Immunohistochemical markers in differential diagnosis of endometrial stromal sarcoma and cellular leiomyoma.

OBJECTIVE: Distinction of endometrial stromal sarcoma (ESS) from benign smooth muscle proliferations like cellular leiomyoma (CL) is sometimes problematic. The purpose of this study was to evaluate the potential utility of a panel of antibodies in the differential diagnosis of ESS and CL. METHODS: Using a standard streptavidin-biotin method, the expression of desmin, alpha smooth muscle actin (SMA), calponin h1, h-caldesmon, estrogen receptor (ER), progesterone receptor (PR), CD10, CD44v3, proliferating cell nuclear antigen (PCNA), and mast cells (MCs) were evaluated in 26 cases of ESS (21 low grade, 5 high grade), 25 CL (17 common CL, 8 highly CL), 25 myometria, and 25 endometria. RESULTS: Among ESS, 20 of 26, 17 of 26, 9 of 26, 12 of 26, 14 of 26, and 22 of 26 were positive for expression of desmin, SMA, calponin h1, ER, PR, and CD10, respectively, while only 2 of 26 were positive for CD44v3 and all were entirely negative for h-caldesmon. Of CL, all were positive for SMA, calponin h1, PR, and CD44v3; 24 of 25, 24 of 25, and 19 of 25 were positive for desmin, h-caldesmon, and ER, respectively, whereas 1 of 25 focally marked with antibodies to CD10. There was no significant difference of PCNA expression between ESS and CL, although the ESS cases tended to have higher values. The MC counts were significantly higher in the CL group than in the ESS group (P < 0.01). When using the cut-off value of seven MCs per HPF to distinguish ESSs from CLs, the sensitivity and specificity of this cut-off value were 92.9% and 100%, respectively. CONCLUSIONS: A panel of h-caldesmon, CD10, and CD44v3 should be used and will distinguish ESS from CL in most cases. In addition, counting the number of MCs might be useful as part of a multivariate approach to the differential diagnosis of them. But the biological function of MC and CD44v3 in these tumors is worthy of further investigation.

[Histological classification in 10 288 cases of ovarian malignant tumors in China].

OBJECTIVE: The histological types of ovarian tumors were investigated and analyzed in China in order to compare with those in other countries, which will benefit to the prevention and treatment of ovarian carcinoma. METHODS: The pathological data from 42 197 cases of ovarian tumors in ten years during 1980 to 1989 were registered according to the WHO classification for ovarian tumors. Some unsure cases pathologically in the previous diagnosis should be reconfirmed according to the WHO classification. RESULTS: Forty-two thousand one hundred and ninety seven cases of ovarian tumors were selected from all tumors in 21 provinces and 3 major regional cities in China. There were 10 288 (24.4%) malignant tumors in all cases. They were composed by 5 650 (54.9%) cases of epithelial tumors, 1 871 (18.2%) cases of germ cell tumors, 873 (8.5%) cases of sex cord tumors, 1 003 (9.7%) cases of secondary tumors, and 891 (8.7%) cases of other tumors. The malignant tumors constituent ratios were 52.8% and 47.2% respectively in the north and south of the Yangtze River. The histological types of ovarian tumors were about the same ratios, but the malignant tumors were different in Chinese 6 major administrative region and also in the region both north and south of the Yangtze River. The ratio of borderline epithelial ovarian tumors to epithelial carcinoma was 1.0:5.9. Borderline serous cystadenocarcinoma appeared to be similar to borderline mucinous cystadenocarcinoma in frequency. Serous cystadenocarcinoma was found to be the most frequent one in malignant epithelial tumors. CONCLUSIONS: Compared with reports abroad, the different types of malignant ovarian tumors in China represent a different distributive pattern. The malignant epithelial ovarian tumors were lower than that in other countries, while the malignant germ cell tumors and sex cord stromal tumors were 6 and 3 times higher than those abroad, the main metastasizing tumors come from gastroenteric carcinoma.