Abstract
Uterine smooth muscle tumors constitute a spectrum of neoplasms. Diagnosis of leiomyomas (LMs) is usually straight forwards; however, atypical leiomyomas (ALMs) and smooth muscle tumors of uncertain malignant potential (STUMPs) have overlapping features and need to be distinguished from leiomyosarcoma. To evaluate progesterone receptor (PR), epithelial growth factor receptor (EGF-R), and galectin-3 expression in LMs, ALMs, STUMPs, and leiomyosarcomas and to assess their possible role in differentiating those tumors. Immunoexpression of EGF-R, PR, and galectin-3 were studied in 44 cases of uterine smooth muscle tumors through retrospective study. Studied cases included 20 LM, 9 ALM, 5 STUMP, and 10 leiomyosarcomas. A semiquantitative score was used to evaluate immunohistochemical staining. EGF-R overexpression was detected in leiomyosarcomas while a lack of or reduced EGF-R expression was observed in the nonsarcomatous group (LMs, ALMs, and STUMPs) with a highly significant difference. On the contrary, there was weak or negative PR staining in leiomyosarcomas compared to intense PR expression in the nonsarcomatous group with a highly significant difference. Meanwhile, galectin-3 was downregulated in leiomyosarcomas compared to the nonsarcomatous group with a significant difference. Correlation analysis revealed negative correlation between EGF-R and PR expression with significant statistical results while correlation of galectin-3 with EGF-R and PR showed insignificant statistical results. Immunoexpression of EGF-R, PR, and galectin-3 could help differentiate challenging cases of uterine smooth muscle tumors. Further studies are recommended to investigate interactions between EGF-R, PR, and galectin-3 and to plan new therapeutic strategies.
Highlights
Uterine smooth muscle tumors (SMTs) are common gynecologic neoplasms [1]
Regarding the steroid receptor status of uterine smooth muscle tumors, Hewedi et al [1] demonstrated intense PR expression in 100% of leiomyomas and atypical leiomyomas, with marked decrease in leiomyosarcomas In addition, progesterone receptors were reported to be expressed in 100% of leiomyomas and in 96% of atypical leiomyomas compared to 47% of leiomyosarcomas [33]
Our findings were consistent with these results, as there was increased nuclear PR immunoreactivity in the nonsarcomatous group compared to the leiomyosarcoma group with significant statistical relation
Summary
Uterine smooth muscle tumors (SMTs) are common gynecologic neoplasms [1]. With regard to mitotic rate, tumor necrosis, and degree of nuclear atypia, uterine SMTs are divided into leiomyomas (LMs), mitotically active leiomyomas, atypical or symplastic leiomyomas, smooth muscle tumors of uncertain malignant potential (STUMPs), and leiomyosarcomas (LMSs) [2]. Uterine smooth muscle tumors of uncertain malignant potential (STUMPs) are uncommon neoplasms with uncertain biological behavior. This category requires accurate interpretation, as a wrong diagnosis leads to different therapeutic and follow-up procedures [3]. Regulation of growth factor gene expression may be mediated by estrogen and progesterone, and this regulation changes other genes’ transcription [9].
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