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Leiomyoma with bizarre nuclei (LBN) have significant cytologic atypia, but high mitotic rate and tumor cell necrosis are absent. Although it is a benign leiomyoma variant, recurrent cases have been described. In this study, we investigated the clinical and pathologic features of LBN and compared them with related studies. A total of 30 patients diagnosed with LBN in our department were included in this study. In all cases, clinical data (age, complaint, surgery type), macroscopic features (size, location, number of leiomyomas, necrosis, and hemorrhage), microscopic features (bizarre cell distribution, bizarre cell density, cellularity, mitotic rate, tumor margin, necrosis, nuclear pseudoinclusions, karyorrhectic nuclei, prominent eosinophilic nucleoli with perinucleolar clearing, cytoplasmic eosinophilic inclusions, staghorn vessels, and alveolar-type edema), and follow-up data (recurrence and survival period) were evaluated. The mean age of the patients was 49.76 yr (range: 38-89 yr). Twenty-two patients (73%) had undergone hysterectomy and 8 patients (27%) had undergone myomectomy. The mean tumor diameter was 6.12 cm (range: 0.5-25 cm). The tumor was intramural in 11 patients (37%), subserosal in 7 patients (23%), and submucosal in 4 patients (13%). Microscopically, the bizarre cell distribution was focal in 8 patients (27%), multifocal in 12 patients (40%), and diffuse in 10 patients (33%). Bizarre cell density was low in 15 patients (50%), intermediate in 8 patients (27%), and high in 7 patients (23%). The mean mitotic count was 1.4 (0-4) in 10 high-power fields, and the tumor margin was regular in all cases. We observed pseudoinclusions in 24 of 30 (80%) tumors, karyorrhectic nuclei in 21 of 30 tumors (70%), prominent eosinophilic nucleoli with perinucleolar clearing in 12 tumors (40%), cytoplasmic eosinophilic inclusions in 11 tumors (37%), staghorn vessels in 9 tumors (30%), and alveolar-type edema in 9 tumors (30%). In addition, we examined the follow-up records of 26 patients (average duration: 58.1 mo). One patient had a smooth muscle tumor in the L3-L4 paravertebral region at 67 mo after hysterectomy. This tumor did not share similar microscopic and immunohistochemical findings to the patient's earlier uterine tumor. The definitive diagnosis of uterine smooth muscle tumors is important for the determination of the prognosis of the patient and the most appropriate therapeutic approach. As in several recent studies, our series has shown that LBN has a benign clinical course. However, other malignant morphologic criteria such as high mitotic rate and tumor cell necrosis should be excluded in the diagnosis of LBN.

Smooth muscle tumors of the uterus are the most common mesenchymal tumors of the gynecologic tract. The vast majority of these are benign leiomyomas that present no diagnostic difficulty. Because some benign smooth muscle tumors may degenerate and uncommon variants exist, the diagnosis can be challenging in some cases. The goal of this research was to investigate EMMPRIN expression in leiomyomas, leiomyoma variants, and leiomyosarcomas (LMS) to determine whether it has a potential role in differential diagnosis. EMMPRIN expression was investigated with immunohistochemistry in 103 uterine smooth muscle tumors, which included 19 usual leiomyomas, 52 leiomyoma variants, and 32 LMS. They were evaluated on the basis of staining extent, intensity, and also their combined score, and the groups were compared. EMMPRIN expression was present in 3 of 19 (15.7%) usual leiomyomas, 23 of 52 (44.3%) leiomyoma variants, and 28 of 32 (87.5%) LMS. There were statistically significant differences in staining extent and intensity, and also for their combined scores, between the LMS and benign groups. Although uterine smooth muscle tumors are usually diagnosed easily with conventional diagnostic criteria, the differentiation of LMS from some variants of leiomyoma can be challenging based soley on morphology. EMMPRIN may be a valuable immunohistochemical marker for differentiating LMS from benign smooth muscle tumors in problematic cases.

