Uterine Cancer

  • Robert A. Soslow
  • Esther OlivaEmail author
Part of the Current Clinical Oncology book series (CCO)


Endometrioid adenocarcinoma is the most common type of endometrial carcinoma (approximately 85%). By definition, it should resemble, at least focally, proliferative-type endometrium with tubular glands lined by mitotically active columnar cells. Common problems in diagnosis involve its distinction from complex atypical hyperplasia, endocervical adenocarcinoma, serous carcinoma, clear cell carcinoma, and carcinosarcoma. Pure serous carcinomas comprise about 10% of endometrial cancers. The term “serous” refers to shared characteristics with cells lining the fallopian tube, particularly the tumor cells’ columnar shape, eosinophilic cytoplasm and tendency to form papillae. However, some serous carcinomas are not papillary but glandular. Importantly, all serous carcinomas exhibit marked nuclear pleomorphism and most demonstrate discrepancies between architectural differentiation and cytologic features. Clear cell carcinoma is the third most common endometrial carcinoma subtype, even though it represents < 5% of cases. Epidemiologic features of patients with clear cell carcinoma are obscure because of this tumor’s rarity, difficulties in diagnostic reproducibility and accumulating evidence that there are perhaps several subtypes of clear cell carcinoma. Most clear cell carcinomas are composed of cells with clear cytoplasm, but this feature is not restricted to clear cell carcinoma and some clear cell carcinomas may contain cells with eosinophilic cytoplasm. Other subtypes of endometrial carcinoma are rare and include squamous, transitional, small cell, and mixed cell types. Among pure mesenchymal tumors of the uterus, leiomyosarcoma is the most common. Microscopic criteria to establish the diagnosis of leiomyosarcoma include the combination of two of the following: cytologic atypia, mitotic activity and tumor cell necrosis. The threshold for mitotic activity varies for spindled, epithelioid and myxoid subtypes. A variety of uterine tumors enter in the differential diagnosis, including several variants of leiomyoma (mitotically active, apoplectic, with bizarre nuclei, highly cellular, and hydropic). Low-grade endometrial stromal sarcomas are ­composed of a homogenous population of small cells with scant cytoplasm resembling proliferative-type endometrial stroma. They show a diffuse growth and infiltrate the uterine wall in a permeative (not destructive) fashion and may have prominent intravascular growth. Carcinosarcomas (malignant mixed mullerian tumors) are biphasic tumors typically composed of highly malignant epithelial and stromal/mesenchymal elements. The histogenesis of these tumors has evolved in recent years and it is now accepted that they either arise from a common pluripotential cell with divergent differentiation or that the sarcomatous component develops from the carcinomatous component by a metaplastic process or dedifferentiation. Other less common mixed or mesenchymal tumors include 1) low-grade müllerian adenosarcoma (composed of benign-appearing glands and malignant stroma); 2) PEComa, which is composed of epithelioid cells that are typically positive for HMB-45 and may be associated with tuberous sclerosis; and 3) intravenous leiomyomatosis which shows a proliferation of smooth muscle cells within vascular spaces. Even though the smooth muscle proliferation is benign it can behave aggressively from the clinical point of view.


Endometrioid Serous clear cell mixed carcinomas leiomyosarcoma endometrial stromal sarcoma carcinosarcoma low-grade müllerian adenosarcoma PEComa intravenous leiomyomatosis 


  1. 1.
    Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983;15(1):10–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Kurman RJ, Norris HJ. Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma. Cancer 1982;49(12):2547–59.PubMedCrossRefGoogle Scholar
  3. 3.
    Longacre TA, Chung MH, Jensen DN, et al. Proposed criteria for the diagnosis of welldifferentiated endometrial carcinoma. A diagnostic test for myoinvasion. Am J Surg Pathol 1995;19(4):371–406.PubMedCrossRefGoogle Scholar
  4. 4.
    Norris HJ, Tavassoli FA, Kurman RJ. Endometrial hyperplasia and carcinoma. Diagnostic considerations. Am J Surg Pathol 1983;7(8):839–47.PubMedCrossRefGoogle Scholar
  5. 5.
    Melhem MF, Tobon H. Mucinous adenocarcinoma of the endometrium: a clinico-pathological review of 18 cases. Int J Gynecol Pathol 1987;6(4):347–55.PubMedCrossRefGoogle Scholar
  6. 6.
    Ross JC, Eifel PJ, Cox RS, et al. Primary mucinous adenocarcinoma of the endometrium. A clinicopathologic and histochemical study. Am J Surg Pathol 1983;7(8):715–29.PubMedCrossRefGoogle Scholar
  7. 7.
    Hendrickson MR, Kempson RL. Ciliated carcinoma–a variant of endometrial adenocarcinoma: a report of 10 cases. Int J Gynecol Pathol 1983;2(1):1–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Tobon H, Watkins GJ. Secretory adenocarcinoma of the endometrium. Int J Gynecol Pathol 1985;4(4):328–35.PubMedCrossRefGoogle Scholar
  9. 9.
    Chen JL, Trost DC, Wilkinson EJ. Endometrial papillary adenocarcinomas: two clinicopathological types. Int J Gynecol Pathol 1985;4(4):279–88.PubMedCrossRefGoogle Scholar
  10. 10.
    Parkash V, Carcangiu ML. Endometrioid endometrial adenocarcinoma with psammoma bodies. Am J Surg Pathol 1997;21(4):399–406.PubMedCrossRefGoogle Scholar
  11. 11.
    Murray SK, Clement PB, Young RH. Endometrioid carcinomas of the uterine corpus with sex cord-like formations, hyalinization, and other unusual morphologic features: a report of 31 cases of a neoplasm that may be confused with carcinosarcoma and other uterine neoplasms. Am J Surg Pathol 2005;29(2):157–66.PubMedCrossRefGoogle Scholar
  12. 12.
    Ronnet BM ZR, Ellenson LG, Kurman RJ. Endometrial carcinoma. In: Kurman RJ, ed. Blaustein's Pathology of the Female Genital Tract. New York: Verlag; 2002:508.Google Scholar
  13. 13.
    Dabbs DJ, Geisinger KR, Norris HT. Intermediate filaments in endometrial and endocervical carcinomas. The diagnostic utility of vimentin patterns. Am J Surg Pathol 1986;10(8):568–76.PubMedCrossRefGoogle Scholar
  14. 14.
    Dabbs DJ, Sturtz K, Zaino RJ. The immunohistochemical discrimination of endometrioid adenocarcinomas. Hum Pathol 1996;27(2):172–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Dallenbach-Hellweg G, Lang-Averous G, Hahn U. The value of immunohistochemistry in the differential diagnosis of endometrial carcinomas. Apmis 1991;23:91–9.Google Scholar
  16. 16.
    McCluggage WG, Sumathi VP, McBride HA, et al. A panel of immunohistochemical stains, including carcinoembryonic antigen, vimentin, and estrogen receptor, aids the distinction between primary endometrial and endocervical adenocarcinomas. Int J Gynecol Pathol 2002;21(1):11–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Castrillon DH, Lee KR, Nucci MR. Distinction between endometrial and endocervical adenocarcinoma: an immunohistochemical study. Int J Gynecol Pathol 2002;21(1):4–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Wang N ZS, Zarbo R, et al. Coordinate expression of cytokeratins 7 and 20 subset analysis defines unique subsets of carcinomas. Appl Immunohistochem 1995;3:99–107.Google Scholar
  19. 19.
    Ginath S, Menczer J, Fintsi Y, et al. Tissue and serum CA125 expression in endometrial cancer. Int J Gynecol Cancer 2002;12(4):372–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Cherchi PL, Bosincu L, Dessole S, et al. Immunohistochemical expression of BerEP4, a new epithelial antigen, in endometrial carcinoma: correlation with clinical parameters. Eur J Gynaecolo Oncol 1999;20(5–6):393–5.Google Scholar
  21. 21.
    Katari RS, Fernsten PD, Schlom J. Characterization of the shed form of the human tumorassociated glycoprotein (TAG-72) from serous effusions of patients with different types of carcinomas. Cancer Res 1990;50(16):4885–90.PubMedGoogle Scholar
  22. 22.
    Reid-Nicholson M, Iyengar P, Hummer AJ, et al. Immunophenotypic diversity of endometrial adenocarcinomas: implications for differential diagnosis. Mod Pathol 2006;19(8):1091–100.PubMedGoogle Scholar
  23. 23.
    Soslow RA, Shen PU, Chung MH, et al. Cyclin D1 expression in high-grade endometrial carcinomas–association with histologic subtype. Int J Gynecol Pathol 2000;19(4):329–34.PubMedCrossRefGoogle Scholar
  24. 24.
    Lax SF, Kendall B, Tashiro H, et al. The frequency of p53, K-ras mutations, and microsatellite instability differs in uterine endometrioid and serous carcinoma: evidence of distinct molecular genetic pathways. Cancer 2000;88(4):814–24.PubMedCrossRefGoogle Scholar
  25. 25.
    Sherman ME, Bur ME, Kurman RJ. p53 in endometrial cancer and its putative precursors: evidence for diverse pathways of tumorigenesis. Hum Pathol 1995;26(11):1268–74.PubMedCrossRefGoogle Scholar
  26. 26.
    Brachtel EF, Sanchez-Estevez C, Moreno-Bueno G, et al. Distinct molecular alterations in complex endometrial hyperplasia (CEH) with and without immature squamous metaplasia (squamous morules). Am J Surg Pathol 2005;29(10):1322–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Schlosshauer PW, Ellenson LH, Soslow RA. Beta-catenin and E-cadherin expression patterns in high-grade endometrial carcinoma are associated with histological subtype. Mod Pathol 2002;15(10):1032–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Gehrig PA, Bae-Jump VL, Boggess JF, et al. Association between uterine serous carcinoma and breast cancer. Gynecol Oncol 2004;94(1):208–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Geisler JP, Sorosky JI, Duong HL, et al. Papillary serous carcinoma of the uterus: increased risk of subsequent or concurrent development of breast carcinoma. Gynecol Oncol 2001;83(3):501–3.PubMedCrossRefGoogle Scholar
  30. 30.
    Magriples U, Naftolin F, Schwartz PE, Carcangiu ML. High-grade endometrial carcinoma in tamoxifen-treated breast cancer patients. J Clin Oncol 1993;11(3):485–90.PubMedGoogle Scholar
  31. 31.
