title: Intravenous leiomyomatosis: an unusual intermediate between benign and malignant uterine smooth muscle tumors.
abstract: Intravenous leiomyomatosis is an unusual smooth muscle neoplasm with quasi-malignant intravascular growth but a histologically banal appearance. Herein, we report expression and molecular cytogenetic analyses of a series of 12 intravenous leiomyomatosis cases to better understand the pathogenesis of intravenous leiomyomatosis. All cases were analyzed for the expression of HMGA2, MDM2, and CDK4 proteins by immunohistochemistry based on our previous finding of der(14)t(12;14)(q14.3;q24) in intravenous leiomyomatosis. Seven of 12 (58%) intravenous leiomyomatosis cases expressed HMGA2, and none expressed MDM2 or CDK4. Colocalization of hybridization signals for probes from the HMGA2 locus (12q14.3) and from 14q24 by interphase fluorescence in situ hybridization (FISH) was detected in a mean of 89.2% of nuclei in HMGA2-positive cases by immunohistochemistry, but in only 12.4% of nuclei in negative cases, indicating an association of HMGA2 expression and this chromosomal rearrangement (P=8.24 × 10(-10)). Four HMGA2-positive cases had greater than two HMGA2 hybridization signals per cell. No cases showed loss of a hybridization signal by interphase FISH for the frequently deleted region of 7q22 in uterine leiomyomata. One intravenous leiomyomatosis case analyzed by array comparative genomic hybridization revealed complex copy number variations. Finally, expression profiling was performed on three intravenous leiomyomatosis cases. Interestingly, hierarchical cluster analysis of the expression profiles revealed segregation of the intravenous leiomyomatosis cases with leiomyosarcoma rather than with myometrium, uterine leiomyoma of the usual histological type, or plexiform leiomyoma. These findings suggest that intravenous leiomyomatosis cases share some molecular cytogenetic characteristics with uterine leiomyoma, and expression profiles similar to that of leiomyosarcoma cases, further supporting their intermediate, quasi-malignant behavior.
authors.affiliation: Departments of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Zehra
authors.initials: Z
authors.lastname: Ordulu
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.|Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Marisa R
authors.initials: MR
authors.lastname: Nucci
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Paola
authors.initials: P
authors.lastname: Dal Cin
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Pathology, Baystate Medical Center, Springfield, MA, USA.
authors.forename: Monica L
authors.initials: ML
authors.lastname: Hollowell
authors.affiliation: Department of Pathology, Baystate Medical Center, Springfield, MA, USA.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Otis
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Hornick
authors.affiliation: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Park
authors.affiliation: Departments of Medical Informatics and Cancer Evolution Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Tae-Min
authors.initials: TM
authors.lastname: Kim
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.|Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Quade
authors.affiliation: Departments of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.|Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Broad Institute of MIT and Harvard, Cambridge, MA, USA.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Morton
mesh_terms: D020732:Cytogenetic Analysis; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D007889:Leiomyoma / Q000235:genetics / Q000473:pathology; D018231:Leiomyomatosis / Q000235:genetics / Q000473:pathology*; D018235:Smooth Muscle Tumor / Q000235:genetics / Q000473:pathology*; D059467:Transcriptome; D014594:Uterine Neoplasms / Q000235:genetics / Q000473:pathology; D019043:Vascular Neoplasms / Q000235:genetics / Q000473:pathology*