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Al-Dasuqi K, Irshaid L, Mathur M. Radiologic-Pathologic Correlation of Primary Retroperitoneal Neoplasms. Radiographics 2021; 40:1631-1657. [PMID: 33001785 DOI: 10.1148/rg.2020200015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An earlier incorrect version of this article appeared in print. The online version is correct.
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Affiliation(s)
- Khalid Al-Dasuqi
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Lina Irshaid
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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52
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Kypriotis K, Kathopoulis N, Tsiriva M, Zacharakis D, Chatzipapas I, Protopapas A. Leiomyoma originating from left round ligament presents as symptomatic inguinal hernia. Clin Case Rep 2021; 9:e04445. [PMID: 34295480 PMCID: PMC8287316 DOI: 10.1002/ccr3.4445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022] Open
Abstract
Leiomyomas may develop at extra-uterine locations and pose diagnostic dile mmas. This is a case of a fibroma originating from the left round ligament presenting as a symptomatic inguinal hernia.
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Affiliation(s)
- Konstantinos Kypriotis
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
| | - Maria Tsiriva
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
| | - Ioannis Chatzipapas
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
| | - Athanasios Protopapas
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
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53
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Pokoradi A, Agrawal A. Large benign leiomyoma of the vulva: an unusual extrauterine location. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:229. [PMID: 34465551 DOI: 10.1016/j.jogc.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Alida Pokoradi
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON
| | - Anita Agrawal
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Queen's University, Kingston, ON
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54
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Pokoradi A, Agrawal A. Léiomyome volumineux bénin de la vulve : une localisation extra-utérine insolite. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:230. [PMID: 34465547 DOI: 10.1016/j.jogc.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alida Pokoradi
- Department of Obstetrics and Gynaecology, Queen's University, Kingston (Ontario)
| | - Anita Agrawal
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Queen's University, Kingston (Ontario)
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55
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Motegi Y, Ogawa H, Tateno K, Suga K, Okada T, Osone K, Katoh R, Ogata K, Sakai M, Sohda M, Makiguchi T, Shirabe K, Saeki H. Large retroperitoneal leiomyoma developed from the pelvic floor to the buttocks. Clin J Gastroenterol 2021; 14:1169-1174. [PMID: 34181172 DOI: 10.1007/s12328-021-01436-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
Retroperitoneal leiomyoma is a very rare disease, with little reported information on its origin. Herein, we report a case of a large retroperitoneal leiomyoma that developed from the pelvic floor. A 44-year-old woman had a large mass protruding outside the body from the right hip. Imaging revealed a large tumor developing from the pelvic floor to the buttocks. It was difficult to identify the place of origin. Upon preoperative biopsy, the patient was diagnosed with retroperitoneal leiomyoma. Tumor removal with abdominoperineal and partial vaginal resection was performed. Based on the histological findings of the surgical specimens, she was diagnosed with a retroperitoneal leiomyoma (gynecologic type) via immunohistochemistry, the tumor cells were positive for αSMA, desmin, estrogen receptor(ER), and progesterone receptor(PgR), but negative for myoglobin, S-100, CD34, and MIB-1.This is a case of a large retroperitoneal leiomyoma that was successfully removed via abdominoperineal and partial vaginal resection.
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Affiliation(s)
- Yoko Motegi
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Hiroomi Ogawa
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Kohei Tateno
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Kunihiko Suga
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Takuhisa Okada
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Katsuya Osone
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Ryuji Katoh
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Kyoichi Ogata
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Makoto Sohda
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan.
- Clinical Department of Pathology, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi Gunma, 371-8511, Japan.
| | - Takaya Makiguchi
- Department of Oral, Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
| | - Hiroshi Saeki
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi Gunma, 371-8511, Japan
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Panagopoulos I, Gorunova L, Andersen K, Lobmaier I, Heim S. Several Fusion Genes Identified in a Spermatic Cord Leiomyoma With Rearrangements of Chromosome Arms 3p and 21q. Cancer Genomics Proteomics 2021; 18:531-542. [PMID: 34183386 DOI: 10.21873/cgp.20278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/AIM Benign smooth-muscle tumors, leiomyomas, occur in nearly every organ but are most common in the uterus. Whereas much is known about the genetics of uterine leiomyomas, little genetic information exists about leiomyomas of other organs. Here, we report and discuss the genetic findings in a para-testicular leiomyoma. MATERIALS AND METHODS Cytogenetic, array comparative genomic hybridization (aCGH) RNA sequencing, reverse-transcription polymerase chain reaction (RT- PCR), and Sanger sequencing analyses were performed on a leiomyoma of the spermatic cord removed from a 61-year-old man. RESULTS The karyotype was 48~50,XY,add(3) (p21),+4,+7,+8,+9,add(21)(q22)[cp9]/46,XY[2]. aCGH confirmed the trisomies and also detected multiple gains and losses from 3p and 21q. RNA sequencing detected the chimeras ARHGEF3-CACNA2D2, TRAK1-TIMP4, ITPR1- DT-NR2C2, CLASP2-IL17RD, ZNF621-LARS2, CNTN4- RHOA, and NR2C2-CFAP410. All chimeras were confirmed by RT-PCR and Sanger sequencing. CONCLUSION Our data, together with those previously published, indicate that a group of leiomyomas may be cytogenetically characterized by aberrations of 3p and the formation of fusion genes.
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Affiliation(s)
- Ioannis Panagopoulos
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway;
| | - Ludmila Gorunova
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Kristin Andersen
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Sverre Heim
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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57
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Guo X, He H, Gao Q, Jin Y. Isolated Metastasis to Spleen-Stomach Space From Follicular Thyroid Cancer Combined With a Benign Subcutaneous Nodule on 18F-FDG PET/CT and 131I Scintigraphy. Clin Nucl Med 2021; 46:e156-e158. [PMID: 32910059 DOI: 10.1097/rlu.0000000000003241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 40-year-old woman with follicular thyroid cancer underwent a systemic PET/CT evaluation before operation and then received total thyroidectomy and radioactive 131I ablation therapy. Posttreatment imaging of 131I whole-body scan with SPECT/CT showed that metastasis on the spleen-stomach space coexists with mimicking subcutaneous metastasis, considering their level of 131I accumulation and morphological changes on PET/CT. However, histopathology confirmed the subcutaneous lesion of fibrous hyperplasia by fine-needle aspiration. This case demonstrates a vital role of SPECT/CT in the diagnosis of metastatic thyroid cancer and mimicking metastasis.
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Affiliation(s)
- Xiuyu Guo
- From the Department of Radiology and Ningbo PET/CT Center, Hwa Mei Hospital, University of Chinese Academy of Sciences
| | - Hua He
- From the Department of Radiology and Ningbo PET/CT Center, Hwa Mei Hospital, University of Chinese Academy of Sciences
| | - Qiaolin Gao
- From the Department of Radiology and Ningbo PET/CT Center, Hwa Mei Hospital, University of Chinese Academy of Sciences
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58
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Pickhardt PJ, Perez AA, Elmohr MM, Elsayes KM. CT imaging review of uncommon peritoneal-based neoplasms: beyond carcinomatosis. Br J Radiol 2021; 94:20201288. [PMID: 33353398 DOI: 10.1259/bjr.20201288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pathologic involvement of the peritoneum can result from a wide variety of conditions, including both neoplastic and non-neoplastic entities. Neoplastic involvement of the peritoneal ligaments, mesenteries, and spaces from malignant spread of epithelial cancers, termed peritoneal carcinomatosis, is frequently encountered at CT evaluation. However, a host of other more unusual benign and malignant neoplasms can manifest with peritoneal disease, including both primary and secondary peritoneal processes, many of which can closely mimic peritoneal carcinomatosis at CT. In this review, we discuss a wide array of unusual peritoneal-based neoplasms that can resemble the more common peritoneal carcinomatosis. Beyond reviewing the salient features for each of these entities, particular emphasis is placed on any specific clinical and CT imaging clues that may allow the interpreting radiologist to appropriately narrow the differential diagnosis and, in some cases, make an imaging-specific diagnosis.
