Provided clinical history
45 year old woman, with intractable uterine bleeding unresponsive to hormone therapy. Mass lesion in the myometrium
Site
Uterus- myometrium
Primary image
Low magnification. H&E stain.
Differential diagnosis
Expand Differential diagnosis
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Smooth muscle tumor of undetermined malignant potential(STUMP), leiomyosarcoma
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Additional tests
More history
Expand More history
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Patient had received lysteda for control of bleeding
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Ask a colleague
Expand Ask a colleague
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COLLEAGUE'S ADVICE HERE
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Stains
ExpandAlcian blue/PAS to Bilirubin |
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Alcian blue/PAS | Expand Dr Torres would ask why! |
Alican blue pH 1.0 | Expand Dr Torres would ask why! |
Alcian blue pH 2.5 | Expand Dr Torres would ask why! |
Auramine | Expand Dr Torres would ask why! |
Bielchowsky | Expand Dr Torres would ask why! |
Bilirubin | Expand Dr Torres would ask why! |
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ExpandColloidal iron to Fontana-Masson |
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Colloidal iron | Expand Dr Torres would ask why! |
Congo red | Expand Dr Torres would ask why! |
Cresyl violet | Expand Dr Torres would ask why! |
Dieterle | Expand Dr Torres would ask why! |
Diff Quik | Expand Dr Torres would ask why! |
Fontana-Masson | Expand Dr Torres would ask why! |
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ExpandGallyas to Gremelius |
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Gallyas | Expand Dr Torres would ask why! |
Giemsa | Expand Dr Torres would ask why! |
GMS | Expand Dr Torres would ask why! |
Gomori's trichrome | Expand Dr Torres would ask why! |
Gram | Expand Dr Torres would ask why! |
Gremelius | Expand Dr Torres would ask why! |
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ExpandJMS to Mucicarmine |
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JMS | Expand Dr Torres would ask why! |
Jones | Expand Dr Torres would ask why! |
Kinyoun | Expand Dr Torres would ask why! |
Luxol fast blue | Expand Dr Torres would ask why! |
Masson trichrome | Expand Dr Torres would ask why! |
M-MAS | Expand Dr Torres would ask why! |
Movat | Expand Dr Torres would ask why! |
Mucicarmine | Expand Dr Torres would ask why! |
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ExpandOil red O to Prussian blue |
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Oil red O | Expand Dr Torres would ask why! |
Orecein | Expand Dr Torres would ask why! |
PAS | Expand Dr Torres would ask why! |
PASD | Expand Dr Torres would ask why! |
PASF | Expand Dr Torres would ask why! |
PTAH | Expand Dr Torres would ask why! |
Prussian blue | Expand Dr Torres would ask why! |
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ExpandReticulin to Ziehl-Neelsen |
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Reticulin | Expand Dr Torres would ask why! |
Sudan black B | Expand Dr Torres would ask why! |
Toluidine blue | Expand Dr Torres would ask why! |
Verhoeff | Expand Dr Torres would ask why! |
Von Kossa | Expand Dr Torres would ask why! |
Warthin-Starry | Expand Dr Torres would ask why! |
Ziehl-Neeslen | Expand Dr Torres would ask why! |
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IHC
ExpandAlpha-1 AT to Cathepsin K |
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alpha-1 AT | Expand Dr Torres would ask why! |
ACTH | Expand Dr Torres would ask why! |
AE1/AE1 | Expand Dr Torres would ask why! |
alpha-fetoprotein | Expand Dr Torres would ask why! |
Alk-I | Expand Dr Torres would ask why! |