    Olson SH, Finstad CL, Harlap S, et al. A case-case analysis of factors related to overexpression of p53 in endometrial cancer following breast cancer. Cancer Epidemiol Biomarkers Prev 1997;6(10):815–7.PubMedGoogle Scholar
  32. 32.
    Parkash V, Carcangiu ML. Uterine papillary serous carcinoma after radiation therapy for carcinoma of the cervix. Cancer 1992;69(2):496–501.PubMedCrossRefGoogle Scholar
  33. 33.
    Pothuri B, Ramondetta L, Martino M, et al. Development of endometrial cancer after radiation treatment for cervical carcinoma. Obstet Gynecol 2003;101:941–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Carcangiu ML, Chambers JT. Uterine papillary serous carcinoma: a study on 108 cases with emphasis on the prognostic significance of associated endometrioid carcinoma, absence of invasion, and concomitant ovarian carcinoma. Gynecol Oncol 1992;47(3):298–305.PubMedCrossRefGoogle Scholar
  35. 35.
    Hendrickson M, Ross J, Eifel P, et al. Uterine papillary serous carcinoma: a highly malignant form of endometrial adenocarcinoma. Am J Surg Pathol 1982;6(2):93–108.PubMedCrossRefGoogle Scholar
  36. 36.
    Ambros RA, Sherman ME, Zahn CM, et al. Endometrial intraepithelial carcinoma: a distinctive lesion specifically associated with tumors displaying serous differentiation. Hum Pathol 1995;26(11):1260–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Spiegel GW. Endometrial carcinoma in situ in postmenopausal women. Am J Surg Pathol 1995;19(4):417–32.PubMedCrossRefGoogle Scholar
  38. 38.
    Darvishian F, Hummer AJ, Thaler HT, et al. Serous endometrial cancers that mimic endometrioid adenocarcinomas: a clinicopathologic and immunohistochemical study of a group of problematic cases. Am J Surg Pathol 2004;28(12):1568–78.PubMedCrossRefGoogle Scholar
  39. 39.
    Demopoulos RI, Mesia AF, Mittal K, Vamvakas E. Immunohistochemical comparison of uterine papillary serous and papillary endometrioid carcinoma: clues to pathogenesis. Int J Gynecol Pathol 1999;18(3):233–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Tashiro H, Isacson C, Levine R, et al. p53 gene mutations are common in uterine serous carcinoma and occur early in their pathogenesis. Am J Pathol 1997;150(1):177–85.PubMedGoogle Scholar
  41. 41.
    An HJ, Logani S, Isacson C, Ellenson LH. Molecular characterization of uterine clear cell carcinoma. Mod Pathol 2004;17(5):530–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Lax SF, Pizer ES, Ronnett BM, Kurman RJ. Clear cell carcinoma of the endometrium is characterized by a distinctive profile of p53, Ki-67, estrogen, and progesterone receptor expression. Hum Pathol 1998;29(6):551–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Carcangiu ML DT, Radice P, Bertario L, Sala P. HNPCC-related endometrial carcinomas show a high frequency of non-endometrial types and of high FIGO grade endometrioid carcinomas. Mod Pathol; 2006:173AGoogle Scholar
  44. 44.
    Vang R, Whitaker BP, Farhood AI, et al. Immunohistochemical analysis of clear cell carcinoma of the gynecologic tract. Int J Gynecol Pathol 2001;20(3):252–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Goodman A, Zukerberg LR, Rice LW, et al. Squamous cell carcinoma of the endometrium: a report of eight cases and a review of the literature. Gynecol Oncol 1996;61(1):54–60.PubMedCrossRefGoogle Scholar
  46. 46.
    Lininger RA, Ashfaq R, Albores-Saavedra J, Tavassoli FA. Transitional cell carcinoma of the endometrium and endometrial carcinoma with transitional cell differentiation. Cancer 1997;79(10):1933–43.PubMedCrossRefGoogle Scholar
  47. 47.
    Spiegel GW, Austin RM, Gelven PL. Transitional cell carcinoma of the endometrium. Gynecol Oncol 1996;60(2):325–30.PubMedCrossRefGoogle Scholar
  48. 48.
    Abeler VM, Kjorstad KE, Nesland JM. Undifferentiated carcinoma of the endometrium. A histopathologic and clinical study of 31 cases. Cancer 1991;68(1):98–105.PubMedCrossRefGoogle Scholar
  49. 49.
    Altrabulsi B, Malpica A, Deavers MT, et al. Undifferentiated carcinoma of the endometrium. Am J Surg Pathol 2005;29(10):1316–21.PubMedCrossRefGoogle Scholar
  50. 50.
    Toro JR, Travis LB, Wu HJ, et al. Incidence patterns of soft tissue sarcomas, regardless of primary site, in the surveillance, epidemiology and end results program, 1978–2001: An analysis of 26,758 cases. Int J Cancer 2006;119(12):2922–30.PubMedCrossRefGoogle Scholar
  51. 51.
    Harlow BL, Weiss NS, Lofton S. The epidemiology of sarcomas of the uterus. J Natl Cancer Inst 1986;76(3):399–402.PubMedGoogle Scholar
  52. 52.