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Affiliation(s)
- Perry J Pickhardt
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Alberto A Perez
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Mohab M Elmohr
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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59
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Stebbings C, Latif A, Gnananandan J. Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain. BMJ Case Rep 2021; 14:14/1/e232797. [PMID: 33504515 PMCID: PMC7843348 DOI: 10.1136/bcr-2019-232797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.
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Affiliation(s)
| | - Ahmed Latif
- General Surgery, Lewisham and Greenwich NHS Trust, London, UK
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60
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Dhulaimi MA, Aldarmasi MA. RENAL, PELVIC AND MESENTERIC TUMORS WITH LOW SIGNAL INTENSITY ON T2-WEIGHTED MR IMAGE: A REVIEW. SANAMED 2020. [DOI: 10.24125/sanamed.v15i3.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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61
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Sabrine D, Hafsa E, Omar M, Jahid A, Znati K, Zakia B, Zouaidia F. Retroperitoneal leiomyoma of gynecologic type: a case report and review of the litterature. J Surg Case Rep 2020; 2020:rjaa489. [PMID: 33391639 PMCID: PMC7758995 DOI: 10.1093/jscr/rjaa489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023] Open
Abstract
Retroperitoneal leiomyomas are rare benign tumors with smooth muscle differentiation, with only ~1001 cases reported in the English literature to date. Because of its scarcity and non-specific presentation, the preoperative diagnosis might be challenging. On histology, these neoplasms share the same macroscopic, morphological and phenotypic features with uterine leiomyoma; thus, they are referred to as leiomyoma of gynecologic type. Herein, we describe a case of a voluminous retroperitoneal leiomyoma in a 51-year-old woman with a history of total hysterectomy to raise awareness about this condition, as its differential diagnosis might be challenging.
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Affiliation(s)
- Derqaoui Sabrine
- Department of Pathology, Ibn Sina Teaching Hospital, Rabat, Morocco
| | - Elouazzani Hafsa
- Surgical Department "A", Ibn Sina Teaching Hospital, Rabat, Morocco
| | - Mkira Omar
- Surgical Department "A", Ibn Sina Teaching Hospital, Rabat, Morocco
| | - Ahmed Jahid
- Department of Pathology, Ibn Sina Teaching Hospital, Rabat, Morocco
| | - Kaoutar Znati
- Department of Pathology, Ibn Sina Teaching Hospital, Rabat, Morocco
| | - Bernoussi Zakia
- Department of Pathology, Ibn Sina Teaching Hospital, Rabat, Morocco
| | - Fouad Zouaidia
- Department of Pathology, Ibn Sina Teaching Hospital, Rabat, Morocco
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Reis Soares R, Ferber Drumond L, Soares da Mata D, Miraglia Firpe L, Tavares Mendonça Garretto JV, Ferber Drumond M. Cardiac metastasizing leiomyoma: A case report. Int J Surg Case Rep 2020; 77:647-650. [PMID: 33395865 PMCID: PMC7708872 DOI: 10.1016/j.ijscr.2020.11.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cardiac intracavitary growth of metastasizing tumour is unusual. Benign Metastasizing Leiomyoma (BML) from the uterus to the heart is extremely rare. It affects premenopausal women with a history of uterine leiomyoma. PRESENTATION OF CASE We report a case of a 42-year-old woman who presented three tumours in the right side of the heart, two years after a hysterectomy due to leiomyomatosis. The cardiac tumours were resected and the diagnosis was uterine leiomyoma. DISCUSSION The patient developed cardiac failure due to three masses at the right side of the heart. Cardiac involvement in BML is usually asymptomatic and rare. The heart masses were surgically removed and a peri ovarian mass was detected and also removed. Although histologically benign, BML exhibits metastatic qualities. CONCLUSION It suggests that BML should be included as a differential diagnosis when a female patient presents an intra cardiac mass and a history of hysterectomy.
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Affiliation(s)
| | | | | | | | | | - Matheus Ferber Drumond
- Biocor Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazilian Society of Cardiac Surgery, Brazil
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63
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Adair LB. CT findings of pathology proven benign metastasizing leiomyoma. Radiol Case Rep 2020; 15:2120-2124. [PMID: 32944110 PMCID: PMC7481490 DOI: 10.1016/j.radcr.2020.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
Benign metastasizing leiomyoma, originally reported in 1934 by Paul Steiner is a rare entity with less than 150 documented cases. While this entity has a favorable prognosis, without proper recognition it could be misdiagnosed as advanced stage metastasis. This case report discusses the relevant imaging findings of a case of benign metastasizing leiomyoma involving a 46-year-old woman which was detected in a preoperative work-up for hysterectomy. The patient presented with chronic cough for 2 years and a history of uterine fibroids. Because benign metastasizing leiomyoma was considered in this patient who presented with lung nodules and pelvic masses, a biopsy of the salient lesions was rapidly performed and enabled pathology to confirm a diagnosis of this entity. This case examines the differential diagnoses associated with multiple pulmonary nodules and provides an example of why the radiologist should consider benign metastasizing leiomyoma in that differential when these findings are identified in perimenopausal women.
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Affiliation(s)
- Luther B. Adair
- Nashville Radiology Partners, 304 S. Jones Blvd., Unit 4377, Las Vegas, NV 89107, USA
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64
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Drolia B, Gupta N, Verma R, Belho ES, Dhawan S. Follow-up 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Evaluation of a Torsion of Uterine Fibroid in an Elderly Female. Indian J Nucl Med 2020; 35:330-332. [PMID: 33642759 PMCID: PMC7905289 DOI: 10.4103/ijnm.ijnm_104_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/04/2022] Open
Abstract
Fibroids are rare in postmenopausal females. Torsion of pedunculated uterine fibroid is also a very rare occurrence in elderly females. We report a rare case of an 84-year-old multiparous, postmenopausal female, a treated case of non-Hodgkin's lymphoma, presenting with a large abdominal mass. The comparative positron emission tomography/computed tomography scan study of the patient revealed that a new mass in the abdomen and pelvis connected with the left adnexa with a pedicle and previously seen fibroid was not visualized on the present scan, thus raising suspicion of torsion of subserosal fibroid. Histopathology confirmed the diagnosis of fibroid.
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Affiliation(s)
- Babita Drolia
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Nitin Gupta
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Ritu Verma
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Ethel Shangne Belho
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Shashi Dhawan
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
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65
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LeGout JD, Bailey RE, Bolan CW, Bowman AW, Chen F, Cernigliaro JG, Alexander LF. Multimodality Imaging of Abdominopelvic Tumors with Venous Invasion. Radiographics 2020; 40:2098-2116. [PMID: 33064623 DOI: 10.1148/rg.2020200047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A broad range of abdominal and pelvic tumors can manifest with or develop intraluminal venous invasion. Imaging features at cross-sectional modalities and contrast-enhanced US that allow differentiation of tumor extension within veins from bland thrombus include the expansile nature of tumor thrombus and attenuation and enhancement similar to those of the primary tumor. Venous invasion is a distinctive feature of hepatocellular carcinoma and renal cell carcinoma with known prognostic and treatment implications; however, this finding remains an underrecognized characteristic of multiple other malignancies-including cholangiocarcinoma, adrenocortical carcinoma, pancreatic neuroendocrine tumor, and primary venous leiomyosarcoma-and can be a feature of benign tumors such as renal angiomyolipoma and uterine leiomyomatosis. Recognition of tumor venous invasion at imaging has clinical significance and management implications for a range of abdominal and pelvic tumors. For example, portal vein invasion is a strong negative prognostic indicator in patients with hepatocellular carcinoma. In patients with rectal cancer, diagnosis of extramural venous invasion helps predict local and distant recurrence and is associated with worse survival. The authors present venous invasion by vascular distribution and organ of primary tumor origin with review of typical imaging features. Common pitfalls and mimics of neoplastic thrombus, including artifacts and anatomic variants, are described to help differentiate these findings from tumor in vein. By accurately diagnosing tumor venous invasion, especially in tumors where its presence may not be a typical feature, radiologists can help referring clinicians develop the best treatment strategies for their patients. ©RSNA, 2020.
