Abstract
Background : We perform transcervical needle biopsies for uterine myoma-like tumors. In the case reported herein, we carried out imprint cytology examinations of transcervical needle biopsy specimens, and report its usefulness for differential diagnosis between uterine leiomyoma and leiomyosarcoma.
Case : A 59-year-old female patient presented to us with the chief complaint of hematuria, and a diagnostic CT revealed a degenerated uterine myoma. Uterine sarcoma was suspected on MRI and PET-CT. We performed transcervical needle biopsies of the uterine tumor ; the specimens showed atypical spindle cells with a mitotic index of 5, but no evidence of coagulative tumor cell necrosis. Imprint cytology of the biopsy specimens showed many loosely adherent spindle cells, apoptotic cells and mitotic cells on a necrotic background, suggesting the diagnosis of leiomyosarcoma. Surgery was performed, and the final histopathological diagnosis was leiomyosarcoma.
Conclusion : Needle biopsy is a useful diagnostic method for differentiation between uterine sarcoma and uterine leiomyoma. Evaluation should be performed in the most highly developed section of the tumor, however, this area is not always included in the small specimens obtained by needle biopsy, resulting in the risk of under-evaluation. The combination of imprint cytology of the needle biopsy specimens, including an evaluation of the number of imprinted tumor cells, may provide useful information for differential diagnosis between these tumors.