    Schwartz PE, Kelly MG. Malignant transformation of myomas: myth or reality? Obstet Gynecol Clin North Am 2006;33(1):183–98, xii.PubMedCrossRefGoogle Scholar
  53. 53.
    Launonen V, Vierimaa O, Kiuru M, et al. Inherited susceptibility to uterine leiomyomas and renal cell cancer. Proc Natl Acad Sci U S A 2001;98(6):3387–92.PubMedCrossRefGoogle Scholar
  54. 54.
    Rammeh-Rommani S, Mokni M, Stita W, et al. Uterine smooth muscle tumors: retrospective epidemiological and pathological study of 2760 cases. J Gynecol Obstet Biol Reprod (Paris) 2005;34(6):568–71.Google Scholar
  55. 55.
    Schwartz LB, Diamond MP, Schwartz PE. Leiomyosarcomas: clinical presentation. Am J Obstet Gynecol 1993;168 (1 Pt 1):180–3.PubMedGoogle Scholar
  56. 56.
    Oliva E, Clement PB, Young RH. Mesenchymal tumours of the uterus: selected topics emphasizing diagnostic pitfalls. Curr Diagn Pathol 2002;8:268–82.CrossRefGoogle Scholar
  57. 57.
    Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol 1994;18(6):535–58.PubMedCrossRefGoogle Scholar
  58. 58.
    Hornick JL, Fletcher CD. Criteria for malignancy in nonvisceral smooth muscle tumors. Ann Diagn Pathol 2003;7(1):60–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Tavassoli F, Devilee P, eds. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Lyon: IARC Press; 2003.Google Scholar
  60. 60.
    Burns B, Curry RH, Bell ME. Morphologic features of prognostic significance in uterine smooth muscle tumors: a review of eighty-four cases. Am J Obstet Gynecol 1979;135(1):109–14.PubMedGoogle Scholar
  61. 61.
    Coard KC, Fletcher HM. Leiomyosarcoma of the uterus with a florid intravascular component (“intravenous leiomyosarcomatosis”). Int J Gynecol Pathol 2002;21(2):182–5.PubMedCrossRefGoogle Scholar
  62. 62.
    Atkins K, Bell S, Kempson R, Hendrickson M. Epithelioid smooth muscle tumors of the uterus. Mod Pathol 2001;14:132A.Google Scholar
  63. 63.
    Kurman RJ, Norris HJ. Mesenchymal tumors of the uterus. VI. Epithelioid smooth muscle tumors including leiomyoblastoma and clear-cell leiomyoma: a clinical and pathologic analysis of 26 cases. Cancer 1976;37(4):1853–65.PubMedCrossRefGoogle Scholar
  64. 64.
    Oliva E, Nielsen PG, Clement PB, et al. Epithelioid smooth muscle tumors of the uterus. A clinicopathologic study of 80 cases. Mod Pathol 1997;10:107A.Google Scholar
  65. 65.
    Prayson RA, Goldblum JR, Hart WR. Epithelioid smooth-muscle tumors of the uterus: a clinicopathologic study of 18 patients. Am J Surg Pathol 1997;21(4):383–91.PubMedCrossRefGoogle Scholar
  66. 66.
    Chen KT. Myxoid leiomyosarcoma of the uterus. Int J Gynecol Pathol 1984;3(4):389–92.PubMedGoogle Scholar
  67. 67.
    King ME, Dickersin GR, Scully RE. Myxoid leiomyosarcoma of the uterus. A report of six cases. Am J Surg Pathol 1982;6(7):589–98.PubMedCrossRefGoogle Scholar
  68. 68.
    Pounder DJ, Iyer PV. Uterine leiomyosarcoma with myxoid stroma. Arch Pathol Lab Med 1985;109(8):762–4.PubMedGoogle Scholar
  69. 69.
    Salm R, Evans DJ. Myxoid leiomyosarcoma. Histopathol 1985;9(2):159–69.CrossRefGoogle Scholar
  70. 70.
    Atkins K, Bell S, Kempson R, Hendrickson M. Myxoid smooth muscle tumors of the uterus. Mod Pathol 2001;14:132A.Google Scholar
  71. 71.
    Leitao MM, Soslow RA, Nonaka D, et al. Tissue microarray immunohistochemical expression of estrogen, progesterone, and androgen receptors in uterine leiomyomata and leiomyosarcoma. Cancer 2004;101(6):1455–62.PubMedCrossRefGoogle Scholar
  72. 72.
    Anderson SE, Nonaka D, Chuai S, et al. p53, epidermal growth factor, and platelet-derived growth factor in uterine leiomyosarcoma and leiomyomas. Int J Gynecol Cancer 2006;16(2):849–53.PubMedCrossRefGoogle Scholar
  73. 73.
    Raspollini MR, Pinzani P, Simi L, et al. Uterine leiomyosarcomas express KIT protein but lack mutation(s) in exon 9 of c-KIT. Gynecol Oncol 2005;98(2):334–5.PubMedCrossRefGoogle Scholar
  74. 74.
    Leath CA, 3rd, Straughn JM, Jr., Conner MG, et al. Immunohistochemical evaluation of the c-kit proto-oncogene in sarcomas of the uterus: a case series. J Reprod Med 2004;49(2):71–5.PubMedGoogle Scholar
  75. 75.
