肺良性转移性子宫平滑肌瘤临床病理分析并文献复习

目的：探讨肺良性转移性子宫平滑肌瘤(benign metastasizing leiomyoma,BML)的临床病理学特点及临床治疗。方法：对1例肺良性转移性子宫平滑肌瘤进行临床资料、病理形态学形态及免疫组织化学观察,并结合文献对其诊断及鉴别诊断、临床治疗、预后进行探讨。结果：肿瘤形态类似子宫平滑肌瘤,瘤细胞呈梭形,无细胞的非典型性,未见坏死,核分裂像罕见。免疫组织化学染色示肿瘤细胞：ER、PR、SMA、Calponin强阳性。结论：BML非常罕见,肺是常见转移部位,因缺乏对其认识,易与其他肿瘤混淆导致误诊。提高对BML的认识对避免误诊非常重要。     

肺良性转移性平滑肌瘤5例临床病理分析并文献复习

目的 探讨肺良性转移性平滑肌瘤(pulmonary benign metastasizing leiomyoma,PBML)的临床病理特征、免疫表型、诊断、鉴别诊断及预后。方法 收集5例PBML的临床资料,采用HE及免疫组化EnVision两步法染色,分析其临床病理特征并复习相关文献。结果 患者发病年龄41～60岁,平均49.2岁,均有6～30年子宫肌瘤手术史;影像学表现均为多发、大小不一的肺内结节。镜下见肌瘤细胞呈梭形,胞质丰富略嗜酸性,瘤细胞异型性小,未见核分裂象及坏死。免疫表型:vimentin、desmin、SMA、ER、PR均阳性,S-100、CD117、CD34、DOG1均阴性,Ki-67增殖指数3%。结论PBML多发于子宫平滑肌瘤手术史的女性患者,组织学表现良好,治疗以手术切除为主,病情进展较缓慢,多数患者的预后较好。     

肺转移性子宫平滑肌瘤1例临床病理分析并文献复习

目的 探讨肺转移性子宫平滑肌瘤的发病机制、临床病理特征、治疗及预后.方法 对1例肺转移性子宫平滑肌瘤大体、组织病理学和免疫组化染色特征进行观察,并复习相关文献.结果 眼观:肺组织1块,其上布满0.2～0.8 cm大小不等灰白色小结节,结节质偏硬,与周围肺组织界清;切面灰白色,实性,较大者似有编织状.镜检:肿瘤细胞梭形,细胞密集区呈束状、编织状排列;其中可见呈腺管状排列的增生的肺泡上皮.细胞稀疏区间质玻璃样变,小血管玻璃样变.未见核分裂象,细胞分化良好,无非典型性、无坏死.免疫组化:vimentin、desmin、SMA、actin均(+),CD31、CD34、p53、CD117、HMB-45、D240、Melanin、Ki-67均(-),BCL-2、PR(+),ER(+),呈腺管状排列的增生肺泡上皮TTF-1(+).结论 肺转移性子宫平滑肌瘤是一种罕见疾病,确诊需要结合病史及免疫组化,治疗以手术切除转移病灶辅以内分泌治疗,具有复发倾向,通常患者长期生存.     

子宫分割性平滑肌瘤1例临床病理分析

目的探讨子宫分割性平滑肌瘤临床病理学特征、诊断及鉴别诊断。方法回顾性分析1例子宫分割性平滑肌瘤的临床病理特征、免疫表型,并复习相关文献。结果患者56岁,B超示盆腔低回声包块,大小15 cm×14 cm×9 cm。MRI示子宫后壁一宫底肌层内肿块影、子宫两旁不规则块状影来源不确定,子宫后壁及双侧附件平滑肌瘤变性?或子宫腺肉瘤合并双侧附件性索来源肿瘤?镜检见肿瘤组织呈分化良好的平滑肌组织形态,沿肌壁局限型分割性生长,无坏死,未见核分裂象,呈丛状分布,平滑肌瘤结节之间明显水肿,平滑肌绕血管或血管丛呈漩涡状或不规则排列。免疫表型:子宫分割性平滑肌瘤瘤细胞表达ER、PR、vimetin、H-caldesmon、desmin、SMA均强阳性,CD34血管阳性,CD117、DOG1、CD10、CD99、HMB-45、S-100、CK和EMA均阴性,Ki-67增殖指数1%。结论子宫分割性平滑肌瘤是平滑肌瘤中极为罕见的亚型,病理诊断尤其是术中冷冻切片易误诊。     

