Difference between revisions of "Uterine leiomyoma"

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#redirect [[Uterine_tumours#Uterine_leiomyoma]]
'''Uterine leiomyoma''', commonly '''fibroid''', is a very common benign smooth muscle tumour of the [[uterus]].


==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.
Images:
*[http://commons.wikimedia.org/w/index.php?title=File:Cutaneous_leiomyosarcoma_-_a_-_intermed_mag.jpg Fascicular pattern - leiomyosarcoma (WC)].
===Variants===
*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]]

Revision as of 19:29, 30 October 2017

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

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.

Images:

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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