AMACR | Expand Dr Torres would ask why! |
AR | Expand Dr Torres would ask why! |
ATRX | Expand Dr Torres would ask why! |
Beta2-microglobulin | Expand Dr Torres would ask why! |
B72.3 | Expand Dr Torres would ask why! |
Beta-catenin | Expand Dr Torres would ask why! |
BCL2 | Expand Dr Torres would ask why! |
BCL6 | Expand Dr Torres would ask why! |
BCLxL | Expand Dr Torres would ask why! |
C3 comp | Expand Dr Torres would ask why! |
CA9 | Expand Dr Torres would ask why! |
Calcitonin | Expand Dr Torres would ask why! |
Calponin | Expand Dr Torres would ask why! |
Calretinin | Expand Dr Torres would ask why! |
CAM5.2 | Expand Dr Torres would ask why! |
Cathepsin K | Expand Dr Torres would ask why! |
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ExpandCD10 to Chromogranin |
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CD10 | Expand Dr Torres would ask why! |
CD117 | Expand Dr Torres would ask why! |
CD138 | Expand Dr Torres would ask why! |
CD15 | Expand Dr Torres would ask why! |
CD1a | Expand Dr Torres would ask why! |
CD20 | Expand Dr Torres would ask why! |
CD21 | Expand Dr Torres would ask why! |
CD23 | Expand Dr Torres would ask why! |
CD3 | Expand Dr Torres would ask why! |
CD30 | Expand Dr Torres would ask why! |
CD31 | Expand Dr Torres would ask why! |
CD34 | Expand Dr Torres would ask why! |
CD35 | Expand Dr Torres would ask why! |
CD4 | Expand Dr Torres would ask why! |
CD43 | Expand Dr Torres would ask why! |
CD45 (LCA) | Expand Dr Torres would ask why! |
CD5 | Expand Dr Torres would ask why! |
CD56 | Expand Dr Torres would ask why! |
CD57 | Expand Dr Torres would ask why! |
CD68 | Expand Dr Torres would ask why! |
CD7 | Expand Dr Torres would ask why! |
CD79a | Expand Dr Torres would ask why! |
CD8 | Expand Dr Torres would ask why! |
CD99 | Expand Dr Torres would ask why! |
CDX2 | Expand Dr Torres would ask why! |
CEA-m | Expand Dr Torres would ask why! |
Chromogranin | Expand Dr Torres would ask why! |
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ExpandCK17 to Glypican 3 |
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CK17 | Expand Dr Torres would ask why! |
CK19 | Expand Dr Torres would ask why! |
CK20 | Expand Dr Torres would ask why! |
CK34betaE12 | Expand Dr Torres would ask why! |
CK5/6 | Expand Dr Torres would ask why! |
CK7 | Expand Dr Torres would ask why! |
CMV | Expand Dr Torres would ask why! |
c-MYC | Expand Dr Torres would ask why! |
Cyclin D1 | Expand Dr Torres would ask why! |
D2-40 | Expand Dr Torres would ask why! |
Desmin | Expand Dr Torres would ask why! |
DOG1 | Expand Dr Torres would ask why! |
EBV | Expand Dr Torres would ask why! |
EMA | Expand Dr Torres would ask why! |
ER and PR | Expand Dr Torres would ask why! |
Factor VIII | Expand Dr Torres would ask why! |
Factor XIIIa | Expand Dr Torres would ask why! |
Fascin | Expand Dr Torres would ask why! |
FH | Expand Dr Torres would ask why! |
FSH | Expand Dr Torres would ask why! |
Gastrin | Expand Dr Torres would ask why! |
GATA3 | Expand Dr Torres would ask why! |
GCDFP-15 (BRST2) | Expand Dr Torres would ask why! |
GFAP | Expand Dr Torres would ask why! |
GH | Expand Dr Torres would ask why! |
Glucagon | Expand Dr Torres would ask why! |
Glypican-3 | Expand Dr Torres would ask why! |
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ExpandHBME-1 to IgM |
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HBME-1 | Expand Dr Torres would ask why! |
HBV core | Expand Dr Torres would ask why! |
HBV surface | Expand Dr Torres would ask why! |
H-caldesmon | Expand Dr Torres would ask why! |
HCG | Expand Dr Torres would ask why! |
Helicobacter | Expand Dr Torres would ask why! |
Hepatocyte | Expand Dr Torres would ask why! |
HER2/neu | Expand Dr Torres would ask why! |
HHV-8 | Expand Dr Torres would ask why! |
HMB-45 | Expand Dr Torres would ask why! |
HNF1beta | Expand Dr Torres would ask why! |