    O'Connor DM, Norris HJ. Mitotically active leiomyomas of the uterus. Hum Pathol 1990;21(2):223–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Perrone T, Dehner LP. Prognostically favorable “mitotically active” smooth-muscle tumors of the uterus. A clinicopathologic study of ten cases. Am J Surg Pathol 1988;12(1):1–8.PubMedCrossRefGoogle Scholar
  77. 77.
    Prayson RA, Hart WR. Mitotically active leiomyomas of the uterus. Am J Clin Pathol 1992;97(1):14–20.PubMedGoogle Scholar
  78. 78.
    Myles JL, Hart WR. Apoplectic leiomyomas of the uterus. A clinicopathologic study of five distinctive hemorrhagic leiomyomas associated with oral contraceptive usage. Am J Surg Pathol 1985;9(11):798–805.PubMedCrossRefGoogle Scholar
  79. 79.
    Norris HJ, Hilliard GD, Irey NS. Hemorrhagic cellular leiomyomas (“apoplectic leiomyoma”) of the uterus associated with pregnancy and oral contraceptives. Int J Gynecol Pathol 1988;7(3):212–24.PubMedCrossRefGoogle Scholar
  80. 80.
    Downes KA, Hart WR. Bizarre leiomyomas of the uterus: a comprehensive pathologic study of 24 cases with long-term follow-up. Am J Surg Pathol 1997;21(11):1261–70.PubMedCrossRefGoogle Scholar
  81. 81.
    Shih IM, Kurman RJ. Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma. Am J Surg Pathol 1998;22(11):1393–403.PubMedCrossRefGoogle Scholar
  82. 82.
    Vang R, Kempson RL. Perivascular epithelioid cell tumor ('PEComa') of the uterus: a subset of HMB-45-positive epithelioid mesenchymal neoplasms with an uncertain relationship to pure smooth muscle tumors. Am J Surg Pathol 2002;26(1):1–13.PubMedCrossRefGoogle Scholar
  83. 83.
    Clement PB, Scully RE. Uterine tumors resembling ovarian sex-cord tumors. A clinicopathologic analysis of fourteen cases. Am J Clin Pathol 1976;66(3):512–25.PubMedGoogle Scholar
  84. 84.
    Irving JA, Carinelli S, Prat J. Uterine tumors resembling ovarian sex cord tumors are polyphenotypic neoplasms with true sex cord differentiation. Mod Pathol 2006;19(1):17–24.PubMedCrossRefGoogle Scholar
  85. 85.
    Krishnamurthy S, Jungbluth AA, Busam KJ, Rosai J. Uterine tumors resembling ovarian sexcord tumors have an immunophenotype consistent with true sex-cord differentiation. Am J Surg Pathol 1998;22(9):1078–82.PubMedCrossRefGoogle Scholar
  86. 86.
    Nielsen GP, Oliva E, Young RH, et al. Alveolar soft-part sarcoma of the female genital tract: a report of nine cases and review of the literature. Int J Gynecol Pathol 1995;14(4):283–92.PubMedCrossRefGoogle Scholar
  87. 87.
    Roma AA, Yang B, Senior ME, Goldblum JR. TFE3 immunoreactivity in alveolar soft part sarcoma of the uterine cervix: case report. Int J Gynecol Pathol 2005;24(2):131–5.PubMedCrossRefGoogle Scholar
  88. 88.
    Giordano G, Gnetti L, Ricci R, et al. Metastatic extragenital neoplasms to the uterus: a clini copathologic study of four cases. Int J Gynecol Cancer 2006;16 Suppl 1:433–8.PubMedCrossRefGoogle Scholar
  89. 89.
    Clement PB, Young RH, Scully RE. Diffuse, perinodular, and other patterns of hydropic degeneration within and adjacent to uterine leiomyomas. Problems in differential diagnosis. Am J Surg Pathol 1992;16(1):26–32.PubMedCrossRefGoogle Scholar
  90. 90.
    Chang KL, Crabtree GS, Lim-Tan SK, et al. Primary uterine endometrial stromal neoplasms. A clinicopathologic study of 117 cases. Am J Surg Pathol 1990;14(5):415–38.PubMedCrossRefGoogle Scholar
  91. 91.
    Oliva E, Clement PB, Young RH. Endometrial stromal tumors: an update on a group of tumors with a protean phenotype. Adv Anat Pathol 2000;7(5):257–81.PubMedCrossRefGoogle Scholar
  92. 92.
    Oliva E, Clement PB, Young RH, Scully RE. Mixed endometrial stromal and smooth muscle tumors of the uterus: a clinicopathologic study of 15 cases. Am J Surg Pathol 1998;22(8):997–1005.PubMedCrossRefGoogle Scholar
  93. 93.
    Baker PM, Moch H, Oliva E. Unusual morphologic features of endometrial stromal tumors: a report of 2 cases. Am J Surg Pathol 2005;29(10):1394–8.PubMedCrossRefGoogle Scholar
  94. 94.
    Oliva E, Young RH, Clement PB, Scully RE. Myxoid and fibrous endometrial stromal tumors of the uterus: a report of 10 cases. Int J Gynecol Pathol 1999;18(4):310–9.PubMedCrossRefGoogle Scholar
  95. 95.
