I cannot read the picture very well. My impression is that there is focal moderate nuclear atypia. I am not so sure the "necrosis" is true tumor necrosis only based on these photos. You need make sure the necrosis is tumor necrosis, not infarct-like necrosis. Also you need count mitotic figures to give a actual number of how many MF/10 high power fields. I do not think this is a diagnosis I can render just based on couple photos without looking the real slides. I did not see any "bizarre nuclei" in the photos provided. If you have any bizarre nuclei, you want to exclude bizarre leiomyoma before rendering leiomyosarcoma.

赵老师说：

有轻-中度核异型。

需要计数核分裂（多少个/10HPF)

确定是否有真正的肿瘤性凝固性坏死

最后才能做出你的诊断。

 诊断子宫平滑肌肉瘤的组织学标准：

1、坏死，2、分裂像；3、细胞异型性；4、浸润；5、转移

只要有真正的凝固性坏死即可诊断。

分裂像带有主观因素。

有细胞异型性不一定是恶性，如奇异性平滑肌瘤。

有浸润也不一定是恶性，如静脉内平滑肌瘤。

有转移也不一定恶性，如转移性平滑肌瘤。

所以要综合分析，本例见到坏死，富有细胞，细胞有异型性，可见分裂像，够肉瘤了。

 Mild to moderate cytologic atypia.

You need to count mitosis  ?/10HPF

Make sure it is true tumor 凝固性坏死

Then you can make your dx

 用于分析恶性平滑肌肿瘤的因素

1、病人年龄

2、肿瘤大小

3、切面表现

4、肿瘤边缘浸润

5、血管浸润

6、细胞学非典型性

7、凝固性肿瘤细胞坏死

8、核分裂指数