Medium power: Pap stain
Spindled cells with pleomorphism in a background of necrosis
High power: Pap stain
Crowded spindle cells with pleomorphic elongated nuclei
High power: Pap stain
Pleomorphic multinucleated cells
High power: Pap stain
Necrosis is a clue towards malignancy. Also look for mitosis
High power: Pap stain
Leiomyosarcomas can show myxoid/ hyaline change
Features
• May be monomorphic
• Elongated cigar shaped nuclei
• Palisading nuclei
• Granular chromatin
• Inconspicuous nucleoli
• Cellularity, nuclear atypia, mitosis and necrosis favor LMS over leiomyoma
• Spindled cells with pleomorphism
• Elongated, irregular nuclei
• Coarse chromatin
• Prominent nucleoli
• Intranuclear cytoplasmic indentations common
• Mitosis and necrosis common
• Spindled cells with pleomorphism
• Elongated, irregular nuclei
• Coarse chromatin
• Prominent nucleoli
• Intranuclear cytoplasmic indentations common
• Mitosis and necrosis common
• May have myxoid/hyaline change
• Mitosis/Necrosis present
• Express SMA, actin, Desmin, vimentin; typically negative for cytokeratin, CD34, CD117, DOG1, S100
Barbazza R et al. Diagn Cytopathol. 1997 Apr;16(4):326-30.