variants of leiomyoma

Cellular leiomyoma (1.8%) was the most common histologic variant; the secondary change was hyalinization (27.8%). Ages of patients ranged from 20 years to 72 years with peak incidence in the 4th decade. 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). Reresection/completion surgery should, therefore, be considered in cases in which there is microscopic or macroscopic residual tumor. 2001 ; 30 (2) : 212-217. Conclusion The distinctive gross appearance and microscopic features are embodied in the designation, "cotyledonoid dissecting leiomyoma." Three neoplasms contained cells with abundant foamy cytoplasm that were immunoreactive for CD68, indicating that they were histiocytes and not neoplastic cells. Hysterectomy is the procedure of choice, organ-sparing surgery is possible. Angioleiomyoma is a benign variant of leiomyoma and is very rare. Angioleiomyomas exhibit a huge degree of vascularization. Keywords: Dicerorhinus sumatrensis; Sumatran rhinoceros; Majority of leiomyoma cases (99.2%) were usual leiomyoma. Benign tumors were diagnosed in 440 cases, and all the benign tumors were leiomyomas except one case of adenomyoma. It is suspected that the shortage of estrogen in postmenopausal women might induce transformation of smooth muscle cells and facilitate the build-up of fat deposits (141). Pathogenesis of this entity is not very clear. Ordinary leiomyoma is the pivotal clinical differential diagnosis. In T1WC, cotyledonoid dissecting LM shows strong enhancement with minimal heterogeneity, as do neighboring LM. Methods We retrospectively reviewed data from 471 patients who underwent surgery for uterine leiomyomas and evaluated their clinical data. Specimens showed conventional leiomyomas, cellular leiomyomas and leiomyomas with bizarre nuclei. There is no indication for any type of adjuvant therapy. It is very effective in differentiating ALM from malignant tumors. Short-term therapy with GnRH analogues can be considered in inoperable cases. Genital leiomyoma, from smooth muscle of the scrotum, nipples and labia majori [1]. LLM have an average diameter of 4.6 cm. Atypia, mitoses and tumor necrosis are not present in cotyledonoid dissecting LM (121, 224). Reconstruction of the tissue defect was performed using oncoplastic guidelines. A diagnosis of an adipocytic tumor can be secured via fat suppression (13, 149). Ultimately, LM with pronounced vascularity should be deemed suspicious of being ALM. Highest mitosis counts of 4 to 9 MF/10 HPF were found in five; one had 1 MF/10 HPF. 1.1.1 (B)). The treatment of choice is a surgical removal of the entire tumor. Uterine Smooth Muscle Tumors (USMTs) can be either benign or malignant. 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. FH IHC can show variable results and presence of retained FH staining should not be used to exclude the possibility of HLRCC. There is no indication for systemic or radiogenic therapy. Majority of the patients were between 41-50 years (46.84% cases). 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. Like ordinary LM, multiple ALM can arise synchronously. LLM is a benign tumor. The specimens were properly labeled, fixed (in NBF), examined grossly, processed, stained and examined microscopically. Background: Uterine leiomyoma with lymphoid infiltration is an extremely rare variant of leiomyoma. Organization of Tumours. We report four cases of an unusual uterine smooth muscle neoplasm. Pathology and Genetics of Tumours Compared to malignant ovarian tumors, however, ascites is absent and CA-125 values are not elevated in ALM (, In contrast to the very rare uterine ANS (see also ANS, Vol. Hendrickson MR, Tavassoli FA, Kempson RL, McCluggage Administering 10mg mifepristone vaginally daily achieved similar clinical results in a comparable sample (273). leiomyoma were found in 88.6% cases and other variants like mitotically active leiomyoma, symplastic leiomyoma, and cellular leiomyoma, neurilemmoma like variant, Fig. There is no indication for adjuvant or additive RT, CHT or HT. Symptoms most closely resemble those of LM. However, SI is slightly higher than in ordinary LM (152, 224). 1.2.1: Histologic aspect of a lipoleiomyoma. A Clinical and Pathologic Analysis of 26 Cases, Apoplectic leiomyomas of the uterus. Cotyledonoid dissecting LM can also fill the entire pelvis (75). Conclusion: Accurate knowledge of these variants and degenerative changes in leiomyomas are mandatory to prevent misdiagnosis and over treatment along Atypical leiomyoma: This lesion likely falls on a spectrum between leiomyoma and leiomyosarcoma. 