Immunohistochemical analysis of a primary ovarian leiomyosarcoma. Case report.
BACKGROUND
Primary ovarian leiomyosarcoma is an extremely rare malignant smooth muscle neoplasm. We report a case of a primary leiomyosarcoma of the ovary managed at our institution.


METHODS
Surgical exploration in a 71-year-old woman revealed a large left adnexal tumor and one separate metastatic implant in one part of the omentum, being classified as a primary ovarian leiomyosarcoma stage III C. The patient was treated with an adjuvant chemotherapy regimen consisting of cisplatin and ifosfamide. The patient remained without any evidence of disease until she died due to apoplexy 14 months after initial surgery. High cellularity, nuclear polymorphism as well as patchy necrosis and large areas of hemorrhage, characterized the tumor. Mitotic activity exceeded 5 mitoses per 10 high-power fields with lots of atypical mitoses. Immunohistochemically, the tumor showed a strong positive staining reaction for muscle actin, alpha-smooth muscle actin and neuron-specific enolase as well as a weak positive reaction for vimentin. Furthermore, immunohistochemistry revealed a positive staining for Ki-67, MMP-1 and MMP-2, and VEGF.


CONCLUSIONS
Until recently, prognostic parameters in ovarian leiomyosarcoma have still not been identified. Thus, the prognostic value of different clinicopathological and immunohistochemical parameters, especially Ki-67, MMPs and VEGF, should be proven in additional cases with long-term follow-up.
Mayerhofer
Klaus
K
Department of Gynecology & Obstetrics, University of Vienna Medical School, A-1090 Vienna, Währinger Gürtel 18-20, Austria. klaus.mayerhofer@akh-wien.ac.at
Lozanov
Plamen
P
Bodner
Klaus
K
Bodner-Adler
Barbara
B
Mayerhofer-Gallenbacher
Nika
N
Hudelist
Gernot
G
Czerwenka
Klaus
K
D000368:Aged; D016228:Endothelial Growth Factors / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D036341:Intercellular Signaling Peptides and Proteins / Q000378:metabolism; D019394:Ki-67 Antigen / Q000378:metabolism; D007890:Leiomyosarcoma / Q000201:enzymology / Q000378:metabolism* / Q000473:pathology; D008222:Lymphokines / Q000378:metabolism; D020781:Matrix Metalloproteinase 1 / Q000378:metabolism; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism; D010051:Ovarian Neoplasms / Q000201:enzymology / Q000378:metabolism* / Q000473:pathology; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
D016228:Endothelial Growth Factors; D036341:Intercellular Signaling Peptides and Proteins; D019394:Ki-67 Antigen; D008222:Lymphokines; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D020778:Matrix Metalloproteinase 2; D020781:Matrix Metalloproteinase 1