Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Int J Surg Pathol. 2023 Aug;31(5):714-720. doi: 10.1177/10668969221117232. Epub 2022 Aug 17.
Malignant transformation in leiomyoma is rare, with a few documented cases of sarcomatous transformation in leiomyomas. However, carcinosarcomatous transformation in leiomyomas is extremely infrequent. A 45-year-old female presented with a mass sensation per abdomen for the last five months. An abdominal ultrasound revealed multiple uterine fibroids. Contrast-enhanced magnetic resonance imaging revealed a large multiloculated abdominopelvic mass arising from the fundus of the uterus, along with multiple smaller subserosal fibroids. A total abdominal hysterectomy with bilateral salpingectomy was performed. Grossly, the uterus was bosselated with multiple subserosal fibroids. The larger degenerated fibroid showed a smooth outer surface; however, the cut surface was predominantly cystic and filled with necrotic material. Microscopically and immunohistochemically, the larger mass showed a high-grade biphasic tumor comprising carcinomatous and sarcomatous components with the peripheral solid areas showing compressed smooth muscle bundles representing the residual leiomyomatous areas. A final diagnosis of carcinosarcomatous transformation in leiomyoma was rendered. The index report highlights the significance of systematic gross and microscopic examination of all the uterine masses in patients with multiple leiomyomata.
平滑肌瘤的恶性转化很少见，有少数文献报道过平滑肌瘤的肉瘤样转化。然而，平滑肌瘤的癌肉瘤转化极为罕见。一位 45 岁女性因腹部肿块感持续五个月就诊。腹部超声显示多发子宫肌瘤。增强磁共振成像显示，子宫底部有一个大的多房性腹盆腔肿块，伴有多个较小的浆膜下肌瘤。行全子宫切除术加双侧输卵管切除术。大体上，子宫呈结节状，有多个浆膜下肌瘤。较大的变性肌瘤表面光滑；然而，切面主要为囊性，充满坏死物质。镜下和免疫组化检查显示，较大的肿块为高级别双相性肿瘤，包括癌性和肉瘤性成分，外周实性区显示受压的平滑肌束，代表残留的平滑肌瘤区。最终诊断为平滑肌瘤的癌肉瘤转化。该索引报告强调了对多发性子宫肌瘤患者的所有子宫肿块进行系统大体和显微镜检查的重要性。
