IFITM1, CD10, SMA, and h-caldesmon as a helpful combination in differential diagnosis between endometrial stromal sarcoma and cellular leiomyoma
Authors: Zhao Weilin , Mei Cui , Ji Xin Hua , Xiong Xin , Shen Xi Hua , Tao Lin , Jia Wei , Pang Li Juan , Sun Zhen Zhu , Wang Chun , Zou Hong 
Published: February 2020

Abstract
The differential diagnosis of endometrial stromal sarcoma (ESS) and uterine cellular leiomyoma (CL) remains a challenge in clinical practice. Cluster of differentiation 10 (CD10) and smooth muscle actin (SMA) are commonly used in the differential diagnosis of ESS and CL. However, the current combination of immunohistochemical antibodies has been shown to be inaccurate, suggesting the need for novel immunomarkers panels for differentiating between ESS and CL. Interferon-induced transmembrane protein 1 (IFITM1) is a novel immunomarker for endometrial stromal cells, h-caldesmon is an immunomarker for smooth muscle cells and has a higher specificity than SMA. So this study aimed to investigate IFITM1, CD10, SMA, and h-caldesmon as a useful combination of biomarkers for diagnosing between ESS and CL. Tissue microarrays were used to detect IFITM1, CD10, SMA, and h-caldesmon immunohistochemical staining in 30 ESS and 33 CL cases. The expressions of IFITM1 and CD10 were high in ESS (86.7% and 63.3%, respectively) but low in CL (18.2% and 21.2%), whereas those of h-caldesmon and SMA were high in both CL (87.9% and 100%) and low in ESS (6.9% and 40%). In diagnosing ESS, IFITM1 had better sensitivity and specificity (86.7% and 81.8%, respectively) than CD10 (63.3% and 78.8%). The specificity of h-caldesmon in diagnosing CL was significantly higher (93.1%) than that of SMA (60%). When all four antibodies were combined for the differential diagnosis, the area-under-the-curve predictive value was 0.995. The most sensitive and specific combinations for diagnosing ESS were IFITM1(+) or CD10(+) and h-caldesmon(-) ( sensitivity 86.7%, specificity 93.9%), IFITM1(+) and h-caldesmon(-) ((sensitivity 80%, specificity 100%). The most sensitive and specific combinations for diagnosing CL were h-caldesmon(+) and SMA(+)(sensitivity 87.9%, specificity 100%), h-caldesmon(+) or SMA(+) and IFITM1(-)(sensitivity 81.8% , specificity 93.1%).Therefore, IFITM1, CD10, SMA, and h-caldesmon are a good combination of biomarkers for the differential diagnosis of ESS and CL.The differential diagnosis of endometrial stromal sarcoma (ESS) and uterine cellular leiomyoma (CL) remains a challenge in clinical practice. Cluster of differentiation 10 (CD10) and smooth muscle actin (SMA) are commonly used in the differential diagnosis of ESS and CL. However, the current combination of immunohistochemical antibodies has been shown to be inaccurate, suggesting the need for novel immunomarkers panels for differentiating between ESS and CL. Interferon-induced transmembrane protein 1 (IFITM1) is a novel immunomarker for endometrial stromal cells, h-caldesmon is an immunomarker for smooth muscle cells and has a higher specificity than SMA. So this study aimed to investigate IFITM1, CD10, SMA, and h-caldesmon as a useful combination of biomarkers for diagnosing between ESS and CL. Tissue microarrays were used to detect IFITM1, CD10, SMA, and h-caldesmon immunohistochemical staining in 30 ESS and 33 CL cases. The expressions of IFITM1 and CD10 were high in ESS (86.7% and 63.3%, respectively) but low in CL (18.2% and 21.2%), whereas those of h-caldesmon and SMA were high in both CL (87.9% and 100%) and low in ESS (6.9% and 40%). In diagnosing ESS, IFITM1 had better sensitivity and specificity (86.7% and 81.8%, respectively) than CD10 (63.3% and 78.8%). The specificity of h-caldesmon in diagnosing CL was significantly higher (93.1%) than that of SMA (60%). When all four antibodies were combined for the differential diagnosis, the area-under-the-curve predictive value was 0.995. The most sensitive and specific combinations for diagnosing ESS were IFITM1(+) or CD10(+) and h-caldesmon(-) ( sensitivity 86.7%, specificity 93.9%), IFITM1(+) and h-caldesmon(-) ((sensitivity 80%, specificity 100%). The most sensitive and specific combinations for diagnosing CL were h-caldesmon(+) and SMA(+)(sensitivity 87.9%, specificity 100%), h-caldesmon(+) or SMA(+) and IFITM1(-)(sensitivity 81.8% , specificity 93.1%).Therefore, IFITM1, CD10, SMA, and h-caldesmon are a good combination of biomarkers for the differential diagnosis of ESS and CL.The differential diagnosis of endometrial stromal sarcoma (ESS) and uterine cellular leiomyoma (CL) remains a challenge in clinical practice. Cluster of differentiation 10 (CD10) and smooth muscle actin (SMA) are commonly used in the differential diagnosis of ESS and CL. However, the current combination of immunohistochemical antibodies has been shown to be inaccurate, suggesting the need for novel immunomarkers panels for differentiating between ESS and CL. Interferon-induced transmembrane protein 1 (IFITM1) is a novel immunomarker for endometrial stromal cells, h-caldesmon is an immunomarker for smooth muscle cells and has a higher specificity than SMA. So this study aimed to investigate IFITM1, CD10, SMA, and h-caldesmon as a useful combination of biomarkers for diagnosing between ESS and CL. Tissue microarrays were used to detect IFITM1, CD10, SMA, and h-caldesmon immunohistochemical staining in 30 ESS and 33 CL cases. The expressions of IFITM1 and CD10 were high in ESS (86.7% and 63.3%, respectively) but low in CL (18.2% and 21.2%), whereas those of h-caldesmon and SMA were high in both CL (87.9% and 100%) and low in ESS (6.9% and 40%). In diagnosing ESS, IFITM1 had better sensitivity and specificity (86.7% and 81.8%, respectively) than CD10 (63.3% and 78.8%). The specificity of h-caldesmon in diagnosing CL was significantly higher (93.1%) than that of SMA (60%). When all four antibodies were combined for the differential diagnosis, the area-under-the-curve predictive value was 0.995. The most sensitive and specific combinations for diagnosing ESS were IFITM1(+) or CD10(+) and h-caldesmon(-) ( sensitivity 86.7%, specificity 93.9%), IFITM1(+) and h-caldesmon(-) ((sensitivity 80%, specificity 100%). The most sensitive and specific combinations for diagnosing CL were h-caldesmon(+) and SMA(+)(sensitivity 87.9%, specificity 100%), h-caldesmon(+) or SMA(+) and IFITM1(-)(sensitivity 81.8% , specificity 93.1%).Therefore, IFITM1, CD10, SMA, and h-caldesmon are a good combination of biomarkers for the differential diagnosis of ESS and CL.