A case of uterine adenomyoma with bizarre smooth muscle cells mimicking leiomyosarcoma

Diagn Cytopathol. 2005 May;32(5):288-91. doi: 10.1002/dc.20226.

Abstract

We report a case of adenomyoma of the uterus that was cytologically difficult to distinguish from leiomyosarcoma. Examination of a uterine cervical smear revealed numerous spindle cells that were present in cell clusters or as isolated cells. These cells contained nuclei that were oval-shaped/elongated with nucleoli and delicate wispy cytoplasm. Large and bizarre nuclei were also identified. Based on these cytological findings leiomyosarcoma was considered: however, this diagnosis remained uncertain because of the absence of mitosis and/or necrotic substance. Histologically, we recognized leiomyomatous smooth muscle cells growing in a solid pattern and intermingled with endometrial-type glands. Moreover, bizarre smooth muscle cells were observed in the surface layer of the tumor. These observations suggest that for a diagnosis of uterine leiomyosarcoma the presence of mitosis and/or necrosis is important in addition to nuclear atypia.

Publication types

  • Case Reports

MeSH terms

  • Adenomyoma / pathology*
  • Adenomyoma / surgery
  • Adult
  • Cell Nucleus / pathology
  • Cytodiagnosis / methods*
  • Diagnosis, Differential
  • Endometrium / pathology
  • Female
  • Humans
  • Leiomyosarcoma / pathology*
  • Myocytes, Smooth Muscle / pathology*
  • Treatment Outcome
  • Uterine Neoplasms / pathology*
  • Uterine Neoplasms / surgery