{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T23:01:23Z","timestamp":1781046083705,"version":"3.54.1"},"reference-count":195,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T00:00:00Z","timestamp":1754697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Uterine leiomyomas (ULM) and uterine leiomyosarcomas (ULMS) represent smooth muscle tumors with similar initial presentations but drastically different outcomes. This literature review analyzes the similarities and differences in their epigenetic profiles to identify diagnostic biomarkers and potential therapeutic targets that could improve clinical management. Both tumor types exhibit mostly distinct epigenetic signatures while sharing key pathway dysregulations. ULMS demonstrates global DNA hypomethylation, increased histone acetyltransferase activity, elevated Histone Deacetylase (HDAC) class I expression, and characteristic microRNA profiles. ULM displays focal methylation patterns and specific microRNA alterations that promote extracellular matrix accumulation. Despite these differences in epigenetic mechanisms, both tumors converge on dysregulation of signaling pathways including PI3K\/AKT\/mTOR, Wnt\/\u03b2-catenin, and Transforming Growth Factor beta (TGF-\u03b2) signaling, suggesting common downstream effects from distinct epigenetic origins. Understanding the shared and distinct epigenetic landscape between ULM and ULMS will enhance our insights into tumor pathogenesis and may offer promising biomarkers and therapeutic targets.<\/jats:p>","DOI":"10.3390\/cancers17162610","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T09:04:53Z","timestamp":1754903093000},"page":"2610","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Decoding the Epigenome: Comparative Analysis of Uterine Leiomyosarcoma and Leiomyoma"],"prefix":"10.3390","volume":"17","author":[{"given":"Marie","family":"Pfaff","sequence":"first","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA"},{"name":"Center for Surgical Science, Department of General, Visceral and Thoracic Surgery, Universit\u00e4tsklinikum Hamburg Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippos","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9033-4570","authenticated-orcid":false,"given":"Haoyu","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethsebie","family":"Sailo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anup","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nita","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA"},{"name":"Office of the Dean, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.fertnstert.2013.03.007","article-title":"Complex Networks of Multiple Factors in the Pathogenesis of Uterine Leiomyoma","volume":"100","author":"Islam","year":"2013","journal-title":"Fertil. 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