右阔韧带肿块（结果已公布）

l****6

女,40岁,发现右阔韧带肿块20天,7*6*3CM

[ 本帖最后由 pathology 于 2007-12-29 20:16 编辑 ]

k****3

合体细胞性平滑肌瘤
鉴别：可能来源于WOLFF的附件肿瘤

x****g

上皮样平滑肌瘤

l****n

长成这样的平滑肌瘤还真没看过，不过部位倒符合。
副节瘤？

l****6

诊断：上皮样平滑肌肉瘤

p****y

Epithelioid Smooth-Muscle Tumors of the Uterus: A Clinicopathologic Study of 18 Patients.
Am. J. Surg. Pathol. Volume 21(4), April 1997, pp 383-391.

Abstract
Epithelioid smooth-muscle tumors of the uterus are uncommon neoplasms for which prognostic factors have not
been well established. A retrospective follow-up study of 18 uterine epithelioid smooth-muscle tumors was
performed. Patients ranged in age from 27 to 83 years (mean, 45 years) and were separated into three groups based
on the nuclear grade of the epithelioid tumor cells. Two tumors had grade 1 nuclei; both were examples of
intravenous leiomyomatosis. They had highest mitosis counts of 1 and 3 mitotic figures (MF)/10 high-power fields
(HPF), no tumor cell necrosis was found, and both patients were alive with no evidence of disease at 64 and 5
months' follow-up. Ten tumors had grade 2 nuclei. All had highest mitosis counts of 0 to 3 MF/10 HPF, except one (5
MF/10 HPF). Tumor cell necrosis was absent in nine and only one had an infiltrative border. Tumor size ranged from
1.5 to 14 cm. Two tumors contained pleomorphic ("symplastic") multinucleated giant cells similar to those seen in
bizarre leiomyomas. All nine patients with follow-up were alive with no evidence of disease 5 to 203 months
postoperatively (median, 74 months). One patient had also received adjuvant radiation therapy. Six tumors had
grade 3 nuclei. Highest mitosis counts of 4 to 9 MF/10 HPF were found in five; one had 1 MF/10 HPF. Maximum
tumor size ranged from 4.5 to 13 cm. Two had tumor cell necrosis, and two had an infiltrative border. Two of these
patients died of tumor 11 and 132 months postoperatively. The former had widespread metastases at initial surgery
(stage IVb); the latter patient (stage I) developed the first of seven tumor recurrences 3 years postoperatively. Both
patients had also received adjuvant chemotherapy. Of the remaining four patients, two were alive with no evidence
of disease at 48 and 83 months, one was alive (tumor status unknown) at 28 months, and one was lost to follow-up.
Based on our findings and those in the literature, we conclude that uterine smooth-muscle tumors with a
predominance of epithelioid cells are extremely uncommon and metastasize infrequently. No single histologic
feature is predictive of metastatic potential. Clinically malignant tumors (i.e., epithelioid leiomyosarcomas)
typically have the combination of significant nuclear atypia (either grade 2 or grade 3 nuclei) and some mitotic
activity (usually at least 3 to 4 MF/10 HPF); most also have tumor cell necrosis.

[ 本帖最后由 pathology 于 2008-2-28 10:56 编辑 ]