Estrogen and progesterone expression of vessel walls with intravascular leiomyomatosis; Discussion of histogenesis

We report seven cases of intravenous leiomyomatosis. Growth beyond the uterus occurred in two of the seven cases in the broad ligament. One 21-year-old patient is one of the youngest reported cases in the literature. Five patients had total abdominal hysterectomy with removal of the adnexa and two patients underwent myomectomy. One of the myomectomy cases had abdominal hysterectomy and bilateral salpingo-oophorectomy one year later due to recurrence. The other one was disease free six months after the operation. Vessel walls harboring intravascular tumor were investigated immunohistochemically for Factor VIII, CD 34, estrogen and progesterone receptors with the hope of making the histogenesis of intravenous leiomyomatosis clear. Immunohistochemical analyses of estrogen receptors, progesterone receptors, vimentin, desmin, smooth muscle actin, CD 10 and h-caldesmon were performed on intravascular tumor cells. Endothelial and subendothelial cells expressed none to scant, very weak progesterone and estrogen receptor positivity. Intravascular tumor cells showed weak (10%) to strong (70%) progesterone receptor positivity and weak (10%) to strong (60%) estrogen receptor positivity. These results do not support the hypothesis of a vessel wall origin for intravenous leiomyomatosis.

Intravenous leiomyomatosis; Uterus

[1] Norris H.J.. Parmley T., Maj M.C.: "Mesenchymal tumors of the uterus. V. Intravenous leiomyomatosis. A clinical and pathologic study of 14 cases". Cancer, 1975, 36, 2164.

[2] Clement P.B.: "Intravenous leiomyomatosis of the uterus". Pathol Annual., 1988, 23, 153.

[3] Mulvany N.J., Slavin D.W., Ostor A.G., Fortune D.W.: "Intravenous leiomyomatosis of the uterus: a clinicopathologic study of 22 cases". Int. J. Gynecol. Pathol., 1994, 13, 1.

[4] Nogales F.F., Navarro N., Victoria J.M.M., Conteras F., Redondo C., Herraiz M.A. et al.: "Uterine intravascular leiomyomatosis: an update and report of seven cases". Int. J. Gynacol. Pathol., 1987, 6, 331.

[5] Heinonen P.K.,T aina T.N.,Ta ulaniemi E.,A me R.O.,K auppila 0.: "Intravenous leiomyomatosis". Ann. Chir. Gynaecol., 1984, 73, 100.

[6] Gehr N.R., Lund 0., Alstrup P., Nielsen J.S., Villadsen A.B., Bartholdy N.: "Recurence of uterine intravenous leiomyomatosis with intracardiac extension. Diagnostic considerations and surgical removal". Scand. Cardiovasc. J., 1999, 33,312.

[7] Nakayama Y., Kitamura S., Kawachi K., Kawata T., F ukutomi M., Hasegawa J., Morita R.: "Intravenous leiomyomatosis extending into the right atrium". Cardiovasc. Surg., 1994, 2, 642.

[8] Suginami H., Kaura R., Ochi H., Matsuura S.: "Intravenous leiomyomatosis with cardiac extension: successful surgical management and histopathologic study". Obstet. Gynecol., 1990, 76, 527.

[9] Okamoto H., Itoh T., Morita S., Matsuura A., Yasuura K.: "Intravenous leiomyomatosis extending into the right ventricle onestage radical excision during hypothermic circulatory arrest" Thorac. Cardivasc. Surg., 1994, 42, 361.

[10] Tierney W.M., Ehrlich C.E., Bailey J.C., King R.D., Roth L.M., Wann S.: "Intravenous leiomyomatosis of the uterus with extension into the heart". Am. J. Med., 1980, 69, 471.

[11] Diakomanolis E., Elsheikh A., Sotiropoulou M., Voulgaris Z., V lachos G., Loutradis D., Michales S.: "Intravenous leiomyomatosis". Arch. Gynecol. Obstet., 2003, 267, 256.

