Uterine PEComas: A Morphologic, Immunohistochemical, and Molecular Analysis of 32 Tumors

Autor: Carmen Tornos, Andre Pinto, Cristina R. Antonescu, Lei Zhang, Tomas Slavik, Kristine M. Cornejo, Joseph W. Carlson, Koen Van de Vijver, Vicente Morales-Oyarvide, Gian Franco Zannoni, Takako Kiyokawa, Jennifer A. Bennett, Esther Oliva, Anna Pesci, Ana C Braga
Rok vydání: 2018
Předmět:
0301 basic medicine
Adult
Pathology
medicine.medical_specialty
Perivascular Epithelioid Cell Neoplasms
Uterus
Mitosis
TFE3
Article
Pathology and Forensic Medicine
03 medical and health sciences
Tuberous sclerosis
0302 clinical medicine
Predictive Value of Tests
Biomarkers
Tumor
Medicine
Humans
Genetic Predisposition to Disease
In Situ Hybridization
Fluorescence
Aged
business.industry
Basic Helix-Loop-Helix Leucine Zipper Transcription Factors
Epithelioid Cells
Reproducibility of Results
Middle Aged
medicine.disease
Immunohistochemistry
Molecular analysis
Tumor Burden
Perivascular Epithelioid Cell Tumors
DNA-Binding Proteins
030104 developmental biology
medicine.anatomical_structure
Phenotype
030220 oncology & carcinogenesis
Pulmonary lymphangioleiomyomatosis
Smooth Muscle Tumor
Uterine Neoplasms
Surgery
Female
Anatomy
Gene Fusion
business
Zdroj: The American journal of surgical pathology. 42(10)
ISSN: 1532-0979
Popis: Uterine perivascular epithelioid cell tumors (PEComas) are rare neoplasms that may show overlapping morphology and immunohistochemistry with uterine smooth muscle tumors. In this study, we evaluated the morphologic, immunohistochemical, and molecular features of 32 PEComas, including 11 with aggressive behavior. Two distinct morphologies were observed: classic (n=30) and those with a lymphangioleiomyomatosis appearance (n=2). In the former, patients ranged from 32 to 77 (mean: 51) years and 13% had tuberous sclerosis. Tumors ranged from 0.2 to 17 (mean: 5.5) cm with 77% arising in the corpus. Epithelioid cells were present in 100% and a spindled component was seen in 37%. Nuclear atypia was low (53%), intermediate (17%), or high (30%). Mitoses ranged from 0 to 36 (mean: 6) and 0 to 133 (mean: 19) per 10 and 50 high-power fields, with atypical mitoses present in 30%. Thin and delicate vessels were noted in 100%, clear/eosinophilic and granular cytoplasm in 93%, stromal hyalinization in 73%, necrosis in 30%, and lymphovascular invasion in 10%. All tumors were positive for HMB-45, cathepsin K, and at least one muscle marker, with most expressing melan-A (77%) and/or MiTF (79%). A PSF-TFE3 fusion was identified in one while another showed a RAD51B-OPHN1 fusion. Follow-up ranged from 2 to 175 (mean: 41) months, with 63% of patients alive and well, 20% dead of disease, 13% alive with disease, and 3% dead from other causes. In the latter group (n=2), patients were 39 and 49 years old, one had tuberous sclerosis, while the other had pulmonary lymphangioleiomyomatosis. Both tumors expressed HMB-45, cathepsin K, and muscle markers, but lacked TFE3 and RAD51B rearrangements. The 2 patients are currently alive and well. Application of gynecologic-specific criteria (≥4 features required for malignancy: size ≥5 cm, high-grade atypia, mitoses1/50 high-power fields, necrosis, and lymphovascular invasion) for predicting outcome misclassified 36% (4/11) of aggressive tumors; thus, a modified algorithm with a threshold of 3 of these features is recommended to classify a PEComa as malignant.
Databáze: OpenAIRE
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