title: A case of uterine adenomyoma with bizarre smooth muscle cells mimicking leiomyosarcoma.
abstract: We report a case of adenomyoma of the uterus that was cytologically difficult to distinguish from leiomyosarcoma. Examination of a uterine cervical smear revealed numerous spindle cells that were present in cell clusters or as isolated cells. These cells contained nuclei that were oval-shaped/elongated with nucleoli and delicate wispy cytoplasm. Large and bizarre nuclei were also identified. Based on these cytological findings leiomyosarcoma was considered: however, this diagnosis remained uncertain because of the absence of mitosis and/or necrotic substance. Histologically, we recognized leiomyomatous smooth muscle cells growing in a solid pattern and intermingled with endometrial-type glands. Moreover, bizarre smooth muscle cells were observed in the surface layer of the tumor. These observations suggest that for a diagnosis of uterine leiomyosarcoma the presence of mitosis and/or necrosis is important in addition to nuclear atypia.
authors.affiliation: Department of Pathology, Showa University Northern Yokohama Hospital, Kanagawa, Japan. yomareko@cmed.showa-u.ac.jp
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Ohta
authors.forename: Takao
authors.initials: T
authors.lastname: Suzuki
authors.forename: Akira
authors.initials: A
authors.lastname: Shiokawa
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Ota
mesh_terms: D018194:Adenomyoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D002467:Cell Nucleus / Q000473:pathology; D003581:Cytodiagnosis / Q000379:methods*; D003937:Diagnosis, Differential; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000473:pathology*; D032389:Myocytes, Smooth Muscle / Q000473:pathology*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery