PMC8302373_01
Gross examination showed an ill-defined submucosal fibroid mass excised from the uterus measuring 12 x 11 x 7 cm with few gray-pink in color polypoid masses measuring 2-3 cm that are soft to rubbery in consistency.
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The initial diagnosis was leiomyoma; hence, a myomectomy was performed (Figure 1).
(a) Histopathology showing nodular cellular proliferation of small- to medium-sized, ovoid or spindle cells, which form interlacing bundles, whorls, and broad bands, H&E x40. (b) Infiltration of the myometrium, H&E x100. (c) The tumor cells exhibit only mild nuclear atypia with few mitotic figures (2-3/10 HPF), H&E x200. (d) Higher magnification H&E x400.
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In addition, a diffuse invasion of the myometrium by the neoplastic cells was revealed (Figure 2).
Immunohistochemistry stains showing the endometrial stromal cells: (a) diffuse and strong positivity for CD10; (b) Desmin: negative; (c) ER: positive (total score + 4/8); (d) PR: positive (total score + 6/8); (e) SMA: negative (internal control); (f) ki67: low rate ~10%.
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IHC showed strong positivity for CD10, ER, and PR, whereas SMA and Desmin were negative (Figure 3).
Specimen of the uterus and both adnexa measuring 12 x 8 x 6 cm. The cut sections show infiltrating ill-defined multifocal tumor nodules, arising from the endometrium, measuring ~7 x 8 cm, gray-yellowish in color, soft fleshy in consistency. The myometrium is thickened ~3-4 cm, and the ovaries contain cystic follicles.
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Based on the results of CT scan, histopathologic studies, and the patient safety, the decision was made to perform a total abdominal hysterectomy with bilateral salpingo-oophorectomy (BSO), greater omentectomy, and appendectomy (Figure 4).