子宫和卵巢腺瘤样瘤的临床病理分析

目的 探讨女性生殖系统腺瘤样瘤的发生、免疫组织化学表达的特征及鉴别诊断。方法 对24例子宫和卵巢腺瘤样瘤进行临床病理及免疫组织化学观察。结果 24例患者中腺瘤样瘤发生于子宫者21例,卵巢者2例,子宫与卵巢同时发生者1例,分别占本院同期子宫及卵巢肿瘤及瘤样病变的0.34%和0.06%。免疫组织化学染色显示：波形蛋白及细胞蛋白（AE1／AE3）均为阳性,呈双相表达;第八因子相关抗原（FⅧRAg)均为阴性;S－100蛋白20例阳性（83.3%),上皮膜抗原（EMA）4例阳性（16.7%);其中10例行calretinin蛋白染色,均为阳性表达。结论 女性生殖系统腺瘤样瘤为间皮起源,子宫为最常见部位。免疫组织化学染色结果可作为诊断及鉴别诊断的重要参考依据。其生物学行为为良性,预后良好。     

Cotyledonoid leiomyoma of uterus: a case report

The diagnosis of uterine smooth muscle tumors is usually not difficult. Occasionally, benign tumors with an unusual growth pattern may cause some diagnostic confusion for pathologists who had not experienced such a tumor before. A fifty-one year old female patient had admitted to our gynecology outpatient clinics with abnormal uterine bleeding (menorrhagia) and undergone a surgery with a diagnosis of pelvic mass. A neoplasm consisting of spindle cell nodules with prominent hydropic degeneration was observed at pathological examination. Tumor cells were positive for vimentin, desmin and smooth muscle actin at immunohistochemical evaluation. Cotyledonoid leiomyomas are rare benign smooth muscle tumors of uterus which are recently defined in the literature. In this article we report a case of cotyledonoid leiomyoma of uterus with an exophytic growth pattern in the serosa and did not contain an intramural dissecting component.     

Breast leiomyoma: a case report and review of the literature

Breast leiomyoma is a rare and benign tumor which arises from a smooth muscle in nipple and areola or smooth muscle metaplasia of myoepithelial cells or myofibroblastic cells. Common differential diagnosis of the breast leiomyoma was as follows: fibroadenoma, myoepithelioma, phyllodes tumor, and leiomyosarcoma. We present here a rare case of solitary leiomyoma of the breast. We described a case of breast leiomyoma diagnosed in an otherwise healthy 37-year-old woman at the Rajaee Hospital. The patient presented with a palpable mass in her right breast since 2 years. Physical examination showed a mobile and smooth mass, without any axillary lymphadenopathy. The radiologic examinations revealed a well-circumscribed ovoid mass, 5 cm in diameter. Excisional biopsy disclosed a well-circumscribed cellular tumor by interlacing fascicles of spindle cells with fibrillary and eosinophilic cytoplasm. The tumoral cells were immunoreactive for smooth muscle actin. There were not any evidences of disease recurrence for 20 months of follow up. Histopathological study and immunohistochemical examinations help in the discrimination between leiomyoma and other benign and malignant breast lesions and determination of outcome.     

Cotyledonoid leiomyoma: a benign uterine tumor with alarming gross appearance

Cotyledonoid leiomyoma or "grapelike" leiomyoma is a very rare tumor among the ever-expanding repertoire of growth variants described in benign uterine leiomyoma. We report a case of cotyledonoid leiomyoma in a 55-year-old woman who presented with menorrhagia and uterine prolapse. A large multinodular fungating tumor adhering to the right posterolateral wall of the uterus and extending to the broad ligament was discovered at vaginal hysterectomy. With a provisional diagnosis of sarcoma, total hysterectomy and bilateral salpingo-oophorectomy were performed. Postoperatively, the patient was well with no evidence of recurrence at 14 months. Pathologic examination revealed a 10-cm, red-brown tumor that comprised multiple bulbous processes protruding over the uterine surface, in continuity with a dissecting intramyometrial component. It was composed of fascicles and nodules of bland-looking smooth muscle cells with prominent perinodular hydropic degeneration. Coagulative necrosis, mitoses, and nuclear atypia were absent. Cotyledonoid leiomyoma apparently results from a combination of several uncommon growth patterns operating together, including subserosal growth, dissecting growth, and perinodular hydropic degeneration. Increased awareness of this grossly alarming variant of benign uterine leiomyoma can help avoid overtreatment.     

