Mitotically Active Leiomyoma: A Word of Caution

Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively uncommon, the female genital tract leiomyomas are one of the most common benign tumors. It is important to rule out the possibility of leiomyosarcoma whenever examining leiomyomas. At times this may be quite taxing as the nuclear atypia may be minimal. Not only many sections have to be submitted but also each section has to be carefully scrutinized for mitotic counts. Even slightly increased mitotic counts have been associated with malignancy. On the other hand, there are occasionally tumors which despite having very high mitotic counts are benign. These tumors are clinically distinct and if proper attention is given diagnosis of malignancy in such cases can be avoided. We describe here a case of vaginal leiomyoma with high mitotic counts in which correct diagnosis was achieved with patience and proper consultation.