2024 Volume 63 Issue 1 Pages 13-18
Background : We present a case of uterine leiomyoma with bizarre nuclei (LBN).
Case : A woman in her forties presented to her doctor with prolonged menstruation and was diagnosed as having a uterine leiomyoma. Over time, the tumor grew to 40 mm in diameter, and the patient was referred to our hospital. Magnetic resonance imaging showed multiple masses in the uterus. Intraoperative rapid diagnosis was performed to distinguish between benign and malignant tumor. Imprint cytology revealed large atypical cells, containing pleomorphic nuclei with degenerative-like chromatin. Nuclear inclusions were present, nucleoli were prominent, and the cell cytoplasm was either lightgreen or not clearly visible. Histologically, bizarre spindle-shaped cells resembling smooth muscle cells were observed. The atypical cells were large, pleomorphic, and contained eosinophilic cytoplasm with occasional nuclear inclusions. No mitotic figures or tumor necrosis were observed. Immunohistochemical analysis revealed diffuse positivity for p16, partial positivity for p53 (wild-type pattern), and a Ki-67 index of less than 1%.
Conclusion : In cases where atypical cells suggestive of leiomyosarcoma are observed, cytological assessment for the presence or absence of tumor necrosis, mitotic figures, and degenerative-like smudged nuclear chromatin can help confirm the diagnosis of LBN.
