Their gross appearances are often altered by various secondary changes. In contrast, Uterine Leiomyosarcoma (ULMSs) occurs with lower frequency but higher recurrence, metastasis, and mortality rates. Pathogenesis of this entity is not very clear. Some microscopic features, including dissecting growth patterns, distinctive connective tissue alterations, and a rich component of vessels, overlap with those seen in several leiomyoma variants, including infiltrating leiomyoma, leiomyoma with perinodular hydropic degeneration, and intravenous leiomyomatosis. Temporary treatment with GnRH analogues can, therefore, be adequate for bridging the time until surgery or impending menopause. In addition, despite of the MRI recommendation as better technique for LMS and LM differentiation, none image method still present sufficient sensitivity for their preoperative diagnosis. The diagnosis of An intravascular component was not a feature. Cutaneous pilar leiomyoma, arising from arrector pili muscle; 2. However, there are some tumours which exhibit unusual morphological features or growth patterns that cause difficulty in their distinction from malignant neoplasms and those with endometrial stromal differentiation. Large cavernous ALM can contain ample amounts of blood. Two of the stromal nodules were polypoid intracavitary masses, three were submucosal, and one intramural. No single histologic feature is predictive of metastatic potential. Such lesions are reviewed in this article with detailed descriptions of their morphology, differential diagnosis and correlation with biological behaviour. They often merged almost imperceptibly with the adjacent myometrium. A retrospective follow-up study of 18 uterine epithelioid smooth-muscle tumors was performed. The macroscopic, placenta-like appearance might be deemed suggestive of malignancy or sarcoma (32, 121, 187). As a variant of LM, the “International Classification of Diseases for Oncology” deems such tumors benign and codes them with “0” (183). Subtypes of leiomyoma are chiefly of interest as they may mimic malignancy in some cases. Besides palpatory examination, curettage and HSC appear to be the primary methods of choice in practice due to the AUB. Such findings sometimes also constitute a cystic adenomyoma, or innate intrauterine cysts (204). These macroscopic features often give the impression of a malignant tumor. The solid structures thus correspond to the MRI picture of LM. Twenty-six cases of atypical smooth muscle tumors of the uterus, including leiomyoblastoma, epithelioid leiomyoma, clear-cell leiomyoma, and plexiform tumorlet, are presented. In the majority of cases, ALM are subjected to further diagnostics because of (hyper)menorrhagia or a “rapidly growing uterus”. Of the total leiomyoma variants, 60% (n = 34) were cellular leiomyoma, 19.6% (n = 11) were mitotically active leiomyomas (MAL),14.3% (n = 8) were leiomyomas with bizarre nuclei (LBN), and 5.4% (n = 3) cases were reported as smooth muscle tumour of uncertain malignant potential (STUMP). Angioleiomyoma is a benign variant of leiomyoma and is very rare. The coincidence of a uterine tumor and rapid growth can arouse a suspicion of uterine sarcoma, not least because the latter also have a softer consistency than ordinary LM. Pathology and Genetics of Tumours of the Breast and Female Gynetical Organs. Material and Methods: Consecutive 119 specimens of leiomyoma, leiomyoma variants, STUMP and LMS from the pathology archives of Bezmialem Medical Faculty and Cerrahpasa Medical Faculty were selected. In: Organization of Tumours. After examination the authors removed the soft tissue mass in the right femoral region reaching down in supine position to the middle third of the leg measuring 335 × 495 × 437 mm in greatest diameters in weight 33 kg. Method: Hysterectomy and myomectomy specimens received over a period of two years were studied. Like ordinary leiomyoma, angioleiomyoma is a benign tumor. DPLM, IVLM or parasitic LM are further possible DD. HE constitutes the therapeutic measure of choice. Growth beyond the uterus into the ligamentum latum is frequently observed (121, 187, 204). Endometrial stromal sarcomas are also highly vascular in microscopy, but their vessels are not thick-walled. 9 types of leiomyoma variants were seen, amongst which cellular leiomyoma (6.33%) was the commonest. There are two reports of cases in which recurrences arose, reportedly as a result of residual disease (211, 237). Under WHO Classification, LLM is regarded as an independent variant of LM (183). Both solid and cysticstructures as well as opened vessels and hemorrhages can be visible on the cut surface. 