Smooth muscle tumor: Difference between revisions

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calcified
 
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|author1=[[User:Mikael Häggström|Mikael Häggström]]
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[[File:Leiomyoma.jpg|thumb|Smooth muscle tumor (in this case leiomyoma).]]
[[File:Leiomyoma.jpg|thumb|Smooth muscle tumor (in this case leiomyoma).]]
 
<noinclude>{{Comprehensiveness}}</noinclude>
==Gross processing==
==Gross processing==
===Gross examination===
===Gross examination===
Examine and describe:<ref name=stora>{{Stora utskärningen}}</ref>
[[File:Fibroid locations.jpg|thumb|Fibroid locations.]]
*Location
When finding fibroids (spherical tumors with whorled pattern, which in the uterus can be presumed to be smooth muscle tumors), examine and describe:<ref name=stora>{{Stora utskärningen}}</ref>
*Number of tumors, if multiple
*Location. If in the uterus:
*Size
:*Intramural/submucosal/subserosal (see image)
*Demarcation
:*{{Moderate-begin}}Posterior/anterior/right or left lateral.{{Moderate-end}}
*Number of tumors, if multiple. May be described simply as "multiple".
*Size (may be described as "up to ___ cm in greatest dimension".
*{{Moderate-begin}}Presence or absence of any hemorrhage or necrosis.{{Moderate-end}}
*{{Comprehensive-begin}}Demarcation{{Comprehensive-end}}


===Selection===
===Selection===
In case of [[hysterectomy]], submit pieces from all smooth muscle tumors >5 cm in diameter.<ref name=stora/>
In case of [[hysterectomy]], submit pieces from all fibroids >5 cm in diameter.<ref name=stora/>
 
Submit any macroscopically abnormal parts of the fibroids (hemorrhagic, necrotic, brittle or softening areas, and areas with blurry delimitation).<ref name=stora/>


Submit any macroscopically abnormal parts of the tumors (hemorrhagic, necrotic, brittle or softening areas, and areas with blurry delimitation).<ref name=stora/>
For fibroids that are significantly calcified, a gross-only description as a calcified fibroid is generally sufficient, without the need to decalcify it to dissect it or sample from it.<ref group=note>When a fibroid has calcifications it has been there a long time, and can be assumed to be benign.</ref>


==Microscopic examination==
==Microscopic examination==
Distinguish leiomyoma (benign) from leiomyosarcoma (malignant).
Distinguish leiomyoma (benign) from leiomyosarcoma (malignant) by looking at the latter's criteria:<ref name=PathologyOutlinesLeiomyosarcoma>{{cite web|url=https://www.pathologyoutlines.com/topic/uteruslms.html|title=Uterus - Smooth muscle tumors - Leiomyosarcoma|author=Paulette Mhawech-Fauceglia, M.D.|website=Pathology Outlines}} Topic Completed: 5 December 2019. Minor changes: 11 August 2020</ref>
*Marked cellular '''atypia'''
*'''Mitoses''': > 10 mitoses/10 high power fields
*'''Necrosis'''
Diagnosis of conventional leiomyosarcoma requires 2 of these 3 histologic features.<ref name=PathologyOutlinesLeiomyosarcoma/>
<gallery mode=packed heights=180>
<gallery mode=packed heights=180>
File:Histopathology of uterine leiomyoma.jpg|'''Leiomyoma'''s typically show smooth muscle in a whorled (fascicular) pattern<ref>{{cite web|url=http://www.pathologyoutlines.com/topic/uterusleiomyoma.html|title=Uterus - Stromal tumors - Leiomyoma|author=Mohamed Mokhtar Desouki|website=pathology Outlines}} Topic Completed: 1 August 2011. Revised: 15 December 2019</ref>
File:Histopathology of a leiomyoma with fascicular growth.jpg|'''Leiomyoma'''s typically show smooth muscle in a fascicular pattern (arrows point at fascicles).<ref>{{cite web|url=http://www.pathologyoutlines.com/topic/uterusleiomyoma.html|title=Uterus - Stromal tumors - Leiomyoma|author=Mohamed Mokhtar Desouki|website=Pathology Outlines}} Topic Completed: 1 August 2011. Revised: 15 December 2019</ref>{{MH}}
File:Histopathology of uterine leiomyoma (Van Gieson's stain).jpg|This variant of Van Gieson's stain distinguishes muscle (yellow) from connective tissue (red)
File:Histopathology of a leiomyoma in a postmenopausal uterus, intermediate magnification.jpg|'''Leiomyoma''', with areas where the cellularity is relatively lower (left) and higher (right).
File:Histopathology of leiomyoma with nuclear pleomorphism.jpg|thumb|'''Leiomyoma''' with nuclear pleomorphism, yet within benign limits.
File:Epithelioid Leiomyoma, Uterus (3) (2556674506).jpg|Epithelioid '''leiomyoma'''
File:Epithelioid Leiomyoma, Uterus (3) (2556674506).jpg|Epithelioid '''leiomyoma'''
File:Leiomyoma of Uterus with Palisading Pattern (5710417630).jpg|'''Leiomyoma''' with palisading pattern
File:Leiomyoma of Uterus with Palisading Pattern (5710417630).jpg|'''Leiomyoma''' with palisading pattern
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</gallery>
</gallery>
Polyp lined by a single layer of columnar epithelium consistent with endometrium. The interior consists of smooth muscles in a whorled pattern. No atypia. The finding is consistent with a pedunculated submucosal leiomyoma.
Polyp lined by a single layer of columnar epithelium consistent with endometrium. The interior consists of smooth muscles in a whorled pattern. No atypia. The finding is consistent with a pedunculated submucosal leiomyoma.
|}
|}<noinclude>
{{Reporting}}
{{Reporting}}
{{Bottom}}
{{Bottom}}</noinclude>

