College of American Pathologists

2010 — October Case of the Month

Posted December 13, 2010


CAP Foundation October 2010 Online Case of the Month

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A 62-year-old woman presented to her gynecologist with a one-month history of pelvic pressure. Workup included a CT scan, which revealed a 10 cm pelvic mass. She underwent an exploratory laparotomy that revealed a mass involving the posterior uterine fundus. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. The specimen consisted of a 731 gram uterus measuring 14.0 x 11.0 x 10.0 cm that contained a well-circumscribed 9.0 x 9.0 x 7.0 cm submucosal mass involving the posterior uterine wall. This mass had a biphasic gross appearance with some areas that were white and whorled intermixed with other areas that were fleshy and light brown/cream colored. There were multifocal areas of hemorrhage but no gross evidence of necrosis. Bilateral ovaries and fallopian tubes were unremarkable.

The master list with the correct answer

  • Atypical leiomyoma
  • Endometrial stromal nodule
  • Epithelioid leiomyoma
  • Epithelioid leiomyosarcoma
  • Undifferentiated uterine sarcoma

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  • Appropriate diagnosis
  • Critique
  • References

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