Uterine sarcoma is a heterogeneous group of neoplasm that represents 5%of uterine malignancies. They consist of pure stromal tumors, the stromal sarcoma, and leiomyosarcoma, in addition to the mixed epithelial and mesenchymal tumors (Carcinosarcoma). Some report of positive staining for CD117, the antigen to a specific transmembrane epitope of kit that is associated with gain of function mutation in the c-kit oncogene.
That implies a clinical response to imatinib Mesylate, a selective tyrosine kinase inhibitors (TKI), it effective in treatment of chronic myeloid leukemia (CML), gastrointestinal stromal tumor GIST. Aim of study 1.Clinicopathological evaluation of different subtypes of uterine sarcoma. 2.To evaluate incidence of C-kit expression in different subtypes of uterine sarcoma, and correlation between C-kit expression and other parameters (stage, size, grade, histopathological subtype, etc.)Material and method Thirty cases of uterine sarcoma collected, the cases were representing a total hysterectomy biopsy for all the cases involved in this study.These retrospective and prospective cases were collected from the pathology departments of The Teaching Laboratories in Baghdad, specialized surgical hospital at the medical city and from the private histopathological laboratories in Baghdad for the period from 2006-2010. All the clinical information including age, site of the lesions , size of tumor, type of thirty treatment all these information have been taken from the patients archive files in the Radiation center and private hospital for retrospective cases and from patients them selves for prospective cases . All paraffin embedded sections were stained with the routine H &E stain for verifying the morphologic diagnosis, and immunohistochemical stain for c-kit.
Results Histopathological evalution for each H&E stian has shown that 30cases of sarcomas divided into
Fifteen cases lieomyosarcoma Eight cases stromal tumor of undetermine malignant potential (STUMP)
Four cases high grade stromal sarcoma (HGSS) two cases low grade stromal sarcoma (LGSS) one case mixed malignantmullran tumor (MMMT) Mean age group of our study (46.3+1.44)rang between(32-62)
The majority of cases were of grade I (13 out of 30; 43.3%). Grade II cases formed 11 out of 30 cases (36.7%). The least number of cases were of grade III (6 out of 30; 20 %) According to AJCC (American Journal Committee on Cancer); the cases were distributed as follows:11cases were of stage I, 8cases were of stage II, 10cases were of stage III, and 1case were of stage IV Immunohistochemical evaluation of result has shown 100%expression of c-kit for all type of sarcoma regardless it histopathological subtypes.10cases show weak focal expression, 3cases show moderate focal expression, and 7cases show diffuse strong expression. There was no significant correlation between age and Immunohistochemical expression of c-kit (r = 0.321, p = 0.084). There was a negative no-significant correlation between size and Immunohistochemical expression of c-kit (r = -0.155, p =0.412 There was a significant positive correlation between grade and Immunohistochemical expression of c-kit (r = 0.792, p <0.001).) There was a significant correlation between Immunohistochemical expression of c-kit and stage with a p-value of <0.001. Most of the cases in stage I showed a weak staining pattern; while all the cases of stage III showed strong staining pattern. Conclusion 1. Our study showed that uterine sarcoma was common in fifth decade of life. 2. C-kit expression was found in 100% of uterine sarcoma. 3. The detection of c-kit in our malignant cases supports the suggestion that mutation of c-kit play a role in uterine sarcoma. 4. C-kit intensity of expression shown that significant correlation with grade, mitotic activity and stage of tumor but C-kit intensity of expression shown that no significant correlation with age, size of tumor.