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. Fat tissue can account for strongly varying shares of total tumor volume (Fig. Methods: All the hysterectomy and myomectomy specimens which were received in the department of pathology, ASCOMS hospital Jammu, Jammu and Kashmir over a period of one year, out of which 79 cases with leiomyomas were included in the study. It appears to develop from the smooth musculature of the veins. Epithelioid variants have been described (32). A rubbery consistency should be deemed suggestive of ALM. Uterine and other genital ALM are very rare and are almost always an unexpected diagnosis. At laparotomy, an exophytic congested bulky tumor resembling placental tissue extended from the uterine wall into the broad ligament and pelvic cavity. Atypia or not, they have a very low mitotic index. The cells have an oval nucleus and are long and slender, and usually there is very little atypia (although there are some benign variants of leiomyoma that have atypia). 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. The strong degree of vascularity lends such tumors a brownish-red to deep red/blueish-red (Fig. This report provides a clinical presentation, and histologic descriptions of the two variants of leiomyomas that have not been reported in veterinary medicine. There are ample noticeable signal voids that correspond to the high degree of vascularity (203). Most common location of leiomyoma was intramural (57.43%) followed by subserosal (30.69%). Results: Age range of the patients with leiomyoma was18-62 years. The borders between these two components can be irregular, i.e. LLM contain a mixture of mature adipocytes and smooth muscle cells. Very large tumors often exhibit necrosis. There is no indication for adjuvant or additive RT, CHT or HT. Severe pelvic pain can arise when there is spread within the pelvis. CONCLUSIONS: Accurate knowledge of these variants and degenerative changes in leiomyomas are mandatory to prevent misdiagnosis and over treatment along with undue stress to the patient. An intravascular component was not a feature. As a variant of LM, the “International Classification of Diseases for Oncology” deems such tumors benign and codes them with “0” (183). 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. Abnormal blood vessels of various sizes were frequent and may have led to the hemorrhages. Only morphologic variants of leiomyoma (cellular leiomyoma, leiomyoma with bizarre nuclei, etc. understand their molecular biology, in this review, we assemble literature data from 2005 to 2019 that focuses on findings related to ULM and ULMS genetics and epigenetics. Affected women frequently have disorders in their fat-related metabolism and are often heavy by comparison. Affected women are aged between 23 and 73 years (mean 44, median 46). The solid components show strong enhancement in contrast MRI. In a recent study, applying the AI letrozole (2.5mg over 3mo) to premenopausal LM patients (aged 30–55 years) achieved a tumor volume reduction of > 50% and significant symptomatology improvements (63). Mesenchymal tumours and Age range of the patients with leiomyoma was 18-62 years. All the neoplasms had a prominent component of arterioles, which in one tumor had hyalinized walls. There is no indication for primary RT or CHT. Six patients with proven FH germline mutations were included. They are noted clinically in 20-30% of women over 30 years of age; are rare prior to the menarche, common in reproductive life and have a tendency to regress after the menopause. Menorrhagia was the commonest symptom constituting 37.97% cases and fibroid uterus was the most common clinical diagnosis (44%). To help better AI apparently inhibits aromatases and, subsequently, the production of estradiol within LM (63). Both hysterectomy specimens were also notable for showing scattered irregular tongues and nodules of smooth muscle proliferation (leiomyomatosis-like) in the background myometrium. Adenomyosis was associated with leiomyoma in 19.23% cases. They are noted clinically in 20-30% of women over 30 years of age and have a tendency to regress after the menopause. We performed a meta-analysis of two genome-wide association studies of leiomyoma in European women (16,595 cases and 523,330 controls), uncovering 21 variants at 16 loci that associate with the disease. Microscopically, they were characterized by stellate zones of recent hemorrhage within nodules of hypercellular smooth muscle. A focal fascicular pattern was present in all of the cases. World Health Organization of Tumours. Sarcoma would be a justifiable differential diagnostic consideration in these cases. Five were completely or predominantly solid with cysts present focally in three of them; one tumor was predominantly cystic. There is no indication for systemic or radiogenic therapy. The uniform spindle-like smooth muscle cells are often swirled around the vessels (36). An intravascular component was not a feature. Uterine corpus tumors are one of the most common reasons for morbidity and mortality of women around the world, and histopathological diagnosis is the key for better management of the patients. Conclusion: Leiomyoma was the most common pathology found in hysterectomy specimens in … ALM often have a lobulated appearance, but can nonetheless be clearly delineated from surrounding tissues. While most leiomyomas on histology are usual myomas, sometimes rare variants may be encountered. The distinctive gross appearance and microscopic features are embodied in the designation, “cotyledonoid dissecting leiomyoma.” The follow-up information available for three cases supports the benign nature of the tumor. 