ISSN: 2149-2247 | E-ISSN: 2149-2549
Erciyes Medical Journal Diagnostic and Prognostic Significance of p16, p53, and bcl-2 Expressions and Ki-67 Proliferation Index in Benign and Malignant Uterine Smooth Muscle Tumors [Erciyes Med J]
Erciyes Med J. 2017; 39(3): 87-93 | DOI: 10.5152/etd.2017.1789

Diagnostic and Prognostic Significance of p16, p53, and bcl-2 Expressions and Ki-67 Proliferation Index in Benign and Malignant Uterine Smooth Muscle Tumors

Aslı Kahraman Akkalp1, Ümit Seza Tetikkurt1, Yazgı Köy1, Abdullah Taner Usta2
1Department of Pathology, İzmir Katip Çelebi University Atatürk Education and Training Hospital, İzmir, Turkey
2Department of Pathology, Bagcilar Training and Research Hospital, İstanbul, Turkey

Objective: This study aimed to evaluate diagnostic parameters such as mitotic count and tumor size in; leiomyosarcomas (LMSs) and benign uterine smooth muscle tumors (USMTs) and to define the diagnostic value and prognostic significance of the Ki-67 proliferation index and p16, p53, and bcl-2 expressions by immunohistochemical (IHC) methods.
Materials and Methods: In total, 44 cases diagnosed as LMS, atypical leiomyoma, or cellular leiomyoma at our pathology
department from January 2010 to December 2015 were included. IHC staining was performed for bcl-2, p16, p53, and Ki-67 using standard techniques.
Results: Tumor size and mitotic index were significant prognostic factors (p=0.008 and p=0.001, respectively). The rate of diffuse p16 expression was significantly higher in the LMS group than in the other LM group (p=0.001). A Ki-67 positivity rate of >10% (increased proliferation) was statistically significantly higher in the LMS group than in the benign USMT group (p=0.0001). No statistically significant difference was found between the LMS and benign USMT groups with respect to bcl-2 expression (p=0.892). Mitotic count and high Ki-67 expression (>%10) were statistically high in cases with relapse/ metastasis (+) (p=0.0001 and p=0.0002, respectively).
Conclusion: In addition to histopathological findings (tumor size and mean mitotic count), diffuse p16 expression and p53 overexpression can be used to distinguish between benign and malignant USMTs. A high mitotic index [≥10/10 (high-power field)] and high Ki-67 expression (>10%) can serve as useful indicators for diagnosing LMS, distinguishing benign tumors, and predicting an aggressive clinical course.

Keywords: Uterine smooth muscle tumor, relapse, metastasis, p16, bcl-2

Aslı Kahraman Akkalp, Ümit Seza Tetikkurt, Yazgı Köy, Abdullah Taner Usta. Diagnostic and Prognostic Significance of p16, p53, and bcl-2 Expressions and Ki-67 Proliferation Index in Benign and Malignant Uterine Smooth Muscle Tumors. Erciyes Med J. 2017; 39(3): 87-93

Corresponding Author: Aslı Kahraman Akkalp, Türkiye
Manuscript Language: English
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