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Clustered pleomorphic, hyperchromatic smooth muscle cells with extensive mitosis
2%
3/123
Granulosa cells scattered around collections of eosinophilic fluid
2/123
Laminated, concentric spherules with dystrophic calcification
Presence of endometrial glands and stroma in the myometrium
11%
14/123
Whorled pattern of smooth muscle bundles with well-defined borders
77%
95/123
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This female patient with abnormal uterine bleeding and presence of asymmetric, firm, nontender uterine masses most likely has leiomyomas, which have a whorled pattern of smooth muscle bundles with well-defined borders on histology (see Illustration A). Leiomyomas, also known as fibroids, are benign smooth muscle growths of the uterine myometrium and often present with multiple discrete tumors. Leiomyomas occur primarily in women ages 20-40 and are commonly seen in African American women. Presentation of leiomyomas may be asymptomatic or involve abnormal uterine bleeding, which can subsequently result in symptoms of iron deficiency anemia (as seen in this patient). On physical exam, the uterus is enlarged, firm, and asymmetric with palpable presence of multiple non-tender tumors. Leiomyomas may in very rare instances undergo malignant transformation into leiomyosarcomas. Illustration A shows the histology of a leiomyoma with a whorled pattern of smooth muscle bundles with well-defined borders on histology. Illustration B shows the histology of leiomyosarcoma with clustered pleomorphic, hyperchromatic smooth muscle cells with extensive mitosis. Illustration C shows the histology of a granulosa cell tumor with Call-Exner bodies. Illustration D shows the histology of a serous papillary cystadenocarcinoma of the ovary featuring psammoma bodies. Illustration E shows the histology of adenomyosis, with the presence of endometrial glands and stroma in the myometrium. Incorrect Answers: Answer 1: Clustered pleomorphic, hyperchromatic smooth muscle cells with extensive mitosis are a feature characteristic of leiomyosarcoma, a tumor that has undergone malignant transformation from a benign leiomyoma. See Illustration B. Answer 2: Granulosa cells scattered around collections of eosinophilic fluid are a feature of Call-Exner bodies, which are seen in granulosa cell tumors, the most common malignant stromal tumor of the ovary. See Illustration C. Answer 3: Laminated, concentric spherules with dystrophic calcification are a feature of psammoma bodies, which can be seen in serous papillary cystadenocarcinoma of the ovary, the most common malignant ovarian neoplasm. See Illustration D. Answer 4: Presence of endometrial glands and stroma in the myometrium is characteristic of adenomyosis, which presents with dysmenorrhea, heavy menstrual bleeding, and a uniformly enlarged, soft uterus. See Illustration E. Bullet Summary: The histological feature of a leiomyoma is a whorled pattern of smooth muscle bundles with well-defined borders.
4.6
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