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He S, Jiang J. Clinical characteristics and treatment outcomes of angioleiomyoma of the female genital tract: a retrospective cohort study. BMC Womens Health 2024; 24:479. [PMID: 39217279 PMCID: PMC11365262 DOI: 10.1186/s12905-024-03322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Angioleiomyoma, a benign tumour composed of smooth muscle cells and thick-walled vessels, is expected to be very rare in the female genital tract. This study aimed to describe the clinicopathological features and treatment outcomes of angioleiomyoma in the female genital tract. METHODS We retrospectively reviewed 89 women with angioleiomyoma in the genital tract who were treated at Third Xiangya Hospital of Central South University between July 2008 and October 2023. Symptom remission rate was the primary outcome of the study. RESULTS Angioleiomyomas accounted for 0.6% of leiomyomas of the female genital tract. The average age of the 89 women was 41.8 ± 8.7 years. Seventy women (78.7%) had a history of uterine surgery, of whom two patients had removed uterine angioleiomyoma by laparoscopic myomectomy. The angioleiomyomas of 61 (68.5%) women were located in the uterine corpus, 17 (19.1%) in the broad ligament, 10 (11.2%) in the cervix and only 1 (1.1%) in the vagina. Abnormal uterine bleeding was the main clinical manifestation of angioleiomyomas located in the uterine corpus or cervix, whereas the main clinical manifestation of angioleiomyomas in the broad ligaments was pelvic mass. Of the 89 women, 59 underwent surgery to preserve the uterus, and 30 underwent total hysterectomy or subtotal hysterectomy. The intraoperative blood loss was more than 500 ml (700-4,500 ml) in six women. The symptom remission rate was 100% after surgery. Among the 59 women with preserved uterus, 8 showed multiple uterine leiomyomas during follow-up, but it was difficult to determine whether they were angioleiomyomas. Angioleiomyomas recurred in one women who underwent total hysterectomy. CONCLUSION Angioleiomyoma is rare in the female reproductive tract, and patients may present with diverse symptoms, which are related to the location of the tumour. Hysterectomy and myomectomy are both effective treatment methods, but the risk of intraoperative bleeding should be recognised for multiple lesions and those with large diameters. Relapse may occur in some patients.
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Affiliation(s)
- Sili He
- Department of Gynecology, The Third Xiangya Hospital of Central South University, NO. 138 Tongzipo, Yuelu District, Changsha, 410013, Hunan, China
| | - Jianfa Jiang
- Department of Gynecology, The Third Xiangya Hospital of Central South University, NO. 138 Tongzipo, Yuelu District, Changsha, 410013, Hunan, China.
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2
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Pham T, Peterson JM, Hasan H, Gomez M. Uterine Angioleiomyoma: Clinical and Histopathologic Differentiation of an Underrecognized Mimicker of Uterine Leiomyoma. Int J Surg Pathol 2024:10668969241256117. [PMID: 39051589 DOI: 10.1177/10668969241256117] [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: 07/27/2024]
Abstract
Angioleiomyoma is an uncommon benign neoplasm of mesenchymal origin that arises from perivascular smooth muscle cells. This soft tissue neoplasm usually occurs in the dermal or subcutaneous tissues of the extremities, head and neck, or trunk with fewer than 40 reported angioleiomyomas arising in the uterine corpus. Herein we report a uterine angioleiomyoma in a 44-year-old G5P4 Hispanic woman with a longstanding history of recurrent abdominal pain, pelvic organ prolapse, abnormal uterine bleeding, anemia, and hypertension. The patient underwent surgical treatment with total laparoscopic hysterectomy with bilateral salpingectomy and a uterosacral ligament suspension. Uterine angioleiomyoma was diagnosed post-operatively based on gross and microscopic features. The location of the uterine angioleiomyoma within the myometrium corresponded with contrast enhancement apparent on preoperative imaging. This and other uterine angioleiomyomas have characteristic imaging, macroscopic, and microscopic features which distinguish it from leiomyoma. Enhancing awareness of this underrecognized entity will facilitate precise diagnosis and thereby enable improved understanding of the clinicopathological characteristics of uterine angioleiomyoma.
