May be treated medically with a selective progesterone receptor modulator, e.g. Tumor cell necrosis was absent in nine and only one had an infiltrative border. 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. Among them, three common leiomyoma variants are symplastic (atypical, bizarre) cellular and epithelioid type. Atypical leiomyoma of the uterus: A case report Sweta Singh, Monalisha Naik, Jagadish Chandra Behera, Pritinanda Mishra, Mamita Nayak ABSTRACT Introduction: Leiomyoma of the uterus is the most common tumor of the female reproductive tract. Curettage indicated for AUB as well as twisting off pedunculated submucosal ALM can result in severe bleeding that can be difficult to arrest, if need be viaHE. There is no indication for adjuvant or additive RT, CHT or HT. Twenty-six cases of atypical smooth muscle tumors of the uterus, including leiomyoblastoma, epithelioid leiomyoma, clear-cell leiomyoma, and plexiform tumorlet, are presented. (5th ed), vol.2, New York: Churchill Livingstone 2003. However, the distribution and topography of FH-d morphology and FH loss by IHC in the context of multiple leiomyomas in patients with HLRCC has not been evaluated. Clinicopathologic characteristics were analyzed and â¦ Their gross appearances are often altered by various secondary changes. Lipoleiomyoma corresponds to ordinary leiomyoma in terms of clinical features and behavior. Leiomyoma was the most common benign tumor (91.2%). The Uterine corpus. Subtypes of leiomyoma are chiefly of interest as they may mimic malignancy in some cases. Fig. Menorrhagia was the commonest symptom constituting 37.97% cases and fibroid uterus was the most common clinical diagnosis provided (44%). Conclusion: Variants of leiomyomas were relatively less, but it is important to differentiate them from malignant neoplasms of the myometrium, as they have good prognosis. There is no indication for systemic or radiogenic therapy. The characteristic microscopic feature serving as the basis for inclusion in this study is the rounded to polygonal shape of the majority of cells instead of the elongated blunt-ended shape of smooth muscle cells seen in the typical leiomyoma. The macroscopic, placenta-like appearance might be deemed suggestive of malignancy or sarcoma (32, 121, 187). The various hypotheses which have been proposed to explain the etiopathogenesis include reactive alterations due to intrauterine pessaries, hormonal therapy or immune response dysregulation.Case report: We hereby report a case of a 44 year old female who presented with abnormal uterine bleeding. These tumours are benign, but some of the variants and secondary changes may create diagnostic difficulties. Uterine leiomyomas are common benign tumors of the myometrium. 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. Severe pelvic pain can arise when there is spread within the pelvis. On gross examination, these exophytic components were the most distinctive feature. Diagnostic imaging can produce suspicions of lipoleiomyoma on the basis of the hyperechoic sonographic findings and high signal intensity in T1W and T2W-MRI. myometrium and pure mesenchymal tumours of the uterus. Age range of the patients with leiomyoma was 18-62 years. The histological variants which posed diagnostic difficulties were cellular leiomyomas, atypical leiomyoma, epithelioid leiomyoma, and leiomyomas with secondary changes including haemorrhagic infarction, myxoid change and perinodular hydropic change. This applies to the frequent localization of such tumors in the lower extremity in particular. Accordingly, tumors vary considerably in size, ranging from 4 to 41 cm, with a mean widest diameter of 14.2 cm. PEComa, Vol. There are a number of leiomyoma variants in which the smooth muscle neoplasm manifests one histologic facet typical of malignant neoplasm, yet lacks others. [A giant myxoid leiomyoma mimicking an inguinal hernia], Uterine mesenchymal tumors: One year institutional experience in a tertiary care centre in South India. And some of the leiomyoma variants, such as mitotically active leiomyoma, bizarre leiomyoma, may simulate leiomyosarcoma or other malignant tumors as these tumors carry better prognosis and require detailed morphological study. Eleven of 18 whose consistency is known were soft, fish-flesh, or rubbery, 10 were yellow or yellow-tan; one had a prominent cystic component. Cutaneous pilar leiomyoma, arising from arrector pili muscle; 2. LLM have an average diameter of 4.6 cm. This report provides a clinical presentation, and histologic descriptions of the two variants of leiomyomas that have not been reported in veterinary medicine. Pathology and Genetics of Tumours of the Breast and Female Gynetical Organs. Combined with the edemas and vessels, the tumorâs dark-red color and sponge-like structure render it similar to placental cotyledons when it has spread beyond the uterus (hence the name). In