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首页> 外文期刊>The Internet Journal of Orthopedic Surgery >Bizarre Leiomyoma – A Close Mimicker Of Its Malignant Counterpart: A Case Report.
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Bizarre Leiomyoma – A Close Mimicker Of Its Malignant Counterpart: A Case Report.

机译：奇异的平滑肌瘤-恶性对口的密谋：一个病例报告。

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INTRODUCTION: Bizarre leiomyoma is infrequently encountered in surgical pathology. It is characterized by presence of multinucleated giant cells with pleomorphic nuclei and little or no mitotic activity. CASE REPORT: A 40 year old female presented with mass per abdomen of two years duration. Clinically she was diagnosed to have fibroid and total abdominal hysterectomy was performed. Grossly uterus was bulky. Cut section revealed multiple grey-white circumscribed tumor nodules with multiple tiny cysts. Microscopy showed features of bizarre leiomyoma characterized by bizarre multinucleated giant cells, moderate to severe pleomorphism and little mitotic activity. However, coagulative necrosis was absent. CONCLUSION: Bizarre leiomyoma closely mimics leiomyosarcoma. A systematicapproach is needed to arrive at the right diagnosis and thereby exclude malignancy. Introduction According to World Health Organization [WHO] classification, Bizarre leiomyoma is defined as “Leiomyoma containing giant cells with pleomorphic nuclei and little or no mitotic activity”.1 In 1909, Kelly and Cullen in their monograph on myomata of uterus described several tumors that macroscopically had the usual appearance of myomata but histologically contained cells suggestive of “sarcomatous degeneration” including large multinucleated tumor cells.1 In 1961 Przybora introduced the term “leiomyosarcoma in situ” for a group of 15 uterine smooth muscle tumors in which distinctly atypical cells, especially multinucleated giant cells were found within otherwise simple myoma. The designation “leiomyosarcoma in situ” never gained favor for these tumors instead, the terms “atypical leiomyoma”, “bizarre leiomyoma”, “pleomorphic leiomyoma” and “symplastic leiomyoma” became popular. The notion that myomatous tumors with bizarre nuclei represent a stage in the development of leiomyosarcoma was discarded. Instead tumors were regarded as histologic variant of otherwise ordinary leiomyoma.1 In 1972, Christopherson et al specifically described 17 bizarre leiomyomas that were called from a large group of uterine tumors with a prior diagnosis or suspicious of sarcoma. In subsequent classification developed for WHO, Christopherson’s term “bizarre leiomyoma” was adopted and “symplastic leiomyoma” and “Pleomorphic leiomyoma” were acknowledged as synonymous designations.1 Bizarre [symplastic] leiomyoma have a frightening microscopic appearance because of the many large giant cells with very large, cytologically malignant looking nuclei, which may be multiple. These lesions, which occur at premenopausal age, lack the mitosis that characterize leiomyosarcoma and have proved to be benign.2 It is composed of tumor cells with variation in size and shape, hyperchromatic nuclei and multinucleated forms but no coagulative necrosis or increased mitotic activity. It may occur spontaneously but is often seen in patients taking progestin compounds.3 A recent trend in classification of uterine smooth muscle neoplasms into clinically benign and clinically malignant groups has been to move from exclusive reliance upon mitotic index [MI] to an approach that incorporates additional histopathologic characteristics.4 Case Report A 40 year old female presented with mass per abdomen over a period of 2 years (fig 1).
机译：简介：奇怪的平滑肌瘤在手术病理中很少见。其特征在于存在具有多形核且几乎没有或没有有丝分裂活性的多核巨细胞。病例报告：一名40岁女性，腹部持续两年包块。临床上她被诊断出患有肌瘤，并进行了全腹子宫切除术。子宫大而笨重。切面可见多处灰白色外接肿瘤结节，并有多个微小囊肿。显微镜检查显示奇异性平滑肌瘤的特征是奇异的多核巨细胞，中等至严重的多态性和有丝分裂活性小。但是，没有凝血坏死。结论：奇异性平滑肌瘤与平滑肌肉瘤极为相似。需要一种系统的方法来进行正确的诊断，从而排除恶性肿瘤。引言根据世界卫生组织（WHO）的分类，奇异性平滑肌瘤被定义为“含有多形核且无或没有有丝分裂活性的巨细胞的平滑肌瘤”。11909年，Kelly和Cullen在其关于子宫肌瘤的专着中描述了几种肿瘤，肉眼通常具有肌瘤的外观，但在组织学上包含暗示“肉瘤变性”的细胞，包括大型多核肿瘤细胞。11961年，Przybora为一组15个子宫平滑肌瘤引入了“原位平滑肌肉肉瘤”一词，其中明显的非典型细胞，尤其是多核巨细胞，是在其他简单的肌瘤中发现的。取而代之的是“原位平滑肌肉瘤”从未受这些肿瘤的青睐，术语“非典型平滑肌瘤”，“ bizarre平滑肌瘤”，“多形性平滑肌瘤”和“交感性平滑肌瘤”开始流行。具有奇异核的肌瘤肿瘤代表平滑肌肉瘤发展阶段的观点被摒弃了。取而代之的是，肿瘤被认为是其他普通平滑肌瘤的组织学变异体。11972年，Christopherson等人特别描述了17种奇异的平滑肌瘤，它们是由一大批事先诊断为或可疑有肉瘤的子宫肿瘤所称。在为WHO制定的后续分类中，采用了克里斯托弗森的术语“ bizarre平滑肌瘤”，并且将“象征性平滑肌瘤”和“多形性平滑肌瘤”视为同义名称。1奇怪的[symplastic]平滑肌瘤在显微镜下表现出令人恐惧的表现，因为许多大型巨细胞非常大的细胞学上看起来很恶性的核，可能是多个。这些病变发生在绝经前，没有特征为平滑肌肉瘤的有丝分裂，并且已被证明是良性的。2它由大小和形状各异，核色增生和多核形式变化的肿瘤细胞组成，但没有凝集性坏死或有丝分裂活性增加。它可能自发发生，但在服用孕激素化合物的患者中经常见到。3子宫平滑肌瘤在临床上分为良性和恶性组的最新趋势是从完全依赖有丝分裂指数[MI]转变为采用其他病例的组织病理学特征。4病例报告一名40岁女性在2年内出现了每腹部肿块（图1）。

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