PMC9910815_01
Ultrasound images of the uterine intramural (A) and subserosal (B) masses show well-defined boundaries and similar echogenicity.
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FIG1
The radiologist diagnosed the three masses as uterine fibroids, and no further imaging was performed (Figure 1).
Gross image showing the uterine serosal surface with subserosal bulgings.
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FIG2
The subserosal masses had a homogeneous, white, firm, solid-cut surface (Figures 2, 3).
Gross image showing necrotic (short arrow) and hemorrhagic (long arrow) cut surface of tumor in the uterine cavity.
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FIG3
The subserosal masses had a homogeneous, white, firm, solid-cut surface (Figures 2, 3).
Hematoxylin and eosin stain of the tumor. Low-power view showing myxoid tumor infiltrating the myometrium.
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FIG4
Necrosis was present, and mitosis was minimal at around 2 per 10 high-power fields (Figures 4-6).
Hematoxylin and eosin stain of the myxoid tumor. 40x magnification of the bland spindle tumor cells (arrows) admixed with inflammatory cells in a myxoid background.
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FIG5
Necrosis was present, and mitosis was minimal at around 2 per 10 high-power fields (Figures 4-6).
Hematoxylin and eosin stain of the uterine inflammatory myofibroblastic tumor (IMT). 40x magnification demonstrating plasma cells (arrows) and mitosis (arrowhead).
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FIG6
Necrosis was present, and mitosis was minimal at around 2 per 10 high-power fields (Figures 4-6).
Vascular invasion of the inflammatory myofibroblastic tumor (IMT) is well-demonstrated in hematoxylin and eosin stain.
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FIG7
Additionally, extensive vascular invasion was revealed by CD31 and CD34 immunohistochemical stains (Figures 7, 8).
CD34 stain highlighting the vascular invasion.
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FIG8
Additionally, extensive vascular invasion was revealed by CD31 and CD34 immunohistochemical stains (Figures 7, 8).
Immunohistochemical stain. The tumor cells are positive for anaplastic lymphoma kinase (ALK).
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FIG9
The tumor cells showed granular cytoplasmic positivity to anaplastic lymphoma kinase (ALK) and focal positivity to desmin and smooth muscle actin, whereas they were negative for caldesmon, estrogen receptor, P16, CD10, and cyclin D1 (Figures 9-11).
Immunohistochemical stain. The tumor cells are focally positive for desmin.
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FIG10
The tumor cells showed granular cytoplasmic positivity to anaplastic lymphoma kinase (ALK) and focal positivity to desmin and smooth muscle actin, whereas they were negative for caldesmon, estrogen receptor, P16, CD10, and cyclin D1 (Figures 9-11).
Immunohistochemical stain. Estrogen receptor (ER) is negative in the tumor cells.
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FIG11
The tumor cells showed granular cytoplasmic positivity to anaplastic lymphoma kinase (ALK) and focal positivity to desmin and smooth muscle actin, whereas they were negative for caldesmon, estrogen receptor, P16, CD10, and cyclin D1 (Figures 9-11).
Hematoxylin and eosin stain of the subserosal leiomyoma with hyalinization (asterisks) and calcification (arrows).
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FIG12
The subserosal masses showed classic leiomyomata with hyalinization and dystrophic calcification (Figure 12).