Surgical Pathology Criteria

Leiomyosarcoma Arising in Vessels

Differential Diagnosis

Intravenous Leiomyomatosis Leiomyosarcoma Arising in Vessels
Originates in uterus Originates in vessel
Confined to vessel lumen and does not infiltrate vascular wall or surrounding tissue Frequently infiltrates vascular wall and surrounding tissue
Frequently hyalinized Rarely hyalinized
Frequently epithelioid Rarely epithelioid
Usually bland and amitotic Usually pleomorphic or with >4 mitotic figures per 50 HPF

Intimal Sarcoma Leiomyosarcoma Arising in Vessels
Pleomorphic, histologically undifferentiated Elongate or spindled eosinophilic cytoplasm
Typically lacks abundant desmin or caldesmon Typically desmin or caldesmon diffusely positive
Most common in great arteries Most common in vena cava but may involve pulmonary artery

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