Difference between revisions of "Leiomyoma"

From Libre Pathology
Jump to navigation Jump to search
(+SO)
(→‎Microscopic: +images)
Line 29: Line 29:
** Fascicular appearance: adjacent groups of cells have their long axis perpendicular to one another; looks somewhat like a braided hair that was cut.
** 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.
* Whorled arrangement of cells.
* Often arise from a muscular artery -- medium-sized artery seen at the periphery of the lesion.


Uncommonly present - see note:
Uncommonly present - see note:
Line 46: Line 47:
===Variants===
===Variants===
*Lipoleiomyoma - with adipose tissue.
*Lipoleiomyoma - with adipose tissue.
**Image: [http://commons.wikimedia.org/wiki/File:Lipoleiomyoma1.jpg Lipoleiomyoma - low mag. (WC)].
*Hypercellular leiomyoma - hypercellularity assoc. with more mutations.<ref>[http://www3.interscience.wiley.com/journal/119360394/abstract http://www3.interscience.wiley.com/journal/119360394/abstract]</ref>
*Hypercellular leiomyoma - hypercellularity assoc. with more mutations.<ref>[http://www3.interscience.wiley.com/journal/119360394/abstract http://www3.interscience.wiley.com/journal/119360394/abstract]</ref>
*Atypical leiomyoma ([[AKA]] ''symplastic leiomyoma'') - leiomyoma with nuclear atypia.
*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>{{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>
*Benign metastasizing leiomyoma.<ref>{{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.
**This is just what it sounds like.  Some believe these are low grade [[leiomyosarcoma]]s.
<gallery>
Image:Atypical_leiomyoma_intermed_mag.jpg | Atypical leiomyoma. (WC/Nephron)
Image:Lipoleiomyoma1.jpg | Lipoleiomyoma - low mag. (WC/Nephron)
</gallery>


==IHC==
==IHC==

Revision as of 19:12, 28 May 2013

A leiomyoma is a very common benign tumour of smooth muscle. Leiomyomas fit into the soft tissue group of lesions. They are extremely common in the uterus. They may also be seen in the skin.

General

  • Benign.

Cutaneous leiomyomas

  • May be part of Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC).[1][2]

Uterine leiomyoma

Main article: Uterine leiomyoma
  • Often called "fibroids".
  • Extremely common... 40% of women by age 40.
  • Can be a cause of AUB (abnormal uterine bleeding).
  • Large & multiple leiomyomas are associated with infertility.

Gross

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

Factors 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.
  • Often arise from a muscular artery -- medium-sized artery seen at the periphery of the lesion.

Uncommonly present - see note:

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

Note:

  • Leiomyosarcoma is diagnosed if all of the following are present: (1) high mitotic rate (dependent on site), (2) marked nuclear atypia (seen at low power), (3) necrosis.

DDx:

Variants

  • Lipoleiomyoma - with adipose tissue.
  • Hypercellular leiomyoma - hypercellularity assoc. with more mutations.[4]
  • Atypical leiomyoma (AKA symplastic leiomyoma) - leiomyoma with nuclear atypia.
  • Benign metastasizing leiomyoma.[5]
    • This is just what it sounds like. Some believe these are low grade leiomyosarcomas.

  • Atypical leiomyoma. (WC/Nephron)

  • Lipoleiomyoma - low mag. (WC/Nephron)

IHC

Work-up of suspicious leiomyomas:[6]

  • CD10 +ve.
  • Ki-67 -ve.
  • SMA +ve.
  • Desmin +ve.

Other stains:

  • H-caldesmon +ve.[7]

Sign out

SKIN LESION, RIGHT LEG, EXCISION:
- LEIOMYOMA.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
The lesion stains for desmin and SMA. It is negative for S-100 and has minimal staining with Ki-67.

See also

References

  1. ↑ URL: http://www.ncbi.nlm.nih.gov/books/NBK1252/. Accessed on: 2 September 2011.
  2. ↑ URL: http://ccr.cancer.gov/staff/gallery.asp?profileid=12822. Accessed on: 2 September 2011.
  3. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 533. ISBN 978-0443066542.
  4. ↑ http://www3.interscience.wiley.com/journal/119360394/abstract
  5. ↑ 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.
  6. ↑ STC. 25 February 2009.
  7. ↑ Zámecník, M.; Kascák, P. (Jul 2011). "Uterine leiomyoma with amianthoid-like fibers.". Cesk Patol 47 (3): 125-7. PMID 21887931.
Retrieved from "https://librepathology.org/w/index.php?title=Leiomyoma&oldid=22017"