Difference between revisions of "Uterine leiomyoma"

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#redirect [[Uterine_tumours#Uterine_leiomyoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Histopathology of uterine leiomyoma.jpg
| Width      =
| Caption    = Uterine leiomyoma. [[H&E stain]].
| Synonyms  = uterine fibroid
| Micro      = spindle cells arranged in fascicles, usually without atypia
| Subtypes  = atypical leiomyoma (symplastic leiomyoma), lipoleiomyoma, cellular leiomyoma, others
| LMDDx      = [[leiomyosarcoma]], [[STUMP]], [[dermatomyofibroma]], [[adenomatoid tumour]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = sharply circumscribed lesion, gray-white, whorled appearance
| Grossing  = [[Hysterectomy for fibroids grossing]]
| Staging    =
| Site      =
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = very common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = other [[uterine tumours]]
| Tx        = surgical (myomectomy, hysterectomy) or medical
}}
'''Uterine leiomyoma''', commonly '''fibroid''', is a very common benign smooth muscle tumour of the [[uterus]].


The more general topic of leiomyoma is covered in the article ''[[leiomyoma]]''.
==General==
*Extremely common... 40% of women by age 40.
*Benign.
**Can be a cause of [[abnormal uterine bleeding]] (commonly abbreviated ''AUB'').
*Large & multiple associated with infertility.
*May be treated medically with a [[selective progesterone receptor modulator]], e.g. ''[[ulipristal]]'' (''Fibristal'').<ref name=pmid24712276>{{Cite journal  | last1 = Delev | first1 = DP. | title = Ulipristal acetate--a review of the new therapeutic indications and future prospects. | journal = Folia Med (Plovdiv) | volume = 55 | issue = 3-4 | pages = 5-10 | month =  | year =  | doi =  | PMID = 24712276 }}</ref>
==Gross==
Feature:
* Sharply circumscribed.
* Gray-white.
* Whorled appearance.
Factor that raise concern for leiomyosarcoma:
* Haemorrhage.
* Cystic degeneration.
* [[Necrosis]].
==Microscopic==
Features:
* Spindle cells arranged in fascicles.
** Fascicular appearance: adjacent groups of cells have their long axis perpendicular to one another; looks somewhat like a braided hair that was cut.
* Whorled arrangement of cells.
Negatives:
* Necrosis (low power) - suggestive of leiomyosarcoma.
* Hypercellularity.
* Nuclear atypia seen at low power.
* Few mitoses.
DDx:
*[[Leiomyosarcoma]].
*[[Smooth muscle tumour of uncertain malignant potential]] (STUMP).
*[[Adenomatoid tumour]].
===Variants===
<!-- variants https://www.ajronline.org/doi/full/10.2214/AJR.14.13946 -->
*Lipoleiomyoma - with adipose tissue.
**Image: [http://commons.wikimedia.org/wiki/File:Lipoleiomyoma1.jpg Lipoleiomyoma - low mag. (WC)].
*Hypercellular leiomyoma - hypercellularity associated with more mutations.<ref name=pmid_none>{{Cite journal  | last1 = Pandis | first1 = N. | last2 = Heim | first2 = S. | last3 = Willén | first3 = H. | last4 = Bardi | first4 = G. | last5 = Flodérus | first5 = U-M. | last6 = Mandahl | first6 = N. | last7 = Mitelman | first7 = F. | title = Histologic—cytogenetic correlations in uterine leiomyomas. | journal = International Journal of Gynecological Cancer | volume = 1 | issue = 4 | pages = 163-68 | month = Jan | year = 1991 | doi = | PMID =  |url=http://www3.interscience.wiley.com/journal/119360394/abstract }}</ref>
*Atypical leiomyoma (AKA ''symplastic leiomyoma'') - leiomyoma with nuclear atypia.
