Kefeli Mehmet, Caliskan Sultan, Kurtoglu Emel, Yildiz Levent, Kokcu Arif
Departments of Pathology (M.K., S.C., L.Y.) Obstetrics and Gynecology (E.K., A.K.), Medical School, Ondokuz Mayis University, Samsun, Turkey.
Int J Gynecol Pathol. 2018 Jul;37(4):379-387. doi: 10.1097/PGP.0000000000000425.
Leiomyoma with bizarre nuclei (LBN) have significant cytologic atypia, but high mitotic rate and tumor cell necrosis are absent. Although it is a benign leiomyoma variant, recurrent cases have been described. In this study, we investigated the clinical and pathologic features of LBN and compared them with related studies. A total of 30 patients diagnosed with LBN in our department were included in this study. In all cases, clinical data (age, complaint, surgery type), macroscopic features (size, location, number of leiomyomas, necrosis, and hemorrhage), microscopic features (bizarre cell distribution, bizarre cell density, cellularity, mitotic rate, tumor margin, necrosis, nuclear pseudoinclusions, karyorrhectic nuclei, prominent eosinophilic nucleoli with perinucleolar clearing, cytoplasmic eosinophilic inclusions, staghorn vessels, and alveolar-type edema), and follow-up data (recurrence and survival period) were evaluated. The mean age of the patients was 49.76 yr (range: 38-89 yr). Twenty-two patients (73%) had undergone hysterectomy and 8 patients (27%) had undergone myomectomy. The mean tumor diameter was 6.12 cm (range: 0.5-25 cm). The tumor was intramural in 11 patients (37%), subserosal in 7 patients (23%), and submucosal in 4 patients (13%). Microscopically, the bizarre cell distribution was focal in 8 patients (27%), multifocal in 12 patients (40%), and diffuse in 10 patients (33%). Bizarre cell density was low in 15 patients (50%), intermediate in 8 patients (27%), and high in 7 patients (23%). The mean mitotic count was 1.4 (0-4) in 10 high-power fields, and the tumor margin was regular in all cases. We observed pseudoinclusions in 24 of 30 (80%) tumors, karyorrhectic nuclei in 21 of 30 tumors (70%), prominent eosinophilic nucleoli with perinucleolar clearing in 12 tumors (40%), cytoplasmic eosinophilic inclusions in 11 tumors (37%), staghorn vessels in 9 tumors (30%), and alveolar-type edema in 9 tumors (30%). In addition, we examined the follow-up records of 26 patients (average duration: 58.1 mo). One patient had a smooth muscle tumor in the L3-L4 paravertebral region at 67 mo after hysterectomy. This tumor did not share similar microscopic and immunohistochemical findings to the patient's earlier uterine tumor. The definitive diagnosis of uterine smooth muscle tumors is important for the determination of the prognosis of the patient and the most appropriate therapeutic approach. As in several recent studies, our series has shown that LBN has a benign clinical course. However, other malignant morphologic criteria such as high mitotic rate and tumor cell necrosis should be excluded in the diagnosis of LBN.
奇异核平滑肌瘤（LBN）具有显著的细胞学异型性，但无高有丝分裂率和肿瘤细胞坏死。尽管它是一种良性平滑肌瘤变体，但已有复发病例的报道。在本研究中，我们调查了LBN的临床和病理特征，并将其与相关研究进行了比较。本研究纳入了我科诊断为LBN的30例患者。所有病例均评估了临床资料（年龄、主诉、手术类型）、宏观特征（大小、位置、平滑肌瘤数量、坏死和出血）、微观特征（奇异细胞分布、奇异细胞密度、细胞密度、有丝分裂率、肿瘤边缘、坏死、核假包涵体、核碎裂核、核仁周围透亮的显著嗜酸性核仁、细胞质嗜酸性包涵体、鹿角状血管和肺泡型水肿）以及随访资料（复发和生存期）。患者的平均年龄为49.76岁（范围：38 - 89岁）。22例患者（73%）接受了子宫切除术，8例患者（27%）接受了肌瘤切除术。肿瘤平均直径为6.12 cm（范围：0.5 - 25 cm）。11例患者（37%）的肿瘤位于肌壁间，7例患者（23%）的肿瘤位于浆膜下，4例患者（13%）的肿瘤位于黏膜下。显微镜下，8例患者（27%）的奇异细胞分布为局灶性，12例患者（40%）为多灶性，10例患者（33%）为弥漫性。15例患者（50%）的奇异细胞密度低，8例患者（二级）为中等，7例患者（23%）高。在10个高倍视野中，平均有丝分裂计数为每1视野1.4个（范围0 - 4），所有病例的肿瘤边缘均规则。我们在30个肿瘤中的24个（8%）观察到假包涵体，3个肿瘤中的21个（70%）观察到核碎裂核，12个肿瘤（40%）观察到核仁周围透亮的显著嗜酸性核仁，11个肿瘤（37%）观察到细胞质嗜酸性包涵体，9个肿瘤（30%）观察到鹿角状血管，9个肿瘤（30%）观察到肺泡型水肿。此外，我们检查了26例患者的随访记录（平均时长：58.1个月）。1例患者在子宫切除术后67个月时，在L3 - L4椎旁区域出现了平滑肌瘤。该肿瘤与患者早期子宫肿瘤在微观和免疫组化结果上不相似。子宫平滑肌瘤的明确诊断对于确定患者的预后和最合适的治疗方法很重要。正如最近的几项研究一样，我们的系列研究表明LBN具有良性的临床病程。然而，在LBN的诊断中应排除其他恶性形态学标准，如高有丝分裂率和肿瘤细胞坏死。
