Obstructive urinary retention in a young female: case report

The authors report a case of acute urinary retention in a young female patient with a large uterine leiomyoma. Urinary symptoms resolved completely after surgery.

[Determination of cellular DNA content in the diagnosis and prognosis of mesenchymal tumors]

The authors present examples on how to use cellular DNA distribution in support of diagnosis, and also to predict biological behavior of mesenchymal tumours. In cases of smooth muscle tumours of the prostate and the uterus, on the basis of histological pattern, it was not possible to distinguish between bizarre cell (pleomorph) leiomyoma and leiomyosarcoma. The prostate tumour showed an euploid polyploid cellular DNA distribution pattern, supporting the diagnosis of benign pleomorph leiomyoma. On the other hand, the uterus tumour showed an aneuploid DNA content with a high S-phase fraction that is characteristic of malignant lesions. Cellular DNA content analysis has helped to estimate the biological behavior of a gastrointestinal stromal tumour originating from the stomach and a retroperitoneal dedifferentiated type of a well differentiated liposarcoma. Small, diploid tumours (< 5 cm in diameter) with a low S-phase fraction behave like benign tumour or malignant tumour with a low malignant potential. The gastrointestinal stromal tumour was diploid with 8% S-phase ratio, therefore we could predict favorable outcome. It means that control examination is required less frequently. Prognostically, the dedifferentiated type of well-differentiated liposarcoma differs from the common well differentiated liposarcomas; the well differentiated part of this tumour consisted of only one diploid subpopulation with a low S-phase ratio, while the poorly differentiated areas contained a diploid and an aneuploid cell population with a significantly higher S-phase fraction than that of diploid one. Aneuploidy and rapid proliferation rate refer to increasing genetic instability, with a clonal selection for development of a more aggressive cell population, thus control examination is required more frequently.

[Primary epididymal tumors: report of 24 cases]

24 cases of primary epididymal tumors including 23 benign and 1 malignant tumors were treated. In these cases, 66.7% situated at epididymal tail, and 12.5% involved both tail and body. Smooth muscle tumor of one case was bilateral, and adenomatoid tumor of another one was multiple. The symptoms of primary epididymal tumors were mild even absent, so the tumor was easily confused with non-tumorous mass of epididymis. Benign epididymal tumor should be differentiated from tuberculosis, chronic inflammation or granuloma. Besides signs of malignant mass, malignant epididymal tumor usually showed thickened spermatic cord, especially enlarged ductus deferens. The removal of the tumor mass or whole epididymis of the same side could cure benign epididymal tumor without recurrence. Malignant epididymal tumor should be treated as malignancy of testis or spermatic cord, with adjuvant chemotherapy or radiotherapy as indicated by the pathological type.

Vaginal leiomyoma. A case report with imaging findings

BACKGROUND

Vaginal leiomyoma is a rare tumor with a variable clinical presentation. The imaging features have not been described previously.

CASE

A 42-year-old nulligravida presented with a vaginal mass. Ultrasound demonstrated a solid, rather than cystic, mass. Magnetic resonance imaging (MRI) showed a homogeneous lesion with a signal similar to that of the myometrium. Excision of a benign vaginal leiomyoma was performed without difficulty.

CONCLUSION

Vaginal leiomyoma presenting as a mass is most often diagnosed clinically and readily treated at surgery. An uncommon presentation may necessitate imaging studies. The lesion described had MRI and ultrasound features similar to its uterine counterpart.

[Leiomyoma of the small intestines--a rare cause of emergency abdominal surgery]

The authors underline that, although rarely found, leiomyomas of the gastrointestinal tract are the most frequent benign tumours of the small intestine. On occasions, from being a simple autoptic finding or diagnosed during the course of explorative laparotomy, they may be responsible for emergency abdominal surgery, hemorrhage, occlusion or perforation. The authors discuss the experience acquired in two cases-treated during the last two years, both of which were symptomatic. In one case there was a palpable abdominal mass, and in both the key symptom was the appearance of melena a few days before being admitted to hospital. The most striking problem of this rare pathology is its diagnosis owing to both the absence of a specific clinical symptoms, and the difficulties shown in radiological diagnostics of the small intestine. In the authors' experience CAT using a contrast medium is an important instrument, whereas clyster of the small intestine is of scarce value. Explorative laparotomy was essential for removing any doubts regarding diagnosis. Both patients underwent extensive intestinal resection, including the mass and relative mesenteric wedge, with TT single-layer anastomosis. The postoperative period was normal.