HPV | Expand Dr Torres would ask why! |
HSV-I | Expand Dr Torres would ask why! |
HSV-II | Expand Dr Torres would ask why! |
IDH-1 | Expand Dr Torres would ask why! |
Inhibin | Expand Dr Torres would ask why! |
INI1 (BAF47) | Expand Dr Torres would ask why! |
Insulin | Expand Dr Torres would ask why! |
Kappa | Expand Dr Torres would ask why! |
Ki-67 | Expand Dr Torres would ask why! |
Lambda | Expand Dr Torres would ask why! |
Leu 7 | Expand Dr Torres would ask why! |
IgA | Expand Dr Torres would ask why! |
IgG | Expand Dr Torres would ask why! |
IgM | Expand Dr Torres would ask why! |
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ExpandLH to PDGFR |
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LH | Expand Dr Torres would ask why! |
LIN28 | Expand Dr Torres would ask why! |
Lysozyme | Expand Dr Torres would ask why! |
mammoglobin | Expand Dr Torres would ask why! |
MAP2 | Expand Dr Torres would ask why! |
MCV | Expand Dr Torres would ask why! |
Melanin A | Expand Dr Torres would ask why! |
MHC class I | Expand Dr Torres would ask why! |
MITF | Expand Dr Torres would ask why! |
MUM1 | Expand Dr Torres would ask why! |
Myeloperoxidase | Expand Dr Torres would ask why! |
MYO D1 | Expand Dr Torres would ask why! |
Myoglobin | Expand Dr Torres would ask why! |
Napsin | Expand Dr Torres would ask why! |
NF | Expand Dr Torres would ask why! |
NKX3.1 | Expand Dr Torres would ask why! |
NSE | Expand Dr Torres would ask why! |
OCT3/4 | Expand Dr Torres would ask why! |
p16 | Expand Dr Torres would ask why! |
P501S | Expand Dr Torres would ask why! |
p53 | Expand Dr Torres would ask why! |
p57 | Expand Dr Torres would ask why! |
p63 | Expand Dr Torres would ask why! |
Pankeratin | Expand Dr Torres would ask why! |
PAX2 | Expand Dr Torres would ask why! |
PAX5 | Expand Dr Torres would ask why! |
PAX8 | Expand Dr Torres would ask why! |
PCNA | Expand Dr Torres would ask why! |
PDGFR | Expand Dr Torres would ask why! |
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ExpandPLAP to WT1 |
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PLAP | Expand Dr Torres would ask why! |
PNL-2C | Expand Dr Torres would ask why! |
Prolactin | Expand Dr Torres would ask why! |
PSA | Expand Dr Torres would ask why! |
PSAP | Expand Dr Torres would ask why! |
RCC | Expand Dr Torres would ask why! |
S-100 | Expand Dr Torres would ask why! |
SALL4 | Expand Dr Torres would ask why! |
Smooth muscle actin | Expand Dr Torres would ask why! |
Somatostatin | Expand Dr Torres would ask why! |
STAT6 | Expand Dr Torres would ask why! |
Synaptophysin | Expand Dr Torres would ask why! |
TdT | Expand Dr Torres would ask why! |
TFE3 | Expand Dr Torres would ask why! |
TFEB | Expand Dr Torres would ask why! |
Thyroglobulin | Expand Dr Torres would ask why! |
Toxoplasma | Expand Dr Torres would ask why! |
TSH | Expand Dr Torres would ask why! |
TTF-1 | Expand Dr Torres would ask why! |
Ubiquitin | Expand Dr Torres would ask why! |
UCHL1 (PGP9.5) | Expand Dr Torres would ask why! |
Ulex Europaeus | Expand Dr Torres would ask why! |
Vimentin | Expand Dr Torres would ask why! |
VIP | Expand Dr Torres would ask why! |
VZV | Expand Dr Torres would ask why! |
WT-1 | Expand Dr Torres would ask why! |
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Molecular testing
Chromosomal translocations
ExpandTranslocations Chr 1-10 |
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t(1;13) PAX7-FKHR | Expand Dr Torres would ask why! |
t(2,13) PAX3-FKHR | Expand Dr Torres would ask why! |
t(8;14) MYC-IGH | Expand Dr Torres would ask why! |
t(9;22) BCR-ABL | Expand Dr Torres would ask why! |
t(9;22) CHN-EWS | Expand Dr Torres would ask why! |
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ExpandTranslocations Chr 11-13 |
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t(11;14) CCND1-IGH | Expand Dr Torres would ask why! |
