PEComas are quite rare and diagnosis involves positivity of Melan-A and HMB45 on immunohistochemistry. Usual treatment is surgery for benign tumors and chemotherapy including mTOR inhibitors for malignant tumors. Here we discuss the radiological and pathological diagnosis, evaluation, and management of a hepatic PEComa. We describe a 51-year-old patient who was diagnosed incidentally after unusual physical exam findings.
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Natella V, Merolla F, Giampaolino P, Bifulco G, Mainenti PP, Insabato L. A huge malignant perivascular epithelioid cell tumor (PEComa) of the uterine cervix and vagina. Pathol Res Pract 2013; 210:186-8. [PMID: 24331571 DOI: 10.1016/j.prp.2013.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 08/02/2013] [Accepted: 10/15/2013] [Indexed: 11/24/2022]
Abstract
Perivascular epithelioid cell tumors (PEComas) are a family of rare mesenchymal neoplasms, including angiomyolipoma, clear-cell "sugar" tumor of the lung and extrapulmonary sites, lymphangioleiomyomatosis, clear-cell myomelanocytic tumor of the falciform ligament/ligamentum teres, and clear-cell tumors at various other anatomic sites. These tumors are characterized by a proliferation of epithelioid cells with clear to eosinophilic cytoplasm, perivascular distribution, and coexpression of myogenic and melanocytic markers. PEComas show a female predominance, occur with some frequency in the gynecological tract, and have an unpredictable biological behavior. We report a case of a huge malignant PEComa arising from the uterine cervix and vagina. To the best of our knowledge, only 6 cases of PEComa in the cervix and 2 cases in the vagina have been reported in the literature.
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Affiliation(s)
- Valentina Natella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Francesco Merolla
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Pierluigi Giampaolino
- Department of Obstetrics and Gynecology, University of Naples Federico II, 80131 Naples, Italy
| | - Giuseppe Bifulco
- Department of Obstetrics and Gynecology, University of Naples Federico II, 80131 Naples, Italy
| | | | - Luigi Insabato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy.
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Wu JH, Zhou JL, Cui Y, Jing QP, Shang L, Zhang JZ. Malignant perivascular epithelioid cell tumor of the retroperitoneum. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:2251-2256. [PMID: 24133607 PMCID: PMC3796251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 08/19/2013] [Indexed: 06/02/2023]
Abstract
Perivascular epithelioid cell tumors (PEComas) are a rare type of mesenchymal neoplasms characterized by a proliferation of perivascular cells with an epithelioid phenotype and expression of myo-melanocytic markers. The majority of PEComas seem to be benign and usually their prognosis is good. Malignant cases are extremely rare, exhibiting a malignant course with local recurrences and distant metastases. We herein report a case of a malignant PEComa arising in the retroperitoneum. The patient was a 55-year-old woman experiencing abdominal discomfort for approximately one month. Ultrasound and computer tomography (CT) scans of the abdomen revealed a solid mass arising from the retroperitoneum. Microscopically, the tumor was composed of epithelioid cells mixed with spindled cells. The nucleus had significant atypia, and the mitoses were obvious. The focal intravascular tumor embolus was visible. Immunohistochemically, the epithelioid tumor cells were positive for HMB45 and Melan-A, and the spindled tumor celLs were positive for SMA and desmin. Seven months after a surgical resection, an ultrasound revealed liver metastases. In conclusion, the malignant PEComas of the retroperitoneum is a very rare neoplasm with unique morphological and immunohistochemical characteristics. It should be differentiated from other epithelioid cell tumors of the retroperitoneum.
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Affiliation(s)
- Ji-Hua Wu
- Department of Pathology and Experimental Medicine, 306 Hospital of PLABeijing 100101, China
| | - Jin-Lian Zhou
- Department of Pathology and Experimental Medicine, 306 Hospital of PLABeijing 100101, China
| | - Yan Cui
- Department of General Surgery, 306 Hospital of PLABeijing 100101, China
| | - Qing-Ping Jing
- Department of Pathology and Experimental Medicine, 306 Hospital of PLABeijing 100101, China
| | - Le Shang
- Department of Pathology and Experimental Medicine, 306 Hospital of PLABeijing 100101, China
| | - Jian-Zhong Zhang
- Department of Pathology and Experimental Medicine, 306 Hospital of PLABeijing 100101, China
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