Smooth muscle tumor

Author: Mikael Häggström

Smooth muscle tumor (in this case leiomyoma).

Gross processing

Gross examination

Examine and describe:

• Location
• Number of tumors, if multiple
• Size
• Demarcation

Selection

In case of hysterectomy, submit pieces from all smooth muscle tumors >5 cm in diameter.

Submit any macroscopically abnormal parts of the tumors (hemorrhagic, necrotic, brittle or softening areas, and areas with blurry delimitation).

Microscopic examination

Distinguish leiomyoma (benign) from leiomyosarcoma (malignant).

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  Leiomyomas typically show smooth muscle in a whorled (fascicular) pattern

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  Leiomyoma, with areas where the cellularity is relatively lower (left) and higher (right).

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  Epithelioid leiomyoma

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  Leiomyoma with palisading pattern

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  Leiomyosarcoma: Variable atypia, often with cytoplasmic vacuoles at both ends of nuclei, and frequent mitoses.

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  Epithelioid leiomyosarcoma

Further information: Evaluation of tumors

Microscopic report

Report:

• Microscopic findings, including any visible linings
• Diagnosis or most probable one
• Any linings or borders.

Example, for a cervical polyp:

Polyp lined by a single layer of columnar epithelium consistent with endometrium. The interior consists of smooth muscles in a whorled pattern. No atypia. The finding is consistent with a pedunculated submucosal leiomyoma.

  See also: General notes on reporting

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