Difficulty distinguishing benign metastasizing leiomyoma from pulmonary metastasis of leiomyosarcoma in a patient with uterine epithelioid smooth muscle tumor

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  • 子宮平滑筋肉腫の肺転移とするか,良性転移性平滑筋腫とするか,診断ならびに取り扱いに苦慮した子宮類上皮平滑筋腫瘍の1例
  • 症例報告 子宮平滑筋肉腫の肺転移とするか,良性転移性平滑筋腫とするか,診断ならびに取り扱いに苦慮した子宮類上皮平滑筋腫瘍の1例
  • ショウレイ ホウコク シキュウ ヘイカツキン ニクシュ ノ ハイ テンイ ト スル カ,リョウセイ テンイセイ ヘイカツ キンシュ ト スル カ,シンダン ナラビニ トリアツカイ ニ クリョ シタ シキュウルイ ジョウヒ ヘイカツキン シュヨウ ノ 1レイ

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Histopathological differentiation between benign and malignant uterine smooth muscle tumors (SMTs) is usually based on the Stanford criteria, which involves the comprehensive evaluation of three indices: cytological atypia, coagulative necrosis, and the mitotic index. These criteria are applicable only to the spindle cell type of SMT, not to other variations such as epithelioid SMT and myxoid SMT. We herein report a case of epithelioid leiomyoma that underwent four histopathological evaluations. A woman in her 30s underwent transcervical resection of a submucosal uterine myoma and developed two local recurrences at the Douglas pouch at 42 and 55 months postoperatively. She subsequently developed multiple pulmonary metastases at 74 months postoperatively. Tumor removal was performed for each recurrence. Ultrasonography and magnetic resonance imaging of the original submucosal uterine myoma, 42 and 55 month recurrences at the Douglas pouch, and 74month pulmonary metastases showed a 3.0 cm solid tumor, a 5.0 cm solid and cystic tumor, a 9.0 cm solid and cystic tumor, and solid tumors with a maximum size of 1.8 cm, respectively. Positron emission tomography of the 42 month recurrence and 74month pulmonary metastases revealed a maximum standardized uptake value of 2.1 and 1.5, respectively. Histopathological findings of the original epithelioid leiomyoma revealed spindle-shaped cells and focal round cells with an epithelial-like appearance. Both recurrences and the pulmonary metastases comprised only round cells with an epithelial-like appearance. No specimens exhibited coagulative necrosis. The mitotic index was 0, 1, 2, and 2, respectively. Immunohistochemical analysis of all specimens revealed αSMA(+)to(3+), estrogen receptor(+), and progesterone receptor(+). The MIB-1 labeling index was 1.2%, 3.4%, 3.7%, and 2.0%, respectively. Great difficulty may be encountered in distinguishing benign metastasizing leiomyoma from pulmonary metastasis in patients with leiomyosarcoma because no histopathological criteria for distinguishing benign from malignant uterine epithelioid SMTs have been established. [Adv Obstet Gynecol, 67(3) : 276-284, 2015 (H27.8)]

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