Spinal extradural leiomyoma in a pediatric patient with acquired immunodeficiency syndrome: case report

OBJECTIVE AND IMPORTANCE

We report a case of two separate cervicothoracic, extradural leiomyomas occurring in a male pediatric patient with acquired immunodeficiency syndrome (AIDS). To our knowledge, such a case has never been reported in the literature.

CLINICAL PRESENTATION

A 9-year-old male patient with AIDS presented with progressive leg weakness. At examination, he was myelopathic with paraparesis and a T4 sensory level to pinprick. A magnetic resonance image revealed two separate cervicothoracic lesions causing cord compression.

INTERVENTION

The patient underwent resection of both lesions. Postoperatively, he regained normal strength in his legs and was discharged home after 2 weeks.

CONCLUSION

With the ever-growing number of pediatric patients with AIDS, the entity will likely be encountered with increasing frequency in the future. Because of the potential for neurological recovery and cure, the neurosurgeon should be cognizant of this entity.

Gut stromal tumors and their clinical behavior

BACKGROUND

Gut stromal tumors (GST) are a group of intramural intestinal tumors formerly known as leiomyoma and leiomyosarcoma. To improve the understanding of GST behavior, we posed the following questions: What are the clinical sequelae? Do size and symptoms correlate? What are the indications for excision?

METHODS

A retrospective analysis (1988 to 1996) of the clinical course for GST patients was completed including long-term follow-up.

RESULTS

We found 39 patients with GST during the last 8 years. Their average age was 65 years and 59% were male. Tumors were found in the small bowel or stomach in 95% of cases. All patients were treated by surgical excision. Histologic grading yielded a benign diagnosis in 77%. Tumors were found incidentally at laparotomy in 41% and had an average size of 1.5 cm. In contrast, 59% of GST patients were symptomatic and the average size was 6 cm. In these 23 symptomatic patients, gastrointestinal bleeding occurred in 70%, of which acute hemorrhage was seen in 69-82% of them required transfusion and half required emergent operation. Additional findings in the symptomatic group included abdominal pain (57%), bowel obstruction (30%), and perforation (9%). An average long-term follow-up of 2.5 years was obtained in all patients (n = 34, 5 had died of other causes). Local recurrence was seen in 2 patients, metastatic disease in 2 other patients, and 30 (88%) were disease free. No patient with a GST discovered incidentally has had it recur.

CONCLUSION

Gut stromal tumors are uncommon yet cause significant patient morbidity. Small GST (<2 cm) were asymptomatic but larger GST were usually symptomatic. Most GST behaved in a benign fashion after local resection. Due to the frequency of serious complications in symptomatic patients, complete excision is recommended for GST, even if incidentally discovered.

Cathepsin B-like activity as a serum tumour marker in ovarian carcinoma

Serum cathepsin B-like activity was determined in 75 patients with ovarian carcinomas and in control groups. Ovarian cancers were of FIGO stages I-IV. Control groups consisted of 15 healthy women, 20 patients with myomas of the uterus, and 17 with benign ovarian cysts. Preoperative results showed elevated cathepsin B-like activity in 100% of the patients with ovarian cancers in relation to healthy subjects and patients with myomas, and in 78% in relation to benign ovarian cysts. Cathepsin B activity increased progressively with the FIGO stage of the disease, but the differences among particular stages were not statistically significant. In serous tumours cathepsin activity was significantly higher only in comparison to endometrioid ones (p < 0.001). Antipapain capacity of cystatins in the sera was also determined. No significant correlation between cathepsin B-like, and antipapain activity of cystatins was found. Serum cathepsin B-like activity may be helpful in the preoperative differential diagnosis between ovarian carcinomas and benign ovarian or uterine tumours.

[Sonohysterography: a new study method of the uterine cavity: evaluation of 84 cases and comparison to hysteroscopy]

Sonohysterography versus hysteroscopy: the assessment of the uterine cavity: a series of 84 cases. We study indications, advantages, limits of a technic of investigation of uterine cavity: sonohysterography. Our results show that sonohysterography is as effective as hysteroscopy in the diagnosis of intrauterine conditions. It is painless, no time consuming. There is no adverse effects and it is helpful in the diagnosis of intrauterine abnormality as a complement of transvaginal scanning.

[A large symptomatic gastric leiomyoma. A case report and considerations of the treatment possibilities]

The authors describe the case of a female patient affected with large symptomatic gastric leiomyoma, six centimeters in diameter, who presented to clinical observation referring gastric pain and melena. The first gastroscopy showed massive bleeding from a submucosal gastric lesion. The lesion was not endoscopically resectable and the injective endoscopic treatment of bleeding failed. The patient was surgically treated with laparotomic excision of the leiomyoma. She was back home in ten days. The authors describe this case to discuss the possibility to resect large gastric leiomyomas using endoscopic resection indeed surgical approach. They also enhance the validity of surgical treatment for its safety and radical approach to large lesions.

