Hart W R, Billman J K
Cancer. 1978 May;41(5):1902-10. doi: 10.1002/1097-0142(197805)41:5<1902::aid-cncr2820410535>3.0.co;2-k.
Twenty-eight uterine tumors originally diagnosed as leiomyosarcomas were histologically reclassified without prior knowledge of follow-up or clinical data. Thirteen (46%) neoplasms were reinterpreted as cellular or pleomorphic leiomyomas. They had sparse mitotic activity with three or fewer mitotic figures per 10 high power microscopic fields (MF/10 HPF). None recurred or metastasized, and all patients were alive from 6.3 to 23 years after operation (median of 14.2 years). In 15 cases the diagnosis of leiomyosarcoma (LMS) was confirmed. All showed hypercellularity, nuclear atypism and high mitotic activity. Mitosis counts ranged from 6 to more than 50 MF/10 HPF with 93% of LMS having at least 15 MF/10 HPF. These patients all died of LMS after post-operative intervals of 3 months to 7.5 years (median survival of 13 months). No consistent correlation was found between length of survival and the patient's menopausal status or histologic grade of LMS. The degree of mitotic activity is the single most reliable diagnostic criterion of malignant potential, albeit not the only one. Surgery alone is ineffective treatment for LMS and combination therapy with radiation therapy and/or chemotherapy should be considered.
28例最初诊断为平滑肌肉瘤的子宫肿瘤在对随访或临床数据不知情的情况下进行了组织学重新分类。13例（46%）肿瘤被重新诊断为细胞性或多形性平滑肌瘤。它们的有丝分裂活性稀疏，每10个高倍显微镜视野（MF/10 HPF）有3个或更少的有丝分裂象。无一例复发或转移，所有患者术后存活6.3至23年（中位时间为14.2年）。15例确诊为平滑肌肉瘤（LMS）。所有病例均表现为细胞增多、核异型性和高有丝分裂活性。有丝分裂计数范围为6至超过50 MF/10 HPF，93%的LMS至少有15 MF/10 HPF。这些患者术后3个月至7.5年（中位生存期13个月）均死于LMS。生存时间与患者的绝经状态或LMS的组织学分级之间未发现一致的相关性。有丝分裂活性程度是恶性潜能的唯一最可靠诊断标准，尽管不是唯一标准。单纯手术对LMS无效，应考虑联合放疗和/或化疗。