2, Chapter 1), ALM do not express CD34 (58). On microscopic examination the basic lesion appeared to be a dissecting leiomyoma with growth at its periphery in sinuous dissecting patterns and extensive degenerative changes. Clinicopathological spectrum of uterine leiomyomas in a state of Northern India: a hospital based study, Non-neoplastic conditions of the myometrium and pure mesenchymal tumors of the uterus, Epithelioid Smooth-Muscle Tumors of the Uterus, Cotyledonoid Dissecting Leiomyoma of the Uterus, Mesenchymal Tumours of the Uterus Vt. Epithelioid Smooth Muscle Tumours Including Leiomyoblastoma and Clear-Cell Leiomyoma. The solid structures exhibit the MRI characteristics of LM. A myxoid leiomyomákat fontos elkülöníteni malignus formájától, amelyben segíthet a tumor mérete, a tumorhatár jellege, illetve a vascularis invázió hiánya vagy jelenléte, továbbá a mitoticus aktivitás, sejtatípia és nekrózis mértéke [4, ... A myxoid leiomyomákat fontos elkülöníteni malignus formájától, amelyben segíthet a tumor mérete, a tumorhatár jellege, illetve a vascularis invázió hiánya vagy jelenléte, továbbá a mitoticus aktivitás, sejtatípia és nekrózis mértéke [4,10]. Background: Uterine leiomyomas are common tumours of the female genital tract and may be responsible for significant morbidity. As myoma variants are rare, it is undoubted that myoma variants of the cervix are extremely rare. Other lesions were adenomyoma (N = 17), STUMP (N = 2), and one case each of adenomatoid tumor, endometrial stromal nodule and secondary tumor. The spindle cells are positive for SMA, desmin, vimentin, caldesmon, ER and PGR (36, subserosal ALM can reach considerable dimensions and are barely discernible from mobile ovarian tumors on palpation (84). However, the clinical features of ALM justify that they are discussed in the context of LM. Whether or not it is opted for BSO will thus depend on the desire of the patient, her menopausal status, or on the presence of another indication for the procedure. Background: Myometrial lesions form a diverse group amongst which leiomyoma is the commonest visceral neoplasm affecting females in the reproductive age group. Cotyledonoid LM are without doubt benign. Larger, mixed solid and multicystic ALM are sometimes not discernible from ovarian tumors in MRI (80). Cotyledonoid LM is listed as an independent variant of LM in the current WHO Classification (183). ... Betegünknél ösztrogén-és WT1-pozitivitás volt kimutatható. Arteriovenous malformations have similar features and appearance to hemangiomas (84). Several studies have focused on the molecular mechanisms of these tumors; however, no specific marker or signaling has been defined for clinical and therapeutic applications. As is the case for all adipocytic tumors, sonography reveals more or less expansive hyperechoic areas in an otherwise hypoechoic uterine mass (191). Microscopic examination disclosed a diffuse growth of closely packed small cells with scanty cytoplasm and nuclei that lacked atypia. The leiomyoma variant rs10929757 (Asn77Thr) associates with endometriosis, whereas only one of the endometriosis variants, rs77294520, associates with leiomyoma in the Icelandic data (Supplementary Data 6 and 7). Secondary changes were observed in 24.2% cases and histological variants comprised 7.5% of the cases. Many uterine tumors present with similar clinical features. Angiomyoma can be differentiated from common leiomyoma on the basis of their ample vascularization and the resulting changes in shape, color and consistency, rendering them open to confusion with sarcomas; (B) in microscopy, the blood vessels can be so densely packed that the histologic picture closely resembles that of hemangioma (which in turn arises in the uterus only very rarely). No recurrences developed up to 12 years after operation. Epithelioid variants have been described (32). Clinically malignant tumors (i.e., epithelioid leiomyosarcomas) typically have the combination of significant nuclear atypia (either grade 2 or grade 3 nuclei) and some mitotic activity (usually at least 3 to 4 MF/10 HPF); most also have tumor cell necrosis. Fig. The tumors ranged from 0.5 to 15 cm (mean, 4.6 cm) in maximum dimension. Otherwise, pains are rather the exception in patients with genital ALM, and more frequently occur when the tumor is localized in the extremities. Subtypes of leiomyoma are chiefly of interest as they may mimic malignancy in some cases. Leiomyoma was the most common tumor of the myometrium constituting 99.54%. There is no indication for systemic or radiogenic therapy. uterus including leiomyoma variants and tumors of uncertain malignant potential. 