PMC4434163_01
a. Gross photograph of uterine serosa showing red bulbous protrusions with a  "placenta-like" appearance.. b. Bland fascicles of smooth muscle dissecting into the background myometrium with a pushing border in multiple areas (1x magnification, hematoxylin and eosin stain).. c. Background of smooth muscle cells with foci of embedded adipose tissue (arrow) showing positive staining for S100. To the left, an occluded vessel with prominent atherosis of the wall is indicated (*) (4 x magnification, S100 stain).. d. Lymphovascular space invasion, as demonstrated by a nodule of smooth muscle tumor with hemorrhage sitting within a vascular space (4 x magnification, hematoxylin and eosin stain).
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Tumor involving the surface of the uterus had a lobulated, red appearance (Fig. 1a). Microscopically the tumor was composed of cytologically bland interlacing fascicles of smooth muscle, which showed infiltration into the surrounding myometrium (Fig. 1b). Multiple areas of the tumor showed collections of cells with adipocytic differentiation, confirmed by an S100 stain (Fig. 1c). Extensive atherosis and thrombosis of intratumoral blood vessels were noted, as well as focal lymphovascular space invasion (Fig. 1d).
Pre-operative CT scan.
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