FIGURES AND TABLES

FIGURE 1.

This uterine mesenchymal tumor is primarily composed of spindled cells, suggesting a smooth muscle tumor. However, the delicate capillaries, the scant cytoplasm, and the absence of thick-walled vessels favor endometrial stromal differentiation. We consider such tumors to demonstrate ambiguous differentiation and suggest management as for a stromal tumor.

FIGURE 2.

Uterine smooth muscle tumor with marked atypia based on the degree of nuclear pleomorphism detected at 60 to 150 magnification.

FIGURE 3.

Uterine smooth muscle tumor with moderate atypia. The scattered pleomorphic nuclei can be seen even at this low magnification.

FIGURE 4.

Coagulative tumor cell necrosis in leiomyosarcoma. Note the abrupt change from viable tumor on the right to necrotic tumor on the left. The hyperchromatic necrotic tumor cell nuclei on the left are characteristic of those in tumor cell necrosis.

FIGURE 5.

Hyaline necrosis in a leiomyoma. Unlike coagulative tumor cell necrosis, there is an eosinophilic band of hyaline between the viable cells at the lower left and the necrotic cells on the right.

FIGURE 6.

Atypical leiomyoma. Although pleomorphism is marked, there is no necrosis. Definite mitotic figures are not found, although there is difficulty in distinguishing mitotic figures from degenerating nuclei.

FIGURE 7.

Epithelioid smooth muscle tumor. The constituent cells are round with abundant cytoplasm.

FIGURE 8.

A and B, low- and high-power views of the cells that compose endometrial stromal sarcoma. Note the resemblance to proliferative phase endometrial stroma. The arching thin-walled capillaries are characteristic of a stromal neoplasm.

FIGURE 9.

Low-grade endometrial stromal sarcoma with glands. The glands are small and are not surrounded by a cuff of hypercellular stroma as would be expected in adenosarcoma.

FIGURE 10.

Adenosarcoma in which the glands are dilated and surrounded by a cuff of stomal cells.

FIGURE 11.

A and B, the characteristic features of atypical polypoid adenomyoma—atypical complex glandular hyperplasia, a smooth muscle stroma, and morules—can be seen in these two photomicrographs.

TABLE 1 - Criteria for Mitotic Figures.

TABLE 2 - Classification of Uterine Smooth Muscle Tumors with Standard Differentiation^a .

TABLE 3 - Diagnostic Strategy for Evaluation of Uterine Smooth Muscle Tumors with Standard Differentiation.