The Natural History of Uterine Leiomyomas: Light and Electron Microscopic Studies of Fibroid Phases, Interstitial Ischemia, Inanosis, and Reclamation
Figure 15
Inanosis of tumor myocytes. Interstitial and vascular ischemia lead to myocyte atrophy and eventual cell death, a process that we refer to as inanosis. In this panel, each image shows cytoplasmic and nuclear atrophy of tumor myocytes, as well as scattered, shrunken cells with marked nuclear pallor that are probably nonviable (arrows in (a)–(e)). In addition to those marked by arrows, there are other similar pale, presumably nonviable cells scattered among the viable cells with blue nuclei, resulting in a mottled pattern. Note the absence of inflammatory reaction. (a) The pale, inanotic cells are widely separated from the capillary at the top and the capillary at the bottom (arrowheads). (b) The pale, presumably dead cells are scattered among atrophic, but viable, cells with dark blue nuclei. (c) The pale, inanotic cells are shrunken but usually maintain elongate shapes. (d) Note that the pale, inanotic cells in the center are the most distant cells from the capillary with the open lumen at the top and the apparent capillary with a red cell in the lumen at the bottom (arrowheads). (e) Pale cells are noted here and there among the atrophic, viable cells in a field without any obvious capillaries. No inflammation is present. Original magnification of photos ((a)–(e)): 132x. (f) Oil immersion image of inanotic cells (myocyte tombstones) with pale nuclei and cytoplasm, in a fibrotic, atrophic field of a Phase 3 tumor. The cell in the center of the field (arrowhead) is located 76 μm from the capillary in the left lower corner (arrow). Original magnification of (f): 330x.
