Uterine sarcomas...Uterine sarcomas Prof. Ben Davidson, MD PhD Department of Pathology, Norwegian...

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)