Uterine myomas in adolescents: case reports and a review of the literature

Uterine myomas are less common in adolescents than in adults. However, they should be considered in adolescent females who present with pelvic mass, abdominal pain, or abnormal uterine bleeding. The diagnosis is based on pelvic examination and ultrasound. Management is observation for small lesions and surgery for larger masses with myomectomy the choice for preservation of fertility. Medical treatments are currently under investigation as adjuncts to surgery. Ten cases of uterine myomas in adolescent and young-adult women between the ages of 13 and 21 are discussed. The clinical presentation and management is compared with the adult population.

[The value of serum CA125 assays in the diagnosis of uterine adenomyosis]

OBJECTIVE

To investigate the value of serum CA125 assays in the diagnosis of uterine adenomyosis.

METHODS

Fifty-five consecutive patients with uterine-adenomyosis and twenty with leiomyoma of uterus, diagnosed by surgery and pathology were studied. The blood samples were taken one day before operation. Twenty normal healthy women were served as controls. CA125 levels were determined by radioimmunoassay method.

RESULTS

The median (M) CA125 levels (Ql-Qu) for patients with adenomyosis, leiomyoma and normal controls were 102.1 (56.3-182.1)kU/L, 34.6 (33.7-43.8)kU/L and 33.1 (32.7-33.8)kU/L respectively. The differences among the three groups were all significant (P < 0.01). The CA125 positive rates (CA125 > 50kU/L) for the above three groups were 80.0%, 10.0% and 5.0% respectively. Patients with adenomyosis had a higher CA125 positive rate than those with leiomyoma or normal controls (P < 0.001). For patients with adenomyosis the CA125 levels were positively correlated with uterine size (r = 0.33, P < 0.05). The adenomyosis patients treating with sex hormone preparations were found to have lower CA125 levels in comparison with non-users (P < 0.05). The mean CA125 level measured in sixteen patients decreased significantly one week postoperation.

CONCLUSIONS

Serum CA125 assay is of great assistance to the diagnosis of uterine adenomyosis as well as to the differential diagnosis between adenomyosis and leiomyoma of uterus.

[Hysteroscopic features in postmenopausal uterine bleeding]

One hundred forty three patients underwent hysteroscopy for abnormal uterine bleeding from January 1993 through December 1994. Sixty patients were postmenopausal. All but 3 of the procedures were performed on outpatient with no significant complications. Three groups could be identified on the basis of endometrial features (color, vascularity, thickness, necrotic areas): 1) negative for cancer, 2) possible or suspect (low or high risk), 3) carcinoma. Biopsy indicated cancer in one of the 16 doubtful cases, and in all (5) of the hysteroscopically diagnosed cancers. Outpatient Hysteroscopy successfully substitutes D&C (dilatation and curettage) for early diagnosis of endometrial cancer.

[Small intestinal leiomyoma causing gastrointestinal hemorrhage]

Leiomyomas are uncommon benign tumors of smooth muscle which may occur wherever smooth muscle is present. The small bowel is the most frequent site. Bleeding is the most common presenting symptom. Other symptoms, nausea, vomiting, abdominal pain are rare. In this article a 44 year-old male, presented, who was admitted with intermittent gastrointestinal bleeding in requence of jejunal leiomyoma with exulceration.

Renal leiomyoma: a case report

We report a case of renal leiomyoma. A 46-year-old woman was found incidentally to have a solid and cystic renal mass on computerized tomography. The angiogram revealed no neovascularity. Nephrectomy was performed. Histologically, it was diagnosed as renal leiomyoma of vascular type. Although preoperative diagnosis of renal leiomyoma is difficult due to the various radiological findings, we should always consider this tumor in the differential diagnosis of renal tumors.

[Retrovesical leiomyoma: a case report]

We report a case of retrovesical leiomyoma in a 53-year-old woman. In September, 1994, she visited our clinic with the chief complaint of urinary retention. Drip infusion pyelography (DIP), computed tomographic (CT) scan, and magnetic resonance imaging (MRI) revealed a large tumor behind the urinary bladder. Simple tumor excision was performed. The tumor, 7 x 7 x 6 cm in size and 250 g in weight, was histologically diagnosed as leiomyoma. This is the 18th case of retrovesical leiomyoma reported in the literature in Japan.

[Fibrous tumors localized in the pleura]

Localized fibrous tumour of the pleura is an uncommon condition which in few cases may exhibit malignant behaviour. Herein the Authors report a large review on this intrathoracic neoplasm focusing, in particular, on differential diagnosis between benign and malignant variants.

