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* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * CALIFORNIA TUMOR TISSUE REGISTRY

LOS ANGELES COUNTY - UNIVERSITY OF SOUTHERN CALIFORNIA MEDICAL CENTER

PROTOCOL

For

MONTHLY STUDY SLIDES

JUNE 1977

UTERINE SMOOTH MUSCLE TUMORS

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CORTRIBUTOR: David Y. Porter, M.D. JUNE 1977 - CASE NO. 1 Mountain View, California

ACCESSION NO. 19536

TISSUE FROM: Uterus

CLINICAL ABST~~CT:

This 53 year old, Gravida II, Para II, Caucasian female complained of painful vaginal bleeding of one month's duration. Previous preg­nancies were uneventful.

Laboratory data: Hemoglobin was 7.0 gm.% with hematocrit of 24%.

SURGERY: (November 18, 1971)

A total hysterectomy with bilateral salpingo-oophorectomy were performed .

GROSS PATHOLOGY:

The specL~en consisted of a 247 gram asymmetric uterus, which was distorted by multiple subserosa! and intramural leiomyomata. A ped­unculated subserosal 7 em. diameter mass on the l eft posterolateral wall had a soft, somewhat gelatinous, semicystic central area and sur­rounding soft pale tan par enchyma. The other nodules w~re firm , white, and well delineated. Two endometrial 0.4 em. diameter polyps were present in the fundus.

FOLLOW-UP:

Postoperative course was uneventful and she was discharged after 7 days. As of May 26~ 1977 , the patient was asymptomatic.

CONTRIBUTOR: R. Riechmann, M.D. JUNE 1977 - CASE NO. 2 Van Nuys, California

ACCESSION NO. 21128

TISSUE FROM: Uterus

CLINICAL ABSTRACT:

This 46 year old female had noticed lower abdominal enlargement over an 11 month period. Her physician felt it to be uterine in origin.

SURGERY:

A hysterectomy and bilateral salpingo-oophorectomy were performed.

GROSS PATHOLOGY:

The specimen consisted of a 1600 gram uterus which contained a 13 em. diameter soft fleshy tumor with focal hemorrhage.

FOLLOW-UP:

Chest radiograph at the time of surgery revealed mass lesions.

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CONTRIBUTOR: Lina Yu, M.D. JUNE 1977 - CASE NO. 3 Westminster, California

ACCESSION NO. 21896

TISSUE FROM: Uterus

CLINICAL ABSTRACT:

This 31 year old Caucasian female was admitted in labor. However, delivery of the baby was prevented due to obstruction by a large cervical tumor. Antenatal examination several months before had re­vealed a small tumor which had apparently grown rapidly in size.

SURGERY:

A eaesarean section was performed, but due to excessive bleeding the uterus was removed along with the child .

GROSS PATHOLOGY:

The uterus was markedly enlarged, measured 18 x 8 x 4 em., and weighed 1800 grams. The surface was markedly distorted by the presence of a large nodule, measuring 13 em. in diameter, composed of tan, slightly bulging, edematous, fleshy tissue. There was no hemorrhage or necrosis. The cervical canal was compressed, distorted, and slit­like.

FOLLOW-UP:

As of February 1977, there was no evidence of recurrence.

CONTRIBUTOR: Shirley E. A. Howard, M.D. JUNE 1977 - CASE NO . 4 Hanford, California

ACCESSION NO. 19363

TISSUE FROM: Cervix

CLINICAL ABSTRACT:

This 37 year old female had a history of pelvic pain diagnosed as endometriosis and a hysterectomy was planned. For the three months prior to this she r eceived Ovral sufficient to suppress menses. This was discontinued over the last month during which she had two episodes of bleeding.

SURGERY:

A hysterectomy was performed.

