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| =Common benign= | | =Common benign= |
| ==Uterine leiomyoma== | | ==Uterine leiomyoma== |
| {{Main|Leiomyoma}}
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| *Often called ''fibroids''. | | *Often called ''fibroids''. |
| *''Fibroid uterus'' redirects here.
| | {{Main|Uterine leiomyoma}} |
| ===General===
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| *Extremely common... 40% of women by age 40.
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| *Benign.
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| **Can be a cause of [[abnormal uterine bleeding]] (commonly abbreviated ''AUB'').
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| *Large & multiple associated with infertility.
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| *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>
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| ===Gross===
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| Feature:
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| * Sharply circumscribed.
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| * Gray-white.
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| * Whorled appearance.
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| Factor that raise concern for leiomyosarcoma:
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| * Haemorrhage.
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| * Cystic degeneration.
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| * [[Necrosis]].
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| ===Microscopic===
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| Features:
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| * Spindle cells arranged in fascicles.
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| ** Fascicular appearance: adjacent groups of cells have their long axis perpendicular to one another; looks somewhat like a braided hair that was cut.
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| * Whorled arrangement of cells.
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| Negatives:
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| * Necrosis (low power) - suggestive of leiomyosarcoma.
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| * Hypercellularity.
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| * Nuclear atypia seen at low power.
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| * Few mitoses.
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| Images:
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| *[http://commons.wikimedia.org/w/index.php?title=File:Cutaneous_leiomyosarcoma_-_a_-_intermed_mag.jpg Fascicular pattern - leiomyosarcoma (WC)].
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| ====Variants====
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| *Lipoleiomyoma - with adipose tissue.
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| **Image: [http://commons.wikimedia.org/wiki/File:Lipoleiomyoma1.jpg Lipoleiomyoma - low mag. (WC)].
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| *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>
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| *Atypical leiomyoma (AKA ''symplastic leiomyoma'') - leiomyoma with nuclear atypia.
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| **Image: [http://commons.wikimedia.org/wiki/File:Atypical_leiomyoma_intermed_mag.jpg Atypical leiomyoma (WC)].
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| *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>
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| **This is just what it sounds like. Some believe these are low grade [[leiomyosarcoma]]s.
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| ===IHC===
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| Work-up of suspicious leiomyomas:<ref>STC. 25 February 2009.</ref>
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| *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>
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| *SMA +ve.
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| *Desmin +ve.
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| *Ki-67 -ve.
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| Others:
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| *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>
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| **Often +ve in leiomyosarcoma.
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| *H-caldesmon +ve.<ref name=pmid14751141/>
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| ===Sign out===
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| <pre>
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| UTERUS WITH CERVIX, UTERINE TUBES AND LEFT OVARY, TOTAL HYSTERECTOMY, BILATERAL SALPINGECTOMY
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| AND LEFT OOPHRECTOMY:
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| - LEIOMYOMATA WITH FOCAL CALCIFICATION AND HYALINE CHANGE.
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| - SECRETORY PHASE ENDOMETRIUM.
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| - LEFT OVARY WITHIN NORMAL LIMITS.
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| - UTERINE TUBES WITHIN NORMAL LIMITS.
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| - UTERINE CERVIX WITHIN NORMAL LIMITS.
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| </pre>
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| ====Myomectomy====
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| <pre>
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| UTERINE MASSES ("FIBROIDS"), MYOMECTOMY:
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| - LEIOMYOMATA.
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| </pre>
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| <pre>
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| UTERINE MASS, HYSTEROSCOPIC MYOMECTOMY:
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| - BENIGN SMOOTH MUSCLE FRAGMENTS COMPATIBLE WITH LEIOMYOMA.
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| - SECRETORY PHASE ENDOMETRIUM.
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| </pre>
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|
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| =Uncommon benign= | | =Uncommon benign= |
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| Images: | | Images: |
| *[http://www.webpathology.com/image.asp?n=6&Case=572 Adenofibroma of the uterus - low mag. (webpathology.com)]. | | *[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496288/figure/F2/ Adenofibroma (nlm.nih.gov)].<ref>{{cite journal |authors=Chawla L, Vatsa R, Roy KK, Kumar S |title=Uterine Adenofibroma: An Unsual Cause of Nonpuerperal Uterine Inversion in Postmenopausal Female |journal=J Midlife Health |volume=8 |issue=2 |pages=95–97 |date=2017 |pmid=28706412 |pmc=5496288 |doi=10.4103/jmh.JMH_27_17 |url=}}</ref> |
| *[http://www.webpathology.com/image.asp?n=7&Case=572 Adenofibroma of the uterus - high mag. (webpathology.com)].
