{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:38:44Z","timestamp":1787647124890,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T00:00:00Z","timestamp":1675814400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014008","name":"Ovarian Cancer Research Alliance","doi-asserted-by":"publisher","award":["650320"],"award-info":[{"award-number":["650320"]}],"id":[{"id":"10.13039\/100014008","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To morphologically and immunophenotypically characterize dedifferentiated uterine leiomyosarcoma (LMS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      We identified 23 dedifferentiated uterine LMS, defined as a malignant uterine smooth muscle tumour containing discrete differentiated and dedifferentiated components (i.e. with and without morphologic and immunophenotypic evidence of smooth muscle differentiation, respectively). The differentiated component was leiomyosarcoma in most cases (17\/23), though some arose from a leiomyoma (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a04) or smooth muscle tumour of uncertain malignant potential (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a02). The dedifferentiated tumour component showed noncohesive polygonal cells with moderate to abundant cytoplasm, pleomorphic nuclei with coarse vesicular to smudged chromatin, one or more macronucleoli, frequent multinucleation,\u00a0and atypical\u00a0mitoses. Three cases showed heterologous osteosarcomatous or chondrosarcomatous differentiation. Immunohistochemistry revealed alterations characteristic of uterine LMS, including Rb loss (18\/19); strong diffuse p16 (17\/19); strong diffuse (9\/19) or complete absence of (5\/19) p53; and ATRX loss (6\/16). Compared to a control cohort of uterine LMS without dedifferentiation, dedifferentiated uterine LMS showed significantly shorter disease\u2010specific (median, 54 versus 20\u00a0months; 5\u2010year DSS, 46% versus 36%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.04) and disease\u2010free (median, 31 versus 8\u2009months; 5\u2010year DFS, 42% versus 8%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.002) survival. Of 19 dedifferentiated uterine LMS with follow\u2010up, 12 had died of disease at median 14 (range, 2\u201373)\u00a0months; four were alive with disease at 4, 12, 44, and 50\u00a0months; and three were alive with no evidence of disease at 56, 109, and 114\u00a0months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Routine prospective recognition of dedifferentiated uterine LMS and distinction from mimics is advocated for accurate prognostication and for further characterisation of these tumours.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/his.14870","type":"journal-article","created":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T03:44:20Z","timestamp":1674791060000},"page":"812-825","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Dedifferentiated leiomyosarcoma of the uterus: a clinicopathologic and immunohistochemical analysis of 23\u00a0cases"],"prefix":"10.1111","volume":"82","author":[{"given":"David B","family":"Chapel","sequence":"first","affiliation":[{"name":"Division of Women's and Perinatal Pathology Brigham and Women's Hospital and Harvard Medical School  Boston MA USA"},{"name":"Department of Pathology University of Michigan \u2013 Michigan Medicine  Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia","family":"Maccio","sequence":"additional","affiliation":[{"name":"Unit of Surgical Pathology S. Chiara Hospital  Trient Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Bragantini","sequence":"additional","affiliation":[{"name":"Unit of Surgical Pathology S. Chiara Hospital  Trient Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4473-7560","authenticated-orcid":false,"given":"Gian F","family":"Zannoni","sequence":"additional","affiliation":[{"name":"Catholic University of Sacred Heart  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6161-3431","authenticated-orcid":false,"given":"Bradley J","family":"Quade","sequence":"additional","affiliation":[{"name":"Division of Women's and Perinatal Pathology Brigham and Women's Hospital and Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1420-7291","authenticated-orcid":false,"given":"Carlos","family":"Parra\u2010Herran","sequence":"additional","affiliation":[{"name":"Division of Women's and Perinatal Pathology Brigham and Women's Hospital and Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa R","family":"Nucci","sequence":"additional","affiliation":[{"name":"Division of Women's and Perinatal Pathology Brigham and Women's Hospital and Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(20000315)88:6<1425::AID-CNCR21>3.0.CO;2-3"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2003.12.029"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.2009.03231.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27555"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/IGC.0000000000000720"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.22239"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.75.9845"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199703000-00002"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19860715)58:2<278::AID-CNCR2820580213>3.0.CO;2-6"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-198707000-00003"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e31825748f0"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.2011.04070.x"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2009.10.005"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200108000-00007"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19901001)66:7<1578::AID-CNCR2820660724>3.0.CO;2-8"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000001928"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2019.152640"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.4103\/0973-1482.140984"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2006.02.030"},{"key":"e_1_2_9_21_1","first-page":"466","article-title":"Histological and immunohistochemical observations of dedifferentiated leiomyosarcoma of the uterus","volume":"41","author":"Fukuda T","year":"1991","journal-title":"Acta Pathol. 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