GROSS PATHOLOGY:

The specimen consisted of a· uterus (with cervix) which weighed 160 grams and measured 10 x 6 x 4 em. The endometrium, myometrium were unremarkable, but the cervix was enlarged, edematous, and asym­metrical, measuring 5 em. in diameter. The right side at 7 o'clock was a projecting, firm, tan nodule 1.8 em. in diameter. Sectioning showed several bulging, grey-tan nodules subjacent, measuring 1 to 2 em. in diameter. They were well circumscribed and homogeneous, mucinous, yellow-grey on section.

FOLLOW-UP:

As of May 19, 1977 , the patient was alive and well without evi­dence of recurrence.

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CONTRIBUTOR: Paul Ortega, M.D. JUNE 1977 - CASE NO. 5 San Francisco, California

ACCESSION NO. 19825

TISSUE FROM: Uterus

CLINICAL ABSTRACT:

This 40 year old Chinese female complained of "abdominal enlargement" of 6 months' duration. There were no other symptoms,

On physical examination a large midline mass filled the pelvis and extended to the umbilicus.

Laboratory data: Chemistries were normal but hemoglobin was 7.2 gm.%.

SURGERY: (July 14, 1972)

A hysterectomy .and bilateral salpingo-oophorectomy were performed.

GROSS PATHOLOGY:

The uterus weighed 1430 grams. The fundus was distorted by a large encapsulated white whorled tumor with extensive mucoid alteration. Some bleeding was also noted.

FOLLOW-UP:

Not available.

CONTRIBUTOR: E. R. Jennings, M.D. JUNE 19.77 - CASE NO. 6 Long Beach, California

ACCESSION NO. 18965

TISSUE FROM: Uterus

CLINICAL ABSTRACT:

This 49 year old feinale noted a "lump" in her lower abdomen over a 2 month period. She had had a right radical mastectomy for carcinoma. two years previously.

Physical examination revealed a large uterus with "a mass on top", which was movable and thought to be a fibroid.

SURGERY: (November 19 , 1970)

An exploratory laparotomy with hysterectomy and left salpingo­oophorectomy were per formed following a dilat ation and curettage. "Several fibroid nodules" were noted in the uterus at surgery.

GROSS PATHOLOGY:

The Uterus and cervix weighed 620 grams and measured 15 X 12 X 7 em. Scattered throughout the myometrium were various sized firm, bulging, whorled, grey-white nodules, the largest measuring 6.5 em. The cent ral ar ea of this largest was mushy, hemorrhagic brown tan.

FOLLOW-UP: (James W. Reynolds, M.D.)

Pos toperatively she did well , At leas t one lung lesion appeared on radiograph within a year, followed by an anterior chest wall nodule in 6 months . The pat ient expired on May 30, 1972, unf ortunately without benefit of an autopsy, with radiographic evidence of lumbar spine involvement.

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CONTRIBUTOR: Kenneth Frankel, M.D. JUNE 1977 - CASE NO. 7 Covina, California

ACCESSION NO. 22263

TISSUE FROM: Uterus

CLINICAL ABSTRACT:

This 42 year old female presented clinically with an acute abdomen.

SURGERY: {February 15, 1977)

The patient was taken to the operating room and an exploratory laparotory was perform~d. An infarcted and ruptured uterine leiomyoma was found. A hysterectomy was performed.

GROSS PATHOLOGY:

The uterus weighed 295 grams and measured 12.5 x 11 .5 x 8.5 em. There were multiple subserosa! 0.3 to 2.5 em. and intramural 0.3 to 3.5 em., well delineated whorled nodules. The largest of these had an area of central softening. Submitted as a separate specimen was an 256 gram, 13.5 x 10.5 x 7.5 em., piece of soft tissue of stated leio­myomatous origin. Sectioning demostrated a 6.5 em. eccentric area of pale red softening and gross hemorrhage. The overlying surface was dark black. Surrourtding this area of softening were broad interlacing pale white to light yellow bands.

FOLLOW-UP:

As of May 24 , 1977, the patient was alive and well.

CONTRIBUTOR: J. N. Carberry, M.D. JUNE 1977 - CASE NO. 8 Lynwood, California

ACCESSION NO. 13211

TISSUE FROM: Uterus

CLINICAL ABSTRACT:

This 46 year old Caucasian female was admitted for work-up of a pelvic mass. She had had a subtotal hysterectomy for a "uter ine malignancy", 17 years previously.

