Terada Tadashi
Departments of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan.
Appl Immunohistochem Mol Morphol. 2015 Feb;23(2):e1-3. doi: 10.1097/PAI.0b013e318218ae15.
Giant lipoleiomyoma (LL) of the uterus is a rare condition. The author reports herein 2 giant LL. The age of the patients was 47 and 66 years. One patient had large LL measuring 10 × 9 × 9 cm located in the subserosa in the uterine cervix. Another patient had giant LL measuring 30 × 30 × 30 cm in the subserosa of the uterine body. Grossly, the LL showed yellowish white color. Microscopically, both the tumors were composed of mature smooth muscle cells and mature lipocytes. Immunohistochemically, both cases showed the same immunohistochemical findings. The adipose tissue element was positive for vimentin, S100 protein, estrogen receptor (ER), and progesterone receptor (PgR); and negative for pancytokeratins (AE1/3 and CAM5.2), α-smooth muscle actin, desmin, HMB45, p53, MDM2, and CDK4. The smooth muscle element was positive for vimentin, desmin, α-smooth muscle actin, ER, and PgR, but negative for pancytokeratins (AE1/3 and CAM5.2), S100 protein, HMB45, p53, MDM2, and CDK4. The Ki-67 labeling was 0.3% in the smooth muscle element and 0.2% in the adipose tissue element in 1 case, and 0.2% and 0.1%, respectively, in another case. In conclusions, 2 cases of subserosal giant LLs of the cervix and body were reported. The main findings were that the adipose tissue element of LL shows cell proliferative activity and that it is positive for ER and PgR. The positive cell proliferation shows that the adipose element of LL was not degenerative tissue but actively proliferative tissue. The presence of ER and PgR in the adipose element suggests that the adipose element of LL was specific fat tissue related to female genital organs.
子宫巨大脂肪平滑肌瘤（LL）是一种罕见疾病。本文作者报告了2例子宫巨大脂肪平滑肌瘤。患者年龄分别为47岁和66岁。1例患者子宫颈浆膜下有一个大小为10×9×9 cm的巨大脂肪平滑肌瘤。另一例患者子宫体浆膜下有一个大小为30×30×30 cm的巨大脂肪平滑肌瘤。大体上，脂肪平滑肌瘤呈黄白色。显微镜下，这两个肿瘤均由成熟的平滑肌细胞和成熟的脂肪细胞组成。免疫组织化学检查显示，两例病例的免疫组化结果相同。脂肪组织成分波形蛋白、S100蛋白、雌激素受体（ER）和孕激素受体（PgR）呈阳性；全细胞角蛋白（AE1/3和CAM5.2）、α平滑肌肌动蛋白、结蛋白、HMB45、p53、MDM2和CDK4呈阴性。平滑肌成分波形蛋白、结蛋白、α平滑肌肌动蛋白、ER和PgR呈阳性，但全细胞角蛋白（AE1/3和CAM5.2）、S100蛋白、HMB45、p53、MDM2和CDK4呈阴性。1例病例中，平滑肌成分的Ki-67标记指数为0.3%，脂肪组织成分的Ki-67标记指数为0.2%；另一例病例中，平滑肌成分和脂肪组织成分的Ki-67标记指数分别为0.2%和0.1%。总之，本文报告了2例子宫颈和子宫体浆膜下巨大脂肪平滑肌瘤病例。主要发现是脂肪平滑肌瘤的脂肪组织成分具有细胞增殖活性，且ER和PgR呈阳性。阳性的细胞增殖表明脂肪平滑肌瘤的脂肪成分不是退行性组织，而是具有活跃增殖能力的组织。脂肪成分中ER和PgR的存在提示脂肪平滑肌瘤的脂肪成分是与女性生殖器官相关的特殊脂肪组织。
