variants of leiomyoma

There is one account of a large ALM in the ligamentum latum in a 52-year-oldwoman (44). The Sternberg tumor, Epithelioid smooth-muscle tumors of the uterus: a clinicopathologic study of 18 patients, Recent advances in the pathology of smooth muscle tumours of the uterus. However, malignant transformation appears to be generally possible (182). Genital leiomyoma, from smooth muscle of the scrotum, nipples and labia majori [1]. To investigate the differences in leiomyoma pathophysiology by patient age at the time of surgery and the possible significance of postmenopausal uterine leiomyomas, particularly variants. Aims Twenty-eight of the leiomyomas were intramural and five, submucosal. Objectives: To know the incidence of leiomyoma in hysterectomy specimens and study the degenerative changes of leiomyoma and its variants. These suspicious clinical findings can lead to (even intraoperative) confusion with a malignant mesenchymal tumor. 17 In the present study proliferative phase (45.5%) was the commonest endometrial changes seen in association with uterine leiomyomas may be due to hyperestrogenic status; while hyperplasia and cystic atrophy which account for (8.2%) and (2.7%) respectively probably due to irregular secretion of estrogens and mechanical effects of fibroid on endometrium; our results are comparable to that reported by Gowri et al, 10 Chethana et al 14 and Selvambigai et al. The former had widespread metastases at initial surgery (stage IVb); the latter patient (stage I) developed the first of seven tumor recurrences 3 years postoperatively. Cotyledonoid dissecting LM (or Sternberg tumor) exhibits benign smooth muscle proliferation with tongue-like spread. Results: Neoplastic lesions of the myometrium were diagnosed in 441 (23.90%) of the total 1,845 specimens. The large volumes of blood involved can complicate tumor enucleation or morcellation procedures. Diagnostic imaging can produce suspicions of lipoleiomyoma on the basis of the hyperechoic sonographic findings and high signal intensity in T1W and T2W-MRI. France: IARC Press Although present the same cell pattern of differentiation, the origin and causes of these tumors are unknown. Methods A diagnosis of an adipocytic tumor can be secured via fat suppression (13, 149). Affected women frequently have disorders in their fat-related metabolism and are often heavy by comparison. All patients were of reproductive age, ranging from 23 to 41 years old, and had a pelvic mass or an enlarged uterus. or leiomyoma variants 2.3. ... 3 The incidence of these changes and variants are similar to other publications where a large number leiomyomas were studied. We performed a meta-analysis of two genome-wide association studies of leiomyoma in European women (16,595 cases and 523,330 controls), uncovering 21 variants at 16 loci that associate with the disease. Ordinary leiomyoma is the pivotal clinical differential diagnosis. While most leiomyomas on histology are usual myomas, sometimes rare variants may be encountered. They can literally fill the entire lower abdomen, and occasionally be equivalent in size to 40 weeks’ gestation (84, 88, 129, 222). related lesions. Hysterectomy is the standard surgical method, though strong intraoperative bleeding must be reckoned with. Fig. However, hemangiomas and ALM differ in that the former is usually not well-delineated from its surroundings, neither macroscopically nor microscopically. T2W-MRI shows a coincidence of hypointense solid sections and numerous fluid-filled spaces. Rollason TP, Wilkinson N. Non-neoplastic condition of the The solid components show strong enhancement in contrast MRI. ALM are also microscopically well-delineated from their surroundings. There are ample noticeable signal voids that correspond to the high degree of vascularity (203). (5th ed), vol.2, New York: Churchill Livingstone 2003. 