Guo Enhui, Li Chengqian, Hu Yanjiao, Zhao Kongyuan, Zheng Qingmei, Wang Liming
Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
Qingdao Medical College, Qingdao University, Qingdao, People's Republic of China.
Int J Womens Health. 2022 Nov 25;14:1641-1656. doi: 10.2147/IJWH.S388278. eCollection 2022.
Leiomyoma with bizarre nuclei (LBN), also known as symplastic leiomyoma, is a histological subtype of benign leiomyoma with bizarre cells and nuclear atypia. Differentiating LBN from other benign leiomyoma subtypes, uterine smooth muscle tumors of uncertain malignant potential (STUMP), or leiomyosarcoma (LMS) can be diagnostically challenging owing to overlapping features in clinical presentation and pathologic morphological analysis. The difficulty of distinguishing LBN from other lesions, especially from LMS, and the potential of LBN for subsequent malignant transformation make LBN an important topic of research. Herein, we review the definition, diagnosis, treatment, and prognosis of LBN. Histopathological examination is essential for distinguishing LBN from other diseases. Pathology sampling and morphological examination remain the key to diagnosis. The newly established ancillary immunohistochemical (IHC) and molecular genetic analysis can be useful tools for differential diagnosis. Furthermore, serum biomarkers and imaging examination may also be useful diagnostic tools. Attention should be paid to the differentiation between LBN and LMS because morphological diagnosis may still be challenging in some cases. Some IHC markers of LBN have been identified, which may be helpful for differential diagnosis. Furthermore, the use of IHC panels as diagnostic markers may be advocated. Molecular genetic studies suggest that some genes can aid with the differential diagnosis between LBN and LMS. However, increasing evidence support the idea that LBN and LMS are molecularly related, indicating that LBN may represent a potentially malignant stage of precancerous progression. At present, conservative treatment is recommended for primary LBN, especially for patients desiring to retain fertility, but close follow-up with imaging examinations is required.
具有奇异核的平滑肌瘤（LBN），也称为合体细胞平滑肌瘤，是一种具有奇异细胞和核异型性的良性平滑肌瘤的组织学亚型。由于临床表现和病理形态学分析存在重叠特征，将LBN与其他良性平滑肌瘤亚型、恶性潜能不确定的子宫平滑肌肿瘤（STUMP）或平滑肌肉瘤（LMS）区分开来在诊断上具有挑战性。区分LBN与其他病变，尤其是与LMS的困难，以及LBN后续发生恶性转化的可能性，使得LBN成为一个重要的研究课题。在此，我们综述LBN的定义、诊断、治疗和预后。组织病理学检查对于区分LBN与其他疾病至关重要。病理取样和形态学检查仍然是诊断的关键。新建立的辅助免疫组织化学（IHC）和分子遗传学分析可能是有用的鉴别诊断工具。此外，血清生物标志物和影像学检查也可能是有用的诊断工具。应注意LBN与LMS之间的鉴别，因为在某些情况下形态学诊断可能仍然具有挑战性。已经确定了一些LBN的IHC标志物，这可能有助于鉴别诊断。此外，可能提倡使用IHC组合作为诊断标志物。分子遗传学研究表明，一些基因有助于LBN与LMS之间的鉴别诊断。然而，越来越多的证据支持LBN与LMS在分子水平上相关的观点，这表明LBN可能代表癌前进展的一个潜在恶性阶段。目前，对于原发性LBN，尤其是对于希望保留生育能力的患者，建议采取保守治疗，但需要通过影像学检查进行密切随访。
