Leiomyoma

From Libre Pathology
Revision as of 04:56, 3 June 2011 by Michael (talk | contribs) (tweakl)
Jump to navigation Jump to search

Leiomyomas are very common benign smooth muscle tumours. They fit into the soft tissue group of lesions.

General

  • Benign.

Uterine leiomyomas

  • 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.

Negatives:

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

Variants

  • Lipoleiomyoma - with adipose tissue.
  • Hypercellular leiomyoma - hypercellularity assoc. with more mutations.[1]
  • Atypical leiomyoma (AKA symplastic leiomyoma) - leiomyoma with nuclear atypia.
  • Benign metastasizing leiomyoma.[2]
    • This is just what it sounds like. Some believe these are low grade leiomyosarcomas

IHC

Work-up of suspicious leiomyomas:[3]

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

See also

References

  1. http://www3.interscience.wiley.com/journal/119360394/abstract
  2. 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.
  3. STC. 25 February 2009.