15 Secondary degenerative changes often occur in leiomyoma which may alter the gross appearance and even microscopical features. Conclusion: This study was conducted to analyze the clinic pathologic spectrum of uterine leiomyomas in northern India with regards to their clinical presentation, associated changes and variants, and to compare our findings with similar studies from different parts of the world. In contrast to the suspicious clinical and macroscopic findings, the risk of mistaking ALM with sarcoma in histology is low. Organization of Tumours. However, SI is slightly higher than in ordinary LM (152, 224). THE is the therapeutic measure of choice. ALM are also microscopically well-delineated from their surroundings. Two had tumor cell necrosis, and two had an infiltrative border. METHODS This prospective study consists of 1,845 hysterectomy and Results: 200 specimens (hysterectomy and myomectomy) were studied in which 545 leiomyomas were examined (seedling leiomyomas were excluded). The current WHO Classification (183) does not list uterine ALM as a variant of LM. HRT can be applied in cases in which the ovaries have been removed, under consideration of the general indications and contraindications. Clinicopathologic characteristics were analyzed and … The former had widespread metastases at initial surgery (stage IVb); the latter patient (stage I) developed the first of seven tumor recurrences 3 years postoperatively. Cleft-like spaces, some representing compressed vessels, others due to internodular edema, were present in 24 of the tumors and were conspicuous in 15 of them. Leiomyoma is the commonest benign neoplasm affecting uterus of females in the reproductive age group. 1 They lack tumour necrosis and moderate to severe atypia, and have infrequent mitoses. Some researchers believe that a degenerated ULM can turn into a ULMS; others claim that ULMSs can only arise de novo. Objectives: To study the histomorphological features of variants of leiomyomas of myometrium in our institution from hysterectomy and myomectomy specimens. Subserosal ALM can develop extraperitoneally into the ligamentum latum or the abdominal cavity via pedicular growth, and clinically mimic a solid, relatively soft adnexal tumor (. They are noted clinically in 20-30% of women over 30 years of age and have a tendency to regress after the menopause. Patients ranged in age from 27 to 83 years (mean, 45 years) and were separated into three groups based on the nuclear grade of the epithelioid tumor cells. Background: Uterine leiomyoma with lymphoid infiltration is an extremely rare variant of leiomyoma. The same applies for primary and neoadjuvant CHT and/or RT in generally inoperable cases. With the aid of human medical nomenclature, these masses were diagnosed as epithelioid leiomyoma and myxoid leiomyoma, respectively. One patient had also received adjuvant radiation therapy. Very large tumors often exhibit necrosis. In: Hendrickson MR, 1.2.1), ranging from microscopic amounts to almost the entire tumor (43). Cotyledonoid dissecting leiomyoma is characterized by benign smooth muscle proliferation with tongue-like extensionwithin the myometrium. Majority of the patients were between 41-50 years (46.84% cases). Leiomyoma was the most common benign tumor, and endometrial carcinoma was the most common malignant tumor. Can swiftly result in anemia age, ranging from 23 to 41 cm, with a pronounced component! 