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Korean Journal of Obstetrics & Gynecology 2006;49(2):431-435.
Published online February 1, 2006.
Clinical Analysis of Uterine Leiomyoma with Increased Mitotic Activity.
Ok Kyoung Kim, Ye Hoon Choi, I So Maeng, Cheol Hoon Park, Duck Yeong Ro, Yong Wook Kim, Tae Eung Kim, Jae Keun Jung, Ju Hwan Kim
1Department of Obstetrics and Gynecology, Our Lady of Mercy Hospital, College of Medicine, Catholic University of Korea. duckyeong20@yahoo.co.kr
2Department of Pathology, Our Lady of Mercy Hospital, College of Medicine, Catholic University of Korea.
3Department of Obstetrics and Gynecology, Cheong Ju St. Mary's Hospital, Korea.
Abstract
OBJECTIVE
To evaluate clinical-pathological aspects of uterine smooth-muscle tumors with a pathological diagnosis of uncertain malignant potential or leiomyomas with increased mitotic activity. METHODS: We reviewed the charts and pathological records of twenty seven patients with smooth muscle tumors of the uterus, with 5-9 mitotic figures per 10HPF (High power fields) and without cytological atypia or necrosis retrospectively. RESULTS: The patients were 29-60 (mean 41.8+/-6.8) years old and mean parity was 1.7+/-0.9. None of the patients had used any hormones preoperatively. The size of the myomatous tumors ranged from 2 to 23 cm (mean 7.1+/-4.6 cm). On gross examination all tumors appeared as typical leiomyomas. Twenty were intramural and 7 were submucous leiomyomas. The mitotic counts ranged 5-9/10 HPF (mean 6.0+/-1.2/10 HPF). Cytological atypia or necrosis were absent. The histological phase of the endometrium could be evaluated in 18 patients. Of these, ten had secretory-phase endometrium and proliferative endometrium was present in eight patients. Hysterectomy was performed in 20 patients with intramural leiomyoma, and myomectomy was in 7 patients under diagnosis of submucosal type. Postoperative follow-up periods ranged 5-94 months (mean 37.0+/-22.6 months). All patients were alive without evidence of recurrence or metastasis. CONCLUSION: Leiomyomas containing from five to nine mitotic figures per 10 HPF, without cellular atypia or necrosis, should be regarded as benign. Hysterectomy need not autonomically be done, as follow-up is a viable alternative. Myomectomy is an appropriate treatment, particularly in young patients interested in reproduction.
Key Words: Uterine leiomyoma with increased mitotic activity


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