Abstract：
Malignant transformation in leiomyoma is rare, with a few documented cases of sarcomatous transformation in leiomyomas. However, carcinosarcomatous transformation in leiomyomas is extremely infrequent. A 45-year-old female presented with a mass sensation per abdomen for the last five months. An abdominal ultrasound revealed multiple uterine fibroids. Contrast-enhanced magnetic resonance imaging revealed a large multiloculated abdominopelvic mass arising from the fundus of the uterus, along with multiple smaller subserosal fibroids. A total abdominal hysterectomy with bilateral salpingectomy was performed. Grossly, the uterus was bosselated with multiple subserosal fibroids. The larger degenerated fibroid showed a smooth outer surface; however, the cut surface was predominantly cystic and filled with necrotic material. Microscopically and immunohistochemically, the larger mass showed a high-grade biphasic tumor comprising carcinomatous and sarcomatous components with the peripheral solid areas showing compressed smooth muscle bundles representing the residual leiomyomatous areas. A final diagnosis of carcinosarcomatous transformation in leiomyoma was rendered. The index report highlights the significance of systematic gross and microscopic examination of all the uterine masses in patients with multiple leiomyomata.
摘要：
平滑肌瘤的恶性转化很少见，在平滑肌瘤中记录了一些肉瘤转化的病例。然而,平滑肌瘤的癌肉瘤转化极为罕见。在过去的五个月中，一名45岁的女性每个腹部都有肿块感。腹部超声显示多发性子宫肌瘤。对比增强的磁共振成像显示子宫底引起的大量多部位腹盆腔肿块，伴有多个较小的浆膜下肌瘤。进行了全腹子宫切除术和双侧输卵管切除术。严重的,子宫有多个浆膜下肌瘤。较大的变性肌瘤显示出光滑的外表面；然而，切面主要是囊性的，充满坏死物质。显微镜和免疫组织化学，较大的肿块显示高级别双相肿瘤,包括癌性和肉瘤性成分,周围实体区域显示压缩的平滑肌束代表残留的平滑肌瘤区域.最终诊断为平滑肌瘤的癌肉瘤转化。该指数报告强调了对多发性平滑肌瘤患者的所有子宫肿块进行系统的大体和显微镜检查的重要性。
