benign tumors of uterus pathology

1. FIBROID
Presented by: Dr.Divya Haridas

2. Leiomyomas of the uterus are extremely common
neoplasms.
The normal myometrium of leiomyoma-containing
uteri expresses higher levels of estrogen receptors, a
fact that may be related to their pathogenesis.
Leiomyomas are much more common in black women,
in whom they have a tendency to be very numerous.

3. These tumors occur subserosally, intramurally, or
submucosally and produce symptoms referable to
their size and location.
submucous tumors produce metrorrhagia, sometimes
massive
The intramural ones result in menorrhagia,and the
subserosal ones usually remain asymptomatic. They
may become large enough to block the ureters,
interfere with pregnancy, or cause inflammatory
complications

4. Multiple uterine leiomyomas Large uterine leiomyoma with
intramural and subserosal
involvement

5. GROSS:Leiomyomas are typically sharply
circumscribed, firm gray white masses ;the
cut surface of a typical leiomyoma has a white
whorled appearance that has been likened to
raw silk.
The uterus is opened to show multiple
submucosal, myometrial, and subserosal
gray-white tumors, each with a
characteristic
whorled appearance on cut section.

6. MICROSCOPICALLY:the tumor is formed by interlacing bundles of smooth
muscle cells separated by a greater or lesser amount of well-vascularized
connective tissue. Ultrastructurally, the features are those of smooth
muscle cells with varying degrees of differentiation
Elongated spindle cells with fibrillary
acidophilic cytoplasm of leiomyoma

7. Leiomyoma Variants
• Red degeneration
• Hydropic degeneration
• Myxoid changes
• Calcification
• Cystic changes
• Fatty metamorphosis

8. Red degeneration (present in 3% of cases) can result in abdominal pain,
vomiting, and fever. This change is characterized grossly by a bulging
surface and a homogeneous dark red appearance and microscopically by
extensive coagulative necrosis. It may be associated with pregnancy or the
use of contraceptive drugs.
Apoplectic leiomyoma is pathogenetically related to red degeneration and is
characterized by stellate zones of recent hemorrhage within nodules of
hypercellular smooth muscle, with few or no mitotic figures.

9. Hydropic degeneration is characterized by the accumulation of edema fluid, often
associated with collagen deposition. It may have a diffuse, perinodular, or other
patterns. Leiomyomas with hydropic degeneration have a delicate filigree pattern
rather than thick fascicles, and the extracellular material is edema fluid. Also, the
presence of medium- to large-caliber blood vessels “floating” in the extracellular
material is more characteristic of hydropic change.

10. Myxoid leiomyoma shows presence of destructive myometrial invasion and
the conventional features of malignancy.
It is hypocellular, well circumscribed borders,no cytological atypia seen.

11. Cellular leiomyoma is a term reserved for those tumors having markedly
increased cellularity but no coagulative necrosis, atypia, or an excessive
number of mitotic figures .Their natural history is the same as for the
ordinary leiomyoma. The differential diagnosis includes leiomyosarcoma
and endometrial stromal neoplasms.

12. Leiomyoma with bizarre nuclei contains foci with bizarre tumor cells showing
variation in size and shape, hyperchromatic nuclei, and multinucleated
forms but no infiltration of myometrium, coagulative necrosis, or
increased mitotic activity.
Alveolar edema, stag horn vessels seen.

13. Cotyledonoid dissecting leiomyoma is so designated because its gross
appearance resembles that of placental tissue. The tumor is exophytic,
bulky, and extends from the uterine wall into the broad ligament and
pelvic cavity.
Microscopically, the appearance is that of a leiomyoma with extensive
degenerative changes . Despite its dissecting pattern, it lacks vascular
invasion and is benign. Variations exist of leiomyomas that are
cotyledonoid but not dissecting,580 and dissecting but not cotyledonoid.
Believe it or not, there is also a cotyledonoid hydropic intravenous
leiomyomatosis.

14. Epithelioid leiomyoma is partially or totally composed of rounded
or polygonal cells. Mixtures of epithelioid, clear cell,
and plexiform patterns occur frequently enough to suggest that they
represent variants of a single entity. A transition to typical smooth
muscle is sometimes observed. Morphologically similar tumors occur
in the round ligament.

15. • Reference : Rosai and ackerman’s surgical
pathology