Radiographs: IVP was negative, but a barium enema showed extrinsic masses. Chest radiograph showed a solitary mediastinal mass.

SURGERY : (July 29, 1963)

Exploratory laparotomy disclosed a tumor extending from the pelvis, involving the bowel, mesentery and other sites . The ovaries were uninvolved, a lthough there were considerable adhesions. At no point did it invade the bowel. The cervical stump was completely peritonized and was separate from t he tumor ~ Nearly complete excision was performed.

GROSS PATHOLOGY:

The specimen consisted of pieces of an irregularly lobulated mass, measuring up to 15 em. in diameter. They were rubbery soft and sectioning revealed glary, pale, yellow-grey, hemorrhagic, mottled tissue. The largest piece was also cystic. Projecting from the surface were multiple elevated bleb-like blisters up to 1.5 em. in diameter. Other areas were either golden yellow or dull yellow-grey, glary, and dif f usely hemorrhagic.

FOLLOW-UP:

Subsequently a chest radiograph showed a mass and on August 7, 1963, a left upper lobectomy and pleural biopsy were performed. The former contained tumor. As of the summer of 1974, the patient was healthy, feeling very well, and had had no further problems.

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CONTRIBUTOR: Sylvan Cohen~ M.D. JUNE 1977 - CASE NO. 9 Panorama City, California

ACCESSION NO. 20427

TISSUE FROM: Uterus

CLINICAL ABSTRACT:

This 43 year old? Gravida III~ Para II~ female presented with slow increase in the size of her uterus with associated pelvic pressure. She had known fibroids many years with recent increase in menstrual flow.

On phys ical examination the uterus was irregular, mobile, and enlarged about 14 weeks in size. No adnexal masses were palpable.

SURGERY: (July 12, 1973)

A t o t al abdominal hysterectomy and bilateral salpingo-oophorectomy were perf ormed.

GROSS PATHOLOGY:

The specimen consisted of a 10 x 10 x 9 em. uterus with accompanying cervix. The serosal surface was extensively distorted by multiple protruding myomas up to 5 em. in diameter.

FOLLOW-UP:

Postoperative course was uneventful and she was placed on Premarin.

CONTRIBUTOR: H. A. Fanselau, M.D. JUNE 1977 - CASE NO. 10 Glendale, California

ACCESSION NO. 19260

TISSUE FROM: Uterus

CLINICAL ABSTRACT:

This 42 year old, Gravida II, Para II, Caucasian female was admitted for removal of uterine fibroids, although there were no symptoms other than pressure in her pelvis.

Pelvic examination showed an enlarged uterus, four times normal size, with multiple fibroids.

SURGERY: (July 5, 1970)

A hysterectomy and bilateral salpingo-oophorectomy were performed.

GROSS PATHOLOGY:

The uterus measured 12.5 x ·7 x 5 em. and contained a 3 em. round calcified mass in the fundus. There were a few other rounded lumps distorting the uterine contour, especially in the right parametrial area. The endometrium measured 0.5 em. i n thickness and the myometrium 2.7 em. There were elongated, rounded, cylindrical worm-like projections in the vascular spaces. These worm-like growths could be dislodged, pulled out, and easily removed, leaving empty spaces. They were white, solid, and had an elastic consistency. These were present in the myo­metrium, right parametrium, and in the ligament between the right ovary and tube.

FOLLOW-UP:

Not available.

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CONTRIBUTOR: Thomas E. Wynn, M.D . JUNE 1977 - CASE NO . 11 San Francisco, California

ACCESSION NO. 17613

TISSUE FROM: Uterus

CLINICAL ABSTRACT:

This 27 year old Caucasian female complained of excessive menstrual flow of 2 years' duration. Over the 6 months prior to admission 2 units of blood were administered because of her anemia. A dilatation and curettage showed secretory changes and she was placed on Oracon, with minimal decrease in flow. When progesterone was unsuccessful a surgical approach was decided upon.

