Uterine sarcomas

Prof. Ben Davidson, MD PhD Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

Uterus tumor course – Oslo, 21-22/1/16

Cases

• 16

• 17

• 18

• 20

• 21

• 22

• 23

• 30

• 35

• 42

Case 16

• 45-years old woman

• Intraluminal leioyoma (“Fødemyom”)

• Tumor (3.5 cm), smooth surface, no necrosis

DIAGNOSIS: LEIOMYOMA WITH BIZARRE NUCLEI

Suggested diagnoses

• Atypical leiomyoma/leiomyoma with bizarre nuclei (17) • Leiomyom (1) • Sarcoma (3) • Atypical leiomyoma vs. sarcoma (1)

Case 17

• 53-years old woman

• Enlarged uterus

• DD leiomyoma vs. LMS

• Curettage

Division of Pathology

DIAGNOSIS: EPITHELIOID LEIOMYOSARCOMA

Suggested diagnoses • Epithelioid LMS (8) • Epithelioid LMS vs. carcinoma (1) • LMS of leiomyoblastoma type (1) • LMS (1) • Sarcoma (3) • HG malignant tumor; sarcoma? • RMS (1) • Undifferentiated carcinoma (2) • Malignant tumor (2) • Poorly differentiated malignant tumor; chorioca.? Undiff. ca.? (1) • Poorly differentiated malignant tumor; sarcoma? CS? (1) • ESS (1) • PSTT (1)

Case 18

• 46-years old woman

• Recurrent menorrhagia

• “Leiomyoma” (7.5 cm) with additional nodules in periphery

• Hysterectomy

DIAGNOSIS: LEIOMYOSARCOMA

Suggested diagnoses

• LMS (17) • Sarcoma – LMS vs. ESS (1) • Sarcoma (4) • HG malignant tumor; sarcoma? (1) • RMS (1)

Case 20

• 62-years old woman

• Tumor in uterine corpus (16 cm) with small necrotic areas

• Frozen section: sarcoma

• Vaginal hysterectomy

DIAGNOSIS: MYXOID LEIOMYOSARCOMA

Suggested diagnoses

• Myxoid LMS (11) • LMS (3) • Sarcoma (2) • Myxoid change in sarcoma (ESS or LMS) (1) • Myxoid leiomyoma (1) • Cellular leiomyoma with atypia (1) • Cellular leiomyoma with atypia vs. ESS (1) • ES nodule vs. myxoid LMS (1) • ES nodule with myxoid change (1) • Embryonal RMS (1) • ESS (1)

Case 21

• 62-years old woman

• Post-menopausal bleeding

• Suspected malignancy

• Abundant curettage, section from this material

DIAGNOSIS: RHABDOMYOSARCOMA

Suggested diagnoses

• RMS (9) • LMS (5) • Sarcoma (5) • UUS (3) • ESS vs. LMS vs. RMS (1) • ESS (1)

Case 22

• 47-years old woman

• Metrorrhagia

• Uterus at 14w pregnancy size

• First curettage: endometrium at secretory phase

• Second curettage: sarcoma, NOS

• Surgery: 10 kg tumor removed in fragments

DIAGNOSIS: UNDIFFERENTIATED UTERINE SARCOMA

Suggested diagnoses • UUS (3) • Sarcoma (7) • LMS (1) • LMS vs. HG-ESS (1) • HG-ESS (1) • LG-ESS (3) • ESS, myxoid variant (1) • ESS (1) • Endometrial stromal tumor; DD sarcoma (1) • PNET (1) • Malignant spindle cell tumor (2) / Malignant tumor (2) • Cellular leiomyoma with mitoses, possibly sarcoma (1)

Case 23

• 45-years old woman

• Clinically cervical myoma, mucoid content

• Uterus removed with additional tissue fragments with diameter up to 6 cm

• Residual tumor in corpus, with sharp delineation from myometrium

DIAGNOSIS: INFLAMMATORY MYOFIBROBLASTIC TUMOR

Suggested diagnoses • IMT (10) • Myxoid LMS (3) • IMT vs. sarcoma (1) • Sarcoma (1) • Sarcoma with lymphoid infiltration (1) • Spindle cell malignant tumor (1) • Malignant tumor (1) • LG-ESS (1) • Myxoid leiomyoma vs. LG sarcoma (1) • Leiomyoma vs. LMS (1) • Spindle cell tumor with inflammation (1) • Epithelioid leiomyoma (1) • ES nodule (1)

Case 30

• 71-years old woman

• Post-menopausal bleeding

• Polyp

• Curettage

DIAGNOSIS: ADENOSARCOMA

Suggested diagnoses

• AS (13) • Sarcoma (2) • ESS (1) • Clear cell leiomyoma (1) • AS vs. adenofibroma vs. CS vs. LG-ESS vs. angiosarcoma (1) • Adenofibroma (2) • RMS (1) • LMS (1) • Angiosarcoma (1) • Mucinous adenocarcinoma (1)