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Pathology - Uterine leiomyomas
Definition
Synonym • Fibroids. • Benign neoplasms of smooth muscle originating in the myometrium.
Epidemiology • Highly prevalent tumors identified in up to 75% of all women. Approximately 20% of women are affected by symptomatic fibroids. Aetiology The exact etiology remains ambiguous; nevertheless, contributing factors encompass race and parity, with black and nulliparous women exhibiting a higher susceptibility.
Pathogenesis • Hormonal tumors that predominantly affect women of reproductive age, exhibit rapid growth during pregnancy, and undergo regression post-menopause. Genetic research indicates that they are clonal neoplasms characterized by chromosomal abnormalities.
Presentation: Menorrhagia. • Subfertility: this is likely attributable to endometrial deformation, hindering implantation. • Pelvic pain: this may be associated with tumor infarction or torsion of a pedunculated fibroid. • Palpable mass: fibroids may attain sufficient size to be discerned abdominally.
Macroscopy • Well-defined, white, whorled tumors that typically protrude from the adjacent myometrium upon incision. • Frequently numerous and may be intramural or extend from the serosal surface (subserosal) or into the uterine cavity (submucosal). • Calcification is prevalent. Infarcted tumors exhibit a red coloration instead of white, a phenomenon referred to as 'red degeneration.'
Histopathology Classical fibroids consist of interlacing fascicles of unremarkable smooth muscle cells characterized by blunt-ended nuclei and eosinophilic cytoplasm. Regions of hyalinization and calcification are prevalent. Numerous histological variants are well-documented, all exhibiting benign behavior. These encompass cellular leiomyoma, highly cellular leiomyoma, mitotically active leiomyoma, and atypical leiomyoma.
Prognosis: Benign tumors exhibit no potential for malignant behavior. Uterine leiomyosarcoma Uterine leiomyosarcoma is a malignant neoplasm of smooth muscle originating in the myometrium. While rare, it constitutes the most prevalent uterine sarcoma. The swift growth of a uterine tumor may raise concerns for leiomyosarcoma; nevertheless, many cases are not identified prior to surgery and are presumed to be big fibroids.
Macroscopically, leiomyosarcomas are inadequately defined and typically do not protrude from the adjacent myometrium due to their infiltrative characteristics. They are more pliable than fibroids and may exhibit signs of necrosis.
Histologically, leiomyosarcomas are neoplasms of smooth muscle that exhibit several abnormal characteristics, including widespread cytological atypia, necrosis of tumor cells, and elevated mitotic activity. Leiomyosarcomas are aggressive tumors characterized by a propensity for local recurrence and metastasis, especially to the liver and lungs.
Definition
Synonym • Fibroids. • Benign neoplasms of smooth muscle originating in the myometrium.
Epidemiology • Highly prevalent tumors identified in up to 75% of all women. Approximately 20% of women are affected by symptomatic fibroids. Aetiology The exact etiology remains ambiguous; nevertheless, contributing factors encompass race and parity, with black and nulliparous women exhibiting a higher susceptibility.
Pathogenesis • Hormonal tumors that predominantly affect women of reproductive age, exhibit rapid growth during pregnancy, and undergo regression post-menopause. Genetic research indicates that they are clonal neoplasms characterized by chromosomal abnormalities.
Presentation: Menorrhagia. • Subfertility: this is likely attributable to endometrial deformation, hindering implantation. • Pelvic pain: this may be associated with tumor infarction or torsion of a pedunculated fibroid. • Palpable mass: fibroids may attain sufficient size to be discerned abdominally.
Macroscopy • Well-defined, white, whorled tumors that typically protrude from the adjacent myometrium upon incision. • Frequently numerous and may be intramural or extend from the serosal surface (subserosal) or into the uterine cavity (submucosal). • Calcification is prevalent. Infarcted tumors exhibit a red coloration instead of white, a phenomenon referred to as 'red degeneration.'
Histopathology Classical fibroids consist of interlacing fascicles of unremarkable smooth muscle cells characterized by blunt-ended nuclei and eosinophilic cytoplasm. Regions of hyalinization and calcification are prevalent. Numerous histological variants are well-documented, all exhibiting benign behavior. These encompass cellular leiomyoma, highly cellular leiomyoma, mitotically active leiomyoma, and atypical leiomyoma.
Prognosis: Benign tumors exhibit no potential for malignant behavior. Uterine leiomyosarcoma Uterine leiomyosarcoma is a malignant neoplasm of smooth muscle originating in the myometrium. While rare, it constitutes the most prevalent uterine sarcoma. The swift growth of a uterine tumor may raise concerns for leiomyosarcoma; nevertheless, many cases are not identified prior to surgery and are presumed to be big fibroids.
Macroscopically, leiomyosarcomas are inadequately defined and typically do not protrude from the adjacent myometrium due to their infiltrative characteristics. They are more pliable than fibroids and may exhibit signs of necrosis.
Histologically, leiomyosarcomas are neoplasms of smooth muscle that exhibit several abnormal characteristics, including widespread cytological atypia, necrosis of tumor cells, and elevated mitotic activity. Leiomyosarcomas are aggressive tumors characterized by a propensity for local recurrence and metastasis, especially to the liver and lungs.
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