난소성삭종양을 닮은 자궁종양 1예

초록

Case History: A 65-year-old woman presented with vaginal bleeding for a week. She had no history for hormonal replacement therapy since menopausal 10 years ago. Abdominal sonographs disclosed a well circumscribed intramural mass suggestive of leiomyoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Miscroscopic Findings: The tumor was composed of solid and trabecular sheets or cords of medium sized, epithelial-like cells with granulose cell-like appearance intervened by fibrous stroma. Individual tumor cells had rounded to slightly elongated vesicular nuclei with frequent small nucleoli. Their cytoplasm varied from scanty to moderate and eosinophilic to abundant to foamy with clear vacuolation. Nuclear groove or feature of Call-Exner body was not present. Mitotic figures were identified up to 3/10HFP, but significant cytologic atypia and tumor cell necrosis was not identified. The mass as a whole was well delineated from the surrounding myometrium with a relatively well-circumscribed periphery. However, portions of the tumor periphery showed irregular extension to the myometrium, where the tumor cells formed sex cord-like arrangement. Definite feature of venous or lymphatic invasion were not appreciated. The lesion had no connection to the overlying inactive endometrium. Reticulin stain showed nests of tumor cells or occasional single tumor cells surrounded by reticulin fiber. On immunohistochemistry, the tumor cells were strong positive for pancytokeratin, desmin and vimentin. They were weak positive for myoglobulin and weak and focal for CD99. They were negative for smooth muscle actin, CD10, EMA, S-100 protein and HMB45. Labeling index of Ki-67 was less than 1%.