多结节水中子宫平滑肌瘤1例报道并文献复习

目的 探讨多结节水中子宫平滑肌瘤(multinodular hydrooic leiomyoma,MHL)的病理学特征.方法 对1例MHL进行免疫组化等染色并复习相关文献.结果 患者40岁,体检时发现子宫肌层内10 cm×9 cm×4 cm大小占位,临床诊断子宫平滑肌瘤,行子宫全切术.眼观:肿瘤由无数水肿明显改变的小结节构成,灰红色,质地软,与子宫肌层呈表浅性犬牙交错.镜检:肿瘤结构疏松,无结构空白腔隙或淡红色水肿液将平滑肌细胞分割成大小不一的细胞巢、索,似脉管内生长.肌瘤周围肌层水样变性并"卫星结节"形成,肿瘤细胞无异型.结论 MHL是一种罕见的变异型肿瘤,预后良好.水样变性的形式有两种:结节周围水样变性和平滑肌瘤内水样变性,肿瘤边缘处常见卫星结节形成和肌层内分割性生长.需与黏液性平滑肌肉瘤、静脉内平滑肌瘤病和血管性肿瘤鉴别.     

677例子宫平滑肌肿瘤的病理诊断

目的：探讨子宫平滑肌肿瘤的病理诊断。方法：对677例子宫平滑肌肿瘤重新观察肿瘤细胞密度,异型性,核分裂象,瘤细胞凝固性坏死和浸润性边缘,作出诊断。结果：普通平滑肌瘤654例,特殊组织类型平滑肌瘤21例（富于细胞型7例,畸异型4例,不典型性9例,核分裂活跃型1例）,恶性潜能未定型平滑肌肿瘤1例,平滑肌肉瘤1例,普通子宫平滑肌瘤核分裂与月经周期显著相关,4例特殊组织类型平滑肌瘤可见肿瘤血管内生长,随访表明特殊组织类型平滑肌瘤为良性经过。结论：特殊组织类型子宫平滑肌瘤虽因形态有异,而导致误诊,但其生物学行为均属良性。     

良性转移性平滑肌瘤5例临床病理分析

目的探讨良性转移性平滑肌瘤(benign metastasizing leiomyoma, BML)的临床病理学特征、诊断及鉴别诊断。方法回顾性分析5例BML的临床病理特征及免疫表型,并复习相关文献。结果 5例患者均有子宫肌瘤病史,分别出现肺转移、腿部转移、乳腺及腹壁转移。镜下为梭形细胞肿瘤,呈编织状、束状、漩涡状排列,部分富于细胞性,异型性小,未见明显核分裂象及坏死。免疫表型:SMA、h-Caldesmon、desmin、vimentin、ER、PR、WT-1均阳性,S-100、CD117、CD34均阴性,Ki-67增殖指数1%～5%。结论 BML多发于育龄期合并子宫肌瘤手术史的女性患者,具有良性的子宫外生长模式,亦可发生于除肺以外的其他部位,最终诊断应基于组织病理检查。     

皮肤交界性平滑肌瘤的复发与恶性转化

目的探讨皮肤交界性平滑肌瘤的复发与恶性转化。方法复习2例皮肤交界性平滑肌瘤及其复发恶性转化的临床病理特征、免疫组化表型及相关文献。结果2例病变位于下肢和额部，肉瘤组织平滑肌标记阳性。结论少数病理诊断为皮肤平滑肌瘤的病例，虽然浅表且组织形态良性，但其生物学恶性潜能尚不能确定，部分病例复发后可转变为典型的平滑肌肉瘤。     

肺良性转移性平滑肌瘤1例并文献复习

目的探讨肺良性转移性平滑肌瘤(pulmonary benign metastasizing leiomyoma,PBML)的临床表现、病理学特征、诊断及鉴别诊断。方法采用免疫组化En Vision法染色检测1例PBML,并进行相关文献复习。结果右肺下叶切除标本,切面灰红色,质软。可见多个灰白色质中结节,最大结节直径2.2 cm。肿瘤细胞密集区呈束状、编织状排列,其间散在部分管腔样结构。梭形肿瘤细胞胞质丰富,核呈长杆状,细胞无异型及坏死。免疫表型:肿瘤细胞中desmin、ER均阳性,管样结构上皮细胞中TTF-1阳性。结论PBML属于可发生转移的良性肿瘤,多见于既往有子宫平滑肌瘤病史的女性,仅依靠影像学易误诊,只有经病理活检及免疫组化标记才能确诊。     

