Dear Editor,
We appreciate the author’s positive comments about our article published in the July 2020 issue of the Oman Medical Journal.1,2
Figure 1: Immunohistochemistry positive for caldesmon, magnification = 200 ×.
Figure 2: Spindled tumor cells showing immunoreactivity for desmin, magnification = 400 ×.
Figure 3: Tumor cells show positive (nuclear) reaction for Ki 67(MIB-1), magnification = 400 ×.
Figure 4: Tumor cells show a strong positive reaction for spinal muscular atrophy, magnification = 400 ×.
We agree with your suggestion to include pre- and intraoperative and macroscopic figures to give more information and knowledge for the readers. Our patient gave us consent to publish the case, understanding that it is a very rare pathology. From an ethical point of view and to respect the patients’ autonomy and confidentiality, we submitted only microscopic pictures as the diagnostic criteria of leiomyosarcoma.3,4
Immunohistochemistry helps to confirm the diagnosis. Our patient tumor cells showed diffuse strong positive staining for smooth muscle actin, caldesmon, and desmin. The Ki-67 (MIB-1) proliferation index was around 30%. Negative staining was observed for CD117, CD4, vimentin, and S100 [Figures 1–4]. The histomorphological features and immunoprofile were consistent with leiomyosarcoma grade 2, according to the French Federation of Cancer Centers Sarcoma Group grading system.2,5
references
- 1. Hayati F, Soe MZ, Azizan N, Payus AL. The Value of Preoperative Diagnosis in Leiomyosarcoma of the Vulva. Oman Med J 2021;36(2):e256.
- Saquib S, Cherawala M, Rahman OA, Keloth TE. Leiomyosarcoma of the vulva mimicking as chronic Bartholin cyst: a case report. Oman Med J 2020;35(4):e153.
- 2. Santos P, Hespanhol A. Informed consent for case reports - an ethical perspective. Acta Bioethica 2017;23(2):271-278.
- 3. Committee on Publication Ethics (COPE). Code of conduct and best practice guidelines for journal editors. 2011 [cited 2015 September]. Available from: www.publicationethics.org.
- 4. Smith SA, Bou Zgheib N, Vallejos AM, Cuda JD. Case report on leiomyosarcoma of the vulva: a rare pathology. Marshall Journal of Medicine 2020;6(3):6.