Case 328 -- Postmenopausal Bleeding

Contributed by Lei Chen, MD, PhD, Rovena L Kessinger, MD, Anisa I Kanbour, MD
Published on line in November 2002


This patient is a 57-year-old black female, para 2 0 0 2, who came in for postmenopausal bleeding. Pelvic ultrasound showed a significantly enlarged uterus, measuring over 19 cm in length, 9 cm in anteroposterior dimension and 14.3 cm in width. The uterus was diffusely inhomogeneous with multiple solid masses. The endometrial echo stripe thickness measured 6.6 mm. Endometrial curettage was performed to further characterize the lesion.


Grossly the specimen consisted of approximately 50cc of pink-tan tissue mixed with blood clot. Microscopically (Figs. 1, 2, 3, 4 and 5), the glandular component was composed of cells with large hyperchromatic nuclei. The stromal component was hypercellular with mostly spindle shaped cells. Occasional cells were round with abundant eosinophilic cytoplasm and a suggestion of cross-striations. CAM5.2 (Fig. 6) and EMA (Fig. 7) stained positive in glandular components, while desmin (Fig. 8) and myoglobin (Fig. 9) stained positive in stromal components. SMMHC (Fig. 10) was negative. The reticulin (Figs. 11 and 12) stain showed both epithelial and sarcomatous components.


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