Myxoid leiomyosarcoma of the uterus

King, Mary E.; Dickersin, G. Richard; Scully, Robert E.

doi:10.1097/00000478-198210000-00001

Cited by 145 publications

(88 citation statements)

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“…61 Myxoid leiomyoma is even rarer that myxoid leiomyosarcoma and this diagnosis should only be made in tumors that are small (essentially o 5 cm), completely well circumscribed, with no cytologic atypia and minimal to absent mitotic activity (o 2/10 HPFs) after extensive sampling (Figures 6a-d). [13][14][15]19,62 It is important to be aware that a benign smooth muscle tumor may be only partially myxoid, and that if the non-myxoid areas are misconstrued as myometrium, the tumor may be interpreted as having infiltrative margins and likely to be a myxoid leiomyosarcoma. Myxoid change may occur in leiomyomas in pregnant women and also near areas of infarction.…”

Section: Tumor Cell Necrosismentioning

confidence: 99%

“…In general 450% component of myxoid or epithelioid component is desired to render a diagnosis of either myxoid or epithelioid leiomyosarcoma although minor components should be noted in the pathology report as it may be the only morphology present in metastases. [13][14][15][16][17][18][19][20] In general, to render a diagnosis of malignancy in smooth muscle tumors of the uterus is relatively straightforward as leiomyosarcomas usually display marked nuclear atypia, high mitotic rate, and tumor cell necrosis. However, it is important to keep in mind that the diagnostic threshold for mitotic rate differs for the different leiomyosarcoma variants.…”

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confidence: 99%

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Practical issues in uterine pathology from banal to bewildering: the remarkable spectrum of smooth muscle neoplasia

Oliva

2016

Modern Pathology

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Among mesenchymal tumors of the uterus, smooth muscle neoplasms are most common. The wide morphologic spectrum, especially within the category of leiomyomas, is responsible for diagnostic problems more frequently with leiomyosarcoma (including mitotically active, apoplectic, and leiomyoma with bizarre nuclei) but also with endometrial stromal tumors. In the former scenario, clinical information, gross appearance as well as strict utilization of morphologic criteria including cytologic atypia, mitotic activity, and tumor cell necrosis are clues in establishing the correct diagnosis. It is important to keep in mind that mitotic rate thresholds vary for the different subtypes of leiomyosarcoma. Of note, p16 should be used with caution in supporting a diagnosis of leiomyosarcoma as it is often positive in leiomyomas with bizarre nuclei and leiomyomas with apoplectic change (in the latter most frequently and more intense near areas of necrosis). MED12 mutations have also a very limited role in this differential diagnosis. Endometrial stromal tumors are by far, less common than smooth muscle tumors, but can be confused with leiomyosarcomas if they are associated with an undifferentiated uterine sarcoma and the low-grade component is overlooked or they have a myxoid/fibroblastic morphology. The differential diagnosis may be confounded if the latter is associated with a high-grade endometrial stromal sarcoma. It is important to highlight that CD10 is not a reliable marker in these differentials and should be used as a part of a panel of antibodies that also includes desmin and h-caldesmon. Two other recently categorized tumors in the uterus that merit special mention are PEComa and inflammatory myofibroblastic tumor as they enter in the differential diagnosis of smooth muscle tumors. PEComa may be part of the tuberous sclerosis syndrome and may show either a predominantly epithelioid or spindle morphology or combination thereof. Rarely, it may contain melanin pigment. There is variable positivity for HMB-45, MelanA, MiTF, and CathepsinK, and some tumors have been shown to express TFE-3 especially when associated with "clear cell" morphology. Patients with adverse outcome have tumors with ≥ 2 of the following features: ≥ 5 cm, infiltration, high-grade cytologic features, mitotic rate ≥ 1/50 high-power fields, necrosis, or lymphovascular invasion. Inflammatory myofibroblastic tumor is important to recognize as it often mimics myxoid smooth muscle tumors, either benign or malignant. The presence of an associated lymphoplasmacytic infiltrate should alert to that possibility and ALK studies (immunostain or FISH) are helpful in establishing this diagnosis. These tumors can behave in a malignant manner if large, associated with abundant myxoid change, brisk mitotic rate or show tumor cell necrosis.

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Section: Tumor Cell Necrosismentioning

confidence: 99%

mentioning

confidence: 99%

Practical issues in uterine pathology from banal to bewildering: the remarkable spectrum of smooth muscle neoplasia

Oliva

2016

Modern Pathology

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“…Occasionally, retroperitoneal leiomyosarcoma may have areas exhibiting epithelioid cytomorphology, multinucleated giant cells, prominent inflammatory infiltrate, or exuberant myxoid change. [67][68][69][70] Rarely, leiomyosarcoma contains granular cytoplasmic change. 71 Leiomyosarcoma, specifically of soft-tissue origin, is considered malignant when some degree of nuclear atypia and mitotic activity, which may be very low (< 1/10 hpf), are present.…”

Section: Retroperitoneal Leiomyosarcomamentioning

confidence: 99%

Practical Issues for Retroperitoneal Sarcoma

et al. 2016

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“…Malignant tumors are myxoid leiomyosarcomas. These tumors feature moderate to marked atypia with or without necrosis and any mitotic index, and the margins are usually infiltrating (19). In other words, for myxoid smooth muscle tumor, paucity or absence of mitotic figures is no assurance of benignancy.…”

Section: Myxoid Smooth Muscle Tumorsmentioning

confidence: 99%