PMC3420638_01
(a) Gross photograph showing a large hemorrhagic mass arising from the uterus. (b) Cut section of the tumor showing whitish whorled areas with interspersed blood vessels.
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fig1
A large hemorrhagic mass measuring 18 x 15 x 8 cm was seen to arise from the lower posterior part of the uterus (Figure 1(a)). The cut surface of the mass was whitish and whorled (Figure 1(b)) with hemorrhagic areas in the periphery.
(a) Photomicrograph showing fascicles of spindle cells with interspersed abundant thick walled vessels. (b) Photomicrograph showing spindle cells with marked cellular atypia.
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fig2
Histological examination of the tumor showed a moderately cellular neoplasm composed of interlacing fascicles of spindle cells with interspersed abundant thick muscular walled vessels (Figure 2(a)). In areas, the spindle cells showed marked atypia with bizarre hyperchromatic nuclei (Figure 2(b)) and some multinucleate giant cells.
(a) Smooth muscle actin. (b) desmin. (c) HMB 45. (d) Ki 67.
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fig3
On immunohistochemistry, the tumor cells showed positivity for smooth muscle actin (SMA) (Figure 3(a)) and desmin (Figure 3(b)). HMB-45 negativity (Figure 3(c)) ruled out the possibility of a perivascular epithelioid cell tumor (PEComa). The Ki-67 proliferation index (Figure 3(d)) was less than 1%.