Review
Recent developments in uterine mesenchymal neoplasms
Sarah Chiang,
Esther Oliva,
Sarah Chiang
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
Search for more papers by this authorCorresponding Author
Esther Oliva
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
Address for correspondence: Esther Oliva, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, WRN 2, Boston, MA 02114, USA. e-mail: [email protected]Search for more papers by this authorSarah Chiang,
Esther Oliva,
Sarah Chiang
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
Search for more papers by this authorCorresponding Author
Esther Oliva
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
Address for correspondence: Esther Oliva, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, WRN 2, Boston, MA 02114, USA. e-mail: [email protected]Search for more papers by this authorAbstract
Smooth muscle and endometrial stromal tumours represent the two most common uterine mesenchymal neoplasms that may present diagnostic dilemmas for the practising surgical pathologist. Recent changes in morphological and staging criteria, as well as the discovery of new immunohistochemical markers, have improved the diagnosis and classification of these tumours. We highlight the difficulty in distinguishing tumour cell necrosis from infarct-type necrosis and the limited utility of p16 immunohistochemical expression in the diagnosis of leiomyosarcoma. We also discuss the controversial use of mitotic activity and necrosis as prognostic factors in endometrial stromal sarcomas. Emerging genetic information has also greatly expanded our understanding of ‘sarcomagenesis’ in both tumour types and may provide insight into potential therapeutic targets for the treatment of leiomyosarcoma and endometrial stromal sarcomas, harboring MED12 (mediator complex subunit 12) mutations and recurrent gene rearrangements, respectively. In this review, we discuss the core updates in the diagnosis and classification of uterine leiomyosarcomas and endometrial stromal sarcomas, highlighting new and important molecular genetic findings that may drive pathogenesis.
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