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Mitotically active leiomyomas of the uterus
1Department of Gynecologic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000.
Human Pathology
|February 1, 1990
Summary
Mitotically active uterine smooth muscle tumors with no atypia and 5-9 mitoses/HPF show a low metastatic rate. Myomectomy may be sufficient, with hysterectomy not always required if patients are monitored.
Area of Science:
- Gynecologic Pathology
- Uterine Neoplasms
- Smooth Muscle Tumors
Background:
- Uterine smooth muscle tumors with increased mitotic activity require careful classification to distinguish benign leiomyomas from malignant leiomyosarcomas.
- Cytologic atypia and high mitotic rates are key features in differentiating these entities.
Purpose of the Study:
- To evaluate the clinical behavior and metastatic potential of uterine smooth muscle tumors characterized by 5-9 mitoses per 10 high-power fields (HPF) and the absence of cytologic atypia.
Main Methods:
- Histopathologic review of 73 uterine smooth muscle tumors with 5-9 mitoses/HPF and no cytologic atypia.
- Assessment of features including necrosis, hemorrhage, vascular intrusion, and abnormal mitoses.
- Clinical follow-up ranging from 23 months to 15 years.
Main Results:
- Vascular ingrowth was observed in 11 of the 73 neoplasms.
- All patients remained alive and well at the last follow-up.
- Of 14 patients treated with myomectomy alone, 13 had no residual or recurrent tumor; one developed recurrence 8 years later.
Conclusions:
- Uterine smooth muscle tumors with 5-9 mitoses/HPF and no cytologic atypia exhibit a low metastatic rate and should not be classified as sarcomas.
- Hysterectomy is not automatically indicated after myomectomy for these tumors; appropriate patient follow-up is crucial.