Mesenchymal tumors of the uterine corpus with heterologous and hematopoietic components: a study of ten cases and review of the literature.

OBJECTIVE: To study the histopathological features of mesenchymal tumors of the uterine corpus with heterologous and hematopoietic components, and review their histogenesis and differential diagnosis from other neoplastic and non-neoplastic lesions. METHODS: Ten cases of mesenchymal tumors of the uterine corpus, massively infiltrated by hematopoioetic cells, or composed of other benign heterologous elements (adipose tissue in the present cases) were retrieved from the archival files of our laboratory and studied histopathologically. Immunohistochemistry was applied in selected cases. RESULTS: Six of our studied cases were diagnosed as leiomyomas, two as lipoleiomyomas, one as a symplastic lipoleiomyoma, and one as an endometrial stromal tumor. The leiomyomas were massively infiltrated by lymphocytes (5 cases) or eosinophils (one case). Immunohistochemical study of the leiomyomas with massive lymphocytic infiltration revealed the presence of a predominantly B-cell population within the infiltrate, which was polyclonal in nature. The endometrial stromal tumor was severely infiltrated by histiocytes, and was positive for vimentin, CD10, PgR and negative for actin, desmin, ER and caldesmon. CONCLUSION: The presence of hematopoietic or heterologous elements within an otherwise bland uterine leiomyoma or endometrial stromal tumor may give rise to diagnostic difficulties. Regularity of the tumor margins, low mitotic activity and absence of nuclear atypia or necrosis should be established for the exclusion of a malignancy. In the presence of massive lymphocytic infiltration of a leiomyoma the clonality of the infiltrate may aid in differentiating it from a malignant lymphoma. The pathogenesis and clinical significance of these rare neoplasms remain to be clarified.

Recurrent endometrial stromal tumors with smooth-muscle differentiation and a protracted clinical course.

BACKGROUND: A 24-year-old white female gravida 1, para 0010, presented with heavy vaginal bleeding and abdominal cramps of 2 weeks' duration. Medical history was remarkable for spontaneous abortion 5 years previously. She had no significant family history or other gynecological problems. Physical examination revealed tissue fragments and blood clots oozing from the cervical os, and her uterus was diffusely enlarged. INVESTIGATIONS: Physical examination, ultrasound, uterine dilation and curettage, immunohistochemistry and human androgen receptor gene clonality analysis, uterine sonohistogram, MRI and exploratory laparotomy. DIAGNOSIS: Intrauterine dissemination of endometrial stromal tumors with smooth-muscle differentiation. MANAGEMENT: Partial wedge resection of the anterior uterine wall via abdominal myomectomy and total abdominal hysterectomy.

Down-regulation of interleukin-1 receptor type 1 expression causes the dysregulated expression of CXC chemokines in endometriotic stromal cells: a possible mechanism for the altered immunological functions in endometriosis.

To evaluate the involvement of chemokines in the pathogenesis of endometriosis, we investigated the expression of CXC chemokines in cultured ovarian endometriotic cyst stromal cells (ECSC), endometrial stromal cells with endometriosis (ESCwE), and normal endometrial stromal cells (NESC). Using ELISA, TNF-alpha significantly enhanced the production of IL-8, growth-related oncogene alpha, and epithelial neutrophil-activating peptide-78 in all cases of ECSC (n = 10), ESCwE (n = 6), and, NESC (n = 10). IL-1beta did not affect the production of these chemokines in eight of 10 cases of ECSC. In contrast, IL-1beta significantly enhanced the expression of these chemokines in all cases of ESCwE (n = 6) and NESC (n = 10). Western blot analysis revealed down-regulation of expression of IL-1 receptor type 1 (IL-1-R1) in all cases of ECSC with low response to IL-1beta (n = 8). In contrast, significant IL-1-R1 expression was detected in all cases of NESC. Although IL-1-R1 expression was detected in all cases of ESCwE (n = 6), its expression in ESCwE tended to decrease compared with that in NESC. Moreover, phosphorylation of inhibitor kappaB-alpha was detected in all cases of ESCwE and NESC after stimulation with IL-1beta, but not in ECSC with low response to IL-1beta (n = 8). In contrast, significant IL-1-R2 expression was detected in all cases of ECSC, ESCwE, and NESC. The present findings suggest that the dysregulation of IL-1/IL-1-R system relates to immunological dysfunction in endometriosis. The alteration of the CXC chemokines expression may be important for elucidation of the pathogenesis of endometriosis.