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Affiliation(s)
- Tuan Pham
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Joshua M Peterson
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Hasanain Hasan
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mariangela Gomez
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
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3
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Wang Y, Zheng A. A case report of giant uterine angioleiomyoma. Asian J Surg 2024:S1015-9584(24)01221-1. [PMID: 38981755 DOI: 10.1016/j.asjsur.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024] Open
Affiliation(s)
- Yisi Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, 610041, China
| | - Ai Zheng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, 610041, China.
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4
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Sato H, Murakami K, Fujishima R, Otani T, Sakai K, Nishio K, Matsumura N. Uterine angioleiomyoma with disseminated intravascular coagulation: a case report. BMC Womens Health 2023; 23:157. [PMID: 37013521 PMCID: PMC10069044 DOI: 10.1186/s12905-023-02292-5] [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: 06/01/2022] [Accepted: 03/18/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Uterine angioleiomyoma is benign tumor that composed of smooth muscle cells and thick-walled vessels. It is a very rare condition reported to present as lower abdominal mass, accompanied by dysmenorrhea and hypermenorrhea. However, its clinical presentation is not known. CASE PRESENTATION We report the case of a 44-year-old Japanese woman who developed severe anemia with disseminated intravascular coagulation without obvious external bleeding. The patient had a huge abdominal mass of over 20 cm in size, which was thought to be a uterine tumor. She received daily blood transfusions and her condition improved rapidly after she underwent hysterectomy. Pathological examination of the tumor revealed spindle-shaped cells with little atypia and mitosis, and numerous large vessels with smooth muscle and thrombus in the vessels. CONCLUSIONS Uterine angioleiomyoma was identified as the cause of the coagulation abnormality. CCND2 and AR gene amplification was detected in the tumor. Uterine tumors that present with coagulopathy despite a clinical course suggestive of benign disease should undergo differential diagnosis for uterine angioleiomyoma.
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Affiliation(s)
- Hanako Sato
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, Japan
| | - Kosuke Murakami
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, Japan.
| | - Risa Fujishima
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, Japan
| | - Tomoyuki Otani
- Department of Pathology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
- Department of Pathology, Yachiyo Hospital, Anjo, Aichi, Japan
| | - Kazuko Sakai
- Department of Genome Biology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Kazuto Nishio
- Department of Genome Biology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, Japan
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5
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Seth A, Mathur A. Angioleiomyoma of Uterus and Cervix: A Rare Report of Two Cases. J Midlife Health 2021; 12:179-184. [PMID: 34526755 PMCID: PMC8409705 DOI: 10.4103/jmh.jmh_102_19] [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: 07/20/2019] [Revised: 02/22/2021] [Accepted: 05/30/2021] [Indexed: 11/21/2022] Open
Abstract
We report two rare cases of genital angioleiomyomas (ALs), one each of uterus and cervix. The uterine AL showed a very rare presentation of endometrial polyp, while the cervical AL presented as an intramural cervical growth. We have also reviewed the literature and enlisted all uterine and cervical ALs reported till now.
