Difference between revisions of "Leiomyosarcoma"

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837 bytes added ,  04:15, 20 December 2011
→‎Microscopic: more, subtypes
(→‎References: chg. cat.)
(→‎Microscopic: more, subtypes)
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==Microscopic==
==Microscopic==
Features:
Features:
*Cellular lesion.
*Usu. cellular lesion.
*Fasicular arrangement:  
*Fasciclar arrangement:  
**Whorled look at low power.
**Whorled look at low power.
**Groups of spindle cells cut peripendicular to their long axis adjacent to groups of spindle cells cut in the plane of their long axis.
**Groups of spindle cells cut peripendicular to their long axis adjacent to groups of spindle cells cut in the plane of their long axis.
*Features of malignancy (need all three):
*Features of malignancy (need all three):
*#Cellular atypia - common.
*#Nuclear atypia.
*#Necrosis.
*#Tumour cell necrosis.
*#*Should be patchy/multifocal.
*#*Should be patchy/multifocal.
*#**Zonal necrosis is suggestive of vascular cause.
*#**Zonal necrosis is suggestive of vascular cause.
*#Mitoses - '''key feature''' - definitions suffers from [[HPFitis]]:
*#Mitoses - '''key feature''' - definitions suffer from [[HPFitis]]:
*#*10 mitoses/HPF.
*#*>=10 mitoses/HPF - if spindled.<ref name=Ref_GP281>{{Ref GP|281}}</ref>
*#*5 mitoses/HPF - if epithelioid.
*#*>=5 mitoses/HPF - if epithelioid.<ref name=Ref_GP281>{{Ref GP|281}}</ref>
*#*2 mitoses/HPF - if myxoid.
*#*>=2 mitoses/HPF - if myxoid.<ref name=Ref_GP281>{{Ref GP|281}}</ref>
*#*>=1 mitosis/HPF - if cutaneous.<ref name=pmid21358302>{{cite journal |author=Kraft S, Fletcher CD |title=Atypical intradermal smooth muscle neoplasms: clinicopathologic analysis of 84 cases and a reappraisal of cutaneous "leiomyosarcoma" |journal=Am. J. Surg. Pathol. |volume=35 |issue=4 |pages=599–607 |year=2011 |month=April |pmid=21358302 |doi=10.1097/PAS.0b013e31820e6093 |url=}}</ref>
*#*>=1 mitosis/HPF - if cutaneous.<ref name=pmid21358302>{{cite journal |author=Kraft S, Fletcher CD |title=Atypical intradermal smooth muscle neoplasms: clinicopathologic analysis of 84 cases and a reappraisal of cutaneous "leiomyosarcoma" |journal=Am. J. Surg. Pathol. |volume=35 |issue=4 |pages=599–607 |year=2011 |month=April |pmid=21358302 |doi=10.1097/PAS.0b013e31820e6093 |url=}}</ref>


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**[http://commons.wikimedia.org/wiki/File:Cutaneous_leiomyosarcoma_-_high_mag.jpg Cutaneous leiomyosarcoma - high mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Cutaneous_leiomyosarcoma_-_high_mag.jpg Cutaneous leiomyosarcoma - high mag. (WC)].


===IHC===
===Subtypes===
Variants:<ref name=Ref_GP284>{{Ref GP|284}}</ref>
*Spindled leiomyosarcoma (leiomyosarcoma NOS) - see above.
*Epithelioid leiomyosarcoma.
*Myxoid leiomyosarcoma.
*Leiomyosarcoma with prominent intravascular growth.
*Leiomyosarcoma with osteoclast-type cells.
*Leiomyosarcoma with clear cells.
*Leiomyosarcoma with xanthoma-type cells.
 
====Epithelioid leiomyosarcoma====
Features:<ref name=Ref_GP281>{{Ref GP|281}}</ref>
*>50% epithelial appearance.
*>=5 mitoses/HPF - definition suffers from [[HPFitis]].
 
====Myxoid leiomyosarcoma====
Features:<ref name=Ref_GP281>{{Ref GP|281}}</ref>
*>=2 mitoses/HPF - definition suffers from [[HPFitis]].
*May have minimal nuclear atypia.
 
==IHC==
*CD10 -ve (important in the context of uterine lesions -- +ve in [[endometrial stromal sarcoma]]).
*CD10 -ve (important in the context of uterine lesions -- +ve in [[endometrial stromal sarcoma]]).
*Positive for SMC markers.
*Positive for SMC markers.
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