Laboratory data: Hemoglobin was 9.6 gm.% .

SURGERY: (July 31, 1968)

A hysterectomy was performed.

GROSS PATHOLOGY:

The uterus with attached cervix weighed 135 grams and measured 9 x 7 x 5 em. Upon opening the uterine cavity a rubbery tumor covered by endometrium was found bulging into the cavity. It was sharply circumscribed and measured 2.5 em. in diameter. It had a white appearance with focal hemorrhage.

FOLLOW-UP:

Not available.

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CONTRIBUTOR: Marvin I. Retsky, M.D. JUNE 1977 - CASE NO. 12 Van Nuys , California

ACCESSION NO. 22349

TISSUE FROM: Uterus

CLINICAL ABSTRACT:

TI1is 31. year old, Gravida IV, Para IV, Caucasian female presented with a history of menorrhagia of several months' duration and underwent a diagnostic dilatation and curettage. This showed mildly atypical proliferative hyperplasia and accompanying atypical spindle cells in a myxomatous stroma.

SURGERY: (May 5, 1977)

A total abdominal hysterectomy was performed.

GROSS PATHOLOGY:

The uterus was symmetrical 'and weighed 90 grams. It was unremarkable except for a 3.3 x 2.5 em. bulging, apparently circumscribed, pink-tan, slightly translucent submucosal nodule.

STUDY GROUP CASES

For

JUNE 1977

CASE NO. 1 - ACC. NO. 1~536

LOS ANGELES: Angiomyolipoma - 9

SAN FRANCISCO: Leiomyoma with myxoid degeneration - 13

CENTRAL VALLEY: Lipomatous leiomyoma - 7; leiomyoma angiomatosum - 1

OAKLAND: Leiomyoma wi.th :fatty degeneration - 11

INLAND (SAN BERNARDINO) : Mixed lipoma - 10

SACRAMENTO: Benign leiomyoma with degenerative changes - 9

RENO: Leiomyoma with edema and lymphangiectasis - 6

OHIO: Leiomyoma - 3

LONG BEACH: Leiomyolipoma with mucinous degeneration - 10

REFERENCE:

Jacobs, D., Cohen, H., and Johnson, J.: Lipoleiomyomas of the Uterus. ~ 44:45-51, 1965.

These uncommon lesions variously called :fibromyolipomas, myolipomas, lipofibromas, lipomyomas, · and hamartomas occured in the cervix, but most :frequently the corpus uteri, and were usually intramural. In 91% of the patients, age was greater than 40 years. Uterine fatty tumors were almost uniformly benign, although malignant tumors with fatty tissue had been described.

FILE DIAGNOSIS:

Lipoleiomyoma, uterus 1820-8860

CASE NO. 2 - ACC. NO. 21128

LOS ANG~: Leiomyosarcoma - 10

SAN FRANCISCO: Leiomyo~arcoma - 13

CENTRAL VALLEY: Leiomyosarcoma - 8

OAKLAND: Leiomyosarcoma - 11

INLAND (SAN BERNARDINO) : Leiomyosarcoma - 10

SACRAMENTO : Leiomyosarcoma - 9

RENO: Leiomyosarcoma - 6

.Q!!!Q.: Leiomyosarcoma - 3

LONG BEACH: Leiomyosarcoma - 10

REFERENCE:

JUNE 1977

Christopherson, W., Williamson, E., and Gray, L.: Leiomyosarcoma of the Uterus. Cancer 29:1512-1517, 1972.

Eighty-one patients with smooth muscles tumors (32 leiomyosarcomas, 31 cellular myomas, 17 bizarre leiomyomas, and 1 intravascular leiomyoma) were followed for an average of 12 years. Five year survival rate was 20.7% in leiomyosarcomas, which were more common in blacks over whites and accurately separated from cellular leiomyomas by mitoses. No patient with fewer than 5 mitoses per 10 high-power field died of disease. No patient with bizarre leiomyoma died of disease. Follow-up averaged 11.2 years.

