Definition/General
Clinical Features
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Gross Description
Microscopic Description
Immunohistochemistry
Molecular/Genetic
Differential Diagnosis
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Patient Information
Name: [Patient Name]\nAge: [X] years\nMRN: [Medical Record Number]\nDate of Procedure: [Date]
Clinical History
Clinical indication: [Rapidly enlarging uterine mass/Abnormal uterine bleeding/Pelvic pain/Weight loss]\nSymptoms: [Heavy menstrual bleeding/Pelvic pressure/Rapid uterine growth/Constitutional symptoms]\nImaging: [Ultrasound/CT/MRI findings]\nPreoperative suspicion: [Leiomyosarcoma/Atypical leiomyoma/Other]\nProcedure: Total hysterectomy +/- staging procedures
Specimen Received
Specimen type: [Total hysterectomy/Radical hysterectomy] +/- [bilateral salpingo-oophorectomy/pelvic lymph nodes]\nUterine weight: [X] grams (normal: 40-100g)\nTumor size: [X] cm in greatest dimension\nFixative: 10% neutral buffered formalin
Gross Examination
The uterus weighs [X] grams and measures [X] x [X] x [X] cm. A large, fleshy tumor measuring [X] cm occupies [specify location within uterus]. The tumor has [ill-defined/infiltrative] borders and shows [soft/firm] consistency. Cut surface reveals [tan-gray/yellow] tissue with areas of [necrosis/hemorrhage/cystic degeneration]. The tumor [extends to the serosal surface/is confined within the myometrium/invades the cervix]. The endometrium measures [X] mm in thickness. [Lymph nodes/adnexa] are [involved/uninvolved/not submitted]. Representative sections submitted: [X] sections of tumor, [X] sections of normal myometrium, [X] sections of endometrium.
Microscopic Examination
Sections show a malignant smooth muscle tumor composed of pleomorphic spindle cells arranged in [fascicular/storiform/sheet-like] patterns. The cells demonstrate significant nuclear atypia with enlarged, hyperchromatic nuclei, prominent nucleoli, and marked pleomorphism. Mitotic activity is high with [X] mitoses per 10 high power fields, including atypical mitotic figures. Tumor necrosis comprises approximately [X]% of the tumor area. [Lymphovascular invasion is present/absent]. The tumor shows [infiltrative growth/pushing borders] and [extends to the serosal surface/is confined to the myometrium]. [Normal smooth muscle differentiation is lost/partially retained].
Immunohistochemistry
Smooth Muscle Actin: [Positive/Focal positive/Negative]\nDesmin: [Positive/Focal positive/Negative]\nh-Caldesmon: [Positive/Negative]\np53: [Overexpressed/Wild-type pattern]\nKi-67 proliferation index: [X]% (high)\nEstrogen Receptor: [Positive/Negative]\nProgesterone Receptor: [Positive/Negative]\nCD117: [Negative] (excludes GIST)
Histological Grade (FNCLCC)
Differentiation: [1/2/3] points ([well/moderately/poorly] differentiated)\nMitotic count: [1/2/3] points ([<9/10-19/>20] mitoses per 10 HPF)\nNecrosis: [0/1/2] points ([absent/<50%/>50%])\nTotal score: [X]/8 points\nFNCLCC Grade: [I/II/III] ([Low/Intermediate/High] grade)
Staging Assessment
Tumor size: [X] cm\nMyometrial invasion: [<50%/>50%]\nCervical involvement: [Present/Absent]\nExtrauterine extension: [Present/Absent]\nLymphovascular invasion: [Present/Absent]\nLymph node status: [Positive/Negative/Not assessed]\nFIGO Stage: [IA/IB/II/III/IV] (pending clinical correlation)
Final Diagnosis
LEIOMYOSARCOMA OF UTERUS\n\nHistological type: [Conventional/Epithelioid/Myxoid] leiomyosarcoma\nFNCLCC Grade: [I/II/III] ([Low/Intermediate/High] grade)\nSize: [X] cm\nFIGO Stage: [IA/IB/II/III/IV]\nMitotic count: [X] per 10 HPF\nNecrosis: [X]%\nLymphovascular invasion: [Present/Absent]\nMargins: [Negative/Positive]
Comments and Prognosis
• Leiomyosarcoma is a rare, aggressive malignant smooth muscle tumor.\n• Overall 5-year survival: 40-60%, strongly dependent on stage and grade.\n• High risk of local recurrence and distant metastasis (lungs most common).\n• Complete surgical resection is the primary treatment.\n• Consider adjuvant chemotherapy (doxorubicin-based regimens).\n• Multidisciplinary tumor board discussion recommended.\n• Regular imaging surveillance for recurrence/metastasis indicated.\n• Prognosis depends on stage, grade, age, and completeness of resection.
Reported By
Dr. [Pathologist Name], MD\nConsultant Pathologist\nDate: [Report Date]\n\nReviewed by: Dr. [Senior Pathologist], MD (if applicable)