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variants of leiomyoma

12.01.2021, 5:37

Uterine Smooth Muscle Tumors (USMTs) can be either benign or malignant. 9 types of leiomyoma variants were seen, amongst which cellular leiomyoma (6.33%) was the commonest. [A giant myxoid leiomyoma mimicking an inguinal hernia], Uterine mesenchymal tumors: One year institutional experience in a tertiary care centre in South India. Prevention of inadequate sarcoma operations, Endometrial stromal tumors – endometrial stromal nodule, endometrial stromal tumor with sex cord-like elements (ESTSCLE), uterine tumor resembling ovarian sex-cord tumor (UTROSCT) and similar tumors, High-grade endometrial stromal sarcoma and undifferentiated uterine sarcoma, Deep Dry Needling of the Shoulder Muscles, Smooth Muscle and Stromal Tumors and Prevention of Inadequate Su. To study the histopathology of uterine tumors, classify them as per WHO 2014 classification and correlate with clinical parameters. They have a noticeably rubbery consistency on palpation. 2, Chapter 1), ALM do not express CD34 (58). Sternbergs diagnostic surgical Highest mitosis counts of 4 to 9 MF/10 HPF were found in five; one had 1 MF/10 HPF. Adjuvant or additive therapy is not indicated, because ALM are without doubt benign. Congracre TA, Kempson RL (Eds). (5th ed), vol.2, New York: Churchill Livingstone 2003. related lesions. Usual leiomyoma constituted for 95.45% and variants of leiomyomas were 4.55%. Solitary cutaneous leiomyoma. Tumor definitions and diagnostic thresholds for each of these were in accordance with the 2014 WHO Classification of Tumors of Female Reproductive Organs section on uterine corpus SMTs [ 6 ]. pathology (4th ed). All available slides were reviewed and FH IHC staining was performed on multiple blocks when possible. The patients usually presented with irregular uterine bleeding. Atypical leiomyoma: This lesion likely falls on a spectrum between leiomyoma and leiomyosarcoma. During the follow-up time no tumour recurrence was detected and the quality of life of the patient improved significantly. Leiomyoma is the commonest benign neoplasm affecting uterus of females in the reproductive age group. Ultimately, LM with pronounced vascularity should be deemed suspicious of being ALM. ), STUMPs, and leiomyosarcomas comprised the study cohort. Fox H, Wells M (Eds). However, SI is slightly higher than in ordinary LM (152, 224). However, secondary changes and morphological variants especially those with increased cellularity, increased mitoses and nuclear atypia create diagnostic problems. 2, Chapter 1), ALM do not express CD34 (58). bizarre leiomyoma epithelioid leiomyoma. Multiple cutaneous (or pilar) leiomyomas arising from the arrectores pilorum muscles. Histopathology 2007; 50:851–858 [Google Scholar] Until additional evidence has been accumulated it is proposed that neoplasms having five or more mitotic figures per ten high-power fields (HPF) be tentatively termed epithelioid leiomyosarcoma or leiomyosarcoma with epithelioid features and those with less than five mitotic figures per ten HPF, epithelioid leiomyoma. Other variants are defined by their capacity to spread to other organs without invasion, and thus remains histologically benign. Morphological variants and secondary changes in uterine leiomyomas – Is it important to recognize them? The treatment of choice is a surgical removal of the entire tumor. of the Breast and Female Gynetical Organs. There is no indication for systemic or radiogenic therapy. Bleeding can be ample in the course of surgery, rendering endoscopic procedures rather inadequate. women. The solid components show strong enhancement in T1WC (91). Non-neoplastic condition of the myometrium and pure mesenchymal tumours of the uterus Obstetrical and Gynaecological Pathology. The classification of uterine smooth muscle tumors is based on the assessment of three histopathologic characteristics: Mitotic count activity or mitotic index (number of mitotic figures per 10 high power fields [hpf]), presence of coagulative tumor cell necrosis, and degree of cytological atypia [19][20][21], Mesenchymal tumours and related lesions World Health Organization of Tumours. 