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Affiliation(s)
- Ankit Seth
- Department of Pathology, Kasturba Hospital, New Delhi, India
| | - Anjali Mathur
- Department of Pathology, Kasturba Hospital, New Delhi, India
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6
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A giant superinfected uterine angioleiomyoma with distant septic metastases: an extremely rare presentation of a benign process and a systematic review of the literature. Arch Gynecol Obstet 2019; 300:841-847. [PMID: 31435775 DOI: 10.1007/s00404-019-05267-w] [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: 02/26/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Uterine angioleiomyoma is a rare type of leiomyoma variant and there are few cases reported in the literature. The definitive diagnosis is usually obtained only after the histopathologic examination because there are no specific imaging criteria for this disease. The objective of this article is to review published cases about this clinical condition. METHODS We report a case of giant angioleiomyoma superinfected by S. agalactiae with the development of latero-cervical distant metastasis in a premenopausal woman. Firstly, the case herein reported was orientated as an endometrial stroma sarcoma in the peri-operative histologic examination by frozen sections. It was treated with laparotomic total hysterectomy, bilateral salpingo-oophorectomy, inframesocolic omentectomy and pelvic and paraaortic lymph node dissection. Postoperative definitive anatomopathological analyses using a proper immunohistochemical panel revealed a case of uterine angioleiomyoma. We also review other case reports published about this clinical condition. RESULTS We present the first case reported in the literature, in our knowledge, of a giant angioleiomyoma superinfected by S. agalactiae with the development of distant septic metastases. Immunohistochemistry permitted the definitive diagnosis of angioleiomyoma. Treatments previously reported are hysterectomy or tumor resection and any patient recurred. CONCLUSIONS The definitive diagnosis is usually obtained after the definitive histopathologic examination since the use of immunohistochemical study has an important role in this regard. Complete surgical removal of the lesion is the treatment of choice, with no recurrent cases reported to date.
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7
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Successfully removed uterine angioleiomyoma by robot-assisted laparoscopic myomectomy. Obstet Gynecol Sci 2018; 61:425-429. [PMID: 29780788 PMCID: PMC5956129 DOI: 10.5468/ogs.2018.61.3.425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/05/2017] [Accepted: 07/24/2017] [Indexed: 11/08/2022] Open
Abstract
Angioleiomyoma is a rare type of leiomyoma variant and there are a few cases reported to date. Herein, we present a case of angioleiomyoma in a 36-year-old woman with lower abdominal pain, initially diagnosed by degenerated uterine leiomyoma. The transvaginal ultrasonogram showed an ovoid-shaped heterogeneously hyperechoic lesion in left cornual site of uterus and pelvic magnetic resonance image showed an about 5.1 cm sized heterogenous T2 intermediate high mass with poor enhancement. The patient underwent a robot-assisted laparoscopic myomectomy, and final histopathologic diagnosis revealed uterine angioleiomyoma. This case is the first case of angioleiomyoma resected by robotic surgery. The patient is on follow up for over 1 year and shows no evidence of recurrence until now.
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8
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Pierro A, Rotondi F, Cilla S, De Ninno M, Mattoni M, Berardi S, Pericoli Ridolfini M, Sallustio G. Giant angioleiomyoma of uterus: A case report with focus on CT imaging. Radiol Case Rep 2018; 13:371-375. [PMID: 29904475 PMCID: PMC6000078 DOI: 10.1016/j.radcr.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/04/2018] [Indexed: 12/01/2022] Open
Abstract
We report a rare case of giant angioleiomyoma located in the uterus and detected in a 37-year-old woman. The uterus is an extremely rare location for angioleiomyoma. The definitive diagnosis is usually obtained only after the histopathologic examination because the imaging criteria are challenging for this disease. We focused our attention on the main computed tomography features able to provide a robust preoperative diagnosis of this rare clinical entity.
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Affiliation(s)
- Antonio Pierro
- Radiology Department, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Fabio Rotondi
- Department of Oncology Surgery, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Maria De Ninno
- Department of Human Pathology, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Marilena Mattoni
- Department of Human Pathology, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Stefano Berardi
- Department of Oncology Surgery, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Marco Pericoli Ridolfini
- Department of Oncology Surgery, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Giuseppina Sallustio
- Radiology Department, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
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9
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Singh S, Naik M, Bag ND, Patra S. Angioleiomyoma of Uterus Masquerading as Malignant Ovarian Tumor. J Midlife Health 2017; 8:145-147. [PMID: 28983163 PMCID: PMC5625580 DOI: 10.4103/jmh.jmh_47_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Uterine angioleiomyoma is rare. A 40-year-old nulliparous woman presented with heavy menstrual bleeding (HMB) for the past 2 years and mass per abdomen with severe dysmenorrhea for three cycles. She had received 8 units of packed cell transfusion outside. Clinical examination revealed a huge 32-week-sized abdominopelvic mass with irregular margins. Ultrasonography (USG) of the abdomen and pelvis showed a large solid cystic mass on the right side of the abdomen with a well-defined hypoechoeic rounded lesion of size 5.7 cm × 5.0 cm, in the right lobe of the liver, with ovaries not being imaged separately. On color Doppler USG, there was moderate vascularity throughout. A provisional diagnosis of malignant ovarian tumor with hepatic metastasis was made. Her hemoglobin was 5.7 g/dl, and she had repeated episodes of HMB upon admission. She was transfused with 5 units of packed cells. Computed tomography (CT) showed a large fundal subserosal uterine fibroid on the right side, with a solid ovarian tumor measuring 5.0 cm × 4.5 cm on the left side, with ascitis, right-sided hydronephrosis, and a well-defined hypoechoeic lesion in the right lobe of the liver, suggestive of hepatic hemangioma. Tumor markers were within normal limits. In view of discrepancy in clinical findings, ultrasound, and CT report, CT-guided biopsy of the huge mass was done which revealed leiomyoma, with no evidence of mitosis, pleomorphism, or malignancy. Laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy was done. Histopathology revealed an angioleiomyoma uterus. At 1-year follow-up, she was asymptomatic, and the liver mass was stable.
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Affiliation(s)
- Sweta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Monalisha Naik
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Narbadyswari Deep Bag
- Department of Radio-diagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Susama Patra
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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10
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Gupta M, Suryawanshi M, Kumar R, Peedicayil A. Angioleiomyoma of Uterus: A Clinicopathologic Study of 6 Cases. Int J Surg Pathol 2017; 26:18-23. [PMID: 28905674 DOI: 10.1177/1066896917731516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Angioleiomyoma is a benign perivascular neoplasm commonly involving subcutaneous tissue of extremities, head, and trunk region. They rarely involve the female genital tract. This study analyses clinicopathological features of 6 cases of uterine angioleiomyoma. METHODS Routine sections of 6 cases were reviewed and immunohistochemical markers namely muscle-specific actin, h-caldesmon, desmin, CD10, WT-1, HMB-45, and melan-A were done. RESULTS Of the 6 cases, 4 cases had tumor involving the corpus and 2 cases had tumor in the cervix. Grossly, all tumors had a whorled and congested cut surface. Microscopic examination of all the cases revealed circumscribed neoplasms composed of interlacing fascicles of benign perivascular smooth muscle cells with evenly distributed slit-like blood vessels (solid variant) along with vessels exhibiting thick muscular walls with swirling pattern (venous variant). In only 2 cases many dilated vessels were seen (cavernous variant). Immunohistochemically, all cases were positive for muscle-specific actin, h-caldesmon, and desmin. All cases were negative for CD10 and WT-1 ruling out endometrial stromal tumor and were negative for HMB-45 and melan-A ruling out perivascular epithelioid cell tumor (both endometrial stromal tumor and perivascular epithelioid cell tumor have prominent vessels but have different histomorphology). In all cases, surgical excision was curative and there were no intraoperative or postoperative complications. Follow-up of all the cases has been unremarkable. CONCLUSION As the World Health Organization has not included angioleiomyoma in the classification of mesenchymal tumors of uterine corpus and cervix, we recommend that it should be included in the classification.
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Affiliation(s)
- Mayank Gupta
- 1 Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Ramani Kumar
- 1 Christian Medical College, Vellore, Tamil Nadu, India
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11
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Uterine angioleiomyoma - a rare variant of uterine leiomyoma: review of literature and case reports. MENOPAUSE REