Quiz. What is your diagnosis?

In 2013, a 38 years-old woman, suffering from myomatous uterus, underwent a subtotal hysterectomy with a diagnosis of a dissecting leiomyoma with features of degeneration, including extensive areas of fibrosis and sclerosis. However, in 2015, the patient started suffering from weight loss and chronic pelvic and abdominal pain. A computed tomography scan of the abdomen revealed multisite abdominal masses localized mainly in the adnexes and a clinical suspicion of a metastatic ovarian tumor was made. In December 2015, the patient underwent a debulking surgery with excision of adnexes, the remaining part of cervix, greater omentum, appendix and visible tumor masses and the specimen from the second surgery (2015) was sent for consultation at our Department. Microscopically, the neoplasm presented multiple foci of sclerosis and collagen formation and the tumor cells had an epithelioid look with very low rate of atypia and scarce mitoses, but the neoplastic areas invaded and dissected the adjacent tissue (Fig. 1A-D). Because of the unusual histopathological texture and disease progression, we requested the specimens from the first surgery (2013). The histopathological view of the primary tumor, which dissected the uterine corpus, was indistinguishable from the tumors removed in the second surgery (Fig. 1E-F).

Marcin Braun1,2, Wojciech Kuncman1, Anna Szumera-Cieækiewicz3,4, Hanna Kose³a-Paterczyk5, Jacek Musia³6, Dorota-Jesionek Kupnicka1, Janusz Ryœ7, Radzislaw Kordek1

1Department of Pathology, Chair of Oncology, Medical University of Lodz, Poland
2Postgraduate School of Molecular Medicine, Medical University of Warsaw, Poland
3Departament of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
4Department of Pathology and Laboratory Medicine Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
5Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
6Department of Pathomorphology “Synevo”, Lodz, Poland
7Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Krakow,