**Image: [http://commons.wikimedia.org/wiki/File:Atypical_leiomyoma_intermed_mag.jpg Atypical leiomyoma (WC)].
*Benign metastasizing leiomyoma.<ref name=pmid16357844>{{Cite journal  | last1 = Patton | first1 = KT. | last2 = Cheng | first2 = L. | last3 = Papavero | first3 = V. | last4 = Blum | first4 = MG. | last5 = Yeldandi | first5 = AV. | last6 = Adley | first6 = BP. | last7 = Luan | first7 = C. | last8 = Diaz | first8 = LK. | last9 = Hui | first9 = P. | title = Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis. | journal = Mod Pathol | volume = 19 | issue = 1 | pages = 130-40 | month = Jan | year = 2006 | doi = 10.1038/modpathol.3800504 | PMID = 16357844 |url=http://www.nature.com/modpathol/journal/v19/n1/full/3800504a.html}}</ref>
**This is just what it sounds like.  Some believe these are low grade [[leiomyosarcoma]]s.
==IHC==
Work-up of suspicious leiomyomas:<ref>STC. 25 February 2009.</ref>
*CD10 +ve.<ref name=pmid14751141>{{Cite journal  | last1 = Zhu | first1 = XQ. | last2 = Shi | first2 = YF. | last3 = Cheng | first3 = XD. | last4 = Zhao | first4 = CL. | last5 = Wu | first5 = YZ. | title = Immunohistochemical markers in differential diagnosis of endometrial stromal sarcoma and cellular leiomyoma. | journal = Gynecol Oncol | volume = 92 | issue = 1 | pages = 71-9 | month = Jan | year = 2004 | doi =  | PMID = 14751141 }}</ref>
*SMA +ve.
*Desmin +ve.
*[[Ki-67]] -ve.
Others:
*p16 usually -ve.<ref name=pmid18156978>{{Cite journal  | last1 = Gannon | first1 = BR. | last2 = Manduch | first2 = M. | last3 = Childs | first3 = TJ. | title = Differential Immunoreactivity of p16 in leiomyosarcomas and leiomyoma variants. | journal = Int J Gynecol Pathol | volume = 27 | issue = 1 | pages = 68-73 | month = Jan | year = 2008 | doi = 10.1097/pgp.0b013e3180ca954f | PMID = 18156978 }}</ref>
**Often +ve in leiomyosarcoma.
*H-caldesmon +ve.<ref name=pmid14751141/>
==Sign out==
<pre>
Uterine Cervix, Uterus, Bilateral Tubes and IUD, Total Hysterectomy and Bilateral Salpingectomy:
- Uterine leiomyomas.
- Mild atherosclerosis.
- Inactive endometrium.
- Intrauterine device (IUD) - gross only.
- Uterine cervix within normal limits.
- Left uterine tube with small paratubal cyst, negative for
  significant pathology.
- Right uterine tube with paratubal cyst, negative for significant pathology.
- NEGATIVE for malignancy.
</pre>
===Block letters===
<pre>
UTERUS WITH CERVIX, UTERINE TUBES AND LEFT OVARY, TOTAL HYSTERECTOMY, BILATERAL SALPINGECTOMY
AND LEFT OOPHRECTOMY:
- LEIOMYOMATA WITH FOCAL CALCIFICATION AND HYALINE CHANGE.
- SECRETORY PHASE ENDOMETRIUM.
- LEFT OVARY WITHIN NORMAL LIMITS.
- UTERINE TUBES WITHIN NORMAL LIMITS.
- UTERINE CERVIX WITHIN NORMAL LIMITS.
</pre>
===Myomectomy===
<pre>
UTERINE MASSES ("FIBROIDS"), MYOMECTOMY:
- LEIOMYOMATA.
</pre>
<pre>
UTERINE MASS, HYSTEROSCOPIC MYOMECTOMY:
- BENIGN SMOOTH MUSCLE FRAGMENTS COMPATIBLE WITH LEIOMYOMA.
- SECRETORY PHASE ENDOMETRIUM.
</pre>
===Micro===
The sections show bland spindle cells within a fascicular architecture. Hyaline change is present. No necrosis is seen. Mild proliferative activity is seen (~ 2 mitoses/10 HPFs, 1 HPF ~0.2376 mm*mm). No cytologic atypia is apparent.
==See also==
*[[Uterine tumours]].
==References==
{{Reflist|1}}
[[Category:Gynecologic pathology]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 17:26, 15 September 2022

