Ranchod M, Kempson R L
Cancer. 1977 Jan;39(1):255-62. doi: 10.1002/1097-0142(197701)39:1<255::aid-cncr2820390139>3.0.co;2-h.
One hundred smooth muscle tumors arising in the gastrointestinal tract and retroperitoneum were reviewed in an attempt to define criteria for the diagnosis of leiomyosarcoma in these sites. On the basis of aggressive behavior, 56 of these neoplasms were diagnosed as leiomyosarcoma. Mitoses were found to be the most useful indicator of malignancy; all of the tumors with five or more mitoses/10 HPF behaved aggressively and smooth muscle tumors with this degree of mitotic activity should be diagnosed as leiomyosarcoma. A paucity of mitoses, however, is no assurance of benignity as nearly 40% of the leiomyosarcomas in this series had fewer than five mitoses/10 HPF. Tumor cell necrosis was closely associated with aggressive behavior even when mitoses were infrequent and it is doubtful that benign smooth muscle tumors develop extensive tumor cell necrosis. In the absence of the requisite number of mitoses or tumor necrosis, it is difficult to distinguish some leiomyosarcomas from leiomyomas, but tumor size, cellularity and cellular atypia may be helpful parameters when assessed together. The importance of these criteria in different anatomical sites is discussed. It is emphasized that the criteria for the diagnosis of leiomyosarcoma of the uterus do not apply to non-uterine smooth muscle tumors. The actuarial 2-year survival rate was as follows: gastric leiomyosarcoma, 40%; small intestinal leiomyosarcoma, 60%; and retroperitoneal leiomyosarcoma, 16%.
对100例发生于胃肠道和腹膜后的平滑肌肿瘤进行了回顾性研究，旨在确定这些部位平滑肌肉瘤的诊断标准。基于侵袭性行为，其中56例肿瘤被诊断为平滑肌肉瘤。有丝分裂被发现是恶性肿瘤最有用的指标；所有每10个高倍视野有5个或更多有丝分裂象的肿瘤都表现出侵袭性，具有这种有丝分裂活性程度的平滑肌肿瘤应诊断为平滑肌肉瘤。然而，有丝分裂象少并不能保证肿瘤为良性，因为在本系列中近40%的平滑肌肉瘤每10个高倍视野的有丝分裂象少于5个。肿瘤细胞坏死与侵袭性行为密切相关，即使有丝分裂象少见，而且良性平滑肌肿瘤是否会发生广泛的肿瘤细胞坏死也值得怀疑。在没有必要数量的有丝分裂象或肿瘤坏死的情况下，很难将一些平滑肌肉瘤与平滑肌瘤区分开来，但肿瘤大小、细胞密度和细胞异型性在综合评估时可能是有用的参数。讨论了这些标准在不同解剖部位的重要性。强调子宫平滑肌肉瘤的诊断标准不适用于非子宫平滑肌肿瘤。2年实际生存率如下：胃平滑肌肉瘤为40%；小肠平滑肌肉瘤为60%；腹膜后平滑肌肉瘤为16%。