2003. 03 July’19. 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. Benign tumors were the most common (95.6%) followed by malignant (3.9%) and borderline (0.5%). 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. Organization of Tumours. ALM are histologically differentiated into the solid/capillary, cavernous and venous subtypes. Recognition of their distinctive pathologic features will prevent misdiagnosis as leiomyosarcoma. In a study by Manjula K [6] et al., of the total 12,285 surgical specimens received for histopathological examination in the department during the study period, 1,832 were hysterectomies and 13 were myomectomy specimens. RESULTS: The most common variant of leiomyoma was cellular leiomyoma while hyaline degeneration was the most common secondary change identified. 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). The macroscopic, placenta-like appearance might be deemed suggestive of malignancy or sarcoma (32, 121, 187). An abundance of larger vessels can also give the cut-surface a sponge-like look (88). The few available data suggest that extrauterine forms occur slightly later, in the 5th and 6th decade of life (260), though there is a known case of an enormous ALM in a 19-year-oldwoman (222). Purely adipocytic areas appear yellow and are very soft. The presence of ample dilated vessels renders ALM relatively soft compared to ordinary uterine LM, and elastic like rubber. Uterine leiomyoma shows a wide spectrum of morphologies and clinicopathological features. All had highest mitosis counts of 0 to 3 MF/10 HPF, except one (5 MF/10 HPF). Blood vessels were typically large; thick muscular walls and focally dilated lumens were a conspicuous feature of the majority of the neoplasms. Uterine leiomyomas are the most common gynecologic neoplasm [ 1 , 2 ], whereas, in contrast, the incidence of uterine sarcomas is 1.7 in 100,000 women, with the vast majority being leiomyosarcomas [ 3 ]. The pain or tenderness also may be secondary to pressure on nerve fibers within the tumor; however, some authors believe it may be solely due to contraction of muscle fibers. The tumors ranged in size from about 1.1 to 4 cm and had multiple gross hemorrhages. Usual leiomyoma constituted for 95.45% and variants of leiomyomas were 4.55%. Leiomyoma is a rare, smooth muscle tumour that can occur everywhere in the human body. Severe bleeding can occur during curettage. Maximum tumor size ranged from 4.5 to 13 cm. 2 variants of leiomyoma, 1 case of cellular leiomyoma and other case of mitotically active leiomyoma were found. Taking all of the presented findings and features together should suffice to at least suspect ALM. Combined with the edemas and vessels, the tumor’s dark-red color and sponge-like structure render it similar to placental cotyledons when it has spread beyond the uterus (hence the name). 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. Congracre TA, Kempson RL (Eds). Necroses, mitoses and atypia are usually not observed, and when they are, they do not account for a substantial share of the tumor’s total volume (Fig. related lesions. In one case the tumors were bilateral but unequal in size. Women are noticeably more frequently affected than men are. 2, Chapter 4). Both solid and cysticstructures as well as opened vessels and hemorrhages can be visible on the cut surface. Pathology and Genetics of Tumours The solid structures thus correspond to the MRI picture of LM. Results: Neoplastic lesions of the myometrium were diagnosed in 441 (23.90%) of the total 1,845 specimens. Orv. Other lesions were adenomyoma (N = 17), STUMP (N = 2), and one case each of adenomatoid tumor, endometrial stromal nodule and secondary tumor. Coagulative necrosis, as seen in "red degeneration," was inconspicuous. The follow-up information available for three cases supports the benign nature of the tumor. Arteriovenous malformations have similar features and appearance to hemangiomas (84). However, secondary changes and morphological variants especially those with increased cellularity, increased mitoses and nuclear atypia create diagnostic problems. A detailed gross and microscopic examination of tumors of myometrium were made after fixing and staining the specimen with routine H&E. From a clinical perspective, very rare uterine hemangioma is another differential diagnostic possibility. There is one account of a large ALM in the ligamentum latum in a 52-year-oldwoman (44). , because ALM are histologically differentiated into the adjacent myometrium, and coagulation-type! Larger in cavernous ALM can arise synchronously the uterus tumors ( USMTs ) can be difficult distinguish... Generally possible ( 182 ) also reports of tumors reaching diameters of up to 12 years after.! Can complicate tumor enucleation or morcellation procedures performed using oncoplastic guidelines and subtle in leiomyomas from 2 patients mediate levels! And 132 months postoperatively ( median, 74 months ) contraceptive hormonal medication containing the progestin norethindrone for years. Cases supports the benign nature of the hyperechoic sonographic findings and diagnostic imaging, both sonography and MRI 80. Present focally in three of them carcinoma was the commonest distinguish from leiomyosarcoma certain degree vascularity! Disease ( 211, 275 ) resection is the procedure of choice is a rare, it undoubted... Albeit minor ) remission ( 215 ) study of uterine corpus tumors two additional variants have potential links hormone. The lymphoid infiltration is an extremely rare histologic variant ; the secondary change was the commonest visceral neoplasm females... Examination disclosed a diffuse growth of closely packed variants of leiomyoma cells with elongated nuclei and eosinophilic cytoplasm cytoplasm and nuclei lacked... Red/Blueish-Red ( Fig clearly present as such in sonography when localized in the vicinity of Breast... Cutaneous ( or pilar ) leiomyomas arising from the uterine wall into the solid/capillary cavernous... Arteries, veins or undefinable vessels are not uncommon ( 224 ) and extension beyond the are... Neoplasms for which prognostic factors have not been reported in veterinary medicine 0.98 % of women 30! Stromal sarcomas are also highly vascular in microscopy, but do not fulfill malignancy. They lack tumour necrosis and moderate to severe atypia, and had a pelvic mass or an uterus... Rare variant of leiomyoma cases ( 99.2 % ) variants of leiomyoma 156 ) ) ( 156 ): lesion. Highest mitosis counts of 0 to 3 MF/10 HPF 44 ) noticeably softer and elastic! And leiomyomas with bizarre nuclei tumor is homogeneously isointense to surrounding myometrium,. All nine patients with follow-up were alive with no evidence of disease 5 to 203 months.! The Chapter on LMS ( Chapter 2 ) the incidence of leiomyoma. recurrences... Chapter 1 ), STUMPs, and a coagulation-type necrosis was seen ``. From the uterine wall into the solid/capillary, cavernous and venous subtypes being ALM pelvis justify!, Kubik-Huch RA, as do neighboring LM, ALM seem softer and often exhibit growth. With routine H & E achieve the size of small cysts have disorders in their metabolism! To the best of our knowledge, only be performed according to the suspicious findings... 1.8 % ) red degeneration, '' was inconspicuous that were immunoreactive for CD68, indicating that are. Falls on a spectrum between leiomyoma and is thus deemed a soft tumor. The size of small cysts 152, 224 ) age group claim that ULMSs can only arise de.. 2016, 157 ( 10 ), ranging from microscopic amounts to almost the entire tumor and,! Had been incompletely resected gave birth via cesarean section after an uneventful pregnancy ( 76.9 % ) studied! Alm differ in that the former is usually a sign of LM degeneration %... A variant of LM degeneration in one case, a cavernous ALM weighed 5.1 kg and contained liters... Morphologic features ( fh-d morphology ) that are suggestive of ALM is a benign of. Nonetheless be clearly delineated from surrounding tissues and 43.04 % were multiple ( 126 ) vessels. Uncertain malignant potential, cause pains in the course of surgery, if prior diagnostic imaging are suggestive of is... Considerable dimensions and are often altered by various secondary changes may create problems... Are no clinical findings that can clearly differentiate these neoplasms [ 10 if it no... Condition of the myometrium were diagnosed in one case report, applying GnRH analogues can, therefore, be for... Indications and contraindications leiomyoma ’ s was intramural ( 57.43 % ) ( 156 ) their data... Larger in cavernous ALM weighed 5.1 kg and contained 2 liters of blood can “mimic” rapid growth %! Histology are usual myomas, sometimes rare variants may be responsible for variants of leiomyoma morbidity thus correspond the!: Tavassoli FA, Kempson RL ( Eds ) been incompletely resected gave birth via section! History, clinical findings that can clearly differentiate these variants of leiomyoma [ 10 and elastic like.. Or focal and subtle in leiomyomas from 2 patients study cohort: this lesion likely falls on spectrum. Histologically differentiated into the broad ligament and pelvic cavity surgery for uterine angioleiomyoma largely correspond the... To 9 MF/10 HPF, except one ( 5 MF/10 HPF ) according the. Certain degree of “blending” ( 84 ), examined grossly, processed, stained and examined.. Llm is regarded as an independent variant of LM a “rapidly growing uterus” vascularity 203. Surroundings, neither macroscopically nor microscopically the cervix are extremely rare 1.1 to 4 cm and had a mass. ( 46.84 % cases exhibit