    Yilmaz A, Rush DS, Soslow RA. Endometrial stromal sarcomas with unusual histologic features: a report of 24 primary and metastatic tumors emphasizing fibroblastic and smooth muscle differentiation. Am J Surg Pathol 2002;26(9):1142–50.PubMedCrossRefGoogle Scholar
  96. 96.
    Clement PB, Scully RE. Endometrial stromal sarcomas of the uterus with extensive endometrioid glandular differentiation: a report of three cases that caused problems in differential diagnosis. Int J Gynecol Pathol 1992;11(3):163–73.PubMedCrossRefGoogle Scholar
  97. 97.
    Levine PH, Abou-Nassar S, Mittal K. Extrauterine low-grade endometrial stromal sarcoma with florid endometrioid glandular differentiation. Int J Gynecol Pathol 2001;20(4):395–8.PubMedCrossRefGoogle Scholar
  98. 98.
    McCluggage WG, Date A, Bharucha H, Toner PG. Endometrial stromal sarcoma with sex cord-like areas and focal rhabdoid differentiation. Histopathol 1996;29(4):369–74.CrossRefGoogle Scholar
  99. 99.
    Oliva E, Clement PB, Young RH. Epithelioid endometrial and endometrioid stromal tumors: a report of four cases emphasizing their distinction from epithelioid smooth muscle tumors and other oxyphilic uterine and extrauterine tumors. Int J Gynecol Pathol 2002;21(1):48–55.PubMedCrossRefGoogle Scholar
  100. 100.
    Lifschitz-Mercer B, Czernobilsky B, Dgani R, et al. Immunocytochemical study of an endometrial diffuse clear cell stromal sarcoma and other endometrial stromal sarcomas. Cancer 1987;59(8):1494–9.PubMedCrossRefGoogle Scholar
  101. 101.
    Kim YH, Cho H, Kyeom-Kim H, Kim I. Uterine endometrial stromal sarcoma with rhabdoid and smooth muscle differentiation. J Korean Med Sci 1996;11(1):88–93.PubMedGoogle Scholar
  102. 102.
    Chu P, Arber DA. Paraffin-section detection of CD10 in 505 nonhematopoietic neoplasms. Frequent expression in renal cell carcinoma and endometrial stromal sarcoma. Am J Clin Pathol 2000;113(3):374–82.PubMedCrossRefGoogle Scholar
  103. 103.
    Farhood AI, Abrams J. Immunohistochemistry of endometrial stromal sarcoma. Hum Pathol 1991;22(3):224–30.PubMedCrossRefGoogle Scholar
  104. 104.
    Lillemoe TJ, Perrone T, Norris HJ, Dehner LP. Myogenous phenotype of epithelial-like areas in endometrial stromal sarcomas. Arch Pathol Lab Med 1991;115(3):215–9.PubMedGoogle Scholar
  105. 105.
    de Leval L, Waltregny D, Boniver J, et al Use of histone deacetylase 8 (HDAC8), a new marker of smooth muscle differentiation, in the classification of mesenchymal tumors of the uterus. Am J Surg Pathol 2006;30(3):319–27.PubMedGoogle Scholar
  106. 106.
    Franquemont DW, Frierson HF, Jr., Mills SE. An immunohistochemical study of normal endometrial stroma and endometrial stromal neoplasms. Evidence for smooth muscle differentiation. Am J Surg Pathol 1991;15(9):861–70.PubMedCrossRefGoogle Scholar
  107. 107.
    Oliva E, Young RH, Amin MB, Clement PB. An immunohistochemical analysis of endometrial stromal and smooth muscle tumors of the uterus: a study of 54 cases emphasizing the importance of using a panel because of overlap in immunoreactivity for individual antibodies. Am J Surg Pathol 2002;26(4):403–12.PubMedCrossRefGoogle Scholar
  108. 108.
    Rush DS, Tan J, Baergen RN, Soslow RA. h-Caldesmon, a novel smooth muscle-specific antibody, distinguishes between cellular leiomyoma and endometrial stromal sarcoma. Am J Surg Pathol 2001;25(2):253–8.PubMedCrossRefGoogle Scholar
  109. 109.
    Baker RJ, Hildebrandt RH, Rouse RV, et al. Inhibin and CD99 (MIC2) expression in uterine stromal neoplasms with sex-cord-like elements. Hum Pathol 1999;30(6):671–9.PubMedCrossRefGoogle Scholar
  110. 110.
    Sumathi VP, Al-Hussaini M, Connolly LE, et al. Endometrial stromal neoplasms are immunoreactive with WT-1 antibody. Int J Gynecol Pathol 2004;23(3):241–7.PubMedCrossRefGoogle Scholar
  111. 111.
    Geller MA, Argenta P, Bradley W, et al. Treatment and recurrence patterns in endometrial stromal sarcomas and the relation to c-kit expression. Gynecol Oncol 2004;95(3):632–6.PubMedCrossRefGoogle Scholar
  112. 112.
    Reich O, Regauer S. Aromatase expression in low-grade endometrial stromal sarcomas: an immunohistochemical study. Mod Pathol 2004;17(1):104–8.PubMedCrossRefGoogle Scholar
  113. 113.
