Watanabe K, Suzuki T
Pathology Division, Fukushima Medical University School of Medicine Hospital, Fukushima, Japan.
Histopathology. 2006 Apr;48(5):563-8. doi: 10.1111/j.1365-2559.2006.02368.x.
To differentiate uterine leiomyoma (LM) with 'pseudosarcomatous' features from leiomyosarcoma (LMS). We hypothesized that because pseudosarcomatous LM is only a benign variant of conventional LM, it may have some characteristics different from LMS.
Fourteen uterine smooth muscle tumours, which had been diagnosed as LMS previously, were reviewed and divided into adverse outcome (true LMS; seven cases) and excellent outcome groups (presumed pseudosarcomatous LM; seven cases) based on their clinical course. The tumours of the adverse outcome group were composed of rather uniform long spindle cells similar to those of leiomyosarcoma arising from the soft tissue. All tumours in this group had coagulative necrosis and all but one case were diagnosed preoperatively as malignant. In contrast, the tumours of the excellent outcome group showed significant histological diversity both between tumours and also in the same tumour and areas indistinguishable from conventional LM were often seen. All the tumours of this group were diagnosed preoperatively as benign. Immunohistochemically, all tumours of the excellent outcome group expressed progesterone receptor, often intensely, and also frequently expressed oestrogen receptor. In contrast, all the tumours of the adverse outcome group lacked them completely.
Pseudosarcomatous LM has characteristics useful for differentiating it from LMS, which are common in conventional LM.
鉴别具有“假肉瘤样”特征的子宫平滑肌瘤（LM）与平滑肌肉瘤（LMS）。我们推测，由于假肉瘤样LM仅是传统LM的一种良性变体，它可能具有一些与LMS不同的特征。
对14例先前被诊断为LMS的子宫平滑肌肿瘤进行回顾，并根据其临床病程分为不良预后组（真性LMS；7例）和良好预后组（推测为假肉瘤样LM；7例）。不良预后组的肿瘤由与软组织来源的平滑肌肉瘤相似的相当一致的长梭形细胞组成。该组所有肿瘤均有凝固性坏死，除1例外在术前均被诊断为恶性。相比之下，良好预后组的肿瘤在肿瘤之间以及同一肿瘤内部均表现出显著的组织学多样性，且常可见到与传统LM难以区分的区域。该组所有肿瘤在术前均被诊断为良性。免疫组化方面，良好预后组的所有肿瘤均表达孕激素受体，且通常表达强烈，同时也经常表达雌激素受体。相反，不良预后组的所有肿瘤均完全缺乏这些受体。
假肉瘤样LM具有一些有助于将其与LMS区分开来的特征，这些特征在传统LM中较为常见。