Objective: To add a new case of primary vulvar lymphangioma circumscriptum to the literature and to review the current literature., Materials and Methods: We searched the PubMed/MEDLINE databases for previous case reports using the key words "vulvar lymphangioma circumscriptum" and "primary vulvar lymphangioma circumscriptum.", Results: We found 21 cases of primary vulvar lymphangioma circumscriptum reported until 2013. Mean age was 32 years (range = 3-76 y), and 62 % of the cases had been treated surgically., Conclusions: The treatment of primary vulvar lymphangioma circumscriptum is mainly surgery. Depending on the age of the patient and the extent of lesion, surgical treatment might be in the form of the local excision, labiectomy, or vulvectomy.

Molluscum contagiosum is an infectious disease presenting with flesh-colored, dome-shaped, umblicated papules. A few atypical presentations have been reported in immunodeficient patients. A 5-year-old boy with acute lymphoblastic leukemia, presented with bright white-colored papular lesions with no umblications on the chin during his continuation chemotherapy. Increased number of the lesions covered almost his entire chin in months. Topical therapies did not improve the lesions. After his bone marrow relapse, induction chemotherapy was withheld because of bronchopneumonia after febrile neutropenia. After initiation of a combination of systemic parenteral antibiotic and antifungal therapies, his parents squeezed one of his papular lesions. Meanwhile, systemic acyclovir was added to his therapy, because of herpes labialis. Despite the large spectrum of his therapies, in 1.5 months, this small lesion progressed to a large lesion with erythematous ground and a central ulceration. Etiology of the lesion could not be enlightened until a skin biopsy that was compatible with the molluscum contagiosum. A partial resolution was achieved by cryotherapy. In conclusion, molluscum contagiosum may present as an ulcerating lesion during childhood leukemia treatment. A skin biopsy should be performed for the accurate diagnosis of atypical cutaneous lesions in immunocompromised patients.

Summary: Polyps are the most common benign lesions in the endometrium. Metastasis to the endometrial polyp from a distant primary tumor is rare. Breast carcinoma is the most frequent extragenital cancer that metastasizes to the endometrial polyp. We report the case of a 63-year-old with metastatic gall bladder adenocarcinoma involving endometrial polyps detected by endometrial curetting. It was the first sign of her metastatic disease. After this diagnosis, bone metastases were detected during radiologic screening. Gastrointestinal tumor metastasis to an endometrial polyp is a very rare event, but if a patient with a known primary extragenital tumor has abnormal vaginal bleeding, the possibility of metastasis should be included in the differential diagnosis.

Summary: Malignant transformation of a mature cystic teratoma of the ovary is rare, and occurs in approximately 2% of all cases. The most common malignancy arising in mature cystic teratoma is squamous cell carcinoma. Sarcomas very rarely develop in mature cystic teratoma. We describe the case of a 65-year-old patient with mature cystic teratoma, and with rhabdomyosarcomatous transformation and contralateral serous carcinoma. To our knowledge, this is the first case of a pure rhabdomyosarcoma arising in a mature cystic teratoma. The clinicopathologic and immunohistochemical findings of this exceptional case are reported and the literature is reviewed.

Summary: The diagnosis of malignant, uncertain malignant potential, and benign uterine smooth muscle tumors is derived from histologic criteria such as tumor cell necrosis, mitotic activity, and cytologic atypia. Morphologically, some variants of leiomyoma can be confused with leiomyosarcoma (LMS). In this study, we compared fascin expression in cases of leiomyoma, leiomyoma variants (LVs), uterine smooth muscle tumor of uncertain malignant potential (STUMP), and LMS, and sought to determine the potential role of fascin in differential diagnosis. Fascin expression was investigated through the immunohistochemistry of paraffin-embedded tissue in 79 cases of uterine smooth muscle tumor including 22 usual leiomyoma, 31 LV, 4 STUMP, and 22 LMS cases. The cases were scored on the basis of staining extent (from 0 to 4) and intensity (from 1 to 3), and were assigned a combined score. Fascin expression was present in 20 of 22 (90.9%) LMS, 2 of 4 (50%) STUMP, 1 of 31 (3.2%) LV, and 1 of 22 (4.5%) usual leiomyoma cases. There was a statistically significant difference in fascin extent and intensity between the LMS and benign groups, but no difference between the LMS and STUMP groups. The results of this study indicate that more distinct fascin expression exists in LMS than in the benign groups. Fascin can serve as a reliable immunohistochemical marker in distinguishing uterine LMS from LVs and usual leiomyoma, and it may usefully be used with histologic criteria in diagnosing problematic cases.