t(11;22) EWS-WT1 | Expand Dr Torres would ask why! |
t(11;22) FLI1-EWS | Expand Dr Torres would ask why! |
t(12;15) ETV6-NTRK3 | Expand Dr Torres would ask why! |
t(12;16) FUS-ATF1 | Expand Dr Torres would ask why! |
t(12;16) CHOP-TLS | Expand Dr Torres would ask why! |
t(12;22) EWS-ATF1 | Expand Dr Torres would ask why! |
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ExpandTranslocations Chr 14-22 |
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t(14,18) IGH-BCL2 | Expand Dr Torres would ask why! |
t(15;17) PML-RARA | Expand Dr Torres would ask why! |
t(16;21) FUS-ERG | Expand Dr Torres would ask why! |
t(17;22) COLA1-PDGFB | Expand Dr Torres would ask why! |
t(21;22) EWS-ERG | Expand Dr Torres would ask why! |
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ExpandTranslocations Chr X & Y |
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t(X;1) PRCC-TFE3 | Expand Dr Torres would ask why! |
t(X;17) TFE3-ASPL | Expand Dr Torres would ask why! |
t(X;18) SYT-SSX | Expand Dr Torres would ask why! |
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Other molecular tests
ExpandMolecular tests (A-B) |
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ALK sequencing | Expand Dr Torres would ask why! |
B cell clonality Southern / PCR | Expand Dr Torres would ask why! |
BCL2 PCR | Expand Dr Torres would ask why! |
BRAF sequencing | Expand Dr Torres would ask why! |
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ExpandMolecular tests (C-H) |
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EBV PCR | Expand Dr Torres would ask why! |
EGRF sequencing | Expand Dr Torres would ask why! |
H3F3A sequencing | Expand Dr Torres would ask why! |
HHV-8 PCR | Expand Dr Torres would ask why! |
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ExpandMolecular tests (K-Z) |
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KIT sequencing | Expand Dr Torres would ask why! |
LOH 1p/19q PCR | Expand Dr Torres would ask why! |
T cell clonality Southern / PCR | Expand Dr Torres would ask why! |
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Diagnosis
Expand Diagnosis
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LEIOMYOMA WITH TRANEXAMIC ACID ASSOCIATED MICROINFARCTION
This smooth muscle tumor depicts no atypia. When in this situation it is prudent to request detailed clinical history. Clinicians often do not inform of all agents given to patients to control uterine bleeding. [1]
References
- ↑ Ip, PP.; Lam, KW.; Cheung, CL.; Yeung, MC.; Pun, TC.; Chan, QK.; Cheung, AN. (Aug 2007). "Tranexamic acid-associated necrosis and intralesional thrombosis of uterine leiomyomas: a clinicopathologic study of 147 cases emphasizing the importance of drug-induced necrosis and early infarcts in leiomyomas.". Am J Surg Pathol 31 (8): 1215-24. doi:10.1097/PAS.0b013e318032125e. PMID 17667546.
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Other cases
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| Number | |
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| Subspecialty (Difficulty) |
Autopsy pathology (jr,sr, f/e)
Breast pathology (jr,sr, f/e)
Cardiovascular pathology (jr,sr, f/e)
Cytopathology (jr,sr, f/e)
Dermatopathology (jr,sr, f/e)
Endocrine pathology (jr,sr, f/e)
Forensic pathology (jr,sr, f/e)
Gastrointestinal pathology (jr,sr, f/e)
Genitourinary pathology (jr,sr, f/e)
Gynecologic pathology (jr,sr, f/e)
Hematopathology (jr,sr, f/e)
Head and neck pathology (jr,sr, f/e)
Lymph node pathology (jr,sr, f/e)
Medical kidney pathology (jr,sr, f/e)
Molecular pathology (jr,sr, f/e)
Neuropathology (jr,sr, f/e)
Pediatric pathology (jr,sr, f/e)
Pulmonary pathology (jr,sr, f/e)
Placental pathology (jr,sr, f/e)
Soft tissue pathology (jr,sr, f/e) |
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| Difficulty | |
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