Evans H L, Chawla S P, Simpson C, Finn K P
Department of Pathology, University of Texas M.D. Anderson Hospital and Tumor Institute, Houston 77030.
Cancer. 1988 Nov 15;62(10):2239-47. doi: 10.1002/1097-0142(19881115)62:10<2239::aid-cncr2820621028>3.0.co;2-y.
Thirty-seven cases of uterine leiomyosarcoma are presented, along with nine cases of leiomyoma variants from which they were distinguished. All patients were followed for a minimum of 10 years. In cases with nuclear pleomorphism, leiomyosarcoma was diagnosed when there were five or more mitotic figures in ten consecutive high-power (X400) fields in the most active area of the tumor, and also when there were fewer mitotic figures but extensive tumor necrosis (there was only one leiomyosarcoma without nuclear pleomorphism, and it had more than 20 mitotic figures in ten high-power fields). Tumor size was the major prognostic factor in the leiomyosarcoma group; five of eight patients with neoplasms measuring less than 5 cm in maximum dimension survived, whereas no patient with a larger tumor did so. Other pathologic and clinical variables, including mitotic rate, tumor necrosis, degree of nuclear pleomorphism, vascular invasion, and patient age, had no significant relationship to survival or tumor behavior in leiomyosarcoma when tumor size was taken into account. The nine cases of leiomyoma variants consisted of three atypical leiomyomas (which had nuclear pleomorphism, one or no mitotic figures per ten high-power fields, and no necrosis), two plexiform leiomyomas, two cases of peritoneal leiomyomatosis, one palisaded leiomyoma, and one case of intravenous leiomyomatosis; all of these patients were tumor-free on follow-up.
本文报告了37例子宫平滑肌肉瘤，并与9例与之鉴别的平滑肌瘤变体病例一同进行分析。所有患者均接受了至少10年的随访。对于存在核异型性的病例，当在肿瘤最活跃区域连续10个高倍（×400）视野中出现5个或更多有丝分裂象时，诊断为平滑肌肉瘤；当有丝分裂象较少但存在广泛肿瘤坏死时（仅有1例无核异型性的平滑肌肉瘤，其在10个高倍视野中有超过20个有丝分裂象），也诊断为平滑肌肉瘤。肿瘤大小是平滑肌肉瘤组的主要预后因素；最大径小于5 cm的8例肿瘤患者中有5例存活，而肿瘤较大的患者无一存活。在考虑肿瘤大小的情况下，其他病理和临床变量，包括有丝分裂率、肿瘤坏死、核异型程度、血管侵犯和患者年龄，与平滑肌肉瘤的生存或肿瘤行为均无显著相关性。9例平滑肌瘤变体包括3例非典型平滑肌瘤（具有核异型性，每10个高倍视野中有1个或无有丝分裂象，且无坏死）、2例丛状平滑肌瘤、2例腹膜平滑肌瘤病、1例栅栏状平滑肌瘤和1例静脉内平滑肌瘤病；所有这些患者在随访中均无肿瘤复发。