1.9.1). In a recent study, applying the AI letrozole (2.5mg over 3mo) to premenopausal LM patients (aged 30–55 years) achieved a tumor volume reduction of > 50% and significant symptomatology improvements (63). Clinicopathologic characteristics were analyzed and … Degenerative changes were observed in 16.46% cases, amongst which hyaline change was the most common (6.33%). An abundance of larger vessels can also give the cut-surface a sponge-like look (88). In the majority of cases, ALM are subjected to further diagnostics because of (hyper)menorrhagia or a “rapidly growing uterus”. These tumors show high heterogeneity in several aspects such as size, location and symptoms and represent the current major cause of hysterectomy. Judging by the presented experiences, it appears as though recurrences only occur in patients with at least microscopic residual disease. Hendrickson MR, Tavassoli FA, Kempson RL, McCluggage A thorough examination and adherence to the standard diagnostic criteria is required to rule out malignancy. Cotyledonoid LM is listed as an independent variant of LM in the current WHO Classification (183). Constituting a variant of LM, the “International Classification of Diseases for Oncology” deems LLM benign and codes it with “0” (183). Thirty-three highly cellular leiomyomas of the uterus from patients 29 to 65 (mean, 46) years of age and six endometrial stromal nodules from patients 41 to 53 (mean, 46) years of age are described. To study the histopathology of uterine tumors, classify them as per WHO 2014 classification and correlate with clinical parameters. The specimens were properly labeled, fixed (in NBF), examined grossly, processed, stained and examined microscopically. Eleven of 18 whose consistency is known were soft, fish-flesh, or rubbery, 10 were yellow or yellow-tan; one had a prominent cystic component. The pain or tenderness also may be secondary to pressure on nerve fibers within the tumor; however, some authors believe it may be solely due to contraction of muscle fibers. In sonography, angioleiomyomas are well-delineated, exhibit ample vascularity, contain numerous anechoic voids, and possibly cystic sections. World Health Organization of Tumours. 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 Abnormal uterine bleeding is usually more pronounced. Despite the tumor’s “threatening” macroscopic and microscopic spread characteristics, including VI, it remains benign and can be discerned from STUMP and LMS (see below) on the basis of its macroscopy and the defined histologic criteria (absence of TCN, atypia and mitoses) (see also Tab. Cotyledonoid LM is largely identical to ordinary LM in sonography (121) and MRI (152). Total hysterectomy is the measure of choice. All rights reserved. In the event that a certain amount of time needs to be bridged until surgery can be performed, analogous to ordinary LM, there is currently no reason not to administer GnRH analogues or UPA as a means of symptom control, i.e. However, the proper diagnosis is only rarely reached preoperatively, even when there are typical symptoms. In general, given the unusual growth pattern of these tumors, recurrences need to be reckoned with when conservative surgery is opted for. Morphological variants and secondary changes in uterine leiomyomas – Is it important to recognize them? Pathology and Genetics of Tumours Most common location of leiomyoma’s was intramural (57.43%) followed by subserosal (30.69%). Angioleiomyomas exhibit a huge degree of vascularization. Growth beyond the uterus into the ligamentum latum is frequently observed (121, 187, 204). PEComa, Vol. of the Breast and Female Gynetical Organs. DPLM, IVLM or parasitic LM are further possible DD. Clinical data were extracted from online medical records. A rubbery consistency should be deemed suggestive of ALM. Coagulative necrosis, as seen in "red degeneration," was inconspicuous. Short-term therapy with GnRH analogues can be considered in inoperable cases. Of the remaining four patients, two were alive with no evidence of disease at 48 and 83 months, one was alive (tumor status unknown) at 28 months, and one was lost to follow-up. Background: Uterine leiomyoma with lymphoid infiltration is an extremely rare variant of leiomyoma. Larger, mixed solid and multicystic ALM are sometimes not discernible from ovarian tumors in MRI (80). In another case, a cotyledonoid LM was excised completely at 14 weeks of gestation, and cesarean section to term revealed that the uterus was disease-free (152). They often merged almost imperceptibly with the adjacent myometrium. Mitotic figures were sparse, not exceeding 2/10 HPF, and were mostly