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10-15 % AdenoCa
Leiomyosarcoma.
This is a hypercellular spindle cell tumor with nuclear atypia and abundant
mitoses. Low power.
HP :
Classic leiomyoma :
Spindle cell lesion with intersecting fascicles of elongated
cells
The nuclei are long and thin with fine pale chromatin and
small nucleoli.
Corkscrew nuclei, which are characteristic of smooth
muscle.
The stroma may be fibrotic, edematous, myxoid, or even
hemorrhagic;
Absence of nuclear atypia.
Mitotic rate (-/<<).
Case 3 :
A 25-year-old female presents to your office for workup of
infertility. In giving a history she describes severe pain
during menses and menorrhagia, and she also tells you that
in the past another doctor told her that she had chocolate
in her cysts.
Based on this history, what abnormality would you most
expect to be present in this patient?
a. Metastatic ovarian cancer
b. Endometriosis
c. Acute pelvic inflammatory disease
d. Cancerous lesion
e. A posteriorly located subserosal uterine leiomyoma
Endometriosis
Ectopic endometrial tissue outside of the uterus.
Histologic : endometrial glands, stroma, and hemosiderin
pigment outside the endometrium.
Location :
Myometrium adenomyosis,
Uterine ligaments (assoc. w/ dyspareunia),
Rectovaginal pouch (pain on defecation and low back pain)
Fallopian tubes (infertility and ectopic pregnancies)
Urinary bladder (hematuria),
GI tract (pain, adhesions, bleeding, and obstruction),
Vagina (bleeding).
Ovary (infertility, cyst)
Figure 17.2. Proliferative endometrium.
Multiple donut-shaped glands are visible,
with dark oblong nuclei and frequent mitoses
(arrow).
JC Sept 2008