Difference between revisions of "Uterine leiomyoma"
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'''Uterine leiomyoma''', commonly '''fibroid''', is a very common benign smooth muscle tumour of the [[uterus]]. | '''Uterine leiomyoma''', commonly '''fibroid''', is a very common benign smooth muscle tumour of the [[uterus]]. | ||
Non-uterine leiomyomas are dealth with in the article ''[[leiomyoma]]''. | |||
==General== | ==General== | ||
Revision as of 19:30, 30 October 2017
Uterine leiomyoma, commonly fibroid, is a very common benign smooth muscle tumour of the uterus.
Non-uterine leiomyomas are dealth with 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).[1]
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.
- Image: Lipoleiomyoma - low mag. (WC).
- Hypercellular leiomyoma - hypercellularity associated with more mutations.[2]
- Atypical leiomyoma (AKA symplastic leiomyoma) - leiomyoma with nuclear atypia.
- Image: Atypical leiomyoma (WC).
- 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]
Others:
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
- ↑ Delev, DP.. "Ulipristal acetate--a review of the new therapeutic indications and future prospects.". Folia Med (Plovdiv) 55 (3-4): 5-10. PMID 24712276.
- ↑ 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.
- ↑ 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.
- ↑ STC. 25 February 2009.
- ↑ 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.
- ↑ 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.