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Uterine PEComas : a morphologic, immunohistochemical, and molecular analysis of 32 tumors

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Abstract
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, mitoses > 1/50 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.
Keywords
perivascular epithelioid cell tumor, PEComa, uterus, tuberous sclerosis, diagnostic criteria, TFE3, RAD51B, EPITHELIOID CELL NEOPLASM, TFE3 GENE REARRANGEMENT, OF-THE-LITERATURE, CATHEPSIN-K IMMUNOREACTIVITY, TUBEROUS SCLEROSIS COMPLEX, PULMONARY LYMPHANGIOLEIOMYOMATOSIS, TUMOR PECOMA, EXTRAPULMONARY LYMPHANGIOLEIOMYOMATOSIS, MESENCHYMAL NEOPLASMS, MOLECULAR-FEATURES

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MLA
Bennett, Jennifer A, Ana C Braga, Andre Pinto, et al. “Uterine PEComas : a Morphologic, Immunohistochemical, and Molecular Analysis of 32 Tumors.” AMERICAN JOURNAL OF SURGICAL PATHOLOGY 42.10 (2018): 1370–1383. Print.
APA
Bennett, J. A., Braga, A. C., Pinto, A., Van de Vijver, K., Cornejo, K., Pesci, A., Zhang, L., et al. (2018). Uterine PEComas : a morphologic, immunohistochemical, and molecular analysis of 32 tumors. AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 42(10), 1370–1383.
Chicago author-date
Bennett, Jennifer A, Ana C Braga, Andre Pinto, Koen Van de Vijver, Kristine Cornejo, Anna Pesci, Lei Zhang, et al. 2018. “Uterine PEComas : a Morphologic, Immunohistochemical, and Molecular Analysis of 32 Tumors.” American Journal of Surgical Pathology 42 (10): 1370–1383.
Chicago author-date (all authors)
Bennett, Jennifer A, Ana C Braga, Andre Pinto, Koen Van de Vijver, Kristine Cornejo, Anna Pesci, Lei Zhang, Vicente Morales-Oyarvide, Takako Kiyokawa, Gian Franco Zannoni, Joseph Carlson, Tomas Slavik, Carmen Tornos, Cristina R Antonescu, and Esther Oliva. 2018. “Uterine PEComas : a Morphologic, Immunohistochemical, and Molecular Analysis of 32 Tumors.” American Journal of Surgical Pathology 42 (10): 1370–1383.
Vancouver
1.
Bennett JA, Braga AC, Pinto A, Van de Vijver K, Cornejo K, Pesci A, et al. Uterine PEComas : a morphologic, immunohistochemical, and molecular analysis of 32 tumors. AMERICAN JOURNAL OF SURGICAL PATHOLOGY. 2018;42(10):1370–83.
IEEE
[1]
J. A. Bennett et al., “Uterine PEComas : a morphologic, immunohistochemical, and molecular analysis of 32 tumors,” AMERICAN JOURNAL OF SURGICAL PATHOLOGY, vol. 42, no. 10, pp. 1370–1383, 2018.
@article{8577158,
  abstract     = {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, mitoses > 1/50 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.},
  author       = {Bennett, Jennifer A and Braga, Ana C and Pinto, Andre and Van de Vijver, Koen and Cornejo, Kristine and Pesci, Anna and Zhang, Lei and Morales-Oyarvide, Vicente and Kiyokawa, Takako and Zannoni, Gian Franco and Carlson, Joseph and Slavik, Tomas and Tornos, Carmen and Antonescu, Cristina R and Oliva, Esther},
  issn         = {0147-5185},
  journal      = {AMERICAN JOURNAL OF SURGICAL PATHOLOGY},
  keywords     = {perivascular epithelioid cell tumor,PEComa,uterus,tuberous sclerosis,diagnostic criteria,TFE3,RAD51B,EPITHELIOID CELL NEOPLASM,TFE3 GENE REARRANGEMENT,OF-THE-LITERATURE,CATHEPSIN-K IMMUNOREACTIVITY,TUBEROUS SCLEROSIS COMPLEX,PULMONARY LYMPHANGIOLEIOMYOMATOSIS,TUMOR PECOMA,EXTRAPULMONARY LYMPHANGIOLEIOMYOMATOSIS,MESENCHYMAL NEOPLASMS,MOLECULAR-FEATURES},
  language     = {eng},
  number       = {10},
  pages        = {1370--1383},
  title        = {Uterine PEComas : a morphologic, immunohistochemical, and molecular analysis of 32 tumors},
  url          = {http://dx.doi.org/10.1097/PAS.0000000000001119},
  volume       = {42},
  year         = {2018},
}

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