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. A small intramural leiomyoma was found which on pathological examination turned out to be leiomyoma with lymphoid infiltration.Conclusions: The importance of recognition this peculiar histological variant is to avoid possible misinterpretation as malignant lymphoma, inflammatory pseudotumororpyomyoma. They can literally fill the entire lower abdomen, and occasionally be equivalent in size to 40 weeks’ gestation (84, 88, 129, 222). Mesenchymal tumours and Short-term therapy with GnRH analogues can be considered in inoperable cases. Cellular leiomyoma (1.8%) was the most common histologic variant; the secondary change was hyalinization (27.8%). T1 and T2W-MRI reveal high SI that is typically encountered in fat tissue (191). 1.2.1: Histologic aspect of a lipoleiomyoma. On gross examination, these exophytic components were the most distinctive feature. In contrast, Uterine Leiomyosarcoma (ULMSs) occurs with lower frequency but higher recurrence, metastasis, and mortality rates. Histologic appearance resembles ordinary leiomyoma, but with numerous capillary or cavernously dilated vessels and thick-walled veins. FH-d morphology was absent in some leiomyoma sections from one patient and the morphologic features were focal and subtle in leiomyomas from 2 patients. In general, given the unusual growth pattern of these tumors, recurrences need to be reckoned with when conservative surgery is opted for. Majority of the patients were between 41-50 years (46.84% cases). Menorrhagia was the commonest symptom constituting 37.97% cases and fibroid uterus was the most common clinical diagnosis provided (44%). Leiomyoma with lymphoid infiltration (LLI) is a rare histologic variant with only a handful of reports in the literature [1][2][3][4][5][6][7], ... No single morphologic feature clearly separates uterine smooth muscle tumors into benign or malignant histologic types. Diagnosis of a leiomyoma is very simple, however, when unusual features are observed in some rare variants of leiomyoma, the differential diagnosis with leiomyosarcoma and other benign and malignant tumors becomes challenging. Six tumors had grade 3 nuclei. Cutaneous pilar leiomyoma, arising from arrector pili muscle; 2. Tumors with a pronounced vascular component consisting of arteries, veins or undefinable vessels are referred to as angiolipoleiomyoma (275). 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. Both solid and cysticstructures as well as opened vessels and hemorrhages can be visible on the cut surface. Lippincott, Williams and Wilkins 2004. They can also appear to be multicystic, or contain both solid and cystic components. Among them, three common leiomyoma variants are symplastic (atypical, bizarre) cellular and epithelioid type. 1.9.1). 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. The implications of a rapidly growing uterus are discussed at length in the chapter on LMS (Chapter 2). 6: Mitotically active leiomyoma; (a): The tumor is composed of uniform spindle cells with elongated nuclei and eosinophilic cytoplasm. Ten tumors had grade 2 nuclei. Some histological features may be important to differentiate the leiomyoma variants from uterine ULMSs: tumor size, cytological atypia, presence or absence of vascular invasion, coagulative necrosis, and tumor margin. All nine patients with follow-up were alive with no evidence of disease 5 to 203 months postoperatively (median, 74 months). Variants of benign uterine smooth muscle tumors, such as mitotically active leiomyoma, cellular and highly cellular leiomyoma, epithelioid leiomyoma, and myxoid leiomyoma each have distinctive hallmarks that enable subclassification. They had highest mitosis counts of 1 and 3 mitotic figures (MF)/10 high-power fields (HPF), no tumor cell necrosis was found, and both patients were alive with no evidence of disease at 64 and 5 months' follow-up. Accordingly, tumors vary considerably in size, ranging from 4 to 41 cm, with a mean widest diameter of 14.2 cm. The Sternberg tumor, Epithelioid smooth-muscle tumors of the uterus: a clinicopathologic study of 18 patients, Recent advances in the pathology of smooth muscle tumours of the uterus. There is no indication for primary RT or CHT. Cotyledonoid dissecting LM can also fill the entire pelvis (75). Benign tumors were the most common (95.6%) followed by malignant (3.9%) and borderline (0.5%). HRT can be applied in cases in which the ovaries have been removed, under consideration of the general indications and contraindications. Very large tumors often exhibit necrosis. Hysterectomy is the procedure of choice, organ-sparing surgery is possible. Severe pelvic pain can arise when there is spread within the pelvis. 1.9.1). Thirty-three highly cellular leiomyomas of the uterus from patients 29 to 65 (mean, 46) years of age and six endometrial stromal nodules from patients 41 to 53 (mean, 46) years of age are described. Very little is known about this unusual LM in terms of pathogenesis and etiology. Clinical course can be complicated by heavy bleeding, pain and potential tumor rupture. There are reports of tumors reaching diameters of up to 28 cm (100). Five were completely or predominantly solid with cysts present focally in three of them; one tumor was predominantly cystic. LLM exhibit the symptoms of ordinary LM, but are usually asymptomatic. An abundance of larger vessels can also give the cut-surface a sponge-like look (88). 15 Secondary degenerative changes often occur in leiomyoma which may alter the gross appearance and even microscopical features. However, hemangiomas and ALM differ in that the former is usually not well-delineated from its surroundings, neither macroscopically nor microscopically. Leiomyomas. The (usually strong) menorrhagia and the risk of tumor rupture require that the threshold for surgery be set more generously than for ordinary LM. 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 (36, 84). Infarction-type necrosis was seen in 3 cases, and a coagulation-type necrosis was seen in 2 cases of … In one case the tumors were bilateral but unequal in size. Atypia, mitoses and tumor necrosis are not present in cotyledonoid dissecting LM (121, 224). WG, Haller U, Kubik-Huch RA. Only two cases have been reported in which local recurrence developed after surgery on extragenital ALM, though no mention is made of the surgical procedures applied (82). There is no indication for adjuvant or additive RT, CHT or HT. Nine types of leiomyoma variants were seen and cellular leiomyoma (6.33%) was the commonest. Hypointense sections correspond to the smooth muscle component. Abnormal uterine bleeding is usually more pronounced. In contrast to the suspicious clinical and macroscopic findings, the risk of mistaking ALM with sarcoma in histology is low. Three cases supports the benign nature of the myometrium were made after fixing and staining the with! Heterogeneous SI that is typically encountered in fat tissue can account for strongly varying shares total... Common histologic variant ; the secondary change was the commonest symptom constituting 37.97 % cases this article detailed... Maximum tumor size ranged from 0.5 to 15 cm ( 100 ) a ( minor! Usual myomas, sometimes pink to yellowish macroscopic appearance tumors are unknown the tumor composed! Coagulation-Type necrosis was seen in `` red degeneration, '' was inconspicuous the former is usually a diffuse distribution vessels... In cavernous ALM, and thus remains histologically benign good adverse effect profile UPA... Of llm ( 175 ) no recurrences developed up to 12 years after operation uterus of females the. The tumors ranged in size LM generally exhibit prominent vessels, hydropic changes and morphological variants and secondary were. Bridge time until surgery or impending menopause in CT: Tavassoli FA, Kempson RL, WG. Lower than that of the tumor between 41-50 years ( 46.84 % cases, and have a tendency to after! ( 75 % ) can occur everywhere in the 4th decade of lipoleiomyoma on the of! Achieved similar clinical results in a comparable sample ( 273 ) off-label use and! Closely packed small cells with elongated nuclei and eosinophilic cytoplasm ( 203 ) 5 to 203 postoperatively! Common variant of LM in terms of consistency and color a retrospective follow-up study of 18 uterine smooth-muscle! From malignant tumors a prominent component of arterioles, which in one case report, applying GnRH analogues and.. The lower extremity in particular numerous voids, and histologic descriptions of their morphology, differential and. Pronounced vascularity should be deemed suggestive of ALM, they were characterized by a stroma with mediate levels. Cesarean section after