Uterine perivascular epithelioid cell tumors (PEComas) and epithelioid smooth muscle neoplasms.
Article Type: Letter to the editor
Subject: Uterine tumors (Development and progression)
Epithelial tumors (Development and progression)
Smooth muscle (Medical examination)
Smooth muscle (Genetic aspects)
Pathology, Cellular (Research)
Author: Fadare, Oluwole
Pub Date: 11/01/2008
Publication: Name: Archives of Pathology & Laboratory Medicine Publisher: College of American Pathologists Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2008 College of American Pathologists ISSN: 1543-2165
Issue: Date: Nov, 2008 Source Volume: 132 Source Issue: 11
Topic: Event Code: 310 Science & research Canadian Subject Form: Uterine tumours; Epithelial tumours
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 230246853
Full Text: To the Editor.--I read with great interest the excellent article by Drs Toledo and Oliva (1) in which the authors enumerated a practical diagnostic approach to smooth muscle neoplasms of the uterus, with an emphasis in the current context on the distinction of uterine perivascular epithelioid cell tumors (PEComas) from uterine epithelioid smooth muscle neoplasms. As the authors note, (1) and as I have outlined elsewhere, (2,3) the precise nature of the relationship between these 2 neoplastic processes is unclear, as is whether they merely represent different points on a single clinicopathologic spectrum. This is primarily attributable to the substantial overlap in clinicopathologic features that exists between them. Nevertheless, they are recognized separately in the World Health Organization classification, (4) and their routine separation is therefore the standard of practice. I agree with the diagnostic approach and distinguishing features outlined by the authors. Additionally, I wish to call attention to a recent report by Adachi et al (5) in which the authors found that PEComas from many anatomic locations express CD1a by immunohistochemistry. We evaluated 18 uterine corpus epithelioid smooth muscle neoplasms (12 epithelioid leiomyomas, 6 epithelioid leiomyosarcomas) and found them all to be CD1a negative. (6) This marker may therefore be of diagnostic utility and provides further evidence of PEComas as a distinct tumor group, separate from epithelioid smooth muscle neoplasms.

(1.) Toledo G, Oliva E. Smooth muscle tumors of the uterus: a practical approach. Arch Pathol Lab Med. 2008;132:595-605.

(2.) Fadare O. Perivascular epithelioid cell tumor (PEComa) of the uterus: an outcome-based clinicopathologic analysis of 41 reported cases. Adv Anat Pathol. 2008;15:63-75.

(3.) Fadare O. Uterine PEComa: appraisal of a controversial and increasingly reported mesenchymal neoplasm. Int Semin Surg Oncol. 2008; 5:7. doi:10.1186/1477-7800-5-7.

(4.) Hendrickson MR, Tavassoli FA, Kempson RL, McCluggage WG, Haller U, Kubik-Huch RA. Mesenchymal tumors and related lesions. In: Tavassoli FA, Devilee P, eds. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Lyon, France: IARC Press; 2003: 233-244. World Health Organization Classification of Tumours.

(5.) Adachi Y, Horie Y, Kitamura Y, et al. CD1a expression in PEComas. Pathol Int. 2008;58: 169-173.

(6.) Fadare O, Liang SX. Epithelioid smooth muscle neoplasms of the uterus do not express CD1a: a potential immunohistochemical adjunct in their distinction from uterine perivascular epithelioid cell tumors [published online ahead of print July 7, 2008]. Ann Diagn Pathol. doi: 10.1016/j.anndiagpath.2008.04.009.

The author has no relevant financial interest in the products or companies described in this article.

Oluwole Fadare, MD

Department of Pathology

Wilford Hall Medical Center

Lackland AFB, TX 78236
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