FILE DIAGNOSIS:

Leiomyosarcoma, uterus 1820-8893

CASE NO. 3 - ACC . NO. 21896 JUNE 1977

LOS ANGELES: Leiomyoma, unusual variant - 10

SAN FRANCISCO: Leiomyoma with hyalinization - 13

CENTRAL VALLEY: Leiomyoma - 8

OAKLAND : Leiomyoma, cellular and hyalinized - 16

INLAND (SAN BERNARDINO} : Degenerating leiomyoma - 5; plexiform leio­myoma - 4; rhabdomyosarcoma - 1

SACRAMENTO: Leiomyoma - 7; leiomyoblastoma - 1; stromal nodule - 2

~: Leiomyoma - 6

OHIO: Leiomyoma - 3

LONG BEACH: Leiomyoma with hyaline degeneration - 10

REFERENCE:

Kurman, R., and Norris, H. : Mesenchymal Tumors of the Uterus VI. Epithelioid Smooth Muscles Tumors Includi.ng Leiomyoblastoma and Clear Cell Leiomyoma. Cancer 37:1853-1865, 1976.

Twenty-six cases of atypical smooth muscles of the uterus, including leiomyoblastoma, epithelioid leiomyoma, clear cell leiomyoma, and plexiform tumorlet were reviewed. Mixtures of all of these patterns occurred with suf£icient frequency with transition to smooth muscle to indicate their being variants of a single entity. Features related to a favorable prognosis included the presence of clear cells, an expansile tumor margin, extensive hyalinization, and absence o£ extensive necrosis. Epithelioid leiomyoma was proposed £or tumors with less than 5 mitoses per 10 high-power field and epithelioid leiomyosarcoma for 5 or more.

FILE DIAGNOSIS:

Hyalinized leiomyoma, uterus 1820-8890

CASE NO. 4 - ACC. NO. 19363 JUNE 1977

LOS ANGELES: Lev grade leiomyosarcoma - 8; cervical tumor, NOS - 2

SAN FRANCISCO: Epithelioid leiomyosarcoma - 7; leiomyoblastoma - 4; small cell sarcoma. - 1; malignant sarcoma - 1

CENTRAL VALLEY: Histiocytic lymphoma - 4; stromal myosis - 2; leiomyosarcoma - 2

OAKLAND: Leiomyosarcoma - 16

INLAND (SAN BERNARDINO) : Leiomyosarcoma - 4; cellular leiomyoma - 3; chronic inflammation (.pseudolymphomal - 2; stromal nodule - 1

SACRAMENTO: Cellular leiomyoma with atypia - 5; leiomyosarcoma, low grade - 2; stromal nodule - 3

~: Leiomyoblastoma - 5; leiomyosarcoma - 1

OHIO: Leiomyoma - 3

LONG BEACH: Endometrial stromal tumor - 6; histiocytic lymphoma - 1; endolymphatic stromal myosis - 1; leiomyosarcoma - 1; stromal sarcoma - 1

FILE DIAGNOSIS:

Small cell leiomyosarcoma, cervix 1809-8893

CASE NO. 5 - ACC. NO. 19825 JUNE 1977

LOS ANGELES :

SAN FRANCISCO:

Cellular leiomyoma - 3; leiomyoma - 4

Cellular leiomyoma - 13

CENTRAL VALLEY: Leiomyoma with degenerative changes - 8

OAKLAND: Leiomyoma with degenerative changes - 17

INLAND (SAN BERNARDINO) : Degenerating leiomyoma - 10

SACRAMENTO : Leiomyoma with mucinous degeneration - 11

RENO: Degenerated lei~myoma - 6

OHIO: Leiomyoma - 3

LONG BEACH: Leiomyoma - 10

FILE DIAGNOSIS :