    Dionigi A, Oliva E, Clement PB, Young RH. Endometrial stromal nodules and endometrial stromal tumors with limited infiltration: a clinicopathologic study of 50 cases. Am J Surg Pathol 2002;26(5):567–81.PubMedCrossRefGoogle Scholar
  114. 114.
    Oliva E, Young RH, Clement PB, et al. Cellular benign mesenchymal tumors of the uterus. A comparative morphologic and immunohistochemical analysis of 33 highly cellular leiomyomas and six endometrial stromal nodules, two frequently confused tumors. Am J Surg Pathol 1995;19(7):757–68.PubMedCrossRefGoogle Scholar
  115. 115.
    Goldblum JR, Clement PB, Hart WR. Adenomyosis with sparse glands. A potential mimic of low-grade endometrial stromal sarcoma. Am J Clin Pathol 1995;103(2):218–23.PubMedGoogle Scholar
  116. 116.
    Clement PB. Intravenous leiomyomatosis of the uterus. Pathol Annu 1988;23:153–83.PubMedGoogle Scholar
  117. 117.
    Gilks CB, Clement PB, Hart WR, Young RH. Uterine adenomyomas excluding atypical polypoid adenomyomas and adenomyomas of endocervical type: a clinicopathologic study of 30 cases of an underemphasized lesion that may cause diagnostic problems with brief consideration of adenomyomas of other female genital tract sites. Int J Gynecol Pathol 2000;19(3):195–205.PubMedCrossRefGoogle Scholar
  118. 118.
    Clement PB, Scully RE. Mullerian adenosarcoma of the uterus: a clinicopathologic analysis of 100 cases with a review of the literature. Hum Pathol 1990;21(4):363–81.PubMedCrossRefGoogle Scholar
  119. 119.
    Major FJ, Blessing JA, Silverberg SG, et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer 1993;71(4 Suppl):1702–9.PubMedCrossRefGoogle Scholar
  120. 120.
    Clement PB, Oliva E, Young RH. Mullerian adenosarcoma of the uterine corpus associated with tamoxifen therapy: a report of six cases and a review of tamoxifen-associated endometrial lesions. Int J Gynecol Pathol 1996;15(3):222–9.PubMedCrossRefGoogle Scholar
  121. 121.
    Clement PB, Scully RE. Mullerian adenosarcomas of the uterus with sex cord-like elements. A clinicopathologic analysis of eight cases. Am J Clin Pathol 1989;91(6):664–72.PubMedGoogle Scholar
  122. 122.
    Ramos P, Ruiz A, Carabias E, et al. Mullerian adenosarcoma of the cervix with heterologous elements: report of a case and review of the literature. Gynecol Oncol 2002;84(1):161–6.PubMedCrossRefGoogle Scholar
  123. 123.
    Clement PB. Mullerian adenosarcomas of the uterus with sarcomatous overgrowth. A clinicopathological analysis of 10 cases. Am J Surg Pathol 1989;13(1):28–38.PubMedCrossRefGoogle Scholar
  124. 124.
    Soslow RA, Ali A, Oliva E. Mullerian adenosarcomas: an immunophenotypic analysis of 35 cases. Am J Surg Pathol 2008;32(7):1013–21.PubMedCrossRefGoogle Scholar
  125. 125.
    Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989–1999. Gynecol Oncol 2004;93(1):204–8.PubMedCrossRefGoogle Scholar
  126. 126.
    McCluggage WG. Malignant biphasic uterine tumours: carcinosarcomas or metaplastic carcinomas? J Clin Pathol 2002;55(5):321–5.PubMedCrossRefGoogle Scholar
  127. 127.
    Zelmanowicz A, Hildesheim A, Sherman ME, et al. Evidence for a common etiology for endometrial carcinomas and malignant mixed mullerian tumors. Gynecol Oncol 1998;69(3):253–7.PubMedCrossRefGoogle Scholar
  128. 128.
    Clement PB, Zubovits JT, Young RH, Scully RE. Malignant mullerian mixed tumors of the uterine cervix: a report of nine cases of a neoplasm with morphology often different from its counterpart in the corpus. Int J Gynecol Pathol 1998;17(3):211–22.PubMedCrossRefGoogle Scholar
  129. 129.
    Costa MJ, Khan R, Judd R. Carcinoma (malignant mixed mullerian [mesodermal] tumor) of the uterus and ovary. Correlation of clinical, pathologic, and immunohistochemical features in 29 cases. Arch Pathol Lab Med 1991;115(6):583–90.PubMedGoogle Scholar
  130. 130.
    Grayson W, Taylor LF, Cooper K. Carcinosarcoma of the uterine cervix: a report of eight cases with immunohistochemical analysis and evaluation of human papillomavirus status. Am J Surg Pathol 2001;25(3):338–47.PubMedCrossRefGoogle Scholar
  131. 131.
    Fukunaga M, Nomura K, Endo Y, et al. Carcinosarcoma of the uterus with extensive neuroectodermal differentiation. Histopathol 1996;29(6):565–70.CrossRefGoogle Scholar
  132. 132.
    Kempson RL, Hendrickson MR. Smooth muscle, endometrial stromal, and mixed Mullerian tumors of the uterus. Mod Pathol 2000;13(3):328–42.PubMedCrossRefGoogle Scholar
  133. 133.