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。     

246例子宫平滑肌肿瘤临床病理分析

目的:探讨子宫平滑肌肿瘤临床病理特征.方法:对246例子宫平滑肌肿瘤的临床病理资料进行回顾性分析.结果:子宫平滑肌肿瘤发病高峰年龄为40～50岁,可伴内膜增生或腺肌病,同时与卵巢、宫颈多种良恶性病变并存.246例子宫平滑肌肿瘤中,91.4%为普通型良性平滑肌瘤;6.9%为平滑肌瘤特殊组织学类型;0.8%为平滑肌肉瘤;0...     

Clear cell carcinoma arising from a uterus‐like mass

A uterus‐like mass is an extrauterine mass with a cavity lined by endometrial tissue and a smooth muscle layer resembling the uterine corpus. It is a rare condition of unknown histogenesis. Herein, we describe a case of clear cell carcinoma arising from a uterus‐like mass located in the retroperitoneal space. The patient, a 67‐year old nulliparous woman, had been followed with the diagnosis of an ovarian endometriotic cyst for 14 years until ultrasonography and magnetic resonance imaging (MRI) demonstrated an enlargement of the cystic mass with a thickened irregular wall. Suspicion of malignant transformation prompted us to excise the lesion. At laparotomy, the uterus and right ovary appeared normal, and a mass measuring 8 cm was identified in the retroperitoneal space without any connection to the uterus. Grossly, the removed mass was composed of a cyst filled with blackish‐brownish fluid and a thick wall resembling uterine myometrium. Microscopically, endometrial tissue inside the cyst, which was diffusely lined by clear cell carcinoma, was identified. Although the histogenesis of a uterus‐like mass remains unclear, this case indicates that malignant tumors may occur from a uterus‐like mass through the pathway similar to the carcinogenesis of endometriosis‐related ovarian neoplasms.     

Multinodular hydropic leiomyoma of the uterus with perinodular hydropic degeneration and extrauterine extension

Multinodular hydropic leiomyoma (MHL) of the uterus is one of the rarest variants of uterine leiomyomas and can create some diagnostic problems. Only five cases have been reported previously. We describe an MHL with perinodular hydropic degeneration in a 48-year-old woman. Gross examination revealed a large and predominantly intramural, edematous multinodular uterine tumor and extrauterine, small grape-like nodules overlying the lateral surface of the uterine serosa. Histologically, the tumor was composed of extra-intrauterine benign, small smooth muscle nodules with perinodular hydropic degeneration, prominent intramural dissecting growth pattern, and satellite nodules closely resembling vascular invasion. Immunohistochemically, these cells stained for desmin, smooth muscle actin and vimentin. The patient had no evidence of disease for 18 months after hysterectomy. Multinodular hydropic leiomyoma is a clinically benign tumor and should not be confused with intravenous leiomyomatosis and some other unusual leiomyoma variants.     

Lipomatous lesions of the uterus

Summary Four lipomatous lesions of the uterus are reported and the available literature from 1965 to 1976 is reviewed. It is suggested that these lesions result from metamorphosis of uterine smooth muscle which can proceed to form localised or diffuse mature adipose tissue in a leiomyoma or in the myometrium.Three terms are suggested for the nomenclature of the various morphological types of lipomatous lesions of the uterus: diffuse lipomatosis in a leiomyoma, circumscribed lipomatosis in a leiomyoma and uterine lipoma.     

Large lipoleiomyoma of the uterine body

Large or giant lipoleiomyoma of the uterine corpus is a rare condition. A 70-year-old Japanese woman consulted our hospital because of a pelvic mass and abnormal uterine bleeding. Physical examination showed a mass in the pelvis. Blood laboratory test showed anemia and leukocytosis. Cholesterol, triglyceride, glucose, and hemoglobin A1c were normal. Tumor markers (CEA, CA19-9, CA125, SCC, and CA72-4) were normal. Imaging modalities including ultrasound and computed tomography revealed a characteristic large (8 × 8 × 9 cm) tumor in the posterior aspect of the uterine body. The tumor was characteristic, and the opacity was heterogenous. Radiologists' diagnosis was angiomyolipoma. Simple hysterectomy and bilateral salpingo-oophorectomy were performed. During the operation, it was found that the mass originated from the posterior aspect of the uterine body. Grossly, the resected mass was heterogenous and whitish yellow. It measured 10 × 9 × 9 cm. The tumor originated from the myometrium and assumed features of subserosal leiomyoma. Histologically, the tumor was composed of adipose tissue and smooth muscle cells. The adipose tissue was mature, and there were no atypical cells or lipoblasts. The smooth muscle areas were composed of red spindle smooth muscle cells. No atypia was seen in the smooth muscles. Mitotic figures were not recognized. Vascular proliferation was not seen. The adipose tissue element accounted for 20% in area; and the smooth muscle element, 80%. Immunohistochemically, the adipose tissue element was positive for vimentin and S100 protein, and negative for pancytokeratins (AE1/3, CAM5.2), α-smooth muscle actin, desmin, CD34, HMB45, p53, MDM2, CDK4, and KIT. The smooth muscle element was positive for vimentin, desmin, and α-smooth muscle actin, but negative for pancytokeratins (AE1/3, CAM5.2), S100 protein, CD34, HMB45, p53, MDM2, CDK4, and KIT. The Ki-67 labeling was approximately 0.3% in the smooth muscle element and approximately 0.2% in the adipose tissue element. The pathological diagnosis was large lipoleiomyoma of the uterine body. The patient is now free of the tumor 2 years after the operation.     