Uterine leiomyoma
Diagnosis in short

Uterine leiomyoma. H&E stain.
Synonyms uterine fibroid
LM spindle cells arranged in fascicles, usually without atypia
Subtypes atypical leiomyoma (symplastic leiomyoma), lipoleiomyoma, cellular leiomyoma, others
LM DDx leiomyosarcoma, STUMP, dermatomyofibroma, adenomatoid tumour
Gross sharply circumscribed lesion, gray-white, whorled appearance
Grossing notes Hysterectomy for fibroids grossing
Prevalence very common
Prognosis benign
Clin. DDx other uterine tumours
Treatment surgical (myomectomy, hysterectomy) or medical

Uterine leiomyoma, commonly fibroid, is a very common benign smooth muscle tumour of the uterus.

The more general topic of leiomyoma is covered in the article leiomyoma.

General

Gross

Feature:

  • Sharply circumscribed.
  • Gray-white.
  • Whorled appearance.

Factor that raise concern for leiomyosarcoma:

  • Haemorrhage.
  • Cystic degeneration.
  • Necrosis.

Microscopic

Features:

  • Spindle cells arranged in fascicles.
    • Fascicular appearance: adjacent groups of cells have their long axis perpendicular to one another; looks somewhat like a braided hair that was cut.
  • Whorled arrangement of cells.

Negatives:

  • Necrosis (low power) - suggestive of leiomyosarcoma.
  • Hypercellularity.
  • Nuclear atypia seen at low power.
  • Few mitoses.

DDx:

Variants

  • Lipoleiomyoma - with adipose tissue.
  • Hypercellular leiomyoma - hypercellularity associated with more mutations.[2]
  • Atypical leiomyoma (AKA symplastic leiomyoma) - leiomyoma with nuclear atypia.
  • Benign metastasizing leiomyoma.[3]
    • This is just what it sounds like. Some believe these are low grade leiomyosarcomas.

IHC

Work-up of suspicious leiomyomas:[4]

  • CD10 +ve.[5]
  • SMA +ve.
  • Desmin +ve.
  • Ki-67 -ve.

Others:

  • p16 usually -ve.[6]
    • Often +ve in leiomyosarcoma.
  • H-caldesmon +ve.[5]

Sign out

Uterine Cervix, Uterus, Bilateral Tubes and IUD, Total Hysterectomy and Bilateral Salpingectomy:
- Uterine leiomyomas.
- Mild atherosclerosis.
- Inactive endometrium.
- Intrauterine device (IUD) - gross only.
- Uterine cervix within normal limits.
- Left uterine tube with small paratubal cyst, negative for 
  significant pathology.
- Right uterine tube with paratubal cyst, negative for significant pathology.
- NEGATIVE for malignancy.

Block letters

UTERUS WITH CERVIX, UTERINE TUBES AND LEFT OVARY, TOTAL HYSTERECTOMY, BILATERAL SALPINGECTOMY 
AND LEFT OOPHRECTOMY:
- LEIOMYOMATA WITH FOCAL CALCIFICATION AND HYALINE CHANGE.
- SECRETORY PHASE ENDOMETRIUM.
- LEFT OVARY WITHIN NORMAL LIMITS.
- UTERINE TUBES WITHIN NORMAL LIMITS.
- UTERINE CERVIX WITHIN NORMAL LIMITS.

Myomectomy

UTERINE MASSES ("FIBROIDS"), MYOMECTOMY:
- LEIOMYOMATA.

UTERINE MASS, HYSTEROSCOPIC MYOMECTOMY:
- BENIGN SMOOTH MUSCLE FRAGMENTS COMPATIBLE WITH LEIOMYOMA.
- SECRETORY PHASE ENDOMETRIUM.

Micro

The sections show bland spindle cells within a fascicular architecture. Hyaline change is present. No necrosis is seen. Mild proliferative activity is seen (~ 2 mitoses/10 HPFs, 1 HPF ~0.2376 mm*mm). No cytologic atypia is apparent.

See also

References

  1. ↑ Delev, DP.. "Ulipristal acetate--a review of the new therapeutic indications and future prospects.". Folia Med (Plovdiv) 55 (3-4): 5-10. PMID 24712276.
  2. ↑ Pandis, N.; Heim, S.; Willén, H.; Bardi, G.; Flodérus, U-M.; Mandahl, N.; Mitelman, F. (Jan 1991). "Histologic—cytogenetic correlations in uterine leiomyomas.". International Journal of Gynecological Cancer 1 (4): 163-68. http://www3.interscience.wiley.com/journal/119360394/abstract.
  3. ↑ Patton, KT.; Cheng, L.; Papavero, V.; Blum, MG.; Yeldandi, AV.; Adley, BP.; Luan, C.; Diaz, LK. et al. (Jan 2006). "Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis.". Mod Pathol 19 (1): 130-40. doi:10.1038/modpathol.3800504. PMID 16357844. http://www.nature.com/modpathol/journal/v19/n1/full/3800504a.html.
  4. ↑ STC. 25 February 2009.
  5. ↑ 5.0 5.1 Zhu, XQ.; Shi, YF.; Cheng, XD.; Zhao, CL.; Wu, YZ. (Jan 2004). "Immunohistochemical markers in differential diagnosis of endometrial stromal sarcoma and cellular leiomyoma.". Gynecol Oncol 92 (1): 71-9. PMID 14751141.
  6. ↑ Gannon, BR.; Manduch, M.; Childs, TJ. (Jan 2008). "Differential Immunoreactivity of p16 in leiomyosarcomas and leiomyoma variants.". Int J Gynecol Pathol 27 (1): 68-73. doi:10.1097/pgp.0b013e3180ca954f. PMID 18156978.
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