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Immunohistochemical panel to differentiate endometrial stromal sarcoma, uterine leiomyosarcoma and leiomyoma: something old and something new
  1. Helena Hwang1,
  2. Koji Matsuo2,
  3. Kara Duncan3,
  4. Elham Pakzamir4,
  5. Huyen Q Pham2,
  6. Adrian Correa3,
  7. Alexander Fedenko3,
  8. Paulette Mhawech-Fauceglia3
  1. 1Department of Anatomic Pathology, University of Texas at Dallas, Dallas, Texas, USA
  2. 2Division of Gynecology Oncology, Departments of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
  3. 3Department of Surgical Pathology, University of Southern California, Los Angeles, California, USA
  4. 4Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
  1. Correspondence to Professor Paulette Mhawech-Fauceglia, MD, Department of Pathology,
    University of Southern California, 1200 N. State Street. Room 7A116, Los Angeles, CA 90033-5000, USA; pfauceglia{at}


Aims To evaluate an immunohistochemical panel differentiating endometrial stromal sarcoma (ESS) from uterine leiomyosarcoma (ULMS) and leiomyoma (LM).

Methods 94 cases (28 ESS, 41 ULMS, 25 LM) were retrieved and arrayed. 10 immunomarkers (estrogen receptor (ER), progesterone receptor (PR), CD10, smooth muscle actin, desmin, h-caldesmon, transgelin, GEM, ASC1, stathmin1) were used. A predictive model was constructed and examined by receiver operating characteristics curve analysis to determine area under the curve (AUC).

Results The combination of ER+/PR+/CD10+/GEM/h-caldesmon/transgelin can predict ESS versus ULMS with AUC predictive value of 0.872 (95% CI 0.784 to 0.961, p<0.0001). The combination of ER+/PR+/CD10+/h-caldesmon/transgelin can predict low grade (LG) ESS from ‘LG’ ULMS with AUC predictive value of 0.914 (95% CI 0.832 to 0.995, p<0.0001). Finally, ULMS and ESS, including the LGs, were more likely to be stathmin1+ than LM.

Conclusions Due to the different clinical course and management, adding novel antibodies (GEM, transgelin) to the well established immunohistochemistry panel seemed to be useful in distinguishing ESS from ULMS and LG ESS from ‘LG’ ULMS. Finally, stathmin1 expression could be of value in differentiating LM from uterine sarcomas.


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