Latest revision as of 12:27, 18 December 2022

Author: Mikael Häggström [note 1]

Smooth muscle tumor (in this case leiomyoma).

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Gross processing

Gross examination

Error creating thumbnail:
Fibroid locations.

When finding fibroids (spherical tumors with whorled pattern, which in the uterus can be presumed to be smooth muscle tumors), examine and describe:[1]

  • Location. If in the uterus:
  • Intramural/submucosal/subserosal (see image)
  • (Posterior/anterior/right or left lateral.)
  • Number of tumors, if multiple. May be described simply as "multiple".
  • Size (may be described as "up to ___ cm in greatest dimension".
  • (Presence or absence of any hemorrhage or necrosis.)
  • ((Demarcation))

Selection

In case of hysterectomy, submit pieces from all fibroids >5 cm in diameter.[1]

Submit any macroscopically abnormal parts of the fibroids (hemorrhagic, necrotic, brittle or softening areas, and areas with blurry delimitation).[1]

For fibroids that are significantly calcified, a gross-only description as a calcified fibroid is generally sufficient, without the need to decalcify it to dissect it or sample from it.[note 2]

Microscopic examination

Distinguish leiomyoma (benign) from leiomyosarcoma (malignant) by looking at the latter's criteria:[2]

  • Marked cellular atypia
  • Mitoses: > 10 mitoses/10 high power fields
  • Necrosis

Diagnosis of conventional leiomyosarcoma requires 2 of these 3 histologic features.[2]

  • Leiomyomas typically show smooth muscle in a fascicular pattern (arrows point at fascicles).[3][image 1]
    Leiomyomas typically show smooth muscle in a fascicular pattern (arrows point at fascicles).[3][image 1]
  • Leiomyoma, with areas where the cellularity is relatively lower (left) and higher (right).
    Leiomyoma, with areas where the cellularity is relatively lower (left) and higher (right).
  • Leiomyoma with nuclear pleomorphism, yet within benign limits.
    Leiomyoma with nuclear pleomorphism, yet within benign limits.
  • Epithelioid leiomyoma
    Epithelioid leiomyoma
  • Leiomyoma with palisading pattern
    Leiomyoma with palisading pattern
  • Leiomyosarcoma: Variable atypia, often with cytoplasmic vacuoles at both ends of nuclei, and frequent mitoses.[4]
    Leiomyosarcoma: Variable atypia, often with cytoplasmic vacuoles at both ends of nuclei, and frequent mitoses.[4]
  • Epithelioid leiomyosarcoma
    Epithelioid leiomyosarcoma

Further information: Evaluation of tumors

Microscopic report

Report:

  • Microscopic findings, including any visible linings
  • Diagnosis or most probable one
  • Any linings or borders.

Example, for a cervical polyp:

Polyp lined by a single layer of columnar epithelium consistent with endometrium. The interior consists of smooth muscles in a whorled pattern. No atypia. The finding is consistent with a pedunculated submucosal leiomyoma.

  See also: General notes on reporting


Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. ↑ When a fibroid has calcifications it has been there a long time, and can be assumed to be benign.

Main page

References

  1. ↑ 1.0 1.1 1.2 Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
  2. ↑ 2.0 2.1 Paulette Mhawech-Fauceglia, M.D.. Uterus - Smooth muscle tumors - Leiomyosarcoma. Pathology Outlines. Topic Completed: 5 December 2019. Minor changes: 11 August 2020
  3. ↑ Mohamed Mokhtar Desouki. Uterus - Stromal tumors - Leiomyoma. Pathology Outlines. Topic Completed: 1 August 2011. Revised: 15 December 2019
  4. ↑ Vijay Shankar, M.D.. Soft tissue - Smooth muscle - Leiomyosarcoma - general. Pathology Outlines. Topic Completed: 1 November 2012. Revised: 11 September 2019

Image sources

  1. ↑ Image(s) by: Mikael Häggström, M.D. Public Domain
    - Author info
    - Reusing images
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