Abstract：
Malignant mixed mesodermal sarcomas (myxoid leiomyosarcomas - MLMS) are a rare form of uterine cancer developed from the smooth muscles of the uterus. It usually affects women in the postmenopausal period and has an aggressive character with an unfavorable evolution and prognosis. This paper presents a case where MLMS was postoperatively confirmed with the aid of the histopathological (HP) examination coupled with specific immunolabeling techniques. In addition, we reviewed modern literature to compare our results. Clinically, patients may present with a pelvic tumor, vaginal bleeding, or abdominal pressure. Imagistic investigations, such as pelvic ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT may support the diagnosis. Nevertheless, solely the HP examination establishes it. Macroscopically, MLMS is soft and gelatinous, unlike the conventional rigid and spiral leiomyoma appearance. Furthermore, the infiltrative, irregular tumor margin is characteristic of MLMS. From a microscopic point of view, the following are present: tumor cell necrosis, nuclear pleomorphism, and variable mitotic activity. With classical Hematoxylin-Eosin (HE) staining, myometrium presents a leiomyomatous structure and multiple nodular formations with the aspect of malignant tumor proliferation, most likely mesenchymal. We used multiple special immunolabeling techniques. Thus, we observed the intense reactivity of the cells to the anti-vimentin antibody, which immunolabeled type III intermediate filament (IF) protein expressed in mesenchymal cells, thus demonstrating tumor mesenchymal affiliation. Smooth cell positivity for alpha-smooth muscle actin (α-SMA) demonstrates that the tumor is present in its whole myometrial structure. Tumor cells also underwent mutations involving the p53 tumor suppressor gene demonstrated by the number of tumoral cells in division immunolabeled with anti-Ki67 proliferation antibody. Tumor development was demonstrated by protein activation of cyclin-dependent kinase (CDK) and the presence of c-Kit-bound hematopoietic stem cells, immunolabeled with the anti-cluster of differentiation 117 (anti-CD117) antibodies. The anti-desmin antibody demonstrates, along with α-SMA, the involvement of myocytes in the tumoral process. The following microscopic characteristics laid the foundation for the diagnosis of MLMS: irregular myometrial invasion, rare mitosis on high-power fields (HPFs), cell pleomorphism, predominant myxoid component that gave a hypocellular appearance, the matrix rich in proteoglycans and glycosaminoglycans, especially hyaluronic acid.
摘要：
恶性混合中胚层肉瘤（粘液样平滑肌肉瘤-MLMS）是一种罕见的子宫癌，由子宫平滑肌发展而来。它通常会影响绝经后妇女，并具有侵略性，具有不利的演变和预后。本文介绍了在组织病理学（HP）检查以及特定免疫标记技术的帮助下，术后确认MLMS的情况。此外,我们回顾了现代文学来比较我们的结果。临床上,患者可能存在盆腔肿瘤，阴道出血,或腹部压力。意象调查,如盆腔超声检查（美国），计算机断层扫描（CT），磁共振成像（MRI），和正电子发射断层扫描（PET）-CT可以支持诊断。然而，只有HP检查才能确定它。宏观上,MLMS柔软且呈凝胶状，不像传统的刚性和螺旋平滑肌瘤的外观。此外，渗透，肿瘤边缘不规则是MLMS的特征。从微观的角度来看，以下是目前：肿瘤细胞坏死，核多态性，和可变的有丝分裂活性。用经典的苏木精-伊红（HE）染色，子宫肌层表现为平滑肌瘤结构和多个结节形成，具有恶性肿瘤增殖的方面，最有可能是间充质。我们使用了多种特殊的免疫标记技术。因此，我们观察到细胞对抗波形蛋白抗体的强烈反应，免疫标记的III型中间丝（IF）蛋白在间充质细胞中表达，从而证明肿瘤间充质的归属。α-平滑肌肌动蛋白（α-SMA）的光滑细胞阳性表明肿瘤存在于其整个肌层结构中。肿瘤细胞还经历了涉及p53肿瘤抑制基因的突变，这通过用抗Ki67增殖抗体免疫标记的分裂中的肿瘤细胞数量来证明。细胞周期蛋白依赖性激酶（CDK）的蛋白激活和c-Kit结合的造血干细胞的存在证明了肿瘤的发展。用抗分化簇117(抗CD117)抗体免疫标记。抗结蛋白抗体证明，连同α-SMA,肌细胞参与肿瘤过程。以下微观特征为MLMS的诊断奠定了基础：不规则肌层侵犯，高功率场（HPF）上的罕见有丝分裂，细胞多态性，主要的粘液样成分表现为细胞减少，富含蛋白聚糖和糖胺聚糖的基质，尤其是透明质酸.