Prolonged storage of fixative for electron microscopy: effects on tissue preservation for diagnostic specimens

Prolonged storage of Karnovsky's fixative, at both 4 and -20 degrees C, is possible in the diagnostic electron microscopy setting. Ultrastructural detail was not compromised in specimens processed in fixative that had been stored for 6 months. Evidence of smooth muscle and neuroendocrine differentiation was present in the form of actin filaments/dense bodies and neurosecretory granules, respectively. No difference in preservation was detected between specimens fixed in freshly prepared Karnovsky's fixative and fixative that had been stored at either 4 or -20 degrees C for up to 6 months. Thus, community hospitals can be provided with Karnovsky's fixative on a semiannual basis for surgical pathology specimens that may require electron microscopy for diagnosis.

[Leiomyoma of the esophagus. Case report]

Of all oesophageal tumours benign tumours account for less than 10%, of which 4% are leiomyomas. These tumours are most frequently asymptomatic, mostly localized in the lower oesophageal third. The most frequent symptoms, if any, are the following: dysphagia, unspecific retrostemal pain, heartburn, and occasionally, weight loss. Tumour enucleation is a therapy of choice in patients with oesophageal leiomyoma. In case of successful surgical removal, the prognosis is good and complains are practically eliminated. A male patient, aged 53, with paroxysmal tachycardia, in whom transhiatal enucleation was carried out in order to remove a large oesophageal leiomyoma after which cardiac complains were eliminated, is reported.

Laparoscopic-assisted transvaginal myomectomy

We conducted a retrospective review of 21 combined laparovaginal myomectomies to treat extensive and deeply infiltrating fundal and posterior wall leiomyomata. Laparoscopy confirmed the size, number, and position of leiomyomata, permitted intramyometrial vasopressin infiltration, and allowed partial enucleation of large and deep myomata. Posterior colpotomy permitted delivery of myomata and uteri, and uterine reconstruction by conventional suturing performed transvaginally. The uteri were then placed in their anatomic position, the colpotomies were repaired, and a final laparoscopic survey and lavage were performed. All surgeries were successfully completed without intraoperative or postoperative complications. This approach allows a layered traditional uterine reconstruction of deep myometrial defects and may enhance the ability to repair extensive uterine defects in a minimally invasive fashion.

An interesting unusual case of endometrial stromal sarcoma

An interesting case with an unusual presentation of endometrial sarcoma is described. This patient presented with a history of continuous vaginal bleeding 3 months following a full term caesarean section and perception of an enlarging abdominal mass. The physical examination revealed an enlarged uterus with a leiomyoma though there was no evidence of the same at the time of the caesarean section. A laparotomy was undertaken and the patient was found to have a large tumor with multiple polypoidal growths invading the myometrium through to the serosa. This was proven to be an endometrial stromal sarcoma on histopathology.

Perinodular hydropic degeneration of a uterine leiomyoma: a diagnostic challenge

Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. With minimal discussion in the surgical pathology literature, appropriate evaluation may be challenging because the differential diagnosis includes other uncommon uterine disorders such as intravenous leiomyomatosis, diffuse leiomyomatosis, myxoid leiomyosarcoma, endometrial stromal sarcoma, angiofibroma, and angiomyxoma. We describe such a diagnostic challenge in a 42-year-old woman with a left adnexal mass discovered during an annual examination. With only three cases of perinodular hydropic degeneration previously reported, this case is the first with extrauterine extension and was initially concerning for a more aggressive process.

Laparoscopic local resection for benign nonepithelial gastric tumors

After experience in laparoscopic cholecystectomy and improvement of laparoscopic instruments, we attempted laparoscopic resection of benign nonepithelial gastric tumors using Endo-GIA. We achieved successful results with this procedure in 2 cases. There were no intra- and postoperative complications. For both patients there was no recurrence during the follow-up period (3.3 and 1.5 years). The important points of this approach are confirmation of the location of the tumor by both gastroendoscopy and laparoscopy, proper selection of the trocar site for insertion of the Endo-GIA, and secure grasping and lifting of the gastric wall, including of the tumor. We conclude that this procedure is technically feasible, safe and useful for benign nonepithelial gastric tumors.

Adenomyosis in the broad ligament and tamoxifen: report of a case

Adenomyosis confined to the broad ligament is extremely rare. Herein we present a case of adenomyosis in the broad ligament with unusual gross features. This 41-year-old woman had been on tamoxifen therapy for 3 years due to breast cancer. Ten months after discontinuing tamoxifen, she underwent exploratory laparotomy for a right adnexal mass suspected as ovarian malignancy. At laparotomy, the mass was located in the right broad ligament with a fibrous stalk connecting to the uterus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathologic examination revealed adenomyosis with cyst formation and an unusual thick capsule. The possible effects of tamoxifen upon the uterus are discussed in this article, in view of reports of tamoxifen associated with endometrial carcinoma and endometriosis.

