Clinicopathologic analysis of cellular leiomyoma; a single-center retrospective review

Öz

Aim: We aimed to investigate clinical and hystopathological characteristics of patients with cellular leiomyoma. Material and Method: We analysed retrospectively the patients who underwent myomectomy or hysterectomy in Gynecology and Obstetrics Clinic, Akdeniz University between 2006 and 2014. Ninety-one patients diagnosed with cellular leiomyoma by histopathological examination were included in the study and their clinicopathological features were reviewed. Results: The mean age of the patients was 44.2 and the mean parity was 2. Majority of the patients (79.1%) were in the premenopausal period. Hysterectomy and bilateral salpingo-oophorectomy were performed in 57 of 91 patients, and 34 patients underwent myomectomy. The mean number of cellular leiomyoma was 1.3 and the mean diameter of cellular leiomyoma was 64.4 mm. Cellular leiomyomas were mostly detected in the intramural part of the uterus on ultrasonographic examination. The most common clinical presentation was menstrual abnormality. The mean follow-up period was 60 months, and no patient had recurrence or malignant transformation during this period. Conclusion: Cellular leiomyoma represents a subset of leiomyoma variants and is defined as typical leiomyoma exhibiting hypercellularity, patients with cellular leiomyoma is required a long-term close clinical follow-up.

Anahtar Kelimeler

• Hysterectomy
• Malignancy
• Myomectomy
• Cellular leiomyoma
• Prognosis

Selüler leiomyomun klinikopatolojik analizi; tek merkezli retrospektif inceleme

Öz

Amaç: Bu çalışmanın amacı selüler leiomyomlu hastaların klinik ve histopatolojik özelliklerini araştırmaktır. Gereç ve Yöntem: 2006-2014 yılları arasında Akdeniz Üniversitesi Kadın Hastalıkları ve Doğum kliniğinde myomektomi veya histerektomi yapılan hastalar retrospektif olarak analiz edildi. Histopatolojik inceleme sonrasında selüler leiomyom tanısı alan 91 hasta çalışmaya dahil edildi ve klinikopatolojik özellikleri değerlendirildi. Sonuçlar: Hastaların ortalama yaşı 44,2 idi, ortalama paritesi 2 idi. Hastaların çoğunluğu (%79,1) premenapozal dönemdeydi. Doksan bir hastadan 57’sine histerektomi ve bilateral salpingooferektomi yapılırken, 34 hastaya myomektomi yapıldı. Ortalama selüler leiomyom sayısı 1,3 ve ortalama selüler leiomyom çapı 64,4 mm olarak saptandı. Ultrasonografik incelemede selüler leiomyomlar en çok uterusun intramural kısmında görüldü. En sık görülen klinik prezentasyon ise menstrüel düzensizlikti. Ortalama takip süresi 60 aydı ve bu sürede hiçbir hastada nüks yada malign transformasyon görülmedi. Sonuç: Selüler leiomyom, leiomyom varyantlarının bir alt grubunu temsil eder ve hiperselülarite sergileyen tipik leiomyom olarak tanımlanır. Selüler leiomyomu olan hastaların uzun dönem yakından klinik izlemi gerekmektedir.

Anahtar Kelimeler

• Histerektomi
• Malignite
• Myomektomi
• Selüler leiomyom
• Takip

Kaynakça

1. Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228. Obstet Gynecol, 2021. 137(6): 100-115.
2. Naz S ,Rehman A, Riyaz A, Jehangir F, Naeem S, Iqbal T. Leiomyoma: Its Variants And Secondary Changes A Five-Year Study. J Ayub Med Coll Abbottabad, 2019; 31(2): 192-195.
3. Sikora-Szczęśniak, D.L. Prevalence of cellular leiomyoma and partially cellular leiomyoma in postoperative samples - analysis of 384 cases. Ginekol Pol, 2016; 87(9): 609-616.
4. Wang C, Zheng X, Zhou Z, Shi Y, Wu Q, Lin K. Differentiating cellular leiomyoma from uterine sarcoma and atypical leiomyoma using multi-parametric MRI. Front Oncol, 2022; 12: 1005191.
5. Ip, P.P., K.Y. Tse, K.F. Tam. Uterine smooth muscle tumors other than the ordinary leiomyomas and leiomyosarcomas: a review of selected variants with emphasis on recent advances and unusual morphology that may cause concern for malignancy. Adv Anat Pathol, 2010;17(2): 91-112.
6. World Health Organization. WHO Classification of Tumours: Female Genital Tumours. 2020 (Accessed 2022 July 5); Available from: https://www.iarc.who.int/news-events/publication-of-the-who-classification-of-tumours-5th-edition-volume-4-female-genital-tumours.
7. Guan, R., W. Zheng, M. Xu. A retrospective analysis of the clinicopathologic characteristics of uterine cellular leiomyomas in China. Int J Gynaecol Obstet, 2012; 118(1): 52-55.
8. Kang M, Kang SK, Yu JH. et al., Benign metastasizing leiomyoma: metastasis to rib and vertebra. Ann Thorac Surg, 2011;91(3): 924-926.

9. Mulayim, N, F. Gucer. Borderline smooth muscle tumors of the uterus. Obstet Gynecol Clin North Am, 2006; 33(1):171-181.
10. Gebre-Medhin S, Nord KH, Möller E et al. Recurrent rearrangement of the PHF1 gene in ossifying fibromyxoid tumors. Am J Pathol, 2012; 181(3): 1069-1677.
11. Schoolmeester JK, Sukov WR, Maleszewski JJ, Bedroske PP, Folpe AL, Hodge JC. JAZF1 rearrangement in a mesenchymal tumor of nonendometrial stromal origin: report of an unusual ossifying sarcoma of the heart demonstrating JAZF1/PHF1 fusion. Am J Surg Pathol, 2013; 37(6): 938-942.
12. Dundr P, Gregová M, Hojný J et al. Uterine cellular leiomyomas are characterized by common HMGA2 aberrations, followed by chromosome 1p deletion and MED12 mutation: morphological, molecular, and immunohistochemical study of 52 cases. Virchows Arch, 2022; 480(2): 281-291.
13. Sharma P, Chaturvedi KU, Gupta R, Nigam S. Leiomyomatosis peritonealis disseminata with malignant change in a post-menopausal woman. Gynecol Oncol, 2004; 95(3):742-745.
14. Rothmund R, Kurth RR, Lukasinski NM et al. Clinical and pathological characteristics, pathological reevaluation and recurrence patterns of cellular leiomyomas: a retrospective study in 76 patients. Eur J Obstet Gynecol Reprod Biol, 2013;171(2): 358-361.
15. Barnaś E, Książek MÖ, Raś R, Skręt A, Skręt-Magierło J, Dmoch-Gajzlerska E. Benign metastasizing leiomyoma: A review of current literature in respect to the time and type of previous gynecological surgery. PLoS One, 2017;12(4): 0175875.
16. Wei, J.J. Leiomyoma with nuclear atypia: Rare diseases that present a common diagnostic problem. Semin Diagn Pathol, 2022; 39(3): 187-200.
17. Nava, H.J., Highly Cellular Leiomyoma Mixed With a Focus of Adenomyosis. Cureus, 2022; 14(8):28129.
18. 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.