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| ==Adenomatoid tumour== | | ==Adenomatoid tumour== |
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| ==Adenosarcoma of the uterus== | | ==Adenosarcoma of the uterus== |
| *[[AKA]] ''uterine adenocarcinoma''. | | *[[AKA]] ''uterine adenosarcoma''. |
| ===General===
| | {{Main|Adenosarcoma of the uterus}} |
| Features:<ref name=pmid20179434>{{Cite journal | last1 = McCluggage | first1 = WG. | title = Mullerian adenosarcoma of the female genital tract. | journal = Adv Anat Pathol | volume = 17 | issue = 2 | pages = 122-9 | month = Mar | year = 2010 | doi = 10.1097/PAP.0b013e3181cfe732 | PMID = 20179434 }}</ref>
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| *Uncommon.
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| *May prolapse through cervical os and thus present as [[cervical polyp]].
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| *Most commonly uterine corpus, occasionally cervix and ovary, rarely in the vagina, fallopian tube, peritoneal surfaces, intestine.
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| *Typically 30-40 years old.
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| Clinical:<ref name=pmid17506376>{{Cite journal | last1 = Abu | first1 = J. | last2 = Ireland | first2 = D. | last3 = Brown | first3 = L. | title = Adenosarcoma of an endometrial polyp in a 27-year-old nulligravida: a case report. | journal = J Reprod Med | volume = 52 | issue = 4 | pages = 326-8 | month = Apr | year = 2007 | doi = | PMID = 17506376 }}</ref>
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| *Most common presentations of Müllerian adenosarcoma (percentages based on series of 41 individuals<ref name=pmid9625851>{{Cite journal | last1 = Verschraegen | first1 = CF. | last2 = Vasuratna | first2 = A. | last3 = Edwards | first3 = C. | last4 = Freedman | first4 = R. | last5 = Kudelka | first5 = AP. | last6 = Tornos | first6 = C. | last7 = Kavanagh | first7 = JJ. | title = Clinicopathologic analysis of mullerian adenosarcoma: the M.D. Anderson Cancer Center experience. | journal = Oncol Rep | volume = 5 | issue = 4 | pages = 939-44 | month = | year = | doi = | PMID = 9625851 }}</ref>):
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| **Vaginal bleeding ~ 70%.
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| **Pelvic mass ~ 40%.
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| **Uterine polyp ~ 30%.
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| *Prognosis (based on series of ~500 individuals<ref name=pmid20688363>{{Cite journal | last1 = Arend | first1 = R. | last2 = Bagaria | first2 = M. | last3 = Lewin | first3 = SN. | last4 = Sun | first4 = X. | last5 = Deutsch | first5 = I. | last6 = Burke | first6 = WM. | last7 = Herzog | first7 = TJ. | last8 = Wright | first8 = JD. | title = Long-term outcome and natural history of uterine adenosarcomas. | journal = Gynecol Oncol | volume = 119 | issue = 2 | pages = 305-8 | month = Nov | year = 2010 | doi = 10.1016/j.ygyno.2010.07.001 | PMID = 20688363 }}</ref>):
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| **Favourable outcome - most detected at an early stage.
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| ***~80% five year survival for stage I tumours.
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| **Outcome better than [[uterine carcinosarcoma|carcinosarcoma]].
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| Treatment:
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| *TAH-BSO.
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| **Tumours are estrogen responsive.
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| *Chemotherapy (platin-based).<ref name=pmid9625851/>
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| ===Microscopic===
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| Features:<ref name=Ref_PBoD1089>{{Ref PBoD|1089}}</ref><ref name=pmid20179434/>
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| *"Malignant stroma" - '''key feature'''.
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| **Stromal nuclear pleomorphism - usually low grade.
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| **WHO criteria: 2+ mitoses / 10 HPF -- definition suffers from [[HPFitis]].
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| ***Mitotic rate criteria often ignored as mitotically inactive tumours metastasize.<ref name=pmid20179434/>
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| *Benign glands with an abnormal shape.
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| *"Cambium layer" = increased cellularity around the epithelial elements.<ref name=pmid20179434/><ref name=medilexicon_cambium/>
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| Notes:
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| *Tumour may vaguely resemble a [[phyllodes tumour]].<ref name=pmid20179434/>
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| *''Cambium layer'' - seen in: adenosarcoma, botryoid [[RMS]].<ref name=medilexicon_cambium>URL: [http://www.medilexicon.com/medicaldictionary.php?t=48297 http://www.medilexicon.com/medicaldictionary.php?t=48297]. Accessed on: 9 August 2011.</ref>
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| DDx:
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| *[[Benign endometrial polyp]].
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| *[[Uterine adenofibroma]].
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| ====Images====
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| <gallery>
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| Image:Uterine_adenosarcoma_-_low_mag.jpg | Uterine adenosarcoma - low mag. (WC)
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| Image:Uterine_adenosarcoma_-_intermed_mag.jpg | Uterine adenosarcoma - intermed. mag. (WC)
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| Image:Uterine_adenosarcoma_-_high_mag.jpg | Uterine adenosarcoma - high mag. (WC)
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| </gallery>
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| ===IHC===
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| *CD10 +ve.<ref name=pmid20179434/>
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| *ER +ve.
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| *PR +ve.
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| ==Uterine leiomyosarcoma== | | ==Uterine leiomyosarcoma== |