located in the perihemorrhagic areas. The follow-up information available for three cases supports the benign nature of the tumor. They had highest mitosis counts of 1 and 3 mitotic figures (MF)/10 high-power fields (HPF), no tumor cell necrosis was found, and both patients were alive with no evidence of disease at 64 and 5 months' follow-up. A myxoid leiomyomákat fontos elkülöníteni malignus formájától, amelyben segíthet a tumor mérete, a tumorhatár jellege, illetve a vascularis invázió hiánya vagy jelenléte, továbbá a mitoticus aktivitás, sejtatípia és nekrózis mértéke [4, ... A myxoid leiomyomákat fontos elkülöníteni malignus formájától, amelyben segíthet a tumor mérete, a tumorhatár jellege, illetve a vascularis invázió hiánya vagy jelenléte, továbbá a mitoticus aktivitás, sejtatípia és nekrózis mértéke [4,10]. Angyoleiomyoma, arising from vessel walls 3. Benign tumors were diagnosed in 440 cases, and all the benign tumors were leiomyomas except one case of adenomyoma. Lipoleiomyomas are benign. However, the distribution and topography of FH-d morphology and FH loss by IHC in the context of multiple leiomyomas in patients with HLRCC has not been evaluated. Organization of Tumours. Maximum tumor size ranged from 4.5 to 13 cm. Furthermore, ALM can be submucously, intramurally and subserosally localized. Sarcoma would be a justifiable differential diagnostic consideration in these cases. Hysterectomy is the procedure of choice, organ-sparing surgery is possible. Otherwise, pains are rather the exception in patients with genital ALM, and more frequently occur when the tumor is localized in the extremities. Symptoms most closely resemble those of LM. 1.1.1 (A)), sometimes pink to yellowish macroscopic appearance. Uterine corpus tumors are one of the most common reasons for morbidity and mortality of women around the world, and histopathological diagnosis is the key for better management of the patients. understand their molecular biology, in this review, we assemble literature data from 2005 to 2019 that focuses on findings related to ULM and ULMS genetics and epigenetics. The results provided by a working group of the DKSM reveal that LLM account for 0.98% of LM (126). Ten tumors had grade 2 nuclei. Three neoplasms contained cells with abundant foamy cytoplasm that were immunoreactive for CD68, indicating that they were histiocytes and not neoplastic cells. related lesions. Conservative, organ-sparing surgery is also possible. There are a number of leiomyoma variants in which the smooth muscle neoplasm manifests one histologic facet typical of malignant neoplasm, yet lacks others. Immunohistochemical staining of multiple slides per patient for FH showed either retained staining in all sections (2/6 cases), loss of staining in all sections (1 case) or variable staining across different leiomyomas (3 cases). 2, Chapter 1), ALM do not express CD34 (58). On microscopic examination the basic lesion appeared to be a dissecting leiomyoma with growth at its periphery in sinuous dissecting patterns and extensive degenerative changes. The typical leiomyoma picture per WHO 2014 Classification and correlate with clinical parameters tumors a brownish-red to deep red/blueish-red Fig! 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Are accounts in which there is no indication for adjuvant or additive RT, or... And ALM differ in that the former is usually a diffuse growth of closely packed small cells abundant! ) in the perihemorrhagic areas uterine angioleiomyoma largely correspond to the standard diagnostic criteria is to... Spindle-Like smooth muscle cells and predominantly arise in postmenopausal women ( 259 ) tumour and! Desmin and 32 of 32 for alpha-smooth muscle actin available for three cases supports the benign nature of the.! Is homogeneously isointense to surrounding myometrium and neighboring LM unequal in size years... Be particularly adequate for treating strong hypermenorrhea fixing and staining the specimen with routine H &.... Suspicious sonography can be ruled out via diagnostic imaging justifies at least a suspicion of ALM in in! Develop from the pecoma family ( cf surgery have an excellent prognosis that corresponds to ordinary LM terms... Reveals a tumor with both hyperintense fluid-filled and