[Female idiopathic urethra tumor: clinical features diagnosis and treatment]

Female idiopathic urethra tumors are reported rarely. We treated fourteen patients patients, and described the clinical manifestations and local features of the tumors, urethra liomyoma, and fibropolypus. We found that there are close relations among tumor stage, prognosis and pathological classification. The main diagnostic methods include vaginal touch, urethroscopy, B-ultrasound exam and biopsy. The diagnostic procedure recommended is tumor location-quality-stage or a three-step method. The main treatment is operation, however, the operative mode should depend on tumor stage and patient's life quality after operation.

Small bowel tumors: an overview

Tumors of the small bowel, both benign and malignant, are relatively uncommon and often present a diagnostic challenge as their symptoms are often vague. This review article outlines the incidence, presentation, diagnosis, and management of small bowel tumors.

Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis

OBJECTIVE

To investigate racial differences in the presence of leiomyomas, condition severity, associated symptoms and age at diagnosis between black and white hysterectomy patients.

STUDY DESIGN

This study included 409 black women and 836 white women aged 18 or older who underwent hysterectomy for noncancerous conditions at 28 hospitals in Maryland. Patients were interviewed shortly before surgery, and hospital records were abstracted after discharge.

RESULTS

Overall, 89% of the black women and 59% of the white women were found to have leiomyomas. Among those with a confirmed presurgical diagnosis of leiomyomas, the average age at diagnosis was 37.5 years for black women and 41.6 for white women, and the average age at hysterectomy was 41.7 for black women and 44.6 for white women. The average uterine weight for black women with leiomyomas was 420.8 g and for white women was 319.1 g. Black women were more likely to have seven or more leiomyomas (57%) in comparison to white women (36%). Black women with leiomyomas were more likely to be anemic (56%) than white women (38%) and more likely to report having very severe or severe pelvic pain (59%) than white women (41%).

CONCLUSION

Black women having hysterectomy had larger and more numerous leiomyomas, and the leiomyomas were more symptomatic than in white women despite a younger age at diagnosis and hysterectomy.

Atypical polypoid adenomyofibroma (APA) versus well-differentiated endometrial carcinoma with prominent stromal matrix: an immunohistochemical study

It can be extremely difficult in some cases to distinguish atypical polypoid adenomyomas (APAs) from invasive adenocarcinoma in an endometrial curettage or biopsy specimen. In order to determine if immunophenotypic features can be exploited to differentiate between these two entities in problematic cases, a series of APAs and myoinvasive well-differentiated endometrial carcinomas (WDCAs) were studied with a panel of standard immunohistochemical markers. All 23 APAs had stromal smooth muscle actin (SMA) reactivity, 12 of 23 had variable degrees of stromal desmin reactivity, and nine of 22 had CD34-positive stromal cells. All epithelial components of the APAs were cytokeratin (AE1 and CAM5.2) positive, whereas 22 of 23 were positive for estrogen receptor (ER) and progesterone receptor (PR). Among the 10 myoinvasive WDCAs, all contained at least some SMA-positive stromal cells, seven of 10 desmin-positive stromal cells, and four of eight CD34-positive stromal cells. All carcinomas studied demonstrated CAM5.2 and PR-positive epithelia; nine of 10 were ER positive. We conclude that the immunophenotype of APAs does not differ significantly from well-differentiated endometrial adenocarcinoma and that immunophenotyping is of little value in distinguishing APA from carcinoma. Because the stroma in APAs histologically and immunophenotypically more closely resembles a hybrid myofibromatous stroma, we prefer to refer to these lesions with the modified designation "atypical polypoid adenomyofibroma," although "APA" may be retained for clinical use.

Leiomyosarcoma of the small intestine presenting as a pelvic mass

We present a challenging case of differential diagnosis of leiomyosarcoma of the small intestine in a patient presented with a pelvic mass. This 43-year-old Japanese woman complained of hypermenorrhea and was diagnosed as myoma uteri. She underwent partial resection of the ileum with a primary end-to-end anastomosis, omentectomy, and appendectomy, as well as a simple hysterectomy and bilateral salpingo-oophorectomy. CT and MRI indicated an intestinal tumor at the gaseous site. The histological diagnosis was leiomyosarcoma of the small intestine and leiomyoma of the uterus. Although such leiomyosarcomas are rare, they can appear as pelvic masses and must be differentiated from gynecologic disease. Preoperative CT and MRI of the abdomen were useful in obtaining the diagnosis.

