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      Morphological and Ancillary Features of Uterine Leiomyosarcoma: Case Report

      case-report

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          Abstract

          We report a rare case of giant uterine leiomyosarcoma in a postmenopausal woman, whose diagnosis was initially suspected at the evaluation of the abdominal efusion, and confirmed after the pathological examination of the uterus in association with the ancillary tests. The evaluation of the abdominal fluid showed single or clusters of malignant, round or spindle-shaped cells. On microscopic examination of the surgical specimen, a dense cell proliferation of spindle cells, with moderate to severe nuclear pleomorphism and significant mitotic activity was observed. Immunohistochemical evaluation demonstrated the loss of myocytic differentiation by focal, weakly positive expression of smooth muscle actin and desmin. The data presented in this case emphasize the relevance of the cytological examination, although the latter has only indicative value, especially since it is an aggressive tumor, frequently associated with mutant expression of p53. In our case, the first indication of the presence of uterine sarcoma was given by the presence of atypical cells in the peritoneal fluid.

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          Most cited references22

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          p16(Ink4a) overexpression in cancer: a tumor suppressor gene associated with senescence and high-grade tumors.

          p16(Ink4a) is a protein involved in regulation of the cell cycle. Currently, p16(Ink4a) is considered a tumor suppressor protein because of its physiological role and downregulated expression in a large number of tumors. Intriguingly, overexpression of p16(Ink4a) has also been described in several tumors. This review attempts to elucidate when and why p16(Ink4a) overexpression occurs, and to suggest possible implications of p16(Ink4a) in the diagnosis, prognosis and treatment of cancer.
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            Uterine leiomyosarcoma: Epidemiology, contemporary treatment strategies and the impact of uterine morcellation

            Leiomyosarcoma, a rare tumor subtype, accounts for 1% of all uterine malignancies, but contributes to a significant proportion of uterine cancer deaths. Surgery is considered the mainstay of treatment for all soft tissue sarcomas, including uterine variants. However, uterine leiomyosarcoma is challenging to diagnose preoperatively and can mimic the appearance of benign uterine leiomyomas. Recently, concerns have grown in this regard, as surgeons have utilized uterine morcellation and myomectomy procedures unknowingly in the setting of occult uterine sarcoma. Because of aggressive tumor biology and relative chemotherapy and radiotherapy resistance, efficacious therapies to achieve prolonged survival or cure in those with both early and advanced-stage uterine leiomyosarcoma have been elusive. The strongest determinant of survival remains stage at diagnosis, though prediction models may provide a more accurate prognosis. Given the aggressive nature of this sarcoma subtype, novel early detection strategies and targeted therapies are the focus of several recently published and ongoing studies. While gemcitabine/docetaxel and doxorubicin remain the most active regimens in the treatment of advanced or recurrent disease, currently available cytotoxic regimens remain inadequate, with 5-year disease-specific survival of <30%. Pazopanib, trabectedin and olaratumab, are FDA-approved, targeted therapies with activity in uterine and other leiomyosarcomas, while aromatase inhibitors and immunotherapies are under active investigation. This review provides a critical appraisal of the literature regarding the contemporary surgical and medical management of uterine leiomyosarcoma, the role of targeted therapies, and the implications of uterine morcellation on gynecologic surgical practice.
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              Prognosis and treatment of uterine leiomyosarcoma: A National Cancer Database study

              To determine overall survival and factors associated with survival of women with uterine leiomyosarcoma.
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                Author and article information

                Journal
                Clin Pathol
                Clin Pathol
                PAT
                sppat
                Clinical Pathology
                SAGE Publications (Sage UK: London, England )
                2632-010X
                27 June 2022
                Jan-Dec 2022
                : 15
                : 2632010X221105224
                Affiliations
                [1 ]Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanţa, Romania
                [2 ]Department of Pathology, Faculty of Medicine, “Ovidius” University of Constanţa, Constanţa, Romania
                [3 ]Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology – CEDMOG, “Ovidius” University of Constanţa, Constanța, Romania
                [4 ]Academy of Medical Sciences of Romania, Romania
                [5 ]Elias Emergency University Hospital, Dermatovenerology Department
                [6 ]“Ovidius” University of Constanta, Institute of Doctoral Studies, School of Medicine
                Author notes
                [*]Raluca Ioana Vodă, Department of Clinical Pathology, “St. Apostle Andrew” Emergency County Hospital, Constanţa, Romania; Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology – CEDMOG, “Ovidius” University of Constanţa, 145 Tomis Avenue, Constanţa 900470, Romania. Email: raluca.v1694@ 123456yahoo.ro
                Author information
                https://orcid.org/0000-0002-9396-2350
                https://orcid.org/0000-0003-1910-9797
                Article
                10.1177_2632010X221105224
                10.1177/2632010X221105224
                9240338
                e87caa0e-3646-450d-9b48-7527c6b689dc
                © The Author(s) 2022

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 6 September 2021
                : 17 May 2022
                Categories
                Case Report
                Custom metadata
                January-December 2022
                ts1

                cytology,differentiation,immunohistochemistry,mesenchymal tumor,uterine leiomyosarcoma

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