Degenerating leiomyoma, uterus 1820-8890

CASE NO. 6 - ACC. NO. 18965

LOS ANGELES: Leiomyosarcoma - 10

SAN FRANCISCO: Leiomyosarcoma - 13

JUNE 1977

CENTRAL VALLEY: Leiomyosarcoma arising in a leiomyoma - 8

OAKLAND: Leiomyosarcoma - 17

INLAND (SAN BERNARDINO) : Leiomyosarcoma - 10

SACRAMENTO: Leiomyosarcoma - 11

RENO: Leiomyosarcoma ~ 6

.Q!!IQ_: Leiomyosarcoma - 3

LONG BEACH: Leiomyosarcoma - 10

FILE DIAGNOSIS:

Leiomyosarcoma, uterus 1820-8893

CASE NO. 7 - ACC. NO. 22263 . JUNE 1977

LOS ANGELES: Atypical leiomyoma - 10

SAN FRANCISCO: Atypical. leiomyoma - 13

CENTRAL VALLEY: Cellular leiomyoma with atypia and degenerative changes - 6; leiomyosarcoma - 2

OAKLAND: Atypical leiomyoma - 17

INLAND (SAN BERNARDINO}: Leiomyosarcoma - 4; cellular leiomyoma - 4; infiltrating stromal nodule - 1

SACRAMENTO: Cellular leiomyoma with atypia - 11

RENO: Cellular leiomyoma - 6

.Q!!!Q: Leiomyoma, cellular - 2; leiomyosarcoma - 1

LONG BEACH: Cellular leiomyoma· - 10

FILE DIAGNOSIS:

Atypical leiomyoma, uterus 1820-8890

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CASE NO. 8 - ACC. NO. 13211 JUNE 1977

LOS ANGELES: Stromal sarcoma - 2; sarcoma, NOS - 5; leiomyosarcoma - 1 hemangiopericytoma - 1

SAN FRANCISCO: Benign metastasizing leiomyoma - 4; leiomyoblastoma, low-grade malignancy - 2; hemangiopericytoma - 3; leiomyosarcoma - 2

CENTRAL VALLEY: Leiomyosarcoma - 4; hemangiopericytoma - 2; leiomyomatosis peritonealis disseminata - 1; endometrial stromal sarcoma - 1

OAKLAND: Low grade leiomyosarcoma - 11; hemangiopericytoma - 5; leio­myoma - 1

INLAND (SAN BERNARDINO): Endolymphatic stromal myosis - 5; hemangio­pericytoma - 4; leiomyoblastoma - 1

SACRAMENTO: Hemangiopericytoma, malignant - 10; vascular leiomyoma - 1

RENO: Metastasizing leiomyoma - 3; leiomyoblastoma - 3

OHIO: Leiomyosarcoma - 1; leiomyoma, cellular - 2

LONG BEACH: Endolymphatic stromal myosis - 8; leiomyoma - 1; endo­metrial stromal sarcoma - 1

FILE DIAGNOSIS:

Low grade leiomyosarcoma, uterus

X-File: Endolymphatic stromal myosis, uterus Hemangiopericytoma, uterus

8893~1820

8931-1820 9151-1820

R.eticulum stain when compared with a stromal nodule was more com­patible with muscle than with stroma.

CASE NO. 9 - ACC. NO. 20427 JUNE 1977

LOS ANGELES: Atypical ·leiomyoma - 10. X-File sex cord tumor

SAN FRANCISCO: Epithelioid leiomyoma - 7; leiomyoblastoma - 4; cellular leiomyoma - 3

CENTRAL VALLEY: Atypical cellular leiomyoma - 4; plexiform tumor let - 3; low grade leiomyosarcoma - 1

OAKLAND: Cellular leiomyoma - 16

INLAND (SAN BERNARDINO) : Plexiform leiomyoma - 7; leiomyoblastoma. - 2; hema.ngiopericytoma. - 1

SACRAMENTO: Leiomyoma ·- 1; epithelioid leiomyoma - 8; angioleiomyoma - 2

RENO: Cellular leiomyoma - 3; leiomyoblastoma - 3

OHIO: Leiomyoma (carcinoid pattern} - 3

LONG BEACH: Epithelioid leiomyoma ($ynonymous leiomyoblastoma) - 8; carcinoid tumor - 1; benign smooth muscle tumor - 1

REFERENCE:

Clement~ P. , and Scully, R. : Uterine Tumors Resembling Ovarian Sex-Cord Tumors. AJCP 66:512-525, 1976.