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Affiliation(s)
- Jordan D LeGout
- From the Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Ryan E Bailey
- From the Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Candice W Bolan
- From the Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Andrew W Bowman
- From the Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Frank Chen
- From the Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Joseph G Cernigliaro
- From the Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Lauren F Alexander
- From the Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
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66
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Lee E, LaBounty T, Romano M, Agarwal PP. Case of the Season: Intravenous Leiomyomatosis: a Rare Cause of Intracardiac Mass. Semin Roentgenol 2020; 55:226-229. [PMID: 32859339 DOI: 10.1053/j.ro.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Lee
- Department of Radiology, University of Michigan, Ann Arbor, MI.
| | - Troy LaBounty
- Department of Internal Medicine-Cardiology, University of Michigan, UMH Cardiovascular, Ann Arbor, MI
| | - Matthew Romano
- Department of Surgery-Cardiac Surgery, University of Michigan, Ann Arbor, MI
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Intravascular Leiomyomatosis as a Rare Cause of Nonthrombotic Pulmonary Embolism. Case Rep Vasc Med 2020; 2020:6084061. [PMID: 32733736 PMCID: PMC7378625 DOI: 10.1155/2020/6084061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/30/2020] [Indexed: 11/24/2022] Open
Abstract
Intravascular leiomyomatosis (IVL) is a very rare condition. It is characterized by the proliferation of benign smooth muscle cells within vascular structures without invasion of these tissues. Symptoms depend on the site of origin and the extent of invasion. Rarely, this neoplasm is located in the inferior vena cava or in the pulmonary vasculature potentially causing symptoms of dyspnea, chest pain, or syncope. We report the case of a 53-year-old woman who was referred to our hospital with extensive pulmonary embolism comprising of a subtotal occlusion of the right pulmonary artery with extension into the left pulmonary artery. Due to persistent dyspnea (New York Heart Association class II) despite anticoagulation, after a six-week period, imaging was repeated and showed stable findings. As she was not responding to adequate anticoagulant therapy, intima sarcoma of the pulmonary artery was suspected, and a pulmonary endarterectomy (PEA) was performed. A smooth, white, intravascular mass was easily and completely removed. Analysis demonstrated a lesion consisting of cells without atypia, showing expression of alpha-smooth muscle actin (alpha SMA) and desmin with partial expression of estrogen receptor (ER) and progesterone receptor (PR), leading to the diagnosis of intravascular leiomyomatosis. The patient fully recovered. Complete surgical removal of the intravascular tumor is recommended to relieve symptoms and prevent possible complications. Clinicians have to be aware that in unresolved pulmonary embolism, nonthrombotic and rare causes, like an intima sarcoma or intravascular leiomyomatosis, should be considered.
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Thombare P, Chheda P, Parikh R, Shetty R, Verma M, Patkar D. Primary ovarian leiomyoma: Imaging in a rare entity. Radiol Case Rep 2020; 15:1066-1070. [PMID: 32461778 PMCID: PMC7243055 DOI: 10.1016/j.radcr.2020.04.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/22/2022] Open
Abstract
Primary ovarian leiomyoma is a very rare benign mesenchymal tumor arising from the smooth muscle of walls of ovarian blood vessels. It is usually seen between 20 65 years of age. Being asymptomatic in many patients, these are incidentally detected. Ultrasonography and magnetic resonance imaging are preferred modality while imaging these lesions. Hereby we present a case of a 35-year-old female with incidentally detected right ovarian mass lesion which was hypointense on ultrasonography, hypointense on both T1W and T2W images, and on histopathology confirmed as primary ovarian leiomyoma. T1- and T2-weighted hypointensity on MRI with early homogenous postcontrast enhancement help in its diagnosis, though many a time it is difficult to differentiate it from other mesenchymal fibrous tumors such as fibroma and fibrothecoma. Histopathology and immunohistochemistry remain the mainstay in final confirmatory diagnosis. It is important to keep this entity in the differential diagnosis of solid T1 and T2 hypointense lesions of the ovary.
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Affiliation(s)
- Pranav Thombare
- DNB Resident, Nanavati super-speciality Hospital, Mumbai, India
| | - Pooja Chheda
- DNB Resident, Nanavati super-speciality Hospital, Mumbai, India
| | - Rashmi Parikh
- Consultant Radiologist, Nanavati super-speciality Hospital, Mumbai, India
| | - Roshan Shetty
- Consultant Radiologist, Pinnacle Imaging centre, Mumbai, India
| | - Mitusha Verma
- Consultant Radiologist, Nanavati super-speciality Hospital, Mumbai, India
| | - Deepak Patkar
- Consultant Radiologist, Head of Department, Nanavati super-speciality Hospital, Mumbai, India
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Ambrosio M, Raimondo D, Savelli L, Salucci P, Arena A, Borghese G, Mattioli G, Giaquinto I, Scifo MC, Meriggiola MC, Casadio P, Seracchioli R. Transvaginal Ultrasound and Doppler Features of Intraligamental Myomas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1253-1259. [PMID: 31944342 DOI: 10.1002/jum.15213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/05/2019] [Accepted: 12/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe the ultrasound (US) features of intraligamental myomas (IMs) using Morphological Uterus Sonographic Assessment group standardized terminology. METHODS This was a retrospective monocentric study. A total of 125 consecutive women with a preoperative US diagnosis of a myoma located close to the uterine isthmus (International Federation of Gynecology and Obstetrics stages 5, 6, and 7) from 2016 to 2019 who underwent laparoscopic or laparotomic myomectomy or hysterectomy were included for study analyses. The US data were retrieved from US reports and stored digital images by 2 authors. Ultrasound features of myomas were described according to Morphological Uterus Sonographic Assessment terminology. Clinical data for the study population were retrieved from the patients' records. RESULTS Nineteen women with a surgical confirmation of an IM were included in the study group; the remaining population constituted the control group (n = 106). Non-uniform echogenicity was detected in 17 of 19 (89%) of IMs compared to 26 of 106 (25%) fibroids in the control group (P < .001). The presence of shadowing was detected in 12 of 19 (63%) IMs compared to 94 of 106 (89%) cases in the control group (P = .004). Intraligamental myomas were more vascularized tumors compared to myomas in the control group (P = .004). Transvaginal US showed high specificity for the diagnosis of an IM (0.93; 95% confidence interval, 0.87-0.96). CONCLUSIONS On US imaging, IMs appear as vascularized solid tumors with nonuniform echogenicity; cones of shadows were less frequent in IMs than the control group, and this finding can help in the differential diagnosis. Knowledge of their specific US features could help sonographers make an accurate diagnosis, allowing them to plan correct surgery and avoid severe complications.
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Affiliation(s)
- Marco Ambrosio
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Savelli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Salucci
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Arena
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Borghese
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Mattioli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ilaria Giaquinto
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Cristina Scifo
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Cristina Meriggiola
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
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Perina L, Marchi G, Busti F, Avesani G, Parisi A, Girelli D. An unusual case of inferior vena cava thrombosis: widening the differential diagnosis. Intern Emerg Med 2020; 15:673-678. [PMID: 31065882 DOI: 10.1007/s11739-019-02093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 04/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Luisella Perina
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giacomo Marchi
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giacomo Avesani
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologica, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Alice Parisi
- Department of Pathology, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Pai AHY, Lin SL, Yen CF. Isolated Omental Leiomyoma without Prior Surgical History. J Minim Invasive Gynecol 2020; 28:162-163. [PMID: 32450225 DOI: 10.1016/j.jmig.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Angel Hsin-Yu Pai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan (Drs. Pai and Yen); Department of Nursing, Taipei Medical University School of Nursing, Taipei (Dr. Lin), Taiwan
| | - Shu-Ling Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan (Drs. Pai and Yen); Department of Nursing, Taipei Medical University School of Nursing, Taipei (Dr. Lin), Taiwan
| | - Chih-Feng Yen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan (Drs. Pai and Yen); Department of Nursing, Taipei Medical University School of Nursing, Taipei (Dr. Lin), Taiwan.