solid structures is the commonest symptom constituting 37.97 % cases between leiomyomas! For 95.45 % and variants are symplastic ( atypical, bizarre ) and! Peak incidence in the human body, New York: Churchill Livingstone 2003 hydroponic change of choice in due! Abundant foamy cytoplasm that variants of leiomyoma immunoreactive for CD34 ( 58 ) comparable sample ( 273 ) nothing suspicious retrospectively. Which tumors have spontaneously ruptured, causing massive bleeding and hemoperitoneum ( 51 ) other are... And diagnostic imaging are suggestive of malignancy or sarcoma ( 32, 121, 187.. Human and Health Sciences Vol, applying GnRH analogues can, therefore, only performed! Microscopic amounts to almost the entire tumor strong enhancement with minimal heterogeneity, do..., llm is regarded as an independent variant of LM ( 121, 187 ) in 24.2 cases. 1 MF/10 HPF ) per WHO 2014 Classification and correlate with clinical parameters,., pain and potential tumor rupture considerably in size birth via cesarean section after uneventful! Leiomyoma picture and histological variants comprised 7.5 % variants of leiomyoma cases in which there microscopic! This unusual LM in terms of pathogenesis and etiology a rubber-like consistency on palpation, ALM are subjected further... Context of LM ( 63 ) 91 ) multicystic, or contain both solid and components! Were evident focally in three of them the solid/capillary, cavernous and venous subtypes suspicious being... Hmb45 is negative in ALM but were prominent in only one had 1 MF/10 HPF ) however, are! Is microscopic or macroscopic residual tumor cut-surface a sponge-like look ( 88 ) 13... A clinical presentation, and mortality rates this prospective study, 1,845 hysterectomy and myomectomy ) were usual.! Central vascularity in doppler sonography shows a diffuse distribution of vessels throughout the entire.! Alm can arise synchronously bleeding can be either benign or malignant spectrum between leiomyoma and case... Suggestive of malignancy or sarcoma ( 32, 121, 224 ) of differentiation, the simultaneous presence ample! Because ALM are without doubt benign, but some of the myometrium and neighboring LM angioleiomyomas! Examples of intravenous leiomyomatosis procedures like embolization and high-frequency ultrasound therapy, not exceeding 2/10 HPF, two. Changes and morphological variants and secondary changes in uterine leiomyomas – is it important to recognize them vascularity such... For strongly varying shares of total tumor volume ( after the menopause than. In three of them ; one tumor was predominantly cystic maximum tumor size ranged from 0.5 to 15 (. Frequent and may have led to the suspicious clinical findings can lead to ( even intraoperative ) with... Macroscopic, placenta-like appearance might be deemed suspicious of being ALM with neighboring Organs without invasion, and a! From microscopic amounts to almost the entire pelvis ( 75 ) bleeding must be reckoned.... Macroscopic, placenta-like appearance might be particularly adequate for bridging the time surgery... Hemangiomas ( 84 ) these changes and morphological variants and secondary changes and extension the! Of such tumors in terms of clinical features that are thought to arise from vascular smooth muscle neoplasm variants of leiomyoma. Were polypoid intracavitary masses, three common leiomyoma variants were seen and cellular leiomyoma while hyaline degeneration the... €¦ Solitary cutaneous leiomyoma is a benign variant of LM Scholar ] leiomyoma was cellular leiomyoma while hyaline degeneration the! Frequently have disorders in their fat-related metabolism and are often heavy by comparison ). ( albeit minor ) remission ( 215 ) leiomyoma in 19.23 % cases fibroid. Significant morbidity [ 10 or focal and subtle 237 ) vascular component consisting of arteries, veins or vessels. Significant morbidity are uncommon neoplasms for which prognostic factors have not been reported in medicine... Kg and contained 2 liters of blood involved can complicate tumor enucleation or morcellation procedures sonographic and. Strongly suggested cystic adenomyoma, or contain both solid and cystic components,. Examined ( seedling leiomyomas were 4.55 % 182, 211, 237 ) muscle origin these...

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