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Liposarcoma arising in uterine lipoleiomyoma: a report of 3 cases and review of the literature.
[pleomorphic liposarcoma]
Primary
sarcomas
of
the
uterus
are
uncommon
,
leiomyosarcoma
being
the
most
frequent
.
Most
uterine
sarcomas
arise
de
novo
,
with
malignant
transformation
of
a
benign
mesenchymal
tumor
being
a
very
rare
event
,
and
is
reported
only
in
leiomyomata
.
The
clinicopathologic
features
of
3
uterine
liposarcomas
arising
in
association
with
a
lipoleiomyoma
were
studied
.
Immunohistochemistry
for
desmin
,
h-caldesmon
,
S
100
,
and
MDM
2
,
and
fluorescence
in
situ
hybridization
for
the
t
(
12
;
16
)
(
q
13
;
p
11
)
were
performed
in
all
cases
.
Patients
ranged
in
age
from
49
to
70
(
mean
,
59
)
years
.
The
tumors
were
centered
in
the
myometrium
,
ranged
in
size
from
10
to
18
.
5
cm
,
and
showed
a
gelatinous
cut
surface
with
foci
of
necrosis
.
On
microscopic
examination
,
the
tumors
had
well-circumscribed
pushing
margins
.
One
neoplasm
was
uniformly
hypocellular
with
a
prominent
myxoid
background
,
and
a
striking
delicate
vascular
network
.
Another
neoplasm
showed
alternating
hypocellular
(
myxoid
)
and
hypercellular
areas
,
whereas
the
third
tumor
was
uniformly
hypercellular
with
a
hyalinized
background
.
In
the
myxoid
areas
,
the
cells
were
small
and
spindle
with
oval
nuclei
and
inconspicuous
nucleoli
.
In
the
hypercellular
areas
,
the
cells
were
pleomorphic
with
large
,
hyperchromatic
nuclei
.
Mitotic
activity
ranged
from
<
3
to
7
/
10
high
-power
fields
.
Lipoblasts
were
present
in
all
tumors
but
were
more
common
in
the
hypercellular
areas
.
Two
tumors
merged
imperceptibly
with
a
lipoleiomyoma
(
1
typical
and
1
with
bizarre
nuclei
)
,
whereas
the
third
tumor
showed
an
infarcted
area
composed
of
ghost
mature
adipocytes
admixed
with
hyalinized
smooth
muscle
most
consistent
with
an
infarcted
lipoleiomyoma
.
Tumors
were
classified
as
myxoid
,
mixed
myxoid
and
pleomorphic
,
and
pleomorphic
liposarcoma
,
respectively
.
The
benign
and
malignant
adipose
components
were
positive
for
S
100
,
whereas
the
benign
smooth
muscle
component
stained
for
desmin
and
h-caldesmon
.
MDM
2
immunostain
was
positive
in
the
2
cases
with
a
pleomorphic
liposarcoma
component
.
Fluorescence
in
situ
hybridization
analysis
was
successfully
completed
in
only
1
of
3
tumors
(
pure
pleomorphic
liposarcoma
)
,
which
failed
to
show
the
t
(
12
;
16
)
and
HMAG
2
amplification
.
The
patients
are
alive
and
well
1
,
2
,
and
20
years
after
initial
surgery
with
no
adjuvant
therapy
.
Primary
liposarcomas
of
the
uterus
are
extremely
rare
and
are
most
likely
to
arise
from
malignant
transformation
of
a
lipoleiomyoma
.
These
tumors
should
be
added
to
the
differential
diagnosis
of
benign
lipomatous
tumors
,
myxoid
mesenchymal
tumors
,
and
malignant
mixed
Müllerian
tumors
(
if
pleomorphic
)
of
the
uterus
.
Diseases
Validation
Diseases presenting
"uniformly hypocellular with a prominent myxoid background"
symptom
pleomorphic liposarcoma
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