Abstract
We report two cases of "uterine leiomyoma with tubules" as a new pathological entity. Since these are biphasic neoplasms (composed by epithelial and mesenchimal elements), the differential diagnosis is between mixed mullerian tumors and uterine tumors resembling ovarian sex cord tumors (UTROSCTs). In the differential diagnosis, the mixed mullerian tumors are easily excluded because of histological and immunohistochemical features. UTROSCTs are similar to the lesions we reported, and the differential diagnosis requires positivity for some immunohistochemical markers as inhibin, CD99, calretinin, Melan-A. Our conclusions are that to perform a diagnosis of UTROSCT at least two immunohistochemical marker have to be expressed; in the present case they didn't, so we call the lesion "leiomyoma with tubules".
Highlights
The presence of cellular structures with epithelial-like or sex cord-like appearance embedded in mesenchimal nodular circumscribed tissue is an unusual finding, and it may cause some difficulties in making the diagnosis or in classifying the lesion
The differential diagnosis of the biphasic mesenchimal uterine neoplasms could be difficult for the pathologist: after exclusion of the mixed mullerian tumors, the problems arise in the distinction of UTROSCTs versus leiomyoma with tubules
UTROSCTs were originally classified by Clement and Scully [1] into two groups
Summary
The presence of cellular structures with epithelial-like or sex cord-like appearance embedded in mesenchimal nodular circumscribed tissue is an unusual finding, and it may cause some difficulties in making the diagnosis or in classifying the lesion. Staining was performed using the following antibodies: CAM5.2 low-weight keratin, AE1/AE3 high-weight keratin, vimentin, desmin, caldesmon, inhibin, estrogen receptor (ER), CD99, CD10, calretinin, progesterone receptor (PgR) and Melan-A. Cases were scored as negative, focally positive ( 50% cells staining). Both neoplasms were situated in the myometrium without involvement of the endometrium. They were well circumscribed, exhibited similar features and were mainly composed of sweeping and intersecting fascicles of smooth muscle cells surrounding a diffuse proliferation of tubular and gland-like structures lined by plump cells with indistinct cytoplasm (Fig. 1). The diagnosis "leiomyoma with tubules was performed for both cases. Into the mesenchymal component it is appreciable the glandular elements (Hematoxylin & Eosin, 100×)
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