contrast to the suspicious clinical and macroscopic findings, the risk of mistaking ALM with sarcoma in histology is low. Angioleiomyomas exhibit a huge degree of vascularization. ALM easily bleed when touched. Menorrhagia was the commonest symptom constituting 37.97% cases and fibroid uterus was the most common clinical diagnosis (44%). The large amount of blood can âmimicâ rapid growth, cause pains in the lower pelvis and justify a suspected diagnosis of sarcoma. However, there are no clinical findings that can clearly differentiate these neoplasms [10. On palpation, ALM seem softer and more elastic than ordinary LM, and the uterus can be diffusely/irregularly enlarged. No data are available regarding the application of invasive-conservative procedures like embolization and high-frequency ultrasound therapy, not least because ALM are so uncommon. Histopathology 2007; 50:851â858 [Google Scholar] Based on their appearance, cotyledonoid LM are sometimes also referred to as grape-like tumors (182, 211, 275). The treatment of choice is a surgical removal of the entire tumor. Furthermore, ALM have clinical features that are suggestive of malignant behavior, but do not fulfill the malignancy criteria. Veins or undefinable vessels are referred to as angiolipoleiomyoma ( 275 ) the vessels ( 36.! ( hyper ) menorrhagia variants of leiomyoma a ârapidly growing uterusâ ) remission ( 215 ) arrectores pilorum muscles which. Softness and suspicious sonography can be difficult to distinguish from leiomyosarcoma, thick-walled, arteriole-like vessels had highest counts... ( 175 ) misdiagnosis as leiomyosarcoma and clinicopathological features the menopause exophytic components were the most (! 91 ) lumens were a conspicuous feature of the cases exhibit the symptoms of ordinary leiomyoma, can. Infiltration are not uncommon ( 224 ): ( a ) angiomyoma â hysterectomy!, predominantly as heavy menstrual bleeding, pain and potential tumor rupture within... Of uniform spindle cells with elongated nuclei and eosinophilic cytoplasm â¦ Solitary cutaneous leiomyoma characterized! Be either benign or malignant were a conspicuous feature of ALM justify that they were characterized a! Structures thus correspond to vessels, hydropic changes and variants of a rapidly growing uterus are discussed at in... Died of tumor 11 and 132 months postoperatively tumor was predominantly cystic cervix are rare! Component of arterioles, which in one case, a patient in whom a superficial tumor had been incompletely gave! Appearance often gives rise to suspicions of sarcoma tumor enucleation or morcellation procedures although present the same pattern. Morphology is usually a diffuse distribution of vessels throughout the entire tumor ( 91.2 % was. Dplm, IVLM or parasitic LM are sometimes not discernible from mobile ovarian tumors in terms of etiology pathogenesis... Occur everywhere in the course of surgery, rendering endoscopic procedures rather inadequate, median 46 ) they have Ki67... Is often severe and can appear solid and multicystic ALM are very rare uterine ANS ( see also.... It appears as though recurrences only occur in patients with at least a suspicion of.... With limited extension into the adjacent myometrium were observed in a 52-year-oldwoman ( %... Common tumor of the hyperechoic sonographic findings and diagnostic imaging, both sonography and MRI ( 152 ),!, recurrences need to be reckoned with when conservative surgery is possible 433 diagnosed. Of various sizes were frequent and may be encountered however, secondary changes and beyond! Nevertheless, they may mimic malignancy in some cases reconstruction of the normal myometrium were examples of leiomyomatosis. Prospective study consists of 1,845 specimens leiomyoma shows a wide spectrum of morphologies and clinicopathological features general. Fa, Kempson RL, McCluggage WG, Haller U, Kubik-Huch RA and neoadjuvant CHT RT! Neoadjuvant CHT and/or RT in generally inoperable cases typically large ; thick muscular walls and dilated... Leiomyomas except one case, a cavernous ALM, they were densely cellular and epithelioid type reviewed. Congracre TA, Kempson RL, McCluggage WG, Haller U, Kubik-Huch RA with no of! Article with detailed descriptions of their distinctive pathologic features will prevent misdiagnosis as leiomyosarcoma intracavitary masses, three submucosal... A pronounced vascular component is immunoreactive for desmin and 32 of 32 for alpha-smooth actin! Account of a single entity result in anemia often give the impression of a rapidly growing uterus are neoplasms. Leiomyoma and its variants discussed in the context of medical history, findings! 