Atypical uterine leiomyoma: a case report and review of the literature

Abstract

BackgroundAtypical uterine leiomyomas show benign behavior. However, the distinction between leiomyomas and leiomyosarcomas may at times be problematic. We report a rare case of atypical uterine leiomyoma. We try to investigate potential immunohistochemical parameters that could be essential to distinguish cases of malignant smooth muscle tumors and those of uncertain or borderline histology.Case presentationA 56-year-old white ethnic Albanian woman from Kosovo presented with uterine bleeding because of uterine multiple leiomyomas. A hysterectomy with unilateral adnexectomy was performed. Her hysterectomy specimen contained multiple leiomyomas in submucosal, intramural and subserosal locations. The leiomyomas were well demarcated, firm and white with a whorled cut surface and one had foci of hemorrhage. Histology of most of the leiomyomas showed a whorled (fascicular) pattern of smooth muscle bundles separated by well-vascularized connective tissue. Smooth muscle cells were elongated with eosinophilic or occasional fibrillar cytoplasm and distinct cell membranes. Some of them developed areas of degeneration including hyaline change, with less than five mitotic figures per ten high power fields in most mitotically active areas, and no significant atypia. One leiomyoma was characterized by moderately to severely pleomorphic atypical tumor cells with low mitotic counts and no coagulative tumor cell necrosis. Immunohistochemistry showed strong immunoreactivity for vimentin, smooth muscle actin and desmin, while cyclin-dependent kinase inhibitor 2A (p16), and B-cell lymphoma 2 (bcl-2) showed focal immunoreactivity, estrogen and progesterone were positive, Ki-67 expressed a low proliferation index, whereas p21 and tumor suppressor gene p53 were negative.ConclusionsThe combination of evaluation of conventional morphologic criteria with cyclin-dependent kinase inhibitor 2A (p16), p21, progesterone, B-cell lymphoma 2, tumor suppressor gene p53 and Ki-67 expression may be of great value in the assessment of uterine smooth muscle tumors of uncertain or borderline histology.

Uterine smooth muscle tumors of uncertain malignant potential: a retrospective evaluation of clinical pathology and immunohistochemistry features

“…In another research, one out of 18 STUMP cases showed positive P53 [37]. Similarly, Manxhuka et al 's results revealed positive P53 in one out of six STUMPs, none of leiomyoma cases, and 16 out of 34 leiomyosarcoma cases [13].…”

“…Immunohistochemistry could be helpful in diagnosis of STUMP, and several tumor markers such as ER, PR, Ki67, P53, P16, and Bcl-2 have been studied recently [12,13]. Studies showed that the expression of Bcl-2 was more prominent in leiomyomas compared to leiomyosarcoma and STUMP [13]. In contrast to leiomyosarcomas, expression of Bcl-2 was concomitant with poor prognosis in STUMP [14].…”

Clinical features of uterine sarcomas presenting mainly with uterine masses: a retrospective study

“…Since variants of benign uterine fibroids may contain changes include hypercellularity, necrosis, nuclear atypia, mitotic figures, and intravascular growth, the distinction between fibroids and uLMS may at times be problematic [ 11 ]. The combination of evaluation of conventional morphologic criteria with immunohistochemistry is of great value in the assessment of uterine smooth muscle tumors histology [ 12 ]. Since previous myomectomy specimens cannot be all re-evaluated, we would only make one hypothesis that uLMS tumor cells may have been present in previous uterine fibroids, and residual cells may progress to uLMS.…”

Uterine smooth muscle tumours of uncertain malignant potential: single-centre experience and review of the literature

“…Some authors discuss adjuvant therapy with progesterone or gonadotropin-releasing hormone analogues; chemotherapy may be considered for recurrent or metastatic disease [6,22,23]. There is no evidence of the effect of any systemic therapy for prevention of relapse or management of primary disease after surgery [7,25,27,[32][33][34].…”