Roth L M, Reed R J, Sternberg W H
Department of Pathology, Indiana University School of Medicine, Indianapolis, USA.
Am J Surg Pathol. 1996 Dec;20(12):1455-61. doi: 10.1097/00000478-199612000-00004.
We report four cases of an unusual uterine smooth muscle neoplasm. All patients were of reproductive age, ranging from 23 to 41 years old, and had a pelvic mass or an enlarged uterus. Two also had menstrual irregularities. At laparotomy, an exophytic congested bulky tumor resembling placental tissue extended from the uterine wall into the broad ligament and pelvic cavity. In one case the tumors were bilateral but unequal in size. On gross examination, these exophytic components were the most distinctive feature. On microscopic examination the basic lesion appeared to be a dissecting leiomyoma with growth at its periphery in sinuous dissecting patterns and extensive degenerative changes. Some microscopic features, including dissecting growth patterns, distinctive connective tissue alterations, and a rich component of vessels, overlap with those seen in several leiomyoma variants, including infiltrating leiomyoma, leiomyoma with perinodular hydropic degeneration, and intravenous leiomyomatosis. An intravascular component was not a feature. The distinctive gross appearance and microscopic features are embodied in the designation, "cotyledonoid dissecting leiomyoma." The follow-up information available for three cases supports the benign nature of the tumor.
我们报告了4例不寻常的子宫平滑肌肿瘤。所有患者均处于育龄期，年龄在23至41岁之间，均有盆腔肿块或子宫增大。其中2例还伴有月经不调。剖腹手术时，可见一个从子宫壁延伸至阔韧带和盆腔的外生性充血性巨大肿瘤，类似胎盘组织。1例患者的肿瘤为双侧性，但大小不等。大体检查时，这些外生性成分是最显著的特征。显微镜检查显示，基本病变似乎是一个弥漫性平滑肌瘤，其周边呈蜿蜒的弥漫性生长模式，并伴有广泛的退行性改变。一些显微镜下特征，包括弥漫性生长模式、独特的结缔组织改变和丰富的血管成分，与几种平滑肌瘤变体所见的特征重叠，包括浸润性平滑肌瘤、结节周围水样变性的平滑肌瘤和静脉内平滑肌瘤病。血管内成分并非其特征。其独特的大体外观和显微镜下特征体现在“子叶状弥漫性平滑肌瘤”这一命名中。3例患者的随访信息支持该肿瘤的良性性质。
