Clinicopathologic analysis of matched primary and recurrent endometrial carcinoma.

It is unknown whether the type and grade of a primary endometrial carcinoma is reliably maintained in recurrence. All matched primary and recurrent endometrial carcinomas diagnosed from 2000 to 2010 at our institution were identified; 34 cases had available slides. Histologic classification was performed using modifications to the World Health Organization criteria. Immunohistochemical analysis for p53, p16, progesterone receptor (PR), and DNA mismatch-repair proteins (MMR) (MLH1, MSH2, MSH6, and PMS2) was performed. Endometrioid carcinoma recurrences were mostly local, whereas serous carcinoma recurrences were mostly peritoneal. Compared with endometrioid carcinoma patients, serous carcinoma patients were older, presented at high stage, and had shorter survival. Serous carcinomas were the most common recurrent endometrial carcinoma (18/34 cases). Overall, 21 cases (62%) displayed similar morphology when comparing primary and recurrent carcinomas, whereas 13 displayed discordant morphology. Seven of 13 endometrioid carcinomas (54%) had a morphologically discordant recurrence, compared with 3 of 14 serous carcinomas (21%), 1 of 4 morphologically ambiguous carcinomas (25%), and both mixed epithelial carcinomas. Serous and morphologically ambiguous carcinomas therefore demonstrated relative morphologic fidelity compared with endometrioid carcinomas. Four morphologically discordant cases demonstrated either pure clear cell carcinoma or clear cell features at recurrence. Seven of 23 matched pairs displayed discordant PR results, with 5 cases, including both endometrioid and serous carcinomas, showing diminished PR expression at recurrence. p53, p16, and DNA MMR staining results were generally concordant when evaluating matched pairs, with only occasional exceptions. Sixty-four percent of all pure endometrioid carcinomas and mixed epithelial carcinomas with an endometrioid component showed loss of expression of MLH1 and/or PMS2; no serous carcinoma demonstrated this abnormality. Clinical and immunohistochemical data supported the use of modifications to the World Health Organization diagnostic criteria. More importantly, the data suggest that when confronted with recurrent endometrial carcinoma, particularly a serous carcinoma, it is reasonable to base therapeutic decisions on the type of the primary tumor, especially if sampling or excising the recurrent tumor is problematic. However, in light of the PR results, sampling a recurrent endometrioid carcinoma may be worthwhile if hormonal therapy is planned. Recurrent endometrioid carcinoma may be enriched for tumors with DNA MMR abnormalities.

"Low-grade leiomyosarcoma" and late-recurring smooth muscle tumors of the uterus: a heterogenous collection of frequently misdiagnosed tumors associated with an overall favorable prognosis relative to conventional uterine leiomyosarcomas.

In most instances, uterine smooth muscle tumors (USMTs) are readily diagnosed as either benign or malignant. Rare patients whose smooth muscle tumors fail to meet leiomyosarcoma (LMS) diagnostic criteria will experience recurrence, and occasional cases of LMS patients experience a protracted clinical disease course. The aim of this study was to investigate whether "low-grade uterine LMS" can be defined as a clinicopathological entity and to learn which histologic features of USMTs correlate with indolent prognosis. We searched institutional databases for cases diagnosed between 1982 and 2008 that had been coded as low-grade LMS and/or cases coded as LMS that were associated with recurrences after 5 years of diagnosis. There were 185 cases with available clinical follow-up data (mean follow-up for survivors was 5.4 y); 57% of patients were dead of disease (DOD), 16% of patients were alive with disease (AWD), and 24% had no evidence of disease (NED). All available slides were reviewed by 2 pathologists (E.V. and R.S.) using Stanford USMT criteria to identify cases of bona fide LMS. Cases were not excluded if they failed to meet these criteria. Nine percent (16 of 185) of tumors had been coded as low-grade LMS. On review of cases with available slides (n=16), only 4 cases (25%) met Stanford USMT criteria for LMS, and 1 additional case was a myxoid LMS. Three cases were reclassified as endometrial stromal sarcomas with smooth muscle differentiation, and 7 cases (44%) failed to meet criteria for sarcoma [ie, they were atypical smooth muscle neoplasms (ASMNs)]. Six of 16 (38%) patients were NED with a mean follow-up of 76 months; 4 of 16 (25%) patients were AWD with a mean follow-up of 102.5 months; 4 of 16 (25%) patients were DOD with a mean follow-up of 79.2 months; and 2 of 16 (12.5%) patients died of unknown causes at 104 and 120 months. Despite being coded as having low-grade LMS in the database, none of the ASMN patients died of disease. Twelve percent of all cases (n=22) were associated with late recurrences. Of the 9 cases with available slides, 5 were bona fide LMSs, and 4 were ASMNs (coded as low-grade LMS in the database and included as part of the low-grade LMS portion of this study). Five of 9 (56%) patients were NED with a mean follow-up of 214 months; 2 (22%) are AWD with a follow-up of 107 and 201 months; and 2 patients were DOD with a follow-up of 108 and 143 months. Bona fide LMS recurrences in this group were earlier (mean, 6.2 y) and frequently fatal (2 of 5), whereas those patients with recurrent ASMN experienced disease progression later (mean, 12 y), and none died of disease. Whether "low-grade" uterine LMSs indeed exist is a matter still open for debate; however, when Stanford criteria are strictly applied, all tumors classified as LMSs should be regarded as intrinsically "high grade."

Light controllable tuning and switching of lasing in chiral liquid crystals.

A new approach based on the use of cholesteric liquid crystals (CLCs) and dye-doped light-sensitive chiral dopants was employed to create lasing materials with reversible tuning and switching. The lasing wavelength of optically-pumped dye-doped cholesteric liquid crystals (CLCs) is shifted by irradiation with UV light. The shift depends on the UV light exposure. Lasing is switched off at high levels of UV light irradiation. A qualitative model describing different lasing regimes is proposed.