[Pelvic Castleman's disease: apropos of a case]

Castleman's disease (CD) is a enigmatic lymphoid disease of unknown etiology which rarely manifest itself as an isolated pelvic mass. We report a case of pelvic Castleman's disease masquerading as a uterine myoma. The patient presented symptoms related to compression of adjacent structures, splenomegaly and abdominal lymphadenopathy, the laboratory data revealed positive Epstein-Barr virus serology, elevated beta 2-microglobulin level and presence of antinuclear antibodies. The intraabdominal involvement, histological patterns and clinical forms of this condition are reviewed. Likewise etiopathogenic, radiologic and therapeutic aspects related with this entity are discussed. We suggest that pelvic Castleman's disease should be included in the differential diagnosis of females presenting a pelvic mass containing calcifications.

[Diagnosis of uterine diseases by combined hysteroscopy and ultrasonography]

OBJECTIVE

To investigate the diagnostic value of combined hysteroscopy with ultrasonography.

METHODS

477 patients were diagnosed by hysteroscopy, ultrasonography, or hysteroscopy combined with ultrasound. The results of the 3 groups were compared with the findings after operations.

RESULTS

This study indicated to diagnose intrauterine lesions, intramural diseases or pelvic disorders, hysteroscopy with ultrasonography was significantly better than either methods alone. The accuracy rate, false positive rate as well as false negative rate were 98.32%, 1.26% and 0.04% respectively.

CONCLUSION

Hysteroscopy is used for diagnosis and treatment of intrauterine lesions, and ultrasonography is difficult to show actual location of lesions within uterine cavity. The present study has shown that hysteroscopy combined with ultrasound could increase the effectiveness and accuracy of uterine diseases' diagnosis.

Metastasizing uterine leiomyoma. A case with cardiac and pulmonary metastasis

A case of histologically benign cardiac and pulmonary metastases from a uterine leiomyoma in a 45-year-old woman is reported. The solitary cardiac tumor consisted of five lobules with a stalk attached to the anterior papillary muscle of the right ventricle, which occupied the right ventricular cavity and almost completely obstructed the pulmonary main trunk in the systolic cycle. Multiple small nodules were found throughout both lungs. The cardiac tumor was resected at open heart surgery and open lung biopsy of the pulmonary lesion was simultaneously performed. Both of them were histologically identical to the apparently histologically benign uterine leiomyoma which had been resected five years previously. Based on the clinical and laboratory findings, it is postulated that antegrade metastases via the venous system resulted in the cardiac metastasis from the uterine leiomyoma and the secondary pulmonary metastasis from the cardiac tumor. In contrast to the light microscopic findings, ultrastructural examination suggested the possibility of malignancy associated with the presence of immature smooth muscle cells. This is the first reported case of a so-called benign metastasizing leiomyoma occurring in the heart.

Office hysteroscopy versus transvaginal ultrasonography in the evaluation of patients with excessive uterine bleeding

OBJECTIVE

Our purpose was to compare office hysteroscopy with transvaginal ultrasonography for diagnosing intrauterine pathologic disorders in patients with excessive uterine bleeding, with specimens obtained from either hysterectomy or operative hysteroscopy used to represent the true diagnosis.

STUDY DESIGN

A total of 149 patients underwent office hysteroscopy between July 1993 and December 1994. They were evaluated for complaints of menorrhagia, metrorrhagia, or postmenopausal bleeding. Data encompassing patient age, gravidity, parity, indication, ultrasonographic and hysteroscopic findings, comfort level, time required, and complications were gathered by resident physicians. Most hysteroscopic examinations were preceded by transvaginal ultrasonography. All patients received premedication with 600 mg of ibuprofen and a paracervical block with 1% lidocaine without epinephrine. Sixty-five patients underwent operative hysteroscopy or hysterectomy later. The pathologic diagnoses of these specimens were compared with hysteroscopic and ultrasonographic findings, and the sensitivity and specificity of each test were calculated.

RESULTS

Hysteroscopy was 79% sensitive and 93% specific in diagnosing intracavitary pathologic disorders, whereas transvaginal ultrasonography was only 54% sensitive and 90% specific. One hundred forty-one patients were comfortable during the procedure, and inspection of the uterine cavity was considered adequate in 136. The majority of procedures were completed in <10 minutes. Twenty-six patients underwent operative hysteroscopy and another 39 underwent hysterectomy. No patient who underwent operative hysteroscopy has had a recurrence of abnormal bleeding over a 12- to 30-month follow-up.

CONCLUSION

Office hysteroscopy is a rapid, safe, well-tolerated, and highly accurate means of diagnosing the cause of excessive uterine bleeding. It permits patient and physician to discuss more treatment options before surgery, including outpatient operative hysteroscopic procedures. This means savings in time and in drug, procedure, professional, and hospital costs.