Abstract:Uterine smooth muscle tumors are the most common tumors of the female genital tract and include leiomyoma (LM) and its variants, smooth muscle tumors of uncertain malignant potential (STUMP), and leiomyosarcoma (LMS). Accurate diagnosis of LMS is determined by nuclear atypia, mitotic count, and the presence or absence of tumor cell necrosis, a process which is often difficult and subjective. In this study, we correlated digital quantification of proliferation marker Ki-67 and mitotic marker phosphohistone H3 (… Show more
“…The use of immunohistochemical stainings such as p16, p53, KI-67, p21, ER, PR, bcl-2 and Twist in the differential diagnosis of uterine smooth muscle tumors with potential malignant behavior has been investigated in the literature [5,15,22]. Of these, p16, p53, and KI-67 are thought to be the most useful in detecting clinically aggressive smooth muscle tumors, but their routine diagnostic use is not currently recommended because reports of their efficacy are scarce [5,22,23]. KI-67 immunohistochemical staining can help distinguish pycnotic nuclei from true mitotic figures and may be useful in evaluating mitotic activity, especially in tumors with atypia but without necrosis.…”
This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Ginekologia Polska" are listed in PubMed.
“…The use of immunohistochemical stainings such as p16, p53, KI-67, p21, ER, PR, bcl-2 and Twist in the differential diagnosis of uterine smooth muscle tumors with potential malignant behavior has been investigated in the literature [5,15,22]. Of these, p16, p53, and KI-67 are thought to be the most useful in detecting clinically aggressive smooth muscle tumors, but their routine diagnostic use is not currently recommended because reports of their efficacy are scarce [5,22,23]. KI-67 immunohistochemical staining can help distinguish pycnotic nuclei from true mitotic figures and may be useful in evaluating mitotic activity, especially in tumors with atypia but without necrosis.…”
This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Ginekologia Polska" are listed in PubMed.
“…Nonetheless, there are a few useful IHC and molecular markers to distinguish between STUMP and LBN, such as IHC staining of Ki-67 and PHH3. 27 , 28 The differentiation between LBN and LMS is the focus of this review because LBN is often misdiagnosed as LMS, 30 , 60 leading to serious clinical consequences, such as overtreatment. Furthermore, some LMS patients may be misdiagnosed because of the lack of histologic evaluation.…”
Section: Discussionmentioning
confidence: 99%
“…11 , 19 In uncertain cases, mitotic counts in more sections and immunostaining for Ki-67 or phosphorylated histone H3 (PHH3) may be helpful. 27 , 28 Furthermore, it is worth noting that infarct-type (hyaline) necrosis can occasionally be observed in LBN. Figure 3 Classic morphological characteristics of smooth muscle tumors of uncertain malignant potential (STUMP).…”
Section: Different Diagnostic Tools For Lbnmentioning
confidence: 99%
“…14 , 35 Recently, Cao et al demonstrated that the digital quantification of Ki-67 could assist in LMS diagnosis and higher Ki-67 values may indicate lower progression-free survival. 27 Figure 5 Photomicrographs (40X) illustrating immunohistochemical staining for the five biomarkers Ki-67, p53, p16, estrogen receptor (ER), and progesterone receptor (PR) in leiomyosarcoma (LMS) and leiomyoma with bizarre nuclei (LBN). In contrast to LBN, LMS shows the overexpression of Ki-67, altered p53, p16 expressions, and the loss of ER and PR expression.…”
Section: Different Diagnostic Tools For Lbnmentioning
Leiomyoma with bizarre nuclei (LBN), also known as symplastic leiomyoma, is a histological subtype of benign leiomyoma with bizarre cells and nuclear atypia. Differentiating LBN from other benign leiomyoma subtypes, uterine smooth muscle tumors of uncertain malignant potential (STUMP), or leiomyosarcoma (LMS) can be diagnostically challenging owing to overlapping features in clinical presentation and pathologic morphological analysis. The difficulty of distinguishing LBN from other lesions, especially from LMS, and the potential of LBN for subsequent malignant transformation make LBN an important topic of research. Herein, we review the definition, diagnosis, treatment, and prognosis of LBN. Histopathological examination is essential for distinguishing LBN from other diseases. Pathology sampling and morphological examination remain the key to diagnosis. The newly established ancillary immunohistochemical (IHC) and molecular genetic analysis can be useful tools for differential diagnosis. Furthermore, serum biomarkers and imaging examination may also be useful diagnostic tools. Attention should be paid to the differentiation between LBN and LMS because morphological diagnosis may still be challenging in some cases. Some IHC markers of LBN have been identified, which may be helpful for differential diagnosis. Furthermore, the use of IHC panels as diagnostic markers may be advocated. Molecular genetic studies suggest that some genes can aid with the differential diagnosis between LBN and LMS. However, increasing evidence support the idea that LBN and LMS are molecularly related, indicating that LBN may represent a potentially malignant stage of precancerous progression. At present, conservative treatment is recommended for primary LBN, especially for patients desiring to retain fertility, but close follow-up with imaging examinations is required.
“…Uterine fibroids (UFs), also known as uterine leiomyoma (UL), fibroma, or leiomyoma, are one of the most prevalent tumors of the female genital tract ( 1 , 2 ). As for the most common mesenchymal uterine neoplasms, leiomyoma is a kind of benign tumor that develops from mesenchymal or connective tissues.…”
ObjectiveTo study specific information on trends in incidence, mortality, disability-adjusted life years (DALY) and the corresponding trends among five sociodemographic index regions, 21 regions, and 204 countries for decision-making, which would enable policymakers to distribute limited resources and devise policies more rationally.MethodsData on uterine fibroids (UNs) from 1990 to 2019, including incidence, mortality, and DALYs, were obtained from the 2019 Global Burden of Disease Study. An estimated annual percentage change (EAPC) was calculated to assess morbidity, mortality, and DALY trends.ResultsThe incident cases of UFs increased from 5,769,658 (95%UI, 7,634,3995–4,274,824) incidences in 1990 to 9,643,336 (95%UI, 7,178,053-12,714,741) incidences in 2017, and the age-standardized incidence rate was steady at 225.67/100,000 persons (95%UI, 167.33–298.87) in 1990 to 241.18/100,000 persons (95%UI, 179,45–318.02) in 2019. The incidence ratio in the high sociodemographic index (SDI) region showed a unimodal distribution, with peaks in 2005. Between 2009 and 2017, the age-standardized death rate of UFs declined globally, especially in low-SDI and low-middle SDI regions. In contrast with 860,619 DALYs (95%UI, 473,067-1,505,289) in 1990, the number of DALYs was 1,378,497 (95%UI, 710,915-2,475,244) in 2019, which had increased significantly, whereas the age-standardized DALY rate decreased expressively with an EAPC of −1.93 (95%CI, from −2.16 to −1.71).ConclusionThe global burden of UFs increased between 1990 and 2019, and the incidences and DALYs increased prominently worldwide, while the deaths from UFs had no evident growth. Lower SDI regions carried an incremental burden of UFs, while disease reduction was observed in higher SDI regions. It is high time we paid attention to the underprivileged regional quality of life and health protection.
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