子宫平滑肌肿瘤诊断中的一些问题

子宫平滑肌瘤是病理医师日常工作中最常遇到的妇科标本之一 ,绝大多数病例不存在诊断的问题。当这种肿瘤出现特殊的组织形态和生长方式而类似于平滑肌肉瘤、子宫内膜间质肿瘤 ,或其他肿瘤的表现时就会造成诊断上的困难[1,2 ] ,往往出现意见分歧。现就子宫平滑肌瘤诊断的陷阱(变型 ) ,子宫平滑肌肉瘤诊断的难点 (标准 ) ,不能确定恶性潜能的子宫平滑肌肿瘤 ,以及诊断子宫平滑肌肿瘤的某些共同原则等问题讨论如下。一、诊断子宫平滑肌瘤的陷阱 (变型 )某些子宫平滑肌瘤的变型可能被误诊为平滑肌肉瘤或其他类型的子宫肿瘤 ,因此 ,正确理解子宫…     

Epithelioid leiomyoma of the larynx

We describe the pathological features of a case of laryngeal epithelioid leiomyoma (leiomyoblastoma) which, to our knowledge, is the second case to be reported in the world literature. A review of the literature confirmed that leiomyoma as such is a very rare neoplasm in the larynx, and only 33 cases have been previously reported. The neoplasm was located in the left vocal cord and consisted of mainly epithelioid, round or spindle-shaped cells, often with clear cytoplasm, which were arranged predominantly in solid nests and sheets. The tumour cells showed positive immunoreactivity for smooth muscle actin and desmin. The tumour showed low mitotic activity and immunostaining with MIB 1 (Ki-67) accordingly revealed the occasional cell only to be positive, confirming a low proliferative activity in agreement with a benign neoplasm. Epithelioid leiomyomas located in other sites have been shown to act occasionally in a malignant fashion, and the necessity for careful long-term follow-up of the patient is therefore emphasized.     

Successful myomectomy during pregnancy

BACKGROUND: Although leiomyomas usually remain asymptomatic during pregnancy, they may complicate its course. In this study, pregnancy outcome observed when myomectomy was performed during pregnancy in carefully selected patients is presented. METHODS: A prospective cohort study of 13 women who underwent myomectomy during pregnancy between January 1994 and December 2001. Surgical management of leiomyoma was required on the basis of characteristics of the myoma and symptoms. RESULTS: Among a total of 15,579 women registered at the authors' prenatal clinic, 622 consecutive pregnant women had sonographically identified myoma; hence, the incidence was 3.9% (95% CI 3.6-4.3%). The vast majority of these women was asymptomatic during pregnancy or managed conservatively (97.4%; 95% CI 96-98%). Among 622 pregnant patients with leiomyoma, 13 presented with complications during pregnancy that required surgical intervention (2.1%; 95% CI 0.9-3.2%), due to increase in lesion size causing discomfort and/or severe abdominal pain not responding to conservative management with analgesic and non-steroidal anti-inflammatory drug medication. In 92% of these cases, successful myomectomy was performed and the pregnancy progressed to term without further complications. CONCLUSIONS: These data provide reassurance for pregnant women with uterine myoma. Surgical management of uterine leiomyoma during pregnancy may be successfully performed in carefully selected patients.     

Pulmonary benign metastasizing leiomyoma: a case report

Pulmonary benign metastasizing leiomyoma (PBML) is a rare entity usually occurring in females with history of uterine leiomyoma, and it is preferential to metastasize to the lung and appears as a histopathologic benign tumor of smooth muscle origin. In this article, the clinical and pathological data from 1 patient with PBML were analyzed. Chest CT scan showed that multiple well-defined nodules in the both lobes of the lungs. The tumor cells in the lung were well differentiated, and the pattern of tumor was similar to the original tumor. IHC identified it originated from smooth muscle cells, consistent with the diagnosis of PBML. Positive staining of estrogen and progestogen receptors was detected in both the leiomyoma and the metastasizing lesions. During two years of observation, pulmonary function parameters were within normal limits and there was no evidence of tumor recurrence.     

