Diagnostic value of progesterone receptor and p53 expression in uterine smooth muscle tumors

BackgroundThe diagnosis of uterine smooth muscle tumors depends on a combination of microscopic features. However, a small number of these tumors still pose difficult diagnostic challenges.AimTo investigate progesterone receptor (PR) and p53 expression in leiomyomas (LMs), atypical leiomyomas (ALMs), smooth muscle tumors of uncertain malignant potential (STUMP), and leiomyosarcomas (LMSs) and to evaluate the potential utility of the selected immunohistochemical markers in differentiating these tumors.Materials and methodsImmunohistochemical expression of PR and p53 was investigated in 41 uterine smooth muscle tumors comprising: 15 LMS, 4 STUMP, 6 ALM and 16 LM. Quantitative evaluation of PR and p53 expression was graded on a scale from 0 to 3+.ResultsLeiomyosarcomas showed reduced PR expression. All LMs as well as ALMs and STUMP were stained intensely for PR. Conversely, LMS was strongly stained with p53, while the three non-sarcomatous groups (STUMP, ALM, LM) were either entirely negative or weakly stained for p53. Regarding both PR and p53 expression, the difference between the LMS group and the three non-sarcomatous groups was highly significant (p < 0.001). Combined high PR - low p53 expression was seen in all the 26 examined cases of the non-sarcomatous group including the STUMP cases and none of the LMS cases. Therefore, it represents a "benign" profile with 100% specificity in diagnosis of a non-sarcomatous tumor.ConclusionImmunohistochemistry for PR and p53 is valuable as an adjunct tool to morphological assessment of problematic uterine smooth muscle tumors.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1033065653646058.

[1]  M. Baggish.  Mesenchymal tumors of the uterus. , 1974, Clinical obstetrics and gynecology.

[2]  S. de Vos,et al.  p53 alterations in uterine leiomyosarcomas versus leiomyomas. , 1994, Gynecologic oncology.

[3]  J. Nesland,et al.  Immunohistochemical analysis of p53 protein in uterine sarcomas. , 1998, Gynecologic oncology.

[4]  T. Suzuki,et al.  Uterine leiomyoma versus leiomyosarcoma: a new attempt at differential diagnosis based on their cellular characteristics , 2006, Histopathology.

[5]  O. Kimberger,et al.  Estrogen and progesterone receptor expression in patients with uterine smooth muscle tumors. , 2004, Fertility and sterility.

[6]  Z. Kavak,et al.  Differential Diagnosis of Smooth Muscle Tumors Utilizing p53, pTEN and Ki-67 Expression with Estrogen and Progesterone Receptors , 2005, Gynecologic and Obstetric Investigation.

[7]  I. Konishi,et al.  Mitotic activity in uterine leiomyomas during the menstrual cycle. , 1989, American journal of obstetrics and gynecology.

[8]  A. al-Nafussi.  Uterine smooth-muscle tumours: practical approach to diagnosis , 2004 .

[9]  K. Mittal,et al.  MIB-1 (Ki-67), p53, estrogen receptor, and progesterone receptor expression in uterine smooth muscle tumors. , 2001, Human pathology.

[10]  S. Topuz,et al.  The expression of Ki-67, p53, estrogen and progesterone receptors affecting survival in uterine leiomyosarcomas. A clinicopathologic study. , 2005, Gynecologic oncology.

[11]  M. Imamura,et al.  Expression of angiogenic factors and apoptotic factors in leiomyosarcoma and leiomyoma. , 2001, International journal of molecular medicine.

[12]  T. Nikaido,et al.  Expression of steroid receptors, Ki-67, and p53 in uterine leiomyosarcomas. , 1999, International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists.

[13]  W. Hatzmann,et al.  Comparison of Cytosolic p53 Protein Levels in the Female Genital Tract and Breast, and Their Tumors , 2000, Tumor Biology.

[14]  K. Kayser,et al.  Benign metastasizing leiomyoma of the uterus: documentation of clinical, immunohistochemical and lectin-histochemical data of ten cases , 2000, Virchows Archiv.

[15]  K. Mccarty,et al.  Cytoplasmic estrogen and progesterone receptor content of uterine sarcomas. , 1984, American journal of obstetrics and gynecology.

[16]  D. Petrović,et al.  Expression of Ki-67, P53 and progesterone receptors in uterine smooth muscle tumors. Diagnostic value. , 2010, Collegium antropologicum.

[17]  R. Kurman,et al.  BLAUSTEIN'S PATHOLOGY OF THE FEMALE GENITAL TRACT , 2004 .

[18]  A. Mcnicol,et al.  p53 immunoreactivity and mutation of the p53 gene in smooth muscle tumours of the uterine corpus , 1995, The Journal of pathology.

[19]  S. Leodolter,et al.  Estrogen and progesterone receptor expression in patients with uterine leiomyosarcoma and correlation with different clinicopathological parameters. , 2003, Anticancer research.

[20]  W. McCluggage,et al.  Uterine leiomyosarcomas are characterized by high p16, p53 and MIB1 expression in comparison with usual leiomyomas, leiomyoma variants and smooth muscle tumours of uncertain malignant potential , 2007, Histopathology.

[21]  A. Kaider,et al.  Leiomyosarcoma of the uterus: a clinicopathologic multicenter study of 71 cases. , 1999, Gynecologic oncology.

[22]  Y. Xu,et al.  [Smooth muscle neoplasms of the uterus--a 51 cases study]. , 1996, Zhonghua bing li xue za zhi = Chinese journal of pathology.

[23]  Ülkü Öner,et al.  Differential expression of P16 and P21 in benign and malignant uterine smooth muscle tumors , 2011, Archives of Gynecology and Obstetrics.

[24]  E. Wallach,et al.  Uterine leiomyomata: etiology, symptomatology, and management. , 1981, Fertility and sterility.

[25]  C. Zaloudek,et al.  Mesenchymal Tumors of the Uterus , 1987 .