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Mitotically active haemorrhagic cellular (apoplectic) leiomyoma.
Y L Hock1, P Goswami, T P Rollason
1Department of Histopathology, Manor Hospital, Walsall, UK.
European Journal of Gynaecological Oncology
|March 22, 2000
Summary
Apoplectic leiomyoma, a rare smooth muscle tumor, can present atypically with a high mitotic index. This case highlights a benign apoplectic leiomyoma with unusual features, showing no recurrence after three years.
Area of Science:
- Gynecologic Pathology
- Surgical Pathology
- Oncology
Background:
- Apoplectic leiomyoma is a rare smooth muscle tumor associated with pregnancy or oral contraceptive use.
- Typically, these tumors exhibit a low mitotic index (0-2 per 10 high power fields), with up to 8 per 10 high power fields considered acceptable.
- Atypical features can occur, necessitating careful evaluation.
Observation:
- This report details an unusual case of apoplectic leiomyoma in a 47-year-old woman.
- The tumor displayed a significantly high mitotic index, reaching up to 20 mitoses per 10 high power fields.
- This mitotic rate is considerably higher than typically observed in apoplectic leiomyomas.
Findings:
- Despite the high mitotic index and atypical features, the tumor was confirmed as benign.
- Clinical and radiological follow-up using computed tomography (CT) for three years showed no evidence of tumor recurrence.
- This suggests that a high mitotic index alone may not necessarily indicate malignant potential in all cases of apoplectic leiomyoma.
Implications:
- This case expands the known spectrum of apoplectic leiomyoma, particularly regarding mitotic activity.
- It underscores the importance of considering clinical context and comprehensive histopathological evaluation in diagnosing smooth muscle tumors.
- Long-term follow-up may be crucial for managing these rare tumors, even those with atypical features.