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Nougaret S, Nikolovski I, Paroder V, Vargas HA, Sala E, Carrere S, Tetreau R, Hoeffel C, Forstner R, Lakhman Y. MRI of Tumors and Tumor Mimics in the Female Pelvis: Anatomic Pelvic Space-based Approach. Radiographics 2020; 39:1205-1229. [PMID: 31283453 DOI: 10.1148/rg.2019180173] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pelvic masses can present a diagnostic challenge owing to the difficulty in assessing their origin and the overlap in imaging features. The majority of pelvic tumors arise from gastrointestinal or genitourinary organs, with less common sites of origin including the connective tissues, nerves, and lymphovascular structures. Lesion evaluation usually starts with clinical assessment followed by imaging, or the lesion may be an incidental finding at imaging performed for other clinical indications. Since accurate diagnosis is essential for optimal management, imaging is useful for suggesting the correct diagnosis or narrowing the differential possibilities and distinguishing tumors from their mimics. Some masses may require histologic confirmation of the diagnosis with biopsy and/or up-front surgical resection. In this case, imaging is essential for presurgical planning to assess mass size and location, evaluate the relationship to adjacent pelvic structures, and narrow differential possibilities. Pelvic US is often the first imaging modality performed in women with pelvic symptoms. While US is often useful to detect a pelvic mass, it has significant limitations in assessing masses located deep in the pelvis or near gas-filled organs. CT also has limited value in the pelvis owing to its inferior soft-tissue contrast. MRI is frequently the optimal imaging modality, as it offers both multiplanar capability and excellent soft-tissue contrast. This article highlights the normal anatomy of the pelvic spaces in the female pelvis and focuses on MRI features of common tumors and tumor mimics that arise in these spaces. It provides an interpretative algorithm for approaching an unknown pelvic lesion at MRI. It also discusses surgical management, emphasizing the value of MRI as a road map to surgery and highlighting anatomic locations where surgical resection may present a challenge. ©RSNA, 2019.
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Affiliation(s)
- Stephanie Nougaret
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Ines Nikolovski
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Viktoriya Paroder
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Hebert A Vargas
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Evis Sala
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Sebastien Carrere
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Raphael Tetreau
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Christine Hoeffel
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Rosemarie Forstner
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Yulia Lakhman
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
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Taraschi G, Aguiar D, Tille JC, Petignat P, Abdulcadir J. Clitoral leiomyoma in a premenopausal woman: a case report. BMC WOMENS HEALTH 2020; 20:89. [PMID: 32357868 PMCID: PMC7195734 DOI: 10.1186/s12905-020-00959-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/22/2020] [Indexed: 12/28/2022]
Abstract
Background Extrauterine leiomyomata is an uncommon lesion that can lead to several problems of differential diagnosis, especially when localized in the external genitalia. There are few reports in the English literature and a novel association with Alport’s syndrome has been investigated since the 1980s. Case presentation Here, we describe the case of a premenopausal woman who presented with an indolent swelling of the right interlabial fossa that resulted in a Bartholin cyst. In addition to this cyst, a benign leiomyoma of the right side of the clitoris was also found and removed. Our patient refused any further examination, although she was informed that genetic counselling could be organized to rule out an association with Alport’s syndrome. Conclusions Extrauterine leiomyomata localized in the external genitalia is an uncommon lesion arising from smooth muscle cells around vascular epithelium or erectile tissue. Since an association between extrauterine leiomyomata and Alport’s syndrome has been described, genetic testing can be proposed to these patients. Upper intestinal tract symptoms such as dysphagia should prompt a gastroenterological evaluation as an association with an esophageal leiomyomatosis has been described.
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Affiliation(s)
- Gianmarco Taraschi
- Department of Obstetrics and Gynaecology, Geneva University Hospitals, 30 Bld de la Cluse, 1211, Geneva, Switzerland.
| | - Diego Aguiar
- Division of Clinical Pathology, Geneva University Hospital, 1 rue Michel-Servet, 1205, Geneva, Switzerland
| | - Jean Christophe Tille
- Division of Clinical Pathology, Geneva University Hospital, 1 rue Michel-Servet, 1205, Geneva, Switzerland
| | - Patrick Petignat
- Department of Obstetrics and Gynaecology, Geneva University Hospitals, 30 Bld de la Cluse, 1211, Geneva, Switzerland
| | - Jasmine Abdulcadir
- Department of Obstetrics and Gynaecology, Geneva University Hospitals, 30 Bld de la Cluse, 1211, Geneva, Switzerland
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A RARE CASE OF A RETROPERITONEAL LEIOMYOMATOSIS. J Gynecol Obstet Hum Reprod 2020; 50:101760. [PMID: 32325271 DOI: 10.1016/j.jogoh.2020.101760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 11/21/2022]
Abstract
Leiomyomas are mostly located in the uterus.Retroperitoneal presentation of leiomyomas are rare and have a greater diagnostic challenge.Because retroperinoteal tumours are quite rare and mostly malignant. Therefore, differantial diagnosis is difficult.We report a rare case of retroperitoneal leiomyomatosis, in which there were concurrent leiomyomas in uterus, pelvic and paraaortic regions that are adjacent to pelvic and paraaortic vascular structures.The patient underwent type 1 hysterectomy and bilateral salpingo-oophorectomy and had a total excision of the myomas from adjacent structures. Histological examination of the surgical specimen revealed that leiomyoma. She has been disease -free for 24 months now.
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Zaidi AZ, Hawley I, Zaidi J. Intravenous leiomyomatosis-a case report. J OBSTET GYNAECOL 2020; 41:996-997. [PMID: 32293219 DOI: 10.1080/01443615.2020.1738362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Z Zaidi
- St George's University of London, London, UK
| | - I Hawley
- Conquest Hospital, East Sussex Healthcare NHS Trust, East Sussex, UK
| | - J Zaidi
- Conquest Hospital, East Sussex Healthcare NHS Trust, East Sussex, UK
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Chrisostomos S, Dimitrios T, Konstantinos Z. Torsion of intestinal parasitic myoma after laparoscopic morcellation: a case report. J Surg Case Rep 2020; 2020:rjaa032. [PMID: 32201556 PMCID: PMC7077677 DOI: 10.1093/jscr/rjaa032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 11/13/2022] Open
Abstract
Uterine fibroids represent the most common type of benign tumor of female genital tract with rate of incidence between 20% and 30% in women older than 35 years. According to current bibliography, the percentage is still increasing due to the fact that many women are postponing their reproductive mapping. Laparoscopic morcellation of uterine fibroids and uterus specimen after hysterectomies has great clinical significance, concerning dissemination and implantation of uterine fragments inside the peritoneal cavity. Parasitic myomas reveal a rare entity, reflecting a broad spectrum of pathogenesis. In cases of parasitic uterine fibroids surgical dissection is mandatory to avoid signs of malignancy.