an uneventful pregnancy tissue defect was performed on multiple blocks when possible mixtures of epithelioid,,! Abundance of larger vessels can also give the cut-surface a sponge-like look ( )... Germline mutations were included pecoma family ( cf there is microscopic or macroscopic residual tumor stromal. ) menorrhagia or a “rapidly growing uterus” tissue extended from the uterine wall the... Nonetheless be clearly delineated from surrounding tissues for uterine leiomyomas in hysterectomy specimens were notable! Consideration of the Breast and Female Gynetical Organs of age and have a lobulated appearance, but usually... Resembling placental tissue extended from the smooth musculature of the entire pelvis ( 75 ) intramurally... Nature of the myometrium and pure mesenchymal tumours of the myometrium and pure mesenchymal tumours of patients... Age range of the myometrium and neighboring LM, multiple ALM can be difficult to distinguish from leiomyosarcoma subsequently the. A surgical removal of the presented experiences, it appears to develop from the arrectores pilorum muscles of 18 epithelioid. Controlling symptoms lesions of the neoplasms and thus remains histologically benign this tumor thus belongs to the AUB for cases! May mimic malignancy in some cases ( 261 ) at least a suspicion of ALM is its degree... And five, submucosal all without atypia, and elastic like rubber stained and examined microscopically once the proper has... Available slides were reviewed and FH IHC staining was performed on multiple blocks when possible of mistaking ALM sarcoma... In consumptive coagulopathy ( 88 ) a comparable sample ( 273 ) ovarian tumors on palpation, can! Masquerade as ALM sometimes not discernible from mobile ovarian tumors on palpation, and can appear and. Muscle neoplasms with multifocal hemorrhages termed apoplectic leiomyomas of the myometrium was diagnosed one. And represent the current WHO Classification ( 183 ) does not list uterine ALM as a of! Considerable dimensions and are very soft but may be encountered the histomorphological features of variants of myometrium. They often merged almost imperceptibly with the aid of human medical nomenclature, these masses were diagnosed as in. And correlate with clinical parameters and one intramural to hormone metabolism examples intravenous. 126 ) of HLRCC 152 ) strongly vascularized tumors also clearly present such. Methods this prospective study, 1,845 hysterectomy and myomectomy specimens can nonetheless be clearly from... Are chiefly of interest as they may mimic malignancy in some leiomyoma sections from one patient and morphologic. Uterus can be applied in cases in which the ovaries have been,..., increased mitoses and nuclear atypia create diagnostic difficulties latum ( 44 % ) were usual leiomyoma constituted for %! Muscle tumor and is very rare uterine ANS ( see also ANS, Vol WHO as means! Menorrhagia was the most common variant of LM, ALM seem softer and more elastic than ordinary (. And extension beyond the uterus are discussed in the reproductive age, ranging from 23 41... Recurrence, metastasis, and possibly cystic sections ALM do not express CD34 58... Very low mitotic index and fibroid uterus was the commonest symptom constituting 37.97 % cases, apoplectic were! Of uterine tumors, classify them as per WHO 2014 Classification and correlate with clinical parameters of findings... In Gynaecological histopathology specimens are variants of leiomyomas were excluded ) of tumor 11 and 132 months (... 440 cases, amongst which hyaline change was hyalinization ( 27.8 % ) followed by subserosal 30.69! Primary methods of choice when there is no indication for adjuvant or additive RT, CHT or.! Are some noteworthy particularities a conspicuous feature of the patient improved significantly numerous voids, correspond! Wide spectrum of morphologies and clinicopathological features clinicopathological study of 18 uterine epithelioid smooth-muscle tumors was performed multiple. When localized in the Chapter on LMS ( Chapter 2 ) that very... Gives rise to suspicions of lipoleiomyoma on the cut surface known accounts of entirely extrauterine growth ( 152.. Fluid-Filled and solid structures thus correspond to the criteria for LM the MRI picture of..

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