[12] Lam P.M., Lo W.K., Yu M.Y., Lau T.K., Cheung T.H.: "Intravenous leiomyomatosis with atypical histologic features: a case report". Int. J. Gynecol. Cancer, 2003, 13, 83.

[13] Clement P.B.,Y oung R.H., Scully R.E.: "Intravenous leiomyomatosis of the uterus a clinicopathological analysis of 16 cases with unusual histologic features". Am. J. Surg. Pathol., I 988, 12, 932.

[14] Andrade L.A., Torresan R.Z., Sales J.F., Vicentini R., De Souza G.A.: "Intravenous leiomyomatosis of the uterus. A report of three cases". Pathol. Oncol. Res., 1998, 4, 44.

[15] Bahary C.M., Gorodeski LG., Nilly M. et al.: "Intravascular leiomyomatosis". Obstet. Gynecol., 1982, (suppl.) 59, 73.

[16] Oliva E.,Y oung R.H.,A min M.B.,C lement P.B.: "An immunoh1stochemical 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 immonoreactivi ty for individual antibodies". Am. J. Surg. Pathol., 2002, 26, 403.

[17] Chu P., Arber D.A.: "Paraffin-section detection of CD IO in 505 nonhematopoietic neoplasms. F requent expression in renal cell carcinoma and endometrial stromal sarcoma". Am. J. Clin. Pathol., 2000, I13, 374.

[18] Chu P.G., Arber D.A., Weiss L.M., Karen L.C.: "Utility of CD 10 in distinguishing between endometrial stromal sarcoma and uterine smooth muscle tumors: an immunohistochemical comparison of 34 cases". Mod. Pathol., 2001, 14, 465.

[19] Nucci M.R., O'Connel J.T., Huettner P.C., Cviko A., Sun D., Quade B.J.: "h-caldesmon expression effectively distinguishes endometrial stromal tumors from smooth muscle tumors". Am. J. Surg. Pathol., 200 I, 25, 455.

[20] Matsumoto K., Yamamoto T., Hisayoshi T.,Asano G.: "Intravenous leiomyomatosis of the uterus with multiple pulmonary metastases associated with large bullae-like cyst formation". Pathol. Int., 2001, 51, 396.

[21] W ray R.D., Dawkins H.: "Primary smooth muscle tumors of the inferior vena cava". Am. J. Surg., 1971, 174, 1009.

[22] Irey N.S., Norris H.J., Washington D.C.: "Intimal vascular lesions associated with female reproductive steroids". Arch. Pathol., 1973, 96, 227.

[23] Herr J.C., Platz C.E., Heidger P.M., Curet L.B.: "Smooth muscle within ovarian decidual nodules: a link to leiomyomatosis peritonealis disseminata?". Obstet. Gynecol., 1979, 53, 451.

[24] Mitsuhashi A., Nagai Y., Sugita M., Nakajima N., Sekiya S.: "GnRH agonist for intravenous leiomyomatosis with cardiac extension. A case report". J. Reprod. Med., 1999, 44, 883.

[25] Kokawa K., Yamoto M., Yata C., Mabuchi Y., Umesaki N.: "Postmenopousal intravenous leiomyomatosis with high levels estradiol and estrogen receptor". Obstet. Gynecol., 2002, 100, 1124.

[26] Orimo A., Inoue S., Ikegami A. et al.: "Vascular smooth muscle cells as target for estrogen". Biochem. Biophy. Res. Com., 1993, 195, 730.

[27] Karas R.H., baur W.E.，Eickles V.M., Mendelson M.E.: "Human vascular smooth muscle cells an estrogen receptor isoform". FEBS Lett., 1995, 18, 103.

[28] Hodges Y.K., Richer J.K., Horvitz K.B., Horvitz L.D.: "Variant estrogen and progesterone receptor messages in human vascular smooth muscle". Circulation, 1999, 25, 2688.

[29] Momeo B., T scheuschilsuren G., Aust G., Metz S., SpanelBorowski K.: "Estrogen receptor expression and synthesis in the human internal thorasic artery". Ann. Anal., 2003, 185, 57.