Myxoid leiomyosarcoma of the uterus

Burch, David M; Tavassoli, Fattaneh A.

doi:10.1111/j.1365-2559.2011.04053.x

Cited by 56 publications

(27 citation statements)

References 34 publications

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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%

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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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“…The presence of any of the following features has been proposed as sufficient for a diagnosis of myxoid leiomyosarcoma: tumor cell necrosis, severe cytologic atypia, or a mitotic index of >2/10 high-power fields (9). In addition, an infiltrative interface with the myometrium and vascular invasion have been proposed as indicative of malignant potential among myxoid neoplasms (10). Although there is significant morphologic overlap with the organizing mucin seen in the present case, there are several features that distinguish the two.…”

Section: Pseudomyxoma Endometriimentioning

confidence: 87%

“Pseudomyxoma Endometrii”

Shaw

Kokh²,

Ioffe³

et al. 2015

International Journal of Gynecological Pathology

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Low-grade appendiceal mucinous neoplasms (LAMNs) are commonly associated with deposition of mucin, with or without admixed low-grade epithelium, on peritoneal surfaces (pseudomyxoma peritonei). We describe a very rare presentation of LAMN as extensive mucin deposition in the endometrium of a 43-yr-old woman initially mistaken for a primary uterine myxoid neoplasm. The patient underwent endometrial curettage that demonstrated abundant myxoid/mucoid material interspersed with small vessels, bland eosinophilic spindled cells, scattered foci of typical endometrial stroma, and occasional endometrioid glands. The endometrial stroma was positive for CD10, and the eosinophilic spindled cells were positive for actin. The lesion was interpreted as "myxoid/mucinous neoplasm, most likely of smooth muscle/endometrial stromal origin." Subsequent laparotomy revealed peritoneal mucin in the anterior cul-de-sac and a dilated appendix. Pathologic review confirmed appendiceal LAMN and multifocal peritoneal mucinosis. The uterus contained scant residual mucoid material. On review of all pathologic material at our institution, the endometrial lesion was consistent with organizing mucin derived from the LAMN with entrapped benign endometrium. "Pseudomyxoma endometrii" is readily mistaken for a primary uterine myxoid neoplasm, particularly myxoid endometrial stromal tumor. A key to diagnosis is recognition that the material is mucin rather than myxoid stroma. This is evidenced by the absence of embedded stromal cells and presence of myofibroblastic, vascular, and macrophage infiltration associated with organization. Epithelium containing goblet cells is an important clue if present. The presence of rare endometrial glands within the endometrial stroma suggests that the latter is entrapped rather than neoplastic.

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“…Microscopically the tumour contains large amount of myxomatous stroma and may invade adjacent tissues. Infiltrating margin is a major factor leading to aggressive behaviour of the tumour [2]. Myxomatous change occurs in 15% of tumours, more commonly in older women.…”

Section: Discussionmentioning

confidence: 99%

A Mitotically Active Uterine Myxoid Leiomyosarcoma Infiltrating The Parametrium And the Ovary

Ashish¹,

Momin²

2017

IOSR JDMS

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Myxoid leiomyosarcoma of the uterus

Abstract: In the absence of TCN, an infiltrative margin is a major factor related to the potential for aggressive behaviour of MLMS.

Cited by 56 publications

References 34 publications

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

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

“Pseudomyxoma Endometrii”

A Mitotically Active Uterine Myxoid Leiomyosarcoma Infiltrating The Parametrium And the Ovary

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