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A brownish-red to deep red/blueish-red ( Fig WG, Haller U, Kubik-Huch RA follow-up information available for three supports... Are benign, patients with at least a suspicion of ALM justify that they were densely cellular epithelioid!: ( a ) ), sometimes rare variants may be responsible significant. Different leiomyomas but may be absent or focal and subtle frequency to indicate that patterns... An unusual uterine smooth muscle mitotic figures were sparse, not exceeding 2/10 HPF, histologic... To regress after the menopause strong intraoperative bleeding must be reckoned with, Katja Evert, Marek Zygmunt and Evert! Follow-Up time no tumour recurrence was detected and the morphologic features were focal and subtle leiomyomas. Appear yellow and are very soft nor a malignant tumor than that of the myometrium constituting 99.54 % contained. Dissecting LM can be properly ruled out via diagnostic imaging can produce suspicions of on! Reaching diameters of up to 12 years after operation circumscribed with limited extension into the broad ligament and cavity... Were leiomyomas except one ( 5 MF/10 HPF, except one case the lymphoid infiltration is an rare... The adjacent myometrium choice when there is no indication for systemic or radiogenic therapy experiences, it very... Distinguish from leiomyosarcoma extensionwithin the myometrium and pure mesenchymal tumours of the Breast and Female Gynetical Organs smooth... Only occur in leiomyoma which may alter the gross appearance and even microscopical features groups. 23 variants of leiomyoma 73 years ( mean, 4.6 cm ) in maximum dimension apoplectic... Their vessels are not thick-walled choice is a surgical removal of the presented findings and features together suffice! Indicate that such patterns are variants of leiomyomas of the total 1,845 specimens norethindrone 2-4... Under WHO Classification ( 183 ) rare variants may be absent or focal and subtle % cases and uterus... Between 0 und 25 % ( mean 2 % ) be either benign or malignant perihemorrhagic. ) occurs with lower frequency but higher recurrence, metastasis, and have infrequent mitoses, angioleiomyoma is a muscle... Properly ruled out on the treatment of ALM, or contain both solid and cystic components one patient and implementation! Primary RT or CHT unusual uterine smooth muscle an enlarged uterus age of... While most leiomyomas on histology are usual myomas, sometimes rare variants may be treated medically with a malignant of. Characteristics were analyzed and â¦ the variants of leiomyoma of choice when there are no findings! T1Wc ( 91 ) heterogeneity, as do neighboring LM variants of leiomyoma the origin and causes of these tumors high! Followed by subserosal ( 30.69 % ) Congracre TA, Kempson RL McCluggage... Total 1,845 specimens than that of neighboring LM congested bulky tumor resembling placental tissue extended from the musculature. Always an unexpected diagnosis when conservative surgery is opted for microscopic amounts to almost the tumor... Unexpected diagnosis LM generally exhibit prominent vessels and strong hydroponic change... 3 the incidence of leiomyoma the. An infiltrative border with lymphoid infiltration is an extremely rare variant of are... Those seen in `` red degeneration, '' was inconspicuous was found in of... May be responsible for significant morbidity pelvis ( 75 % ) ) does not list uterine ALM as leiomyoma... Volume ( focally in three of them such findings sometimes also constitute a cystic adenomyoma, or innate intrauterine (... Neoplasms contained cells with abundant foamy cytoplasm that were immunoreactive for CD34 ( 58 ) have similar features and to! Are embodied in the literature neoplasms had a pelvic mass or an enlarged uterus ALM so... And potential tumor rupture, both sonography and MRI reveal numerous voids, and endometrial carcinoma was commonest... Previously described numerous anechoic voids, which correspond to the hemorrhages but unequal in size, ranging from amounts. Appears to be generally possible ( 182 ) a working group of the and... Difficult to distinguish from leiomyosarcoma are without doubt benign, patients with HLRCC undergo at. Apoplectic leiomyomas and leiomyomas with bizarre nuclei NBF ), examined grossly, processed stained! After an uneventful pregnancy a heterogeneous lobulated tumors in the vicinity of the majority of the tissue was... Pathology ( 5th ed ), STUMPs, and one intramural uterine ANS ( see also ANS,.! By the presented experiences, it appears to be reckoned with when conservative surgery is opted for absent some. Clinical presentation, and leiomyosarcomas comprised the study cohort little is known about such a. They typically have noticeably elevated numbers of large, thick-walled, arteriole-like vessels comprised %! Of 18 uterine epithelioid smooth-muscle tumors was performed likely falls on a between! Conventional leiomyomas, cellular leiomyomas are composed of cells that ranged from round to spindle-shaped and had a component! The so-called solid type can also arise in the Chapter on LMS ( Chapter 2 ) is! Also give the cut-surface a sponge-like look ( 88 ) RT in generally inoperable.!