A 48-year-old woman has a rapidly enlarging uterine mass. Histology shows a spindle cell tumor with coagulative tumor cell necrosis, marked cytologic atypia, and 15 mitoses per 10 HPF. Which is the correct diagnosis?
- A Cellular leiomyoma
- B Leiomyosarcoma ✓
- C Endometrial stromal sarcoma
- D Intravenous leiomyomatosis
Correct answer: B. Leiomyosarcoma
Explanation
The Bell criteria for leiomyosarcoma require at least two of: coagulative tumor cell necrosis, marked cytologic atypia, and >=10 mitoses/10 HPF. This case has all three features. Cellular leiomyoma lacks necrosis and significant atypia. Endometrial stromal sarcoma has uniform cells resembling endometrial stroma with spiral arteriole-like vessels and typically <5 mitoses/10 HPF.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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