Department of Pathology, Hospital Universitario Dr. Peset, Valencia, Spain.
Department of Pathology, Hospital Universitario Dr. Peset, Valencia, Spain.
Rev Esp Patol. 2020 Jan-Mar;53(1):61-65. doi: 10.1016/j.patol.2018.06.002. Epub 2018 Jul 26.
Uterine leiomyosarcoma (LMS) with osteoclastic giant cells (OGCs) is extremely rare. However, its morphological appearance and aggressive behavior may have resulted in its being diagnosed as so-called giant cell malignant fibrous histiocytoma (MFH) in the past. Effusions are not uncommon in LMS and may be indicative of an unfavorable prognosis. We report a case with the cytological appearance of a uterine LMS with OGCs metastatic to lower pelvic peritoneum. The pelvic washing specimen consisted of three-dimensional aggregates of atypical cells. The cytohistologic and immunohistochemical study obtained from the cell block and the tumor mass showed overlapping features such as bizarre pleomorphic spindle cells containing numerous evenly dispersed OGCs. The malignant tumor cells showed extensive positivity for desmin, h-caldesmon and multifocal positivity for smooth muscle actin (SMA) whereas OGCs stained with CD68. We stress the usefulness of performing cell block and subsequent immunohistochemistry in order to make an accurate cytohistologic correlation.
富含破骨细胞样巨细胞的子宫平滑肌肉瘤极其罕见。然而，其形态学表现和侵袭性行为可能导致过去将其误诊为所谓的巨细胞恶性纤维组织细胞瘤（MFH）。子宫平滑肌肉瘤常伴有渗出液，这可能预示着预后不良。我们报告了一例具有富含破骨细胞样巨细胞的子宫平滑肌肉瘤的细胞学表现，该肿瘤转移至骨盆下部的腹膜。盆腔冲洗标本由三维聚集的非典型细胞组成。从细胞块和肿瘤组织获得的细胞组织化学和免疫组织化学研究显示出重叠的特征，如含有大量均匀分散的破骨细胞样巨细胞的奇异多形性梭形细胞。恶性肿瘤细胞广泛表达结蛋白、h-钙调蛋白和平滑肌肌动蛋白（SMA）的局灶性阳性，而破骨细胞样巨细胞则表达 CD68。我们强调了进行细胞块和随后的免疫组织化学检查以进行准确的细胞组织学相关性的重要性。
