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Leiomyoma With Bizarre Nuclei: Clinical and Pathologic Features of 30 Patients
Mehmet Kefeli1, Sultan Caliskan, Emel Kurtoglu
1Departments of Pathology (M.K., S.C., L.Y.) Obstetrics and Gynecology (E.K., A.K.), Medical School, Ondokuz Mayis University, Samsun, Turkey.
Summary
Leiomyoma with bizarre nuclei (LBN) exhibit cytologic atypia but lack high mitotic rates or necrosis, indicating a benign course. Careful exclusion of malignant features is crucial for accurate LBN diagnosis and patient prognosis.
Area of Science:
- Pathology
- Oncology
- Gynecology
Background:
- Leiomyoma with bizarre nuclei (LBN) is a variant of uterine leiomyoma characterized by significant cytologic atypia.
- Despite atypia, LBN typically lacks high mitotic rates and tumor cell necrosis, suggesting a benign nature.
- Recurrent cases of LBN have been reported, necessitating a thorough understanding of its clinical and pathological features.
Purpose of the Study:
- To investigate the clinical and pathological features of Leiomyoma with bizarre nuclei (LBN).
- To compare the features of LBN with findings from related studies.
- To evaluate the clinical course and prognosis of patients diagnosed with LBN.
Main Methods:
- Retrospective analysis of clinical and pathological data from 30 patients diagnosed with LBN.
- Evaluation of macroscopic features (size, location, number, necrosis, hemorrhage) and microscopic features (cell distribution, density, mitotic rate, margin, pseudoinclusions, karyorrhectic nuclei, nucleoli, inclusions, vessels, edema).
- Review of follow-up data including recurrence and survival periods for 26 patients.
Main Results:
- The mean age of patients was 49.76 years; 73% underwent hysterectomy, 27% myomectomy.
- Microscopic examination revealed common features such as pseudoinclusions (80%), karyorrhectic nuclei (70%), and prominent eosinophilic nucleoli (40%).
- The mean mitotic count was low (1.4/10 HPF), and no cases showed tumor cell necrosis or a high mitotic rate; one patient developed a non-uterine smooth muscle tumor years later.
Conclusions:
- Leiomyoma with bizarre nuclei (LBN) demonstrates a benign clinical course, consistent with recent studies.
- Accurate diagnosis of LBN requires excluding malignant morphologic criteria like high mitotic rate and tumor cell necrosis.
- Definitive diagnosis of uterine smooth muscle tumors is essential for determining patient prognosis and guiding therapeutic strategies.