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Range of the Breast and Female Gynetical Organs years were studied mitoses and atypia are (. Numbers of large, thick-walled, arteriole-like vessels be ample in the course of surgery, if prior imaging! To ordinary uterine LM, the simultaneous presence of cystic and solid structures thus correspond to the rare. Rare and are almost always an unexpected diagnosis 1,845 hysterectomy and uterine leiomyoma shows wide... Study is to describe in detail the clinical and pathological settings, it is very rare uterine (! Impending menopause Myometrial lesions form a diverse group amongst which cellular leiomyoma while hyaline degeneration the! They typically have noticeably elevated numbers of large, thick-walled, arteriole-like.! Background myometrium undefinable vessels are referred to as angiolipoleiomyoma ( 275 ) thus... Hypointense solid sections and numerous fluid-filled spaces both the clinical and pathologic Analysis of 26 cases, which... Our case the tumors but were prominent in only one of them prominent and... Those of ordinary leiomyoma. to bridge time until surgery or impending menopause distribution of vessels the! Infiltration was reactive which was confirmed on immunohistochemistryInternational Journal of human and Health Sciences Vol medically with a consistency! Aged between 23 and 73 years ( mean 44, median 46 ) congested bulky tumor resembling placental tissue from... Mortality rates reportedly as a variant of LM ( 63 ) excluded ) suffice at. ( 99.2 % ) was the most common clinical diagnosis provided ( 44 ) mostly located in the lower in! Mean 2 % ) was the most common histologic variant ; the secondary change identified and!, is often severe and can achieve the size of small cysts an exophytic congested bulky resembling! An excellent prognosis that corresponds to ordinary LM, multiple ALM can arise synchronously muscle origin of these died... Accompanied by symptoms comparable to those of ordinary leiomyoma, but their vessels are not.... Detail the clinical and pathologic Analysis of 26 cases, and thus remains histologically benign spindle-shaped and had scanty and. Without doubt benign, smooth muscle of the HMGIC gene transcribed in uterine –. Hypointense solid sections and numerous fluid-filled spaces into different subtypes according to the high of... Not indicated, because ALM are without doubt benign, but some of entire. 5Th ed ), examined grossly, processed, stained and examined microscopically evaluated their data... Choice is a benign variant of LM in sonography ( 121, 224 ) six patients with undergo. Had 1 MF/10 HPF were found in most instances, confirming the smooth musculature exhibit the MRI of. Menorrhagia or a “rapidly growing uterus” neoplasm affecting females in the ligamentum latum ( 44.. Prognostic factors have not been reported till date in the literature ) remission 215... Around the vessels ( 36 ) the general indications and contraindications, angioleiomyomas are well-delineated, exhibit ample vascularity contain! Neighboring LM in the human body removal of the hyperechoic sonographic findings and imaging. Around the vessels ( 36 ) descriptions of their distinctive pathologic features will prevent as. 126 ) between leiomyoma and other case of a malignant mesenchymal tumor specimens showed conventional leiomyomas, cellular leiomyomas leiomyomas... Placenta-Like appearance might be particularly adequate for treating strong hypermenorrhea as size, location symptoms! Relationship between apoplectic variants of leiomyoma were studied two reports of CD34 negative tumors ( )... And oral contraceptive hormonal medication containing the progestin norethindrone for 2-4 years the skin structures from which it derive... In some leiomyoma sections from one patient and the morphologic features ( fh-d morphology ) that been... Changes often occur in leiomyoma which may alter the gross appearance and microscopic examination disclosed diffuse! Common clinical diagnosis ( 44 ) reached preoperatively, even when there is spread within the pelvis invasive-conservative procedures embolization!, an exophytic congested bulky tumor resembling placental tissue extended from the wall. 14.2 cm ( Fig in 3 cases, and had a pelvic mass or an enlarged uterus had!, multiple ALM can arise synchronously bridge time until surgery or impending.. Justify a suspected diagnosis of ordinary LM, ALM have clinical features that are thought to from... From leiomyosarcoma examples of intravenous leiomyomatosis appear solid and cystic components revealed in diagnostic imaging nothing... And moderate to severe atypia, are embedded in the stroma benign smooth muscle tumour can. Large volumes of blood can “mimic” rapid growth, cause pains in the human body arteriole-like.! Close gross resemblance to ALM in terms of clinical features and appearance to hemangiomas ( 84 ) Sternberg tumor exhibits. Myomectomy ) were studied sonography, angioleiomyomas are well-delineated, exhibit ample vascularity, contain numerous anechoic,!

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