Fukunaga M, Ushigome S
Department of Pathology, Jikei University School of Medicine, Tokyo, Japan.
Histopathology. 1998 Feb;32(2):160-4. doi: 10.1046/j.1365-2559.1998.00320.x.
Familiarity with benign uterine smooth muscle tumours with unusual growth patterns by gynaecologists and pathologists is essential in avoiding misdiagnosis and overtreatment.
An enlarged uterus in a 35-year-old woman contained numerous, ill-defined nodules with marked hydropic changes which showed an extrauterine extension. Histologically, although some nodules had an appearance of conventional leiomyoma, the predominant part of the lesion was characterized by ill-defined spindle cell nodules with marked hydropic changes and irregular dissection of the myometrium. The cellularity was variable from area to area and there were neither nuclear atypia nor mitotic figures. No coagulative tumour necrosis was observed. The extrauterine components, which were in continuity with the intrauterine nodule, were histologically identical to the intrauterine nodules except for the complication of endometriosis. Immunohistochemically, the tumour cells were positive for vimentin, desmin, alpha-smooth muscle actin and muscle actin (HHF35). The tumour was DNA diploid by flow cytometry. The patient was well and without disease 6 months after hysterectomy.
This tumour illustrates that rare benign smooth muscle tumours can proliferate in dissecting and extrauterine growth patterns, findings that should not be confused with malignant mesenchymal tumours.
妇科医生和病理学家熟悉具有不寻常生长模式的子宫良性平滑肌肿瘤对于避免误诊和过度治疗至关重要。
一名35岁女性子宫增大，含有许多边界不清的结节，伴有明显的水样变性，并显示有宫外延伸。组织学上，虽然一些结节具有传统平滑肌瘤的外观，但病变的主要部分表现为边界不清的梭形细胞结节，伴有明显的水样变性和子宫肌层的不规则分离。不同区域的细胞密度各不相同，既无核异型性也无核分裂象。未观察到凝固性肿瘤坏死。与子宫内结节相连的宫外部分，除伴有子宫内膜异位症外，组织学上与子宫内结节相同。免疫组化显示，肿瘤细胞波形蛋白、结蛋白、α平滑肌肌动蛋白和肌动蛋白（HHF35）呈阳性。流式细胞术检测肿瘤为DNA二倍体。子宫切除术后6个月，患者情况良好，无疾病复发。
该肿瘤表明，罕见的良性平滑肌瘤可呈分离性和宫外生长模式增殖，这些表现不应与恶性间叶性肿瘤相混淆。
