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Adenomatoid tumour of the uterus is frequently associated with iatrogenic immunosuppression
Author(s) -
Tamura Daisuke,
Maeda Daichi,
Halimi Sultan Ahmad,
Okimura Masato,
KudoAsabe Yukitsugu,
Ito Satoru,
Sato Naoki,
Shibahara Junji,
Nanjo Hiroshi,
Terada Yukihiro,
Goto Akiteru
Publication year - 2018
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13726
Subject(s) - immunosuppression , uterus , medicine , adenomatoid tumor , pathology , immunohistochemistry
Aims Uterine adenomatoid tumour ( AT ) is a benign proliferation of cells showing mesothelial differentiation within the myometrium that usually presents as a single nodule. Rare diffuse uterine AT s have been reported, often in patients undergoing immunosuppressive therapy. Herein, we aimed to elucidate the general association between the incidence of uterine AT and iatrogenic immunosuppression by cohort analysis. Methods and results We analysed 611 consecutive hysterectomy specimens to determine the incidence of AT and its correlation with the immunosuppressive status. Mesothelial lineage, p16 expression, mismatch repair ( MMR ) protein alterations, and the possible integration of tumorigenic viruses were examined by in situ hybridizasion and immunohistochemistry. AT s were detected in 14 of 611 hysterectomy cases (2.3%). The incidence of AT was significantly higher in the immunosuppressed ( IS ) group (5/20, 25.0%) than in the non‐ IS group (9/591, 1.52%), with a relative risk of 16.4. Of the five AT s in the IS group, three were multifocal or diffuse. Latent uterine AT was detected, by in toto sectioning, in one of four immunosuppressed autopsy cases. The tumor cells of AT s commonly expressed calretinin and podoplanin. Characteristic block‐type (≥90%) positivity for p16 was observed in most AT s. None of the AT s were positive for human herpes virus type 8, Merkel cell polyomavirus, SV 40 large T antigen, Epstein‐Barr virus, and human papilloma virus, and the MMR proteins were retained. A TRAF 7 mutation was identified from macrodissected tissue in one of 12 AT s by Sanger sequencing. Conclusion Uterine AT is an immunosuppression‐associated mesothelial lesion characterised by p16 overexpression.