Mitotically Active Leiomyoma: A Word of Caution

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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Mitotically Active Leiomyoma: A Word of Caution

Anwar Ul Haque*, Ambreen Moatasim* and Farhan Aslam**
* Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
** Department of Medicine, Geisinger Medical Center Danville, Pennsylvania, USA.

Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively uncommon, the female
genital tract leiomyomas are one of the most common benign tumors. It is important to rule out the possibility of
leiomyosarcoma whenever examining leiomyomas. At times this may be quite taxing as the nuclear atypia may be minimal.
Not only many sections have to be submitted but also each section has to be carefully scrutinized for mitotic counts. Even
slightly increased mitotic counts have been associated with malignancy. On the other hand, there are occasionally tumors
which despite having very high mitotic counts are benign. These tumors are clinically distinct and if proper attention is given
diagnosis of malignancy in such cases can be avoided. We describe here a case of vaginal leiomyoma with high mitotic
counts in which correct diagnosis was achieved with patience and proper consultation.
Key words: Leiomyoma; mitotically active leiomyoma; mitotic counts.


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