Smooth muscle neoplasms of the uterus other than ordinary leiomyoma: A study of 46 cases, with emphasis on diagnostic criteria and prognostic factors

Abstract

Thirty-seven cases of uterine leiomyosarcoma are presented, along with nine cases of leiomyoma variants from which they were distinguished. All patients were followed for a minimum of 10 years. In cases with nuclear pleomorphism, leiomyosarcoma was diagnosed when there were five or more mitotic figures in ten consecutive high-power (X400) fields in the most active area of the tumor, and also when there were fewer mitotic figures but extensive tumor necrosis (there was only one leiomyosarcoma without nuclear pleomorphism, and it had more than 20 mitotic figures in ten high-power fields). Tumor size was the major prognostic factor in the leiomyosarcoma group; five of eight patients with neoplasms measuring less than 5 cm in maximum dimension survived, whereas no patient with a larger tumor did so. Other pathologic and clinical variables, including mitotic rate, tumor necrosis, degree of nuclear pleomorphism, vascular invasion, and patient age, had no significant relationship to survival or tumor behavior in leiomyosarcoma when tumor size was taken into account. The nine cases of leiomyoma variants consisted of three atypical leiomyomas (which had nuclear pleomorphism, one or no mitotic figures per ten high-power fields, and no necrosis), two plexiform leiomyomas, two cases of peritoneal leiomyomatosis, one palisaded leiomyoma, and one case of intravenous leiomyomatosis; all of these patients were tumor-free on follow-up.

Diagnostic and Prognostic Significance of p16, p53, and bcl-2 Expressions and Ki-67 Proliferation Index in Benign and Malignant Uterine Smooth Muscle Tumors

“…In recent studies, tumor size was found to be a prognostic factor for stage I disease, and both 5 and 10-cm thresholds were proposed (9,(19)(20)(21). Moreover, in our study, the mean tumor size was statistically significantly larger in the LMS group (11.88±7.79) than in the AL and CL group (p=0.008).…”

Uteri̇n Lei̇omyosarkom: 22 Olguda Patolojik Değerlendirme (Uterine Leiomyosarcoma: Pathologic evaluation of 22 Cases)

“…En önemli prognostik faktör tanı sırasındaki tümörün yaygınlığıdır. Diğer önemli kötü prognostik faktörler ise yaş, tümör çapıve mitotik sayının çokluğudur (10)(11)(12)(13)(14). LMS'lar zaman zaman tanı güçlüğü yaratabilmektedirler.…”

Smooth Muscle, Endometrial Stromal, and Mixed Müllerian Tumors of the Uterus

“…Many studies have demonstrated a relationship between cytologic atypia and outcome for uterine smooth muscle tumors (1,(15)(16)(17). The problem, as always, is defining significant atypia in a way that is reproducible and easily communicated to others.…”

“…Leiomyosarcomas are most often hemorrhagic and soft, and many feature the celebrated fish flesh texture. The usual leiomyosarcoma more often than not is more than 5 cm in diameter (15,16). Microscopically, it is easily recognized as malignant in the vast majority of cases, and usually there is no difficulty in identifying it as a smooth muscle neoplasm.…”

“…Microscopically, it is easily recognized as malignant in the vast majority of cases, and usually there is no difficulty in identifying it as a smooth muscle neoplasm. It is common for pleomorphism to be marked, mitotic counts to be in the range of 15 to 30 mf/10 hpf, and abnormal division figures to be abundant (15)(16)(17). In addition, most leiomyosarcomas contain areas of coagulative tumor cell necrosis; in fact, tumors that contain areas of coagulative tumor cell necrosis behave aggressively often enough to be considered leiomyosarcoma if significant atypia is present or tumors of uncertain malignant potential if atypia is absent (1).…”