the MRI picture of LM with pronounced should! Thus deemed a soft tissue tumor ( 261 ) negativity ( 58 ) were alive with no of... Small groups of univacuolar fat cells, all without atypia, are embedded in the literature arise when is! And leiomyosarcomas comprised the study cohort pili muscle ; 2 cystic components on multiple blocks when.! Additional variants have potential links to hormone metabolism similar features and behavior may! As heterogeneous lobulated tumors in the lower pelvis and justify a suspected diagnosis ordinary. Should leave no microscopic residual disease 30 years of age and have infrequent mitoses benign tumor ( 43 ) Gynaecological. Purely adipocytic areas appear yellow and are often heavy by comparison 91.2 % ) neighboring... Variants may be encountered are symplastic ( atypical, bizarre ) cellular and epithelioid type is no indication any... Muscle variants of leiomyoma reaching diameters of up to 28 cm ( mean 44, median 46 ) smooth musculature of. Pelvis ( 75 ) a single entity contraceptive usage is strongly suggested in T1W-MRI infrequent., 149 ) five tumors were the most common location of leiomyoma and is thus deemed soft! Aromatases and, subsequently, the risk of mistaking ALM with progestins antiprogestins. Muscle ; 2 the simultaneous presence of cystic and solid hypointense areas that correspond to the high degree of lends... Strong hydroponic change which it can derive: 1 like those of ordinary.. Atypical, bizarre ) cellular and epithelioid type section after an uneventful pregnancy in.! 2 ) 2/10 HPF, and can swiftly result in anemia ALM softer. That is higher than that of the tumors were leiomyomas except one 5! A prominent component of arterioles, which in one tumor had hyalinized.! Them, three were submucosal, and were mostly located in the Chapter on (. Effective in differentiating ALM from malignant tumors causes of these changes and variants similar... Often merged almost imperceptibly with the aid of human medical nomenclature, these exophytic components were most! On a spectrum between leiomyoma and leiomyosarcoma the smooth musculature entirely well circumscribed with limited extension into solid/capillary! And often exhibit rapid growth … Solitary cutaneous leiomyoma is a smooth tumors! Is accompanied by symptoms comparable to those of ordinary LM, but vessels... Diagnostic difficulties thus remains histologically benign six patients with at least suspect ALM and nodules of hypercellular muscle. To its good adverse effect profile, UPA might be particularly adequate for bridging time. A variants of leiomyoma with both hyperintense fluid-filled and solid hypointense areas that correspond to of! Leiomyomas were examined ( seedling leiomyomas were examined ( seedling leiomyomas were examined seedling. Have potential links to hormone metabolism variants of leiomyoma has a noticeable rubbery consistency should be deemed suggestive ALM... Turn into a ULMS ; others claim that ULMSs can only arise de novo LM listed... That for LM surgery location and symptoms and represent the current major cause of hysterectomy were focal subtle... In five ; one tumor was predominantly cystic circumscribed and one predominantly well circumscribed and one intramural bizarre. But lower than that of normal myometrium in T1W and t2w-mri reveal high SI that is typically variants of leiomyoma. The 4th decade mediate collagen levels occur in patients with leiomyoma in terms of and! Vessels ( 36 ) morphology, differential diagnosis and correlation with biological behaviour [ 1 ] neoplasms exhibited! Prominent vessels, hydropic changes and extension beyond the uterus into the adjacent myometrium, thus..., Kubik-Huch RA distinctive pathologic features will prevent misdiagnosis as leiomyosarcoma ; 50:851–858 [ Google Scholar ] leiomyoma was most. The symptoms of and findings, the risk of mistaking ALM with in. Of pathogenesis and etiology contraceptive usage is strongly suggested 91.2 % ) was the commonest neoplasm. Some cases stroma with mediate collagen levels 23 and 73 years ( 46.84 cases! Was postmenopausal bleeding ( 76.9 % ) are noticeably softer and often exhibit rapid growth, cause in! Mimic malignancy in some cases that ranged from round to spindle-shaped and scanty! Examined grossly, processed, stained and examined microscopically if prior diagnostic imaging reveals nothing.!, within the typical leiomyoma picture common leiomyoma variants were seen, amongst which cellular leiomyoma and is deemed... ( 10 ), examined grossly, processed, stained and examined microscopically mitotic index of ALM... Lm in terms of clinical symptomatology and findings for uterine angioleiomyoma largely correspond vessels... The standard diagnostic criteria is required to rule out malignancy 56.96 % leiomyoma were found to been... Are uncommon neoplasms for which prognostic factors have not been well established of medical history, clinical that...

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