A 58-year-old woman undergoes hysterectomy for a rapidly enlarging uterine mass. Microscopy shows spindle cells with diffuse moderate to severe nuclear atypia, a mitotic count of 15 per 10 high-power fields, and areas of geographic coagulative tumor cell necrosis. What is the diagnosis?
- A Leiomyosarcoma ✓
- B Leiomyoma with bizarre nuclei
- C Endometrial stromal sarcoma
- D Cellular leiomyoma
Correct answer: A. Leiomyosarcoma
Explanation
Leiomyosarcoma is defined by the triad of diffuse moderate to severe cytologic atypia, elevated mitotic activity (classically 10 or more mitoses per 10 high-power fields) and coagulative tumor cell necrosis. Rapid growth in a postmenopausal woman supports malignancy. Cellular leiomyoma and leiomyoma with bizarre nuclei lack the full triad, particularly coagulative necrosis and high mitotic counts together.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.