Solitary fibroleiomyomatous hamartoma of the lung in a patient without a pre-existing smooth-muscle tumor

A solitary well-demarcated tumor was found in the left lung of a 53-year-old man. It was located in the posterior region of the lower lobe just adjacent to, but apart from, the pleura. It was resected by video-associated thoracic surgery. Macroscopically, the tumor was a whitish solid nodule without hemorrhage or necrosis, and it was 1.5 cm in diameter. Histologically, the tumor consisted of a proliferation of fibromuscular tissue in interlacing fascicles in which many tubular or cleft-like epithelial inclusions were involved. The epithelial inclusions showed cystic changes with goblet cell metaplasia in part, but no atypical changes. Other mesenchymal components such as cartilaginous, myxomatous or adipose tissues were not seen. The patient had no history of neoplasm, including smooth-muscle tumor. Thus, we diagnosed this tumor as a "true" fibroleiomyomatous hamartoma, as distinct from so-called fibroleiomyomatous hamartoma or benign metastasizing leiomyoma, which are usually found in the lungs of women who have had hysterectomies, as multiple fibromuscular nodules. We report here this rare case and we review and discuss published reports of fibromuscular tumors of the lung.     

Progesterone down-regulates insulin-like growth factor-I expression in cultured human uterine leiomyoma cells

BACKGROUND: Insulin-like growth factor-I (IGF-I) plays crucial roles in uterine leiomyoma cell growth through stimulating proliferation and inhibiting apoptosis. The present study was conducted to elucidate whether progesterone affects IGF-I and its receptor expression in cultured leiomyoma cells. METHODS: Isolated leiomyoma cells were subcultured in Phenol Red-free Dulbecco's modified Eagle's medium supplemented with 10% fetal bovine serum for 120 h and then stepped down to serum-free conditions for an additional 48 h in the presence or absence of 17beta-estradiol (E(2)) (10 ng/ml) or progesterone (100 ng/ml). IGF-I and its receptor mRNA and immunoreactive IGF-I in the cultured cells were assessed by quantitative RT-PCR with Southern blot analysis and by radioimmunoassay with Seppak C18 chromatography, respectively. The presence of estrogen receptor (ER) and progesterone receptor (PR) in cultured leiomyoma cells was immunocytochemically examined. RESULTS: Both treatment with progesterone alone and treatment with E(2) and progesterone combined significantly decreased IGF-I mRNA and protein expression in cultured leiomyoma cells compared with that in untreated cultures, but treatment with E(2) alone did not. IGF-I receptor mRNA expression in those cells was not affected by treatment with either E(2) or progesterone. Immunocytochemical analysis revealed that PR protein expression in cultured leiomyoma cells maintained in a serum-free condition for 48 h whereas ER protein expression in the cells remarkably decreased after 24 h culture under the serum-free condition. CONCLUSIONS: The present study provided evidence for the first time that progesterone down-regulates IGF-I mRNA and protein expression in cultured leiomyoma cells without affecting IGF-I receptor mRNA expression.     

Cellular ‘neurothekeoma’: an epithelioid variant of pilar eiomyoma? Morphological and immunohistochemical analysis of a series

Cellular neurothekeoma is a recently recognized benign cutaneous neoplasm, which is currently regarded as being of nerve sheath origin and is thought to represent a variant of conventional neurothekeoma (dermal nerve sheath myxoma). Nine new cases presenting predominantly in adolescents or young adults are described. Morphologically they were characterized by short fascicles or small nests of palely eosinophilic epithelioid or spindle-shaped cells which ramified in an ill-defined manner between dermal collagen bundles. Myxoid matrix was absent or sparse. Scattered normal mitoses and multinucleate giant cells were often present. Immunohistochemically all nine cases were strongly NK1/C3 positive, seven were weakly NSE positive and three were smooth muscle actin positive. Staining for S-100 protein, PGP 9.5, epithelial membrane antigen and desmin was negative in all cases. In view of its distinctive architecture and immunophenotype, both of which are totally different from conventional neurothekeoma, it is proposed that cellular 'neurothekeoma' is a separate discrete entity which may represent an epithelioid variant of pilar leiomyoma.