| Background and Objective:Atypical leiomyoma(ALM) has long been regarded as a variant of uterine leiomyoma(ULM) and progress benignly, with characers such as low morbidity rate or good prognosis. However, there has been many articles arguing that ALM may act in aggressive behaviors and cause disease-specific deaths. Whereas, methods diagnosing ALMs are confined to pathological diagnosis. In the year of 2011,Makinen N et al. discovered that MED12 exon 2 mutations are characteristic markers of ULM. A literature published in 2014 found that ALM and LMS share many molecular alterations, but not with ULM. Moreover, after analyzing 5 ALM cases diagnosed between the year of 1976-1999, Robert L. Giuntoli II proposed that ALM could transform malignantly. Basing on the analyses above,we question the theory that ALM is a variant of leiomyoma.Methods:In this study, we totally located 31 cases of ALM and 50 cases of ULM, all reconfirmed the diagnoses based on the World Health Organization and Stanford criteria. We summarized clinical information of the patients and then conducted follow-ups.We also checked HE and P16/P53 immunohistochemical expression rate of all the specimen.Results:The difference of age,symptom,operation selection,diameter of the mass and recurrence probability is not significant between two groups.However, cytologic atypia,nuclear aypia or mitoses can be seen in ALM rather than ULM. Furthermore, the immunohistochemical expression rate of P16 and P53 is significantly higher in ALM.Conclusion:ALM is similar to ULM in its clinical behaviors, like high cure rate and low recurrence rate. It’s pathology features are diffuse, focal or multi-focal moderate to severe cytologic atypia,<5 mitoses/10HPF), density of nuclear atypia is intermediate-high and no coagulative tumor necrosis. The immunohistochemical expression rate of P53 and P16 of ALM is much higher than that of ALM, leading us to investigate whether ALM is really a subtype of ULM. |
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