Unusual morphological features of uterine leiomyomas treated with progestogens

Boyd, Clinton; McCluggage, W. Glenn

doi:10.1136/jcp.2011.089664

Cited by 27 publications

(19 citation statements)

References 17 publications

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“…Histologic findings described in leiomyomas associated with progestin therapy include increased mitotic activity, stellate hemorrhage (apoplectic change), and ''red degeneration.'' 69,70 Additional common findings described by Boyd and McCluggage 71 are early infarct-type necrosis, often multifocal without a reparative rim of granulation tissue (which could be mistaken for coagulative tumor cell necrosis), mitotic count of up to 10 mitoses/10 HPFs, and focal myxoid change. The most characteristic progestin-associated change is the appearance of myocytes with pyknotic nuclei and abundant deeply eosinophilic cytoplasm adjacent to the necrotic areas.…”

Section: Therapy-related Changes In Uterine Smooth Muscle Tumors and mentioning

confidence: 90%

Recent Developments in Surgical Pathology of the Uterine Corpus

Hanley

Birdsong

Mošunjac

2017

Archives of Pathology &Amp; Laboratory Medicine

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There have been several updates recently on the classification of uterine tumors. Endometrial carcinomas have traditionally been divided into 2 types, but some are difficult to classify and do not fit readily into either of the currently recognized categories. The Cancer Genome Atlas Research Network has recently defined 4 new categories of endometrial cancer on the basis of mutational spectra, copy number alteration, and microsatellite instability, which might provide independent prognostic information beyond established risk factors. The Society of Gynecologic Oncology, moreover, now recommends systematic screening of every patient with endometrial cancer for Lynch syndrome. The new definition of high-grade endometrial stromal sarcoma disregards the number of mitotic figures as a primary diagnostic criterion and instead specifies moderate atypia still resembling stromal origin but lacking the pleomorphism of undifferentiated uterine sarcoma; these tumors also harbor a JAZF1-SUZ12 gene rearrangement. Mitotic count, atypia, and coagulative necrosis are the main histologic criteria that define leiomyosarcoma. Determining the type of necrosis can be very challenging in patients receiving various treatment modalities for symptomatic fibroids before myomectomy, since key histologic features of ischemic-type necrosis are often absent. Ancillary stains including p16, p53, MIB-1, trichrome, and reticulin may be helpful in tumors harboring necrosis that is difficult to classify. Minimally invasive gynecologic surgeries have introduced histologic artifacts that complicate the diagnosis. It is essential to recognize these as procedure-related artifacts to avoid upstaging tumors and triggering unnecessary adjuvant treatment.

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Section: Therapy-related Changes In Uterine Smooth Muscle Tumors and mentioning

confidence: 90%

Recent Developments in Surgical Pathology of the Uterine Corpus

Hanley

Birdsong

Mošunjac

2017

Archives of Pathology &Amp; Laboratory Medicine

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“…The World Health Organization has recently (2014) updated its criteria for mesenchymaltumors of the female reproductive tract [10], and variants of benign smooth muscle tumorsare diagnosed according to their unusual histologicfeatures. Mitotically active leiomyomais defined by the presence of 10-15 mitoses/10 high-power fields (hpf) [11,12] and may be seen in patients with enhanced hormonalstates (pregnancy or taking exogenoushormones).…”

Section: Discussionmentioning

confidence: 99%

Histomorphological study of uterine leiomyomas and its variants with brief review of literature

Budihal

Pawar²,

Manasa

2019

Trop J Pathol Microbiol

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Background: Uterine mesenchymal tumours are a heterogeneous group of neoplasms that can frequently be diagnostically challenging. Most subtypes of leiomyoma are chiefly of interest in that they mimic malignancy in one or more respects. Objective: To evaluate the histomorphological features of uterine leiomyomas and its variants. Materials and methods: Total of 477 cases of uterine leiomyomas and its variants were analysed prospectively in a period of 2years during July 2010 to June 2012 to assess the various pattern of leiomyomas. Cases were studied in detail about complete history, clinical examination and other findings. Results: In the study 468 (98.11%) cases showed features of conventional leiomyoma and 8 cases showed variants of leiomyomas (1.68%). Conclusion: Although their diagnosis is straight forward in most cases, difficulties arise with particular leiomyoma variants, especially highly cellular leiomyoma (often confused with an endometrial stromal tumour) and leiomyoma with bizarre nuclei, mitotically active leiomyoma which may cause concern for leiomyosarcoma.

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“…Almost all the patients in our study who had a known drug history took pre‐operative hormones or tranexamic acid. These drugs have been reported to induce ischaemia with infarct‐type necrosis . Two of us (P.I., A.C.) have shown previously that the use of tranexamic acid (marketed as Cyklokapron™ and Transamine™) for the treatment of leiomyoma‐associated menorrhagia may cause intratumoral thrombosis of blood vessels and infarct‐type necrosis .…”

Section: Discussionmentioning

confidence: 99%