    George E, Manivel JC, Dehner LP, et al. Malignant mixed mullerian tumors: an immunohistochemical study of 47 cases, with histogenetic considerations and clinical correlation. Hum Pathol 1991;22(3):215–23.PubMedCrossRefGoogle Scholar
  134. 134.
    Meis JM, Lawrence WD. The immunohistochemical profile of malignant mixed mullerian tumor. Overlap with endometrial adenocarcinoma. Am J Clin Pathol 1990;94(1):1–7.PubMedGoogle Scholar
  135. 135.
    Pea M, Martignoni G, Zamboni G, Bonetti F. Perivascular epithelioid cell. Am J Surg Pathol 1996;20(9):1149–53.PubMedCrossRefGoogle Scholar
  136. 136.
    Bonetti F, Pea M, Martignoni G, et al. Clear cell (“sugar”) tumor of the lung is a lesion strictly related to angiomyolipoma–the concept of a family of lesions characterized by the presence of the perivascular epithelioid cells (PEC). Pathol 1994;26(3):230–6.CrossRefGoogle Scholar
  137. 137.
    Folpe AL, Goodman ZD, Ishak KG, et al. Clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres: a novel member of the perivascular epithelioid clear cell family of tumors with a predilection for children and young adults. Am J Surg Pathol 2000;24(9):1239–46.PubMedCrossRefGoogle Scholar
  138. 138.
    Pea M, Bonetti F, Zamboni G, et al. Melanocyte-marker-HMB-45 is regularly expressed in angiomyolipoma of the kidney. Pathol 1991;23(3):185–8.CrossRefGoogle Scholar
  139. 139.
    Zamboni G, Pea M, Martignoni G, et al. Clear cell “sugar” tumor of the pancreas. A novel member of the family of lesions characterized by the presence of perivascular epithelioid cells. Am J Surg Pathol 1996;20(6):722–30.PubMedCrossRefGoogle Scholar
  140. 140.
    Folpe AL, Mentzel T, Lehr HA, et al. Perivascular epithelioid cell neoplasms of soft tissue and gynecologic origin: a clinicopathologic study of 26 cases and review of the literature. Am J Surg Pathol 2005;29(12):1558–75.PubMedCrossRefGoogle Scholar
  141. 141.
    Fukunaga M. Perivascular epithelioid cell tumor of the uterus: report of four cases. Int J Gynecol Pathol 2005;24(4):341–6.PubMedCrossRefGoogle Scholar
  142. 142.
    Bosincu L, Rocca PC, Martignoni G, et al. Perivascular epithelioid cell (PEC) tumors of the uterus: a clinicopathologic study of two cases with aggressive features. Mod Pathol 2005;18(10):1336–42.PubMedCrossRefGoogle Scholar
  143. 143.
    Burke M, Opeskin K. Death due to intravenous leiomyomatosis extending to the right pulmonary artery. Pathol 2004;36(2):202–3.CrossRefGoogle Scholar
  144. 144.
    Topcuoglu MS, Yaliniz H, Poyrazoglu H, et al. Intravenous leiomyomatosis extending into the right ventricle after subtotal hysterectomy. Ann Thorac Surg 2004;78(1):330–2.PubMedCrossRefGoogle Scholar
  145. 145.
    Virzi G, Ragazzi S, Bussichella F, et al. Intravenous leiomyomatosis extending from the inferior caval vein to the pulmonary artery. J Thorac Cardiovasc Surg 2007;133(3):831–2.PubMedCrossRefGoogle Scholar
  146. 146.
    To WW, Ngan HY, Collins RJ. Intravenous leiomyomatosis with intracardiac involvement. Int J Gynaecol Obstet 1993;42(1):37–40.PubMedCrossRefGoogle Scholar
  147. 147.
    Mulvany NJ, Slavin JL, Ostor AG, Fortune DW. Intravenous leiomyomatosis of the uterus: a clinicopathologic study of 22 cases. Int J Gynecol Pathol 1994;13(1):1–9.PubMedCrossRefGoogle Scholar
  148. 148.
    Nogales FF, Navarro N, Martinez de Victoria JM, et al. Uterine intravascular leiomyomatosis: an update and report of seven cases. Int J Gynecol Pathol 1987;6(4):331–9.PubMedCrossRefGoogle Scholar
  149. 149.
    Norris HJ, Parmley T. Mesenchymal tumors of the uterus. V. Intravenous leiomyomatosis. A clinical and pathologic study of 14 cases. Cancer 1975;36(6):2164–78.PubMedCrossRefGoogle Scholar
  150. 150.
    Clement PB, Young RH, Scully RE. Intravenous leiomyomatosis of the uterus. A clinicopathological analysis of 16 cases with unusual histologic features. Am J Surg Pathol 1988;12(12):932–45.PubMedCrossRefGoogle Scholar
  151. 151.
    Han HS, Park IA, Kim SH, Lee HP. The clear cell variant of epithelioid intravenous leiomyomatosis of the uterus: report of a case. Pathol Int 1998;48(11):892–6.PubMedCrossRefGoogle Scholar
  152. 152.
    Jordan LB, Al-Nafussi A, Beattie G. Cotyledonoid hydropic intravenous leiomyomatosis: a new variant leiomyoma. Histopathol 2002;40(3):245–52CrossRefGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of PathologyMassachusetts General HospitalBoston

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