Such tumors were encountered in 14 women (30-60 years old) seen for vaginal bleeding and uterine enlargement. They were divided into 2 groups, based on predominance of stromal (.Group 1) or epithelial-like component (Group 2). Group 1 behaved as aggressively as endometrial stromal sarcoma {.2-15 years) • Group 2 remained confined to the uterus with benign postoperative course (4-7 years).

FILE DIAGNOSIS:

Atypical cellular epithelioid leiomyoma, uterus 1820-8890

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CASE NO. 10 - ACC. NO. 19260 JUNE 1977

LOS ANGELES: Intravenous leiomyomatosis - 10

SAN FRANCISCO: Intraveno~s leiomyomatosis - 13

CENTRAL VALLEY: Intravascular leiomyomatosis - 4; endolymphatic stromal myosis - 3; cellular leiomyoma - 1

OAKLAND: Intravascular leiomyomatosis - 16

INLAND (SAN BERNARDINO): Intravenous leiomyomatosis- 10

SACRAMENTO: Endolymphatic stromal myosis - 1; intravenous leiomyo­matosis - 10

RENO: Intravenous leiomyoma - 3

OHIO: Intravenous leiomyomatosis - 3

LONG BEACH: Intravenous leiomyomatosis - 10

FILE DIAGNOSIS:

Intravascular leiomyomatosis~ uterus 1820-8891

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CASE NO. 11 - ACC. NO. 17613 JUNE 1977

LOS ANGELES: Atypical leiomyoma - 10

SAN FRANCISCO: Atypical leiomyoma, borderline malignancy - 12; leiomyoma - 1

CENTRAL VALLEY: Cellular leiomyoma with progesterone effect and de­generative change - 4; low grade leiomyosarcoma - 4

OAKLAND: Atypical leiomyoma - 16

INLAND (SAN BERNARDINO}: Degenerating leiomyoma with atypia - 10

SACRAMENTO: Atypical leiomyoma - 11

~: Cellular leiomyoma - 5; leiomyosarcoma - 1

OHIO: Leiomyoma - 2; leiomyosarcoma - 1

LONG BEACH: Leiomyoma with atypia (? possible exogenous hormone effect) - 10

REFERENCE:

Fechner, R. : Atypical Leiomyomas and Synthetic Progestin Therapy. AJCP 49:697-703, 1968 •

First-such tumors with bizarre nuclear changes which might .have been considered leiomyosarcoma by those who disregarded mitoses (en­larged hyperchromatic nuclei and occassional multinucleated giant cells). Even if only focal, such atypia should not be considered as malignant change. Whether these changes were related to the progesten or coin­cidental was not clear .

FILE DIAGNOSIS:

Cellular leiomyoma with progesterone effect, uterus 1820-8890

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CASE NO. 12 - ACC. NO. 22349 JUNE 1977

LOS ANGELES: Leiomyoma with myxoid degeneration - 10

SAN FRANCISCO: Atypical leiomyoma - 13

CENTRAL VALLEY: Leiomyoma with myxoid changes - 8

OAKLAND: Leiomyoma with degenerative changes - 13; endolymphatic stromal myosis - 3

INLAND (SAN BERNARDINO} : Myxomatous degenerating leiomyoma - 8; clear cell leiomyoma - l

SACRAMENTO: Leiomyoma with mucinous degeneration - 10; myxomatous leiomyoma - 1 ·

RENO: Degenerated leiomyoma - 6

OHIO: Leiomyoma - 3

LONG BEACH: Leiomyoma - 8; endolymphatic stromal myosis - 1; myxo­sarcoma - 1

FILE DIAGNOSIS:

Leiomyoma with myxoid degeneration, uterus 1820-8890