Intracardiac extension of intravenous leiomyomatosis. A case report

Intravenous leiomyomatosis spreading through the inferior vena cava to the right heart is a rare neoplasm. We report the case of a patient with a uterine leiomyoma which through a right uterine vein progressed along the inferior vena cava up to the right ventricle. She was successfully operated, carrying out a total resection in two surgical stages. Surgical technique considerations are discussed.

[Adenomatoid tumor of the uterus--2 case reports]

We report two cases of the so-called adenomatoid tumor of the uterus, which have been detected in patients who underwent surgery for leiomyomas. The clinical signs, origin and immunohistochemical characteristics of the adenomatoid tumor are described. Adenomatoid tumors are slow growing epithelioid neoplasias with a co-expression of vimentin and cytokeratins. The characteristic cytokeratins are numbered 7, 8, 18, 19 and 5. The mesothelial histogenesis of the tumor can be confirmed. Our results rule out origins from Müllerian or mesonephrogenous ducts and angioma or adenoma. Considering our experiences, adenomatoid and leiomyoma cannot be distinguished macroscopically. The hysterectomy or salpingo-oophorectomy, primarily performed under other diagnoses, are the therapies of choice.

Leiomyoma of the esophagus with special reference to the characteristics of this tumor in teenagers

BACKGROUND/AIMS

Leiomyoma, the most common benign esophageal tumor, occurs rarely in youths. We herein reported our experiences with this tumor, paying particular attention to two cases in teenagers.

MATERIALS AND METHODS

We have surgically treated 12 patients with leiomyoma of the esophagus from 1978 to 1995. Ten of them occurred in adult and two occurred in teenagers aged 17 and 18. We evaluated the characteristics, diagnosis and treatment of these cases, particularly in young patients.

RESULTS

The age range was from 17 to 55, and the mean was 40.5 years. The mean longitudinal size of 12 tumors in 10 adult cases was 4.9 cm, while both tumors in the teenagers were larger in size, over 10 cm. Endoscopic ultrasonography was useful in the diagnosis of the tumors. All tumors were enucleated without any complication. In young cases, in spite of the large size of the tumors, an enucleation was also possible and the long-term result was satisfactory.

CONCLUSION

Regarding the young cases, in spite of the large size of the tumor, an enucleation of the tumor should be tried whenever possible, in consideration of the patient's postoperative quality of life.

Choroidal leiomyoma of vascular origin

A 38-year-old female patient was admitted for serious retinal detachment. Clinical examination revealed detachment in the lower half of the retina, with a suspect hemispherical tumorous formation. Echography did not positively demonstrate the presence of tumor. Vitrectomy was performed and a tumor fragment was taken for histologic analysis. The finding indicated the presence of leiomyoma choroideae, a very rare and benign smooth muscle tumor.

Adult renal hamartomas

Renal angiomyolipomas, the most familiar of the renal hamartomas, are well known to radiologists, despite being uncommon and of limited clinical importance, because angiomyolipomas represent one of the few lesions for which a specific diagnosis can be achieved on the basis of radiologic findings in the majority of cases. Because of the diversity in the relative amounts of various cellular components and because of the occasional association with acute hemorrhage, the radiologic features of angiomyolipomas can be somewhat varied. At sonography, angiomyolipomas appear echogenic with acoustic shadowing. At computed tomography (CT), these lesions typically appear as well-marginated, small (< 5 cm in size), cortical masses of predominantly fat attenuation with heterogeneous soft-tissue attenuation interspersed throughout. Some angiomyolipomas are larger and poorly marginated because of hemorrhage. Typical angiomyolipomas are largely composed of fat; those uncommon tumors without demonstrable fat cannot be radiologically distinguished from renal cell carcinoma. Renal leiomyoma, a lesion that pathologically overlaps with angiomyolipoma to some degree, has a quite different imaging appearance (ie, homogeneous, without detectable fat) that cannot be distinguished from malignant renal lesions.

[A case of myomectomy for infertility and a following twin pregnancy associated with hyperthyroidism]

The authors describe an infertility case caused by a posterior wall subendometrial fibromyoma of the uterus and treated by traditional transcavitary myomectomy dwelling upon details of the operative technique. The following pregnancy is complicated by twin gestation, hyperthyroidism and preterm delivery. Fetuses were born by caesarean section one in good condition, the other affected by myelomeningocele with good prognosis. Clinical pictures emerged during pregnancy are discussed, in particular the therapy of hyperthyroidism, beta 2-adrenoceptor stimulants drugs, diagnosis and multifactorial genesis of fetal malformation.

Zygomatic leiomyoma. Case report

Leiomyoma is a benign tumor that originates from the smooth muscle. If often develops in the uterus and in organs rich of smooth muscle like bowel and subcutaneous tissue. It is infrequently observed in the oral nasal cavities or in paranasal sinuses. The authors, after an accurate revision of the literature, present their first case of zygomatic leiomyoma. They underline the diagnostic aspects in relationship to histologic and immunohistochemical examinations, for surgical therapy.