PMID- 28731868
OWN - NLM
STAT- MEDLINE
DCOM- 20171002
LR  - 20220419
IS  - 1532-0979 (Electronic)
IS  - 0147-5185 (Print)
IS  - 0147-5185 (Linking)
VI  - 41
IP  - 10
DP  - 2017 Oct
TI  - Inflammatory Myofibroblastic Tumors of the Female Genital Tract Are 
      Under-recognized: A Low Threshold for ALK Immunohistochemistry Is Required.
PG  - 1433-1442
LID - 10.1097/PAS.0000000000000909 [doi]
AB  - Inflammatory myofibroblastic tumor (IMT) of the female genital tract is 
      under-recognized. We investigated the prevalence of ALK-positive IMT in lesions 
      previously diagnosed as gynecologic smooth muscle tumors. Immunohistochemistry 
      (IHC) for ALK was performed on tissue microarrays of unselected tumors resected 
      from 2009 to 2013. Three of 1176 (0.26%) "leiomyomas" and 1 of 44 (2.3%) 
      "leiomyosarcomas" were ALK IHC positive, confirmed translocated by fluorescence 
      in situ hybridization (FISH) and therefore more appropriately classified as IMT. 
      On review significant areas of all 4 tumors closely mimicked smooth muscle tumors 
      morphologically, but all showed at least subtle/focal features suggesting IMT. 
      Recognizing that the distinction between IMT and leiomyoma/leiomyosarcoma can be 
      subtle, we then reviewed 1 hematoxylin and eosin slide from each patient 
      undergoing surgery for "leiomyoma" from 2014 to 2017 and selected cases for ALK 
      IHC with a low threshold. Of these, 30 of 571 (5.3%) underwent IHC. Two were 
      confirmed to be IHC positive and FISH rearranged. Of the 6 IMTs, only 1 tumor 
      with a previous diagnosis of leiomyosarcoma, an infiltrative margin and equivocal 
      necrosis, metastasized. Of note it demonstrated a less aggressive clinical course 
      compared with most metastatic leiomyosarcomas (alive with disease at 6 y). The 
      patient was subsequently offered crizotinib to which she responded rapidly. In 
      conclusion, IMTs may closely mimic gynecologic smooth muscle tumors. IMTs account 
      for at least 5 of 1747 (0.3%) tumors previously diagnosed as leiomyoma and 1 of 
      44 (2.3%) as leiomyosarcoma. These tumors may be recognized prospectively with 
      awareness of subtle/focal histologic clues, coupled with a low threshold for ALK 
      IHC.
FAU - Pickett, Justine L
AU  - Pickett JL
AD  - *Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research 
       paragraph signGynaecological Oncology, Royal North Shore Hospital, St Leonards daggerDepartment of 
      Anatomical Pathology, Royal North Shore Hospital  parallelUniversity of Sydney 
      #Department of Obstetrics and Gynecology, St George Hospital **University of NSW 
      double daggerdouble daggerPrince of Wales Clinical School, University of New South Wales, Sydney 
      daggerdaggerDepartment of Medical Oncology, Prince of Wales Hospital and Royal Hospital for 
      Women, Randwick double daggerDepartment of Anatomical Pathology, SYDPATH, St Vincent's 
      Hospital  section signThe Kinghorn Cancer Centre and Garvan Institute of Medical Research, 
      Darlinghurst, NSW, Australia.
FAU - Chou, Angela
AU  - Chou A
FAU - Andrici, Juliana A
AU  - Andrici JA
FAU - Clarkson, Adele
AU  - Clarkson A
FAU - Sioson, Loretta
AU  - Sioson L
FAU - Sheen, Amy
AU  - Sheen A
FAU - Reagh, Jessica
AU  - Reagh J
FAU - Najdawi, Fedaa
AU  - Najdawi F
FAU - Kim, Yoomee
AU  - Kim Y
FAU - Riley, Denise
AU  - Riley D
FAU - Maidens, Jayne
AU  - Maidens J
FAU - Nevell, David
AU  - Nevell D
FAU - McIlroy, Kirsten
AU  - McIlroy K
FAU - Valmadre, Susan
AU  - Valmadre S
FAU - Gard, Greg
AU  - Gard G
FAU - Hogg, Russell
AU  - Hogg R
FAU - Turchini, John
AU  - Turchini J
FAU - Robertson, Gregory
AU  - Robertson G
FAU - Friedlander, Michael
AU  - Friedlander M
FAU - Gill, Anthony J
AU  - Gill AJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Surg Pathol
JT  - The American journal of surgical pathology
JID - 7707904
RN  - EC 2.7.10.1 (ALK protein, human)
RN  - EC 2.7.10.1 (Anaplastic Lymphoma Kinase)
RN  - EC 2.7.10.1 (Receptor Protein-Tyrosine Kinases)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anaplastic Lymphoma Kinase
MH  - Female
MH  - Genital Diseases, Female/metabolism/*pathology
MH  - Granuloma, Plasma Cell/metabolism/*pathology
MH  - Humans
MH  - Immunohistochemistry
MH  - Middle Aged
MH  - Receptor Protein-Tyrosine Kinases/*analysis/metabolism
MH  - Young Adult
PMC - PMC5598906
COIS- Conflicts of Interest and Source of Funding: Supported by the Sydney Vital, 
      Translational Cancer Research, through a Cancer Institute NSW competitive grant. 
      The authors have disclosed that they have no significant relationships with, or 
      financial interest in, any commercial companies pertaining to this article.
EDAT- 2017/07/22 06:00
MHDA- 2017/10/03 06:00
PMCR- 2017/09/14
CRDT- 2017/07/22 06:00
PHST- 2017/07/22 06:00 [pubmed]
PHST- 2017/10/03 06:00 [medline]
PHST- 2017/07/22 06:00 [entrez]
PHST- 2017/09/14 00:00 [pmc-release]
AID - 10.1097/PAS.0000000000000909 [doi]
PST - ppublish
SO  - Am J Surg Pathol. 2017 Oct;41(10):1433-1442. doi: 10.1097/PAS.0000000000000909.