E-ISSN: 2619-9467

Contents    Cover    Publication Date: 20 Sep 2023
Year 2023 - Volume 33 - Issue 3

Open Access

Peer Reviewed

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Clinicopathological Comparison of Leiomyoma Variants and Leiomyosarcomas: A Retrospective Analysis

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JCOG. 2023;33(3):178-83
DOI: 10.5336/jcog.2023-97716
Article Language: EN
Copyright Ⓒ 2020 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Objective: To compare leiomyoma variants and leiomyosarcoma (LMS) in terms of clinicopathological characteristics. Material and Methods: We evaluated the clinical and pathology outcomes of 57 patients who underwent myomectomy or hysterectomy between September 2013 and August 2022 and were diagnosed with cellular leiomyoma (CL), mitotically active leiomyoma (MAL), leiomyoma with bizarre nuclei (LBN), or LMS. Intraoperative frozen results were compared with the final pathology results. Leiomyoma variants (CL, MAL, and LBN) were compared with each other and with LMS. Results: Patients in the LMS group were older than those in the leiomyoma variants group (p<0.001). Frozen results in the variant group was 6.7% malignant, whereas 100% in the LMS group. Age (p=0.207), menopausal status (p=0.347), fibroid size (p=0.432), and number (p=0.598) did not differ between CL, MAL, and LBN groups. The median follow-up of leiomyoma variants and LMS groups was 61 months (4-105 months) and 20.5 months (6-85 months), respectively. No recurrence was observed in leiomyoma variants group whereas, recurrence was observed in 5 patients, and 3 patients died after recurrence in the LMS group. Conclusion: In this study, no recurrence was observed in the leiomyoma variants groups during the follow-up period and the prognosis is favorable. Not all tumors in the group of leiomyoma variants already meet the diagnostic criteria for LMS. Therefore, the detailed naming of the leiomyoma variants by subgroups does not seem to be of additional benefit for patient follow-up.
  1. Bulun SE. Uterine fibroids. N Engl J Med. 2013;369(14):1344-55. [Crossref]  [PubMed] 
  2. Zhang Q, Ubago J, Li L, Guo H, Liu Y, Qiang W, et al. Molecular analyses of 6 different types of uterine smooth muscle tumors: Emphasis in atypical leiomyoma. Cancer. 2014;120(20):3165-77. [Crossref]  [PubMed] 
  3. Giuntoli RL 2nd, Metzinger DS, DiMarco CS, Cha SS, Sloan JA, Keeney GL, et al. Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol. 2003;89(3):460-9. [Crossref]  [PubMed] 
  4. Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol. 1994;18(6):535-58. [Crossref]  [PubMed] 
  5. Denschlag D, Ackermann S, Battista MJ, Cremer W, Egerer G, Follmann M, et al. Sarcoma of the Uterus. Guideline of the DGGG and OEGGG (S2k Level, AWMF Register Number 015/074, February 2019). Geburtshilfe Frauenheilkd. 2019;79(10):1043-60. [Crossref]  [PubMed]  [PMC] 
  6. Porter AE, Kho KA, Gwin K. Mass lesions of the myometrium: interpretation and management of unexpected pathology. Curr Opin Obstet Gynecol. 2019;31(5):349-55. [Crossref]  [PubMed] 
  7. Oliva E. Practical issues in uterine pathology from banal to bewildering: the remarkable spectrum of smooth muscle neoplasia. Mod Pathol. 2016;29 Suppl 1:S104-20. [Crossref]  [PubMed] 
  8. Ly A, Mills AM, McKenney JK, Balzer BL, Kempson RL, Hendrickson MR, et al. Atypical leiomyomas of the uterus: a clinicopathologic study of 51 cases. Am J Surg Pathol. 2013;37(5):643-9. [Crossref]  [PubMed] 
  9. Longacre TA, Lim D, Parra-Herran C. Uterine leiomyosarcoma. In: World Health Organization, ed. Female Genital Tumours: WHO Classification of Tumours. 5th ed. Lyon: IARC Press; 2020. p.283-5.
  10. Downes KA, Hart WR. Bizarre leiomyomas of the uterus: a comprehensive pathologic study of 24 cases with long-term follow-up. Am J Surg Pathol. 1997;21(11):1261-70. [Crossref]  [PubMed] 
  11. Croce S, Young RH, Oliva E. Uterine leiomyomas with bizarre nuclei: a clinicopathologic study of 59 cases. Am J Surg Pathol. 2014;38(10):1330-9. [Crossref]  [PubMed] 
  12. Bennett JA, Weigelt B, Chiang S, Selenica P, Chen YB, Bialik A, et al. Leiomyoma with bizarre nuclei: a morphological, immunohistochemical and molecular analysis of 31 cases. Mod Pathol. 2017;30(10):1476-88. [Crossref]  [PubMed]  [PMC] 
  13. Travaglino A, Raffone A, Santoro A, Raimondo D, Improda FP, Cariati F, et al. Risk of recurrence in uterine leiomyoma with bizarre nuclei: a systematic review and meta-analysis. Geburtshilfe Frauenheilkd. 2021;81(11):1217-23. [Crossref]  [PubMed]  [PMC] 
  14. Kefeli M, Caliskan S, Kurtoglu E, Yildiz L, Kokcu A. Leiomyoma with bizarre nuclei: clinical and pathologic features of 30 patients. Int J Gynecol Pathol. 2018;37(4):379-87. [Crossref]  [PubMed] 
  15. Devereaux KA, Schoolmeester JK. Smooth muscle tumors of the female genital tract. Surg Pathol Clin. 2019;12(2):397-455. [Crossref]  [PubMed] 
  16. Taran FA, Weaver AL, Gostout BS, Stewart EA. Understanding cellular leiomyomas: a case-control study. Am J Obstet Gynecol. 2010;203(2):109.e1-6. [Crossref]  [PubMed] 
  17. Major FJ, Blessing JA, Silverberg SG, Morrow CP, Creasman WT, Currie JL, et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer. 1993;71(4 Suppl):1702-9. [Crossref]  [PubMed] 
  18. Ip PP, Cheung AN. Pathology of uterine leiomyosarcomas and smooth muscle tumours of uncertain malignant potential. Best Pract Res Clin Obstet Gynaecol. 2011;25(6):691-704. [Crossref]  [PubMed] 
  19. Tulandi T, Ferenczy A. Biopsy of uterine leiomyomata and frozen sections before laparoscopic morcellation. J Minim Invasive Gynecol. 2014;21(5):963-6. [Crossref]  [PubMed]