Case 380 -- A Woman in her 60s with Hysterectomy

Contributed by Deepak Mohan, MD, Elise Hoff, MD, Mirka Jones, MD, David J Dabbs, MD
Published on line in March 2004


PATIENT HISTORY:

A woman in her 60s underwent a hysterectomy for high-grade cervical dysplasia and dysfunctional uterine bleeding.

INTRA OPERATIVE CONSULTATION:

Uterus, anterior cul-de-sac peritoneum, frozen section - 0.7 X 0.4 X 0.3 cm. Pink-yellow tissue:

  1. Deferred
  2. Atypical lesion, probably mesenchymal

GROSS DESCRIPTION:

Uterus with bilateral adnexa, 84 grams, 7.0 x 5.0 x 1.7 cm. The serosal surface is pink-tan and smooth with a mass located at the fundus measuring 3.5 x 3.0 x 2.0 cm. Sectioning reveals slightly yellowish-tan and hemorrhagic tissue. The endometrial cavity is approximately 4.0 x 2.0 cm. with a 0.1 cm. thick, tan-pink and focally hemorrhagic lining. The myometrium is 2.0 cm. in thickness with multiple firm pale nodules up to 1.5 cm. in greatest dimension. Sectioning reveals tan-whorled tissue pattern.

CYTOLOGY PELVIC WASH:

Small-round, spindle cells, with scant wispy cyanophilic cytoplasm "comet cells" as described by Kanbour et al, isolated or loose aggregates of cells with elongated or caudate shapes and cyanophilic cytoplasm Fig 1-8.

Figs. 1-8:   Pelvic Wash Positive for Malignant Cells

MICROSCOPIC DESCRIPTION:

Figs. 9-11:   1.5 cm whorled lesion

Figs. 12-23    Tan yellow areas with hemorrhage

Figs. 24 & 25:   Desmin positivity in the spindle cells

Figs. 26 & 27:   Smooth Muscle Actin Positivity in the spindle cells

FINAL DIAGNOSIS


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