title: Frequency, histological, and immunohistochemical properties of massive inflammatory lymphocytic infiltration of leiomyomas of the uterus: an entity causing diagnostic difficulties.
abstract: Massive lymphocytic infiltration of the leiomyomas of the uterus is rare and causes diagnostic difficulties. The objective of this study is to estimate the frequency, to analyze the clinicopathologic features, to explore the possible pathogenetic factors, and to discuss the differential diagnosis of this entity. We reviewed the pathology reports of 379 patients who underwent surgery for leiomyomas at our institution, from 1999 until 2003, and we identified five cases of leiomyomas with massive lymphocytic infiltration. Thereafter, we reviewed the records of these five patients to identify the clinical, ultrasonographic, and surgical findings they had presented. Leiomyomas with lymphocytic infiltration were characterized by the presence of small lymphocytes, few plasma cells, and occasional germinal lymphocytes such as lymphoblasts confined into the leiomyoma. Immunohistochemistry was positive for desmin and leukocyte common antigen and showed a positive reaction to kappa and lambda light chains that is consistent with the polyclonal nature of an inflammatory infiltration. Gross appearance and ultrasonographic and color Doppler findings were the same as of a typical leiomyoma. Lymphocytic infiltration of leiomyomas is a rare histological entity. Although an inflammatory process seems to be the pathogenetic factor, other mechanisms such as an immunological or autoimmune response, a specific human leukocyte antigen alteration, or a viral infection could also be the cause of this entity. Differential diagnosis must be made from malignant lymphoma, pyomyoma, and inflammatory pseudotumor of the uterus, based on their special histological characteristics.
authors.affiliation: Second Department of Obstetrics and Gynecology, University of Athens, Areteion University Hospital, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Botsis
authors.forename: Carolina
authors.initials: C
authors.lastname: Koliopoulos
authors.forename: Agathi
authors.initials: A
authors.lastname: Kondi-Pafitis
authors.forename: George
authors.initials: G
authors.lastname: Creatsas
mesh_terms: D000328:Adult; D001402:B-Lymphocytes / Q000473:pathology; D003893:Desmin / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D017493:Leukocyte Common Antigens / Q000032:analysis; D008214:Lymphocytes / Q000737:chemistry / Q000473:pathology*; D008875:Middle Aged; D013601:T-Lymphocytes / Q000473:pathology; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
chemical_list: D003893:Desmin; D017493:Leukocyte Common Antigens