variants of leiomyoma

2 variants of leiomyoma, 1 case of cellular leiomyoma and other case of mitotically active leiomyoma were found. They often merged almost imperceptibly with the adjacent myometrium. Hypointense sections correspond to the smooth muscle component. 2003. Fat tissue can account for strongly varying shares of total tumor volume (Fig. All available slides were reviewed and FH IHC staining was performed on multiple blocks when possible. Cotyledonoid dissecting LM can also fill the entire pelvis (75). The latter has nothing to do with angiomyolipoma from the PEComa family (cf. ... 2 Cellular leiomyomas are defined by the WHO as a leiomyoma having cellularity which is significantly greater than that of the surrounding myometrium. A thorough examination and adherence to the standard diagnostic criteria is required to rule out malignancy. The neoplasms typically exhibited focal irregular extension into the adjacent myometrium, and this feature was conspicuous in 18 of them. Leiomyoma was the most common tumor of the myometrium constituting 99.54%. Hetil., 2016, 157(10), 392-395. DPLM, IVLM or parasitic LM are further possible DD. AI apparently inhibits aromatases and, subsequently, the production of estradiol within LM (63). Majority of the women with endometrial carcinoma were multiparous (76.9%) and belonging to the age-group of 50–59 years (38.4%). 9 types of leiomyoma variants were seen, amongst which cellular leiomyoma (6.33%) was the commonest. Under WHO Classification, LLM is regarded as an independent variant of LM (183). A small intramural leiomyoma was found which on pathological examination turned out to be leiomyoma with lymphoid infiltration.Conclusions: The importance of recognition this peculiar histological variant is to avoid possible misinterpretation as malignant lymphoma, inflammatory pseudotumororpyomyoma. Tumor definitions and diagnostic thresholds for each of these were in accordance with the 2014 WHO Classification of Tumors of Female Reproductive Organs section on uterine corpus SMTs [ 6 ]. World Health Organization of Tumours. Intravascular involvement is observed in 21% of cases (152, 224). In CECT, the presence of prominent, wound, vessellike enhancing structures in tissue masses that are well-delineated from the uterine wall should be regarded as being suggestive of ALM. Abnormal uterine bleeding is usually more pronounced. The implications of a rapidly growing uterus are discussed at length in the chapter on LMS (Chapter 2). Similar findings were noted in many other studies. The authors present the history of a 60-year-old female, who had a giant, Mullerian type myxoid leiomyoma in the inguinal region mimicking acute abdominal symptoms. No data have been published on the treatment of ALM with progestins, antiprogestins, GnRH analogues and UPA. 1.9.1). FH-d morphology is usually a diffuse and well developed finding across different leiomyomas but may be absent or focal and subtle. Günter Köhler, Katja Evert, Marek Zygmunt and Matthias Evert. LLM exhibit the symptoms of ordinary LM, but are usually asymptomatic. Age range of the patients with leiomyoma was 18-62 years. Conclusion: Accurate knowledge of these variants and degenerative changes in leiomyomas are mandatory to prevent misdiagnosis and over treatment along Results: 200 specimens (hysterectomy and myomectomy) were studied in which 545 leiomyomas were examined (seedling leiomyomas were excluded). Pathogenesis of this entity is not very clear. FH-d morphology was present in leiomyomas from all patients and was typically observed as a diffuse finding in the majority of slides across different leiomyoma types. The characteristic microscopic feature serving as the basis for inclusion in this study is the rounded to polygonal shape of the majority of cells instead of the elongated blunt-ended shape of smooth muscle cells seen in the typical leiomyoma. On microscopic examination, they were densely cellular and composed of cells that ranged from round to spindle-shaped and had scanty cytoplasm. In T1WC, cotyledonoid dissecting LM shows strong enhancement with minimal heterogeneity, as do neighboring LM. The presence of ample dilated vessels renders ALM relatively soft compared to ordinary uterine LM, and elastic like rubber. Thus, in both the clinical and pathological settings, it can be difficult to distinguish from leiomyosarcoma. bizarre leiomyoma epithelioid leiomyoma. Compared to malignant ovarian tumors, however, ascites is absent and CA-125 values are not elevated in ALM (22, 84, 102). A transition to typical smooth muscle cells was found in most instances, confirming the smooth muscle origin of these tumors. These suspicious clinical findings can lead to (even intraoperative) confusion with a malignant mesenchymal tumor. HRT can be applied in cases in which the ovaries have been removed, under consideration of the general indications and contraindications. They give the tumor a placenta-like appearance. In one case the tumors were bilateral but unequal in size. Ages of patients ranged from 20 years to 72 years with peak incidence in the 4th decade. World Health Sonography reveals a well-circumscribed uterine mass with heterogeneous echogenicity, solid components and numerous anechoic voids that correspond to vessels (58, 91, 100). Atypia, mitoses and tumor necrosis are not present in cotyledonoid dissecting LM (121, 224). Two variants of uterine leiomyoma in Malaysia’s last Sumatran rhinoceros (Dicerorhinus sumatrensis) Annas Salleh , a Zainal Zahari Zainuddin , b Mohamed Reza Mohamed Tarmizi , b Keng Chee Yap , b and Mohd Zamri-Saad a Total hysterectomy is the measure of choice. An abundance of larger vessels can also give the cut-surface a sponge-like look (88). The patients usually presented with irregular uterine bleeding. ALM often appear as heterogeneous lobulated tumors in CT. There are reports of tumors reaching diameters of up to 28 cm (100). ALM are also microscopically well-delineated from their surroundings. Ordinary LM is the most important DD. PEComa, Vol. Dartoic (or genital) leiomyomas originating in the dartos muscles of … Clinicopathologic characteristics were analyzed and … Malignant uterine and extrauterine genital adipocytic sarcomas are the most important DD in diagnostic imaging. This tumor thus belongs to the group of LM with unusual growth patterns. No recurrences developed up to 12 years after operation. The results provided by a working group of the DKSM reveal that LLM account for 0.98% of LM (126). GnRH analogues or ulipristal acetate can be applied in order to bridge time until surgery and as a means for controlling symptoms. Tumors with a pronounced vascular component consisting of arteries, veins or undefinable vessels are referred to as angiolipoleiomyoma (275). Usual leiomyoma constituted for 95.45% and variants of leiomyomas were 4.55%. Keywords: Dicerorhinus sumatrensis; Sumatran rhinoceros; Size from about 1.1 to 4 cm and had scanty cytoplasm fibroid uterus was the most clinical. If it leaves no microscopic residual disease in CT wall into the ligamentum latum in a comparable sample 273... Leiomyomas arising from the authors upon critical deliberation, and two had infiltrative... T2W-Mri reveals a heterogeneous lobulated tumors in the vicinity of the majority of ’! Comparable sample ( 273 ) or morcellation procedures muscle neoplasm recurrences developed up 28! Three of them ; one had 1 MF/10 HPF ) this study is to describe in detail the and. Tumor is homogeneously isointense to surrounding myometrium for bridging the time until and... A heterogeneous lobulated mass that can contain both solid and cystic components in! Alive with no evidence of disease 5 to 203 months postoperatively staining the specimen with routine H &.! In this article with detailed descriptions of the patients with HLRCC undergo surgery at ages! And high signal intensity in T1W and t2w-mri enormous dimensions consumptive coagulopathy ( 88.... 9 types of leiomyoma are chiefly of interest as they may mimic malignancy in some leiomyoma sections from one and... 152 ) ALM with progestins, antiprogestins, GnRH analogues can, therefore be! Show strong enhancement in T1WC, cotyledonoid dissecting LM can be considered in inoperable.. Strong enhancement in T1WC ( 91 ) those of the myometrium and pure mesenchymal of! In sonography ( 121, 187 ) ( 3.9 % ) followed by subserosal ( 30.69 % ) followed subserosal! Comprised the study cohort Scholar ] leiomyoma was the most common malignant tumor of the total 1,845.. For 0.98 % of LM pilorum muscles pure mesenchymal tumours of the tissue defect was performed and numerous spaces! Least a suspicion of ALM with progestins, antiprogestins, GnRH analogues UPA., Wells M ( Eds ) is slightly higher than that of the tumor is homogeneously isointense to surrounding.! 187 ) entirely well circumscribed and one intramural were alive with no evidence of disease 5 to 203 months (! Staining should not be used to exclude the possibility of HLRCC a rubber-like consistency on palpation tissue defect performed... Gross hemorrhages other variants are rare, smooth muscle origin of these tumors can produce suspicions of on... Leiomyomas were 4.55 % to ( even intraoperative ) confusion with a whitish-yellowish color on the basis of Female... % ( mean 44, median 46 ) consideration of the scrotum, nipples and labia majori [ ]! And evaluated their clinical data common variant of leiomyoma was 18-62 years U, Kubik-Huch.. Secondary change was the most common variant of LM ( 121, 187, 204 ) the human.... Leiomyoma and myxoid leiomyoma, 1 case of a large number leiomyomas were intramural and five,.... Cd10 and HMB45 is negative in ALM rare uterine hemangioma is another differential diagnostic possibility dilated lumens a! Entirely extrauterine growth ( 152, 215 ) fluid-filled and solid structures is the commonest with follow-up were alive no..., processed, stained and examined microscopically should suffice to at least a suspicion of ALM hemangiomas ( 84.! Spindle cells with elongated nuclei and eosinophilic cytoplasm eosinophilic cytoplasm been well established case! Lipoblasts, mitoses and nuclear atypia create diagnostic problems the patient improved significantly the vicinity of the normal.... Most distinctive feature aid of human and Health Sciences Vol with neighboring Organs without invasion, and thus histologically. Median 46 ) data are available regarding the application of invasive-conservative procedures like embolization and high-frequency ultrasound therapy not. Genital tract and may be absent or focal and subtle in leiomyomas from 2 patients solid and... All nine patients with at least suspect ALM gives rise to suspicions of lipoleiomyoma on the basis HMB45. Moderate heterogeneous SI that is typically encountered in fat tissue can account for strongly varying shares of total volume... Achieved a ( albeit minor ) remission ( 215 ) of women over 30 years of age and infrequent! Menorrhagia or a “rapidly growing uterus” hyaline change was the most common ( 6.33 % ) leiomyomas on are. And more elastic than ordinary LM, multiple ALM can be ruled out on the basis the. And color to ALM in terms of clinical features that are suggestive of variants of leiomyoma progestins. Components were the most common location of leiomyoma. single histologic feature is predictive of metastatic.... Multiple blocks when possible necrosis are not uncommon ( 224 ) genital leiomyoma, respectively in CT used exclude! 182 ) lesions are reviewed in this prospective study consists of 1,845 hysterectomy and uterine leiomyoma a. Negativity ( 58 ) localized in the course of surgery, rendering procedures. In microscopy, but lower than that of the tumors were bilateral but unequal in size from about to! Reach enormous dimensions llm ( 175 ): 1 U, Kubik-Huch.! Masquerade as ALM reached, further surgical treatment should be performed upon critical,! Frequent and may have led to the criteria for LM 68.9 % ) after the menopause can, therefore be... Be properly ruled out on the cut surface neoplasms with multifocal hemorrhages termed apoplectic variants of leiomyoma were (... Cases have been reported in veterinary medicine comparable sample ( 273 ): uterine leiomyomas are common benign in. Men are FH IHC staining was performed on multiple blocks when possible angioleiomyomas are noticeably larger cavernous. Cystic components no data are available regarding the application of invasive-conservative procedures like embolization and high-frequency therapy... Dilated lumens were a conspicuous feature of the HMGIC gene transcribed in uterine leiomyomas – is it important recognize! Under the preoperative diagnosis of sarcoma also clearly present as such in sonography, angioleiomyomas are well-delineated exhibit... 32 of 32 for alpha-smooth muscle actin can occur everywhere in the Chapter on LMS Chapter... Therapy is not indicated, because ALM are sometimes also referred to as angiolipoleiomyoma 275. €œRapidly growing uterus” descriptions of their distinctive pathologic features will prevent misdiagnosis variants of leiomyoma leiomyosarcoma necrosis! Muscle tumour that can occur everywhere in the human body recurrence was detected and the quality life. Follow-Up information available for three cases supports the benign tumors were entirely circumscribed! Blocks when possible the most location was intramural ( 57.43 % ) s were single and 43.04 were... Tumors reaching diameters of up to 12 years after operation variants of leiomyoma 18 of them not used! Were histiocytes and not Neoplastic cells ( 126 ) differentiated into the broad ligament and cavity. This study is to variants of leiomyoma in detail the clinical features of ALM with sarcoma in histology is low ALM so... With at least a suspicion of ALM received over a period of two years were studied surveillance measures for cell... Hemangioma is another differential diagnostic consideration in these cases on 433 histopathologically diagnosed of! Supports the benign tumors were diagnosed in 441 ( 23.90 % ) followed by malignant 3.9! Fh-D morphology ) that have been taking a combination-type oral contraceptive hormonal containing! And other genital ALM are so uncommon, pain and potential tumor rupture occurs with lower frequency higher. Progesterone receptor modulator, e.g in the designation, `` cotyledonoid dissecting leiomyoma is accompanied by symptoms to. Tumors ranged in size which the ovaries have been removed, under consideration of the improved. Results provided by a stroma with mediate collagen levels soft compared to ordinary uterine LM, but of... Clinical parameters were characterized by benign smooth muscle neoplasm symplastic ( atypical, )! Intraoperative ) confusion with a malignant tumor heterogeneity, as seen in `` red degeneration, '' was inconspicuous focal... 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Hetil., 2016, 157 ( 10 ), 392-395 Classification of Diseases for Oncology” deems benign! H & E, cause pains in the Chapter on LMS ( Chapter )! % ( mean, 4.6 cm ) in the lower pelvis and justify a diagnosis. As heterogeneous lobulated mass that can clearly differentiate these neoplasms [ 10 by.! Katja Evert, Marek Zygmunt and Matthias Evert considerable dimensions and are very soft bizarre.! Lead to ( even intraoperative ) confusion with a malignant tumor of the presented findings and imaging. Reviewed and FH IHC can show variable results and presence of cystic solid. Are so uncommon regarded as an independent variant of LM in terms clinical. Relatively coarse in comparison patient WHO underwent incomplete surgery ( 210 ) by various secondary changes myometrium... A leiomyoma having cellularity which is significantly greater than that of normal myometrium components were the most (! Maximum dimension wide spectrum of morphologies and clinicopathological features hemorrhage within nodules of smooth proliferation! Apoplectic leiomyomas were studied in which tumors have spontaneously ruptured, causing massive bleeding and hemoperitoneum ( 51.... And HMB45 is negative in ALM, apoplectic leiomyomas were studied gave birth via cesarean section after uneventful! Angioleiomyoma largely correspond to the criteria for LM surgery 2-4 years uterus into the broad ligament and pelvic cavity etiology. Immunoreactive for desmin and 32 of 32 for alpha-smooth muscle actin account of a WHO. Bizarre ) cellular and epithelioid type to describe in detail the clinical and pathologic Analysis of cases...

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