Department of Pathology, The University of Hong Kong, Queen Mary Hospital.
Best Pract Res Clin Obstet Gynaecol. 2011 Dec;25(6):691-704. doi: 10.1016/j.bpobgyn.2011.07.003. Epub 2011 Aug 23.
Uterine leiomyosarcomas are the most common uterine sarcomas. For clinicians, they are difficult tumours to manage. Preoperative detection is difficult because of the similarity in clinical presentation to ordinary fibroids. They are highly aggressive tumours and the effectiveness of adjuvant therapy remains controversial with surgery remaining the mainstay of treatment. Despite treatment, disease frequently recurs. For pathologists, diagnosis of most leiomyosarcomas using current diagnostic criteria is usually straightforward, as most tumours often possess two or more diagnostic microscopic features, including diffuse atypia, high mitotic count and tumour cell necrosis. Diagnostic difficulties usually relate to tumours having only one of these worrisome features, with or without other additional unusual morphologic findings. These latter tumours have been labelled as uterine smooth-muscle tumours of uncertain malignant potential. Those that are followed by a recurrence are biologically low-grade leiomyosarcomas. Epithelioid and myxoid leiomyosarcomas are less common, and their diagnostic criteria are different to tumours of usual spindle cell differentiation. In this review, we discuss the pathology of leiomyosarcomas, including an update on smooth-muscle tumours of uncertain malignant potential, with emphasis on the controversy of labelling of atypical leiomyomas. The problems with histologic diagnosis, immunohistochemical studies and molecular pathology are reviewed.
子宫平滑肌肉瘤是最常见的子宫肉瘤。对于临床医生来说，它们是难以治疗的肿瘤。由于临床表现与普通肌瘤相似，术前检测困难。它们是高度侵袭性肿瘤，辅助治疗的效果仍存在争议，手术仍然是主要的治疗方法。尽管进行了治疗，疾病仍经常复发。对于病理学家来说，使用当前的诊断标准，大多数平滑肌肉瘤的诊断通常很简单，因为大多数肿瘤通常具有两个或更多个诊断性微观特征，包括弥漫性异型性、高有丝分裂计数和肿瘤细胞坏死。诊断困难通常与仅具有一个令人担忧的特征的肿瘤有关，无论是否存在其他不常见的形态学发现。这些后者肿瘤被标记为具有不确定恶性潜能的子宫平滑肌肿瘤。那些随后复发的是生物学上低度恶性的平滑肌肉瘤。上皮样和平滑肌肉瘤较少见，其诊断标准与通常的纺锤形细胞分化的肿瘤不同。在这篇综述中，我们讨论了平滑肌肉瘤的病理学，包括对具有不确定恶性潜能的平滑肌肿瘤的最新更新，重点是对非典型平滑肌瘤的标记的争议。还回顾了组织学诊断、免疫组织化学研究和分子病理学的问题。