Cotyledonoid leiomyoma of the uterus

In the growing knowledge of rare interesting tumors, the cotyledonoid leiomyoma is a tumor with an alarming appearance, of benign nature, but dealt with undue severity. We report a case of cotyledonoid leiomyoma in a 40 yr old female who presented with urinary retention and in whom a clinical diagnosis of uterine fibroid was made. On laparotomy, friable nodules were seen in the lower part of the uterus. Hence the diagnosis of sarcoma was considered and total abdominal hysterectomy with unilateral salpingo-oopherectomy was done. The friable nodules were removed piecemeal. Microscopic examination revealed nodules of bland looking smooth muscle cells arranged in-interlacing fascicles with perinodular hydropic degeneration. Necrosis or nuclear atypia was not seen. Increased awareness of this grossly alarming variant of benign leiomyoma can help avoid over treatment.     

Recurrent mesectodermal leiomyoma of the ciliary body: a case report

A 19-yr-old woman with a previous history of a mass of the right ciliary body presented with a decreased visual acuity of right eye. Clinicoradiologic examinations suggested a recurrent mass of the ciliary body. Enucleation of the right eye was performed under the impression of malignant tumor. On microscopic examination, the tumor was a mesectodermal leiomyoma of the ciliary body. On immunohistochemistry, the tumor cells were reactive to smooth muscle actin and vimentin, but not reactive to cytokeratin, S-100 protein, neurofilament, desmin, epithelial membrane antigen, HMB-45, glial fibrillary acidic protein, and synaptophysin. Electron microscopy revealed numerous thin longitudinally placed myofilaments and focal densities in the cytoplasms. In the review of the literature, only 27 cases of mesectodermal leiomyoma of the ciliary body were reported, however, there was no report of recurrent cases. Mesectodermal leiomyoma should be differentiated from other orbital spindle-cell tumors such as amelanotic melanomas and glial tumors. Immunohistochemical and electron microscopic studies may be useful for the correct diagnosis by showing smooth muscle differentiation in the tumor cells.     

The growth arrest-specific gene CCN5 is deficient in human leiomyomas and inhibits the proliferation and motility of cultured human uterine smooth muscle cells

Uterine fibroids (leiomyomas) are a major women's health problem. Currently, the standard for treatment remains hysterectomy, since no other treatment modalities can reduce both symptoms and recurrence. As leiomyomas are benign neoplasias of smooth muscle cells, we sought to understand the regulation of uterine smooth muscle cell mitogenesis by CCN5, a growth arrest-specific gene in vascular smooth muscle cells which is induced and maintained by heparin treatment. Using autologous human myometrial and leiomyoma smooth muscle cells, we demonstrate that the proliferation and motility of both cell types are inhibited by the overexpression of CCN5. Surprisingly, we show that even though CCN5 is induced by heparin in vascular smooth muscle cells, treatment with heparin does not induce CCN5 expression in human uterine smooth muscle cells. Furthermore, we examine CCN5 mRNA expression in 10 autologous pairs of human myometrial and leiomyoma tissues and determine that CCN5 is down-regulated in 100% of the leiomyoma tissues analysed when compared to their normal myometrial counterparts. Thus, our data strongly suggest that CCN5 may exert an important function in maintaining the normal uterine phenotype and that loss of the anti-proliferative protein CCN5 from normal myometrium may account, at least in part, for tumorigenesis.     