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Affiliation(s)
- Sofoudis Chrisostomos
- Department of Obstetrics and Gynecology, Konstandopoulio General Hospital, Athens, Greece,Correspondence address. Chrisostomos Sofoudis, Department of Obstetrics and Gynecology, Konstandopoulio General Hospital, Ippokratous Str. 209, 11472 Athens, Greece. E-mail:
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Corbett GA, O'Gorman C, Kamran W. Intravenous leiomyomatosis: the first reported case of intraoperative intracaval embolisation of tumour to the right atrium. BMJ Case Rep 2020; 13:13/3/e233341. [PMID: 32169987 DOI: 10.1136/bcr-2019-233341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Intravenous leiomyomatosis is extremely rare. This case describes a 42-year-old woman who presented with abdominal distension, cyclical bloating and urinary retention. Preoperative imaging showed a multilobulated uterine mass. Following multidisciplinary team discussion, a complete staging surgery consisting of midline laparotomy, total hysterectomy and bilateral salpingo-oophrectomy was performed. Intraoperatively, a large multilobulated uterine mass was noted with engorgement of the infundibulopelvic ligaments due to intravascular extension of tumour. On removal of the uterus, the patient desaturated and became hypotensive. Intraoperative transoesophageal echocardiography revealed mass extending from the inferior vena cava (IVC) into the right atrium (RA). The cardiothoracic surgical team retrieved a worm-like mass extending from the IVC into the RA. Histopathological examination diagnosed a large uterine leiomyoma with intravenous leiomyomatosis. The mass from the RA was a bland spindle cell tumour which matched the uterine mass histopathologically. Intravenous leiomyomatosis is a rare variant of uterine leiomyoma. Although intracardiac extension has been described, this is the first case of intraoperative embolisation of pelvic tumour to the RA at hysterectomy.
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Affiliation(s)
- Gillian A Corbett
- Department of Gynaecological Surgery, Saint James's Hospital, Dublin, Ireland
| | - Catherine O'Gorman
- Department of Gynaecological Surgery, Saint James's Hospital, Dublin, Ireland.,Department of Gynaecology, Trinity College Dublin, Dublin, Ireland
| | - Waseem Kamran
- Department of Gynaecological Surgery, Saint James's Hospital, Dublin, Ireland
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Miller H, Lammie JL, Noche-Dowdy L, Nyárádi Z, Gonciar A, Bethard JD. Differential diagnosis of calcified nodules from a medieval Székely woman in Transylvania. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 28:42-47. [PMID: 31923824 DOI: 10.1016/j.ijpp.2019.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 12/21/2019] [Accepted: 12/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To differentially diagnose two calcified objects found with the well-preserved and nearly complete skeletal remains excavated in June 2012 by the Haáz Rezső Múzeum in Odorheiu Secuiesc, Romania. MATERIAL Two objects measuring 25.55 × 18.23 mm and 17.62 × 16.38 mm found with the skeletal remains of a probable female approximately 25-35 years old at the time of death. METHODS Analysis utilized X-ray, SEM, EDS, CT scanning, and gross morphology to assess pathological conditions with calcification as a common sign. RESULTS Multiple analyses of the objects revealed two roughened ovoid nodes with internal hollows and openings. Elemental analysis indicated an organic origin, likely representing calcified soft tissue. CONCLUSIONS Differential diagnosis determined the calcified nodules to be consistent with calcified tumors, and most consistent with a calcified leiomyoma with cystic degeneration, potentially uterine. SIGNIFICANCE The identification of the calcified nodules as most consistent with calcified uterine leiomyomas adds to the paucity of paleopathological literature on calcified leiomyomas and calcified tumors more broadly. It also allows for an important discussion of the health of women in medieval Transylvania. LIMITATIONS Interpretation would be aided if a more precise origination within the body was known. Careful excavation and improved recognition of organic objects is necessary for a more definite diagnosis. SUGGESTIONS FOR FURTHER RESEARCH Soft tissue calcifications are a common process in a wide variety of diseases and can arise in all areas of the body. Pathological calcifications are relatively common in modern contexts, but remain rare in paleopathological literature.
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Affiliation(s)
- Heidi Miller
- Department of Anthropology, University of South Florida, Tampa, FL, 33620, United States.
| | - Jean Louise Lammie
- Department of Anthropology, University of South Florida, Tampa, FL, 33620, United States
| | - Liotta Noche-Dowdy
- Department of Anthropology, University of South Florida, Tampa, FL, 33620, United States
| | - Zsolt Nyárádi
- Haáz Rezső Múzeum, Strada Beclean 2-6, Odorheiu Secuiesc, 535600, Romania
| | | | - Jonathan D Bethard
- Department of Anthropology, University of South Florida, Tampa, FL, 33620, United States
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Abstract
This article provides an overview of the imaging evaluation of benign ovarian and adnexal masses in premenopausal and postmenopausal women and lesions discovered during pregnancy. Current imaging techniques are discussed, including pitfalls and differential diagnosis when necessary, as well as management. It also reviews the now well-established American College of Radiology (ACR)/Society of Radiologists in Ultrasound consensus guidelines and covers the more recently introduced Ovarian-Adnexal Reporting and Data System by the ACR and the recently published ADNEx Scoring System.
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Affiliation(s)
- Nadia J Khati
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA.
| | - Tammy Kim
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
| | - Joanna Riess
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
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81
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Soni S, Pareek P, Narayan S. Disseminated peritoneal leiomyomatosis: an unusual presentation of intra-abdominal lesion mimicking disseminated malignancy. Med Pharm Rep 2020; 93:113-116. [PMID: 32133455 PMCID: PMC7051819 DOI: 10.15386/mpr-1421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/04/2019] [Accepted: 10/05/2019] [Indexed: 11/23/2022] Open
Abstract
Leiomyoma are commonly seen as benign smooth muscle tumors of the uterus. Smooth muscle tumors with unusual growth pattern are rare and include 3 primary neoplasms: intravenous leiomyomatosis (IVL), benign metastasizing leiomyoma (BML) and disseminated peritoneal leiomyomatosis (DPL). DPL is a rare benign disease, often giving the appearance of metastatic ovarian or peritoneal carcinoma. It is a disease that predominately affects women at their reproductive age. The risk of malignant transformation is 2–5%. There are no standard treatment guidelines for the management of the DPL. The unusual presentation of the disease delays the diagnosis or is often misdiagnosed and thus over treated, which may lead to increased morbidity and mortality. Therefore careful consideration and high index of suspicion is required for the proper management of such cases.
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Affiliation(s)
- Sweta Soni
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Puneet Pareek
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Satya Narayan
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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82
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Kang HW, Shin JY, Choi JW. Primary Angiosarcoma of the Mesentery: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:423-427. [PMID: 36237378 PMCID: PMC9431807 DOI: 10.3348/jksr.2020.81.2.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/10/2019] [Accepted: 08/04/2019] [Indexed: 11/15/2022]
Abstract
혈관육종은 림프관 및 혈관 내피세포에서 기원하는 피부와 연부조직에서 흔히 발생하는 악성종양으로, 장간막에서 발생한 혈관육종은 드물게 보고되어 왔다. 저자들은 CT와 MRI에서 점진적으로 조영증강되는 종괴로 내부에 출혈과 괴사 부분을 포함한 원발성 장간막 혈관육종의 1예를 경험하여 이를 보고하는 바이다.
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Affiliation(s)
- Hyeon Wook Kang
- Department of Radiology, Daegu Fatima Hospital, Daegu, Korea
| | - Ji Yeol Shin
- Department of Radiology, Daegu Fatima Hospital, Daegu, Korea
| | - Ju Wan Choi
- Department of Radiology, Daegu Fatima Hospital, Daegu, Korea
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83
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Demir Çaltekin M, Onat T, Aydoğan Kırmızı D, Başer E. An Unusual Localization of Leiomyoma: Vaginal Leiomyoma. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.661422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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84
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Kothandaraman K, Dorairajan G, Subbaiah M, Dorairajan LN, Badhe BA, Keepanasseril A. Recurrent leiomyoma of the vulva mimicking peripheral nerve sheath tumour. BMJ Case Rep 2019; 12:12/12/e232065. [PMID: 31818892 DOI: 10.1136/bcr-2019-232065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Leiomyoma, a benign monoclonal tumour, is very rarely found in extrauterine sites, especially in the vulval region. Histopathology of the soft tissue tumours affecting this region is similar and immunohistochemistry (IHC) may be essential to confirm the diagnosis. We report a case of a 63-year-old postmenopausal woman who presented with a recurrent vulval mass involving the clitoris and left labia majora with suspected urethral involvement. Although the wedge biopsy was reported as peripheral nerve sheath tumour, staining with smooth muscle actin clinched the diagnosis of leiomyoma, highlighting the importance of IHC for diagnosis.
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Affiliation(s)
- Keerthana Kothandaraman
- Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gowri Dorairajan
- Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Murali Subbaiah
- Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - L N Dorairajan
- Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Bhawana A Badhe
- Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Anish Keepanasseril
- Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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85
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Abstract
RATIONALE Pulmonary benign metastasizing leiomyoma (PBML) is rare, usually occurs in women who underwent hysterectomy during the reproductive years, and has no obvious clinical symptoms. A full understanding of the characteristics of PBML is important for its sequential treatment and prognosis. PATIENT CONCERNS In this report, a 36-year-old female patient with previous uterine leiomyoma who underwent 3 surgical resections of the uterus, bilateral fallopian tubes, and partial omentum was investigated. The physical examination revealed a tumor in the right lower lobe and mediastinum and a solid nodule in the right middle lobe. DIAGNOSES Chest computed tomography (CT) confirmed a tumor in the right lower lobe and mediastinum and a solid nodule in the right middle lobe. Further positron-emission tomography computed tomography (PET-CT) with 18F-fluorodeoxyglucose (FDG) of the whole body showed mildly intense accumulation of 18F-FDG in the tumor (maximum standardized uptake value [SUV max], 2.6). A pathological examination then confirmed the presence of fibrous and vascular tissue after CT-guided percutaneous biopsy of the tumor in the right lower lobe. Additionally, surgical resection of the tumor and nodule was performed for histological analysis and immunohistochemical assays for estrogen receptor (ER) and progesterone receptor (PR). INTERVENTIONS The patient underwent complete tumor surgical resection and nodule wedge resection. OUTCOMES No postoperative complications occurred. No recurrence or other signs of metastasis were found during an 18-month follow-up observation period. CONCLUSION In this case, lung and mediastinal metastasis of uterine fibroids was observed. However, depending on only a postoperative histological analysis is insufficient for the diagnosis of PBML. Histological analysis combined with an evaluation of the expression levels of ER and PR is crucial for the diagnosis and treatment of PBML.
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Affiliation(s)
| | | | | | - Yuwei Guo
- Department of pathology, Hebei Medical University Fourth Hospital
| | - Mengdi Cong
- Department of pathology, Children's hospital of Hebei Province, Shijiazhuang, China
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86
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Dhawan K, Bansal N, Gupta NM, Dhawan S. Clinical progression of renal vein leiomyoma: A case report. Int J Surg Case Rep 2019; 65:249-254. [PMID: 31734478 PMCID: PMC6864330 DOI: 10.1016/j.ijscr.2019.10.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/19/2019] [Accepted: 10/29/2019] [Indexed: 11/05/2022] Open
Abstract
Vascular smooth muscle tumours are rare entities. Majority of these are malignant. Differentiation between a vascular – leiomyoma and a leiomyosarcoma is chiefly upon histopathological examination. Imaging alone is non-contributory. The rarity of the tumour makes predicting the prognosis a challenging prospect. Renal Leiomyomas do not show aggressive behaviour and excellent prognosis is predicted post nephrectomy. An eight-year long charting of progress of leiomyoma in our case has demonstrated the non-malignant potential of such tumours.
Introduction Vascular leiomyoma originating in the renal vein is a rare entity. Our case allowed us charting of progression of renal vein leiomyoma for 8-years’ duration. Apart from intraluminous growth causing displacement of viscera, the leiomyoma did not show any aggressive behaviour. Eventually, removal of the tumour through nephrectomy provided complete symptomatic relief to our patient. Case presentation A 75-year old female presented with an eight-year long history of severe pain in right flank. CT imaging revealed a mass arising from the right renal vein and a few hepatic tumours. The differentials included leiomyosarcoma, in view of hepatic lesions. Excision of the tumour was performed with radical nephrectomy. Immunohistopathological examination confirmed it to be a case of leiomyoma. Three months post-op, the patient reported complete pain relief and no adverse events, and there were no signs of recurrence. Discussion and conclusion Vascular leiomyomas do not show any aggressive behaviour. However, their growth tends to displace the normal viscera, causing pressure effects that may give rise to intractable pain. Vascular obstruction affects GFR and renal function. In our patient, despite a long period of growth, the tumour did not show any malignant changes. Tumour excision through radical nephrectomy resulted in symptomatic improvement in our patient. Since imaging alone does not distinguish a leiomyoma from its malignant counterpart with certainty, surgical excision may be warranted in all the cases.
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Affiliation(s)
- Kuldeep Dhawan
- Dhawan Hospital, Plot #1, Sector 7, Panchkula, Haryana, 134109, India.
| | - Nakul Bansal
- Dhawan Hospital, Plot #1, Sector 7, Panchkula, Haryana, 134109, India.
| | - N M Gupta
- Dhawan Hospital, Plot #1, Sector 7, Panchkula, Haryana, 134109, India.
| | - Simran Dhawan
- Dhawan Hospital, Plot #1, Sector 7, Panchkula, Haryana, 134109, India.
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87
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Chin CH, Chen TH. A tumor mass from inferior vena cava extending to right atrium. Kaohsiung J Med Sci 2019; 36:71-72. [PMID: 31571394 DOI: 10.1002/kjm2.12133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/26/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Chih-Hui Chin
- Cardiovascular Center, Cathay General Hospital, Taipei, Taiwan
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88
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Withers A, Mitchell A, Holsten S. Surgical Management of a Parasitic Leiomyoma within a Ventral Hernia. Am Surg 2019. [DOI: 10.1177/000313481908500904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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89
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Nguyen TC, Drew PA, Dang LH, Yuan C. Cancer Genes Mutations in Benign Metastasizing Leiomyoma: A Case Report. Cureus 2019; 11:e5154. [PMID: 31523581 PMCID: PMC6741366 DOI: 10.7759/cureus.5154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Benign metastasizing leiomyoma is a very uncommon clinicopathologic entity with unknown molecular pathogenesis. We present a case of a 40-year-old woman who has a history of surgical resection of a large uterine leiomyoma and then subsequently presented with benign metastasizing leiomyomas to her lungs. Due to her tumor being estrogen receptor (ER) positive and progesterone receptor (PR) positive, she was empirically treated with anastrozole with sustained clinical benefit. Molecular studies with Foundation One testing showed low mutational burden and mutational variants in five known cancer genes. Our findings have important clinical and pathogenetic implication for metastasizing uterine leiomyoma.
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Affiliation(s)
- Thu-Cuc Nguyen
- Internal Medicine, University of Central Florida, Orlando, USA
| | - Peter A Drew
- Pathology, University of Florida, Gainesville, USA
| | - Long H Dang
- Hematology and Oncology, Ochsner Health System, Baton Rouge, USA
| | - Cai Yuan
- Hematology and Oncology, University of Florida, Gainesville, USA
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90
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Barnaś E, Raś R, Skręt-Magierło J, Wesecki M, Filipowska J, Książek M, Skręt A, Widenka K. Natural history of leiomyomas beyond the uterus. Medicine (Baltimore) 2019; 98:e15877. [PMID: 31232922 PMCID: PMC6636938 DOI: 10.1097/md.0000000000015877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Most leiomyomas are located in the uterus. Leiomyomas are rarely found outside the uterus and classified as leiomyoma beyond the uterus (LBU). This group consists of disseminated peritoneal leiomyomatosis, benign metastasizing leiomyoma, intravenous leiomyomatosis, parasite leiomyoma located in the broad ligament and retroperitoneal space. The descriptions of the patients who suffer from these types of leiomyomas are presented mainly in case reports. PATIENT CONCERNS A 34-year-old multiparous woman was operated on multiple recurrent uterine leiomyoma in parametrium. At one time, 32 leiomyomas were removed. Thirteen months following it, in next laparotomy, 132 leiomyomas were excised. Histologically, both were intravenous leiomyomas (IVLs). DIAGNOSIS AND INTERVENTIONS In follow-up, computed tomography (CT) and magnetic resonance imaging scans were performed to look for next recurrent leiomyoma. Accidentally, the mass was found in inferior vena cava which was diagnosed as intravenous vena cava leiomyoma. The mass was removed and the final diagnosis of intravenous myoma was confirmed in histopathology. OUTCOMES CT scan performed 3 months after the surgery for leiomyoma in vena cava revealed no pathology. Next 10 months' follow-up was uneventful. LESSONS The recurrent multiple uterine leiomyoma precede LBU. The uterine leiomyoma spreads intravenously route to parametria as parasite leiomyoma, then to vena cava. It has to be taken into account in follow-up.
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Affiliation(s)
| | - Renata Raś
- Department of Physics, Rzeszow University of Technology
| | | | - Mariusz Wesecki
- Oncology Surgery Department, Specialist Hospital in Brzozów, Podkarpacki Oncological Center, Brzozów
| | - Justyna Filipowska
- Chair of Electroradiology, Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszow
| | - Mariusz Książek
- Clinical Department of Pathology, Frederick Chopin Clinical Provincial Hospital No 1
| | - Andrzej Skręt
- Obstetrics and Gynecology Clinic, Medical Faculty, University of Rzeszow, Rzeszow
| | - Kazimierz Widenka
- Clinical Department of Cardiac Surgery, Medical Faculty, University of Rzeszów, Rzeszów, Poland
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91
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Hernández-Plata E, Velázquez-Wong AC, Jiménez-Ramírez C, Fernández-Ramírez F, Galicia-Sánchez LM, Flores-García CA, Hernández-Hernández JM, Rosas-Vargas H, Huicochea-Montiel JC, Espinosa-Poblano E. Identification of genomic copy number variations in lung benign metastasizing leiomyomatosis. CLINICAL RESPIRATORY JOURNAL 2019; 13:105-113. [PMID: 30597752 DOI: 10.1111/crj.12987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/01/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Lung metastasizing leiomyomatosis (LML) is an infrequently diagnosed pathology developed after sexual maturation, commonly preceded by uterine myomas. Symptoms can include difficulties to breathe, cough, dyspnea and pain, because of mechanical obstruction exerted by expanding local growing leiomyomas. Lung leiomyomas are normally detected by imaging studies, but nowadays the precise diagnosis demands histological characterization of biopsies obtained from the affected tissues. The purpose of the present study was to determine the presence of genomic alterations in circulating cells of LML. METHODS Immunohistochemical characterization of a lung biopsy extracted by thoracoscopy was performed. Pathologic proliferative smooth muscle cells were observed in a major lung metastasizing nodule, with a growing pattern similar to a uterine myoma. The presence of cellular linages different to smooth muscle cells was discarded by testing the presence of a battery of molecular markers. Also, a normal karyotype was determine by GTG-banding cytogenetic study, but a high density microarray analysis revealed six submicroscopic chromosomal regions displaying genomic abnormalities: microduplications were detected on chromosomes 4, 14, 17 and 22; and microdeletions on chromosomes 8 and 10. CONCLUSION This study remarks the relevance of submicroscopic chromosomal analysis of unusual pathologic conditions such as Benign Metastasizing Leiomyomatosis. This propitiate a better understanding of the molecular basis on the development of the pathology, in order to reckon on minimally invasive diagnostic methods, and to design appropriate treatments.
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Affiliation(s)
- Everardo Hernández-Plata
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social IMSS, Ciudad de México, México.,Departamento de Neuropatología Molecular, Instituto de Fisiología Celular, UNAM, Ciudad de México, México
| | - Ana Claudia Velázquez-Wong
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social IMSS, Ciudad de México, México
| | - Carmina Jiménez-Ramírez
- Unidad Médica de Alta Especialidad, Hospital de traumatología, Dr. Victorio de la Fuente Narváez Instituto Mexicano del Seguro Social IMSS, Ciudad de México, México
| | | | - Luz María Galicia-Sánchez
- Servicio de Neumología, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
| | - César Antonio Flores-García
- Departamento de Patología, Unidad Médica de Alta Especialidad, Hospital de Cardiología del Centro Médico Nacional, Siglo XXI, IMSS, Ciudad de México, México
| | - José Manuel Hernández-Hernández
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social IMSS, Ciudad de México, México
| | - Haydeé Rosas-Vargas
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social IMSS, Ciudad de México, México
| | - Juan Carlos Huicochea-Montiel
- Departamento Clínico de Genética Médica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Eliseo Espinosa-Poblano
- Servicio de Neumología, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional, Siglo XXI, IMSS, Ciudad de México, México
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92
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Psichogios CI, Chatziioannou AN, Klapa IH, Psichogios DI, Antoniou AG. Leiomyoma of the Retzius space in a male patient: A case report and a diagnostic approach to Retzius space diseases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:51-54. [PMID: 30374998 DOI: 10.1002/jcu.22654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
Retzius space is a small anatomical compartment located directly posterior to the pubic symphysis and anterior to the urinary bladder. Diseases developing primarily in this space are rare; only 7 cases of leiomyomas of the Retzius space have been reported in the literature so far, all of them in female patients. We present a unique case of a leiomyoma of the Retzius space in a male patient. An imaging-based diagnostic approach to Retzius space disease is proposed.
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Affiliation(s)
- Christos I Psichogios
- 1st department of Radiology, "Aretaieion" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Achilles N Chatziioannou
- 1st department of Radiology, "Aretaieion" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Ioanna H Klapa
- 1st department of Radiology, "Aretaieion" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Dimitris I Psichogios
- 2nd department of Surgery, "Aretaieion" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Aristides G Antoniou
- 1st department of Radiology, "Aretaieion" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
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93
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Anand A, Choudhary A, Dougall P, Bansal B, Chawla M. Parasitic Leiomyoma on PET-CT in A Suspected Case of Uterine Sarcoma - Report on Diagnosis and Management. Indian J Nucl Med 2019; 34:332-334. [PMID: 31579245 PMCID: PMC6771215 DOI: 10.4103/ijnm.ijnm_52_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case is a very good example of how a multimodality approach was taken in diagnosis and management of patient with suspected uterine sarcoma, which turned out to be uterine leiomyoma with parasitic leiomyoma mimicking the pararenal deposit. There has been an increased use of fluorodeoxyglucose avid positron emission tomography-computed tomography in pelvic malignancies, especially in the cases where there is suspected extrapelvic spread. It was an interesting finding of parasitic leiomyoma, which can be easily thought to be as deposit/mass in a patient with pelvic malignancy.
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Affiliation(s)
- Anuja Anand
- Department of Nuclear Medicine and PET-CT, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Amish Choudhary
- Department of Oncosurgery, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Pankaj Dougall
- Department of Nuclear Medicine and PET-CT, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Bhavna Bansal
- Department of Pathology, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Madhavi Chawla
- Department of Nuclear Medicine and PET-CT, Max Super Speciality Hospital, Saket, New Delhi, India
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94
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Gerashchenko AV, Filonenko TG, Golubinskaya EP, Kalfa MA, Kriventsov MA. Morcellation-Induced Leiomyomatosis Peritonealis Disseminata: A Rare Case Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2019; 44:60-64. [PMID: 30666077 PMCID: PMC6330526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is a benign disease characterized by the presence of multiple small nodules on the omentum, parietal, and visceral peritoneum. It corresponds to leiomyoma and often resembles metastases of malignant tumors; however, with favorable prognosis. Here we describe a 46-year-old woman, diagnosed with LPD, to demonstrate the etiopathogenesis of the developed leiomyomatosis following endoscopic extirpation of the uterus with the use of a power morcellator. The patient was operated for diffuse leiomyoma using a power morcellator. Six months later, during a follow-up visit, disseminated tumor nodes on the peritoneum were revealed. Histological and immunohistochemical (smooth muscle α-actin, vimentin, estrogen receptors, progesterone receptors, and Ki67) study confirmed the diagnosis of LPD. As part of the follow-up, certain regression of the tumor nodes was noted against the backdrop of the onset of menopause and the corresponding decline of estrogen levels. Currently, the prognosis is favorable and follow-up is ongoing. Such cases are rare, but the condition is particularly important due to its iatrogenic nature. It has attracted the attention of the Food and Drug Administration (FDA) because power morcellation is probably associated with the risk of spreading suspected cancerous tissue. The existing high risk of iatrogenic LPD formation indicates the need for detailed reporting of all similar clinical cases, including the established pathogenetic and pathomorphological mechanisms of this process to prevent morcellator-related complications.
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95
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Wu YH, Lee YT, Lee CI, Tzeng YH, Wei J. Nonthrombotic pulmonary embolism caused by intravenous leiomyomatosis: A case report. Medicine (Baltimore) 2019; 98:e14118. [PMID: 30653137 PMCID: PMC6370129 DOI: 10.1097/md.0000000000014118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
RATIONALE Pulmonary embolism is a potentially devastating medical condition. Although deep-vein thrombosis is the most common etiology, a nonthrombotic pulmonary embolism is not uncommon. PATIENT CONCERNS A 45-year-old woman was admitted to our hospital for progressive effort dyspnea for 3 weeks. DIAGNOSIS Echocardiography revealed a mobile mass extending from the right atrium to the bilateral proximal pulmonary artery. As the mass was no response to thrombotic therapy, intravenous leiomyomatosis was suspected. Computed tomography (CT) revealed a hypo-attenuated tumor extending from the ovarian vein to the pulmonary artery. INTERVENTIONS A 1-stage operation for the surgical removal of the tumor, right salpingo-oophorectomy and subtotal hysterectomy were performed. Surgical specimen was identified as uterine leiomyomatosis without malignant transformation. OUTCOMES The patient was followed- up for 2 years and subsequent CT did not reveal any notable lesions. LESSONS Nonthrombotic pulmonary embolism is a potentially life-threatening complication. This case indicated intravenous leiomyomatosis should be considered in the differential diagnosis for certain cases. Complete surgical excision was the only curative treatment.
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Affiliation(s)
- Yi-Hsiao Wu
- Department of Cardiovascular Surgery, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung City
| | | | - Chuin-I Lee
- Department of Surgery, Da Chien General Hospital, Miaoli City
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging, Health Management Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng-Hsin General Hospital, Taipei
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96
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Benton A, Sood S, Wagner S, Newell J, Harkins G. Disseminated Peritoneal Leiomyomatosis Following Hysteroscopic Leiomyoma Morcellation. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Benton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Shelly Sood
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
| | - Stephen Wagner
- Departments of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Jordan Newell
- Departments of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Gerald Harkins
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
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97
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Mousa HM, Al-Salam SA, Abdullah A, Abu-Zidan FM. Primary anterior abdominal wall leiomyoma in a pregnant woman. ANZ J Surg 2018; 89:E527-E528. [PMID: 30239100 DOI: 10.1111/ans.14855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/04/2018] [Accepted: 08/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hussam M Mousa
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Suhail A Al-Salam
- Department of Histopathology, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
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98
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Paul PG, Shintre H, Mehta S, Gulati G, Paul G, Mannur S. Parasitic Myomas: An Unusual Risk after Morcellation. Gynecol Minim Invasive Ther 2018; 7:124-126. [PMID: 30254954 PMCID: PMC6135166 DOI: 10.4103/gmit.gmit_36_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 24-year-old unmarried woman had undergone laparoscopic myomectomy for single degenerated myoma of size 15 cm. Uncontained morcellation of the myoma was done with an electromechanical morcellator. Two years later, she presented with abdominal pain, and laparoscopy revealed enlarged uterus (20 weeks) with multiple degenerated myomas. There were multiple parasitic myomas measuring 1-3 cm in the pelvis and anterior abdominal wall which were removed laparoscopically. Histopathology of all the myomas including parasitic myomas confirmed the diagnosis of leiomyoma. The formation of parasitic myomas was assumed to be due to the myomatous fragments which were left behind during morcellation at the time of initial myomectomy. Methods to prevent this complication are colpotomy, mini-laparotomy, or in-bag morcellation.
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Affiliation(s)
- P G Paul
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
| | - Hemant Shintre
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
| | - Santwan Mehta
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
| | - Gunjan Gulati
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
| | - George Paul
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
| | - Sumina Mannur
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
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99
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Virarkar M, de Castro Faria S, Patnana M, Zhang M, Sagebiel T. Leiomyoma of the Prostate: Case Report and Review of the Literature. Clin Genitourin Cancer 2018; 16:e771-e776. [DOI: 10.1016/j.clgc.2018.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/24/2018] [Accepted: 01/27/2018] [Indexed: 01/02/2023]
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100
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Ferrario L, Zerbi P, Angiolini MR, Agarossi A, Riggio E, Bondurri A, Danelli P. Leiomyomatosis peritonealis disseminata: A case report of recurrent presentation and literature review. Int J Surg Case Rep 2018; 49:25-29. [PMID: 29933173 PMCID: PMC6010956 DOI: 10.1016/j.ijscr.2018.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/25/2018] [Accepted: 06/10/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Leiomyomatosis peritonealis disseminata (LPD) is an uncommon disease featured by the presence of multiple nodules of smooth muscle cells scattered in the abdominal cavity. To date only about 150 cases have been reported in literature. We report a case of recurrent LPD after laparotomy. CASE PRESENTATION In March 2016 a 36-year-old female, with a history of multiple previous laparoscopic myomectomies, consulted her gynaecologist complaining abdominal pain; a MRI was performed and reported multiple pelvic masses, subsequently excised during laparotomy. The patient refused a total hysterectomy with bilateral salpingo-oopherectomy so a close follow-up was recommended. In November 2017 when a new MRI revealed recurrency of the disease, a second laparotomy is performed and all visible nodules are excised. The histological exam confirms LPD diagnosis. On follow-up after three months the patients is completely asymptomatic. DISCUSSION Differential diagnosis of LPD is challenging due to its similarity to carcinomatosis and to other benign abdominal disorders. Malignant transformation is rare, but it may occur, so a close follow-up is necessary. Even if there is no consensus regarding the treatment, hormonal therapy is probably the best first line approach, while surgery should be the second choice. CONCLUSIONS LPD is an uncommon but potentially severe disease. In our opinion larger studies are necessary to improve our diagnostic effectiveness and to define the best therapeutic strategy.
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Affiliation(s)
- Luca Ferrario
- Department of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", "Luigi Sacco" University Hospital, Università degli Studi di Milano, 20157 Milan, Italy.
| | - Pietro Zerbi
- Department of Pathology, Department of Biomedical and Clinical Sciences "Luigi Sacco", "Luigi Sacco" University Hospital, Università degli Studi di Milano, 20157 Milan, Italy
| | - Maria Rachele Angiolini
- Department of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", "Luigi Sacco" University Hospital, Università degli Studi di Milano, 20157 Milan, Italy
| | - Alberto Agarossi
- Department of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences "Luigi Sacco", "Luigi Sacco" University Hospital, Università degli Studi di Milano, 20157 Milan, Italy
| | - Eliana Riggio
- Department of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", "Luigi Sacco" University Hospital, Università degli Studi di Milano, 20157 Milan, Italy
| | - Andrea Bondurri
- Department of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", "Luigi Sacco" University Hospital, Università degli Studi di Milano, 20157 Milan, Italy
| | - Piergiorgio Danelli
- Department of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", "Luigi Sacco" University Hospital, Università degli Studi di Milano, 20157 Milan, Italy
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