Pure lipoma of the uterus: a rare case report

Pure fatty tumors of the uterus are exceedingly rare. The more common lipomatous tumor is lipoleiomyoma with varying amounts of two components. Most are post-operative chance findings following hysterectomy for leiomyoma. Computed Tomography and Magnetic Resonance Imaging can assist in pre-operative diagnosis. A 60 year old post-menopausal woman presented with a mass per abdomen. Ultrasound revealed fibroid uterus with lipomatous areas. The hysterectomy specimen showed a pure intramural lipoma of the uterus. As clinical symptoms and signs of uterine lipoma are indistinguishable from uterine leiomyoma, various imaging techniques can aid in pre-operative diagnosis. The diagnosis of pure lipoma of the uterus should only be made when any smooth muscle if present is confined to the periphery of the tumor.     

Diffuse leiomyomatosis of the uterus

The clinical and pathological features of four cases of the rare entity diffuse leiomyomatosis of the uterus are described. The patients, who ranged in age from 28 to 35 years, presented with a six month to ten year history of abnormal uterine bleeding, dysmenorrhoea and an enlarged uterus. Hysterectomy in each case revealed a symmetrically enlarged uterus containing numerous small ill-defined leiomyomatous nodules. On microscopic examination the nodules were composed of compact fascicles and interweaving bundles of plump uniform benign smooth muscle cells. The nodules blended with each other and merged imperceptibly with the surrounding less cellular normal myometrium. The four patients are alive and well without further treatment. The follow-up period ranged from six months to twelve years.     

A cystic adenomatoid tumor of the uterus simulating lymphangioma grossly

We are reporting a rare case of an adenomatoid tumor of the uterus having multicystic gross appearance. A 32-year-old woman complaining of dysmenorrhea had multicystic mass lesions on the posterior wall of the right cornual region of the uterus. The specimen showed a honeycomb appearance with mucoid content. Microscopically, numerous gland-like spaces lined with low cuboidal cells were observed beneath the serosa, and mucopolysaccharide material accumulated in the cystic spaces forming, honeycomb-like lesions surrounded by myometrial tissue. The postoperative course was uneventful and the patient was discharged on the 9th day after the operation. "Cystic adenomatoid tumor of the uterus" was diagnosed. The patient is being followed up continuously, so far without recurrence.     

Heparin inhibits proliferation of myometrial and leiomyomal smooth muscle cells through the induction of alpha-smooth muscle actin, calponin h1 and p27

Mast cells are widely distributed in human tissues, including the human uterus. However, the function of mast cells in uterine smooth muscle has not been clearly established. Mast cells possess secretory granules containing such substances as heparin, serotonin, histamine and many cytokines. To help establish the role of mast cells in the human myometrium, the action of heparin was investigated using smooth muscle cells (SMC) from normal myometrium and from leiomyoma. The proliferation of cultured myometrial and leiomyomal SMC was inhibited by heparin treatment. Flow cytometric analysis showed that the population in the G1 phase of the cell cycle increased under heparin treatment. Western blotting analysis showed that markers of SMC differentiation such as alpha-smooth muscle actin (alpha-SMA), calponin h1 and cyclin-dependent kinase inhibitor p27 were induced by heparin, whereas cell-cycle-related gene products from the G1 phase of the cell cycle, such as cyclin E and cdk2, were not changed. Taken together, these results indicate that heparin inhibits the proliferation of myometrial and leiomyomal SMC through the induction of alpha-SMA, calponin h1 and p27. We suggest that heparin from mast cells may induce differentiation in uterine SMC and may influence tissue remodelling and reconstruction during physiological and pathophysiological events.     

Clear Cell Leiomyoma (Leiomyoblastoma) of the Uterus: Ultrastructural Observations

The infrastructure of a benign uterine epithelioid leiomyoma with prominent clear cells (“leiomyoblastoma”) was studied to define the subcellular changes that yield the distinctive light microscopic pattern of this rare lesion. The main constituent of the cytoplasm was multiple cytolysosomes composed of vesicular, membranous material. Aggregates of glycogen also contributed to the clear appearance of the cytoplasm seen by light microscopy. In addition, the cells contained scattered aggregates of typical smooth muscle myofilaments with densities that certified that the lesion was a variant of a leiomyoma. The fine structural features of this lesion are distinctly different than those described in gastrointestinal leiomyoblasto-mas and indicate that the uterine clear cell leiomyoma is a unique lesion that should be separated from nonuterine leiomyoblastomas. Furthermore, the ultrastructural features of the uterine clear cell tumor suggest the lesion represents a leiomyoma that has undergone sublethal cell injury. The term “leiomyoblastoma” implies a primitive tumor and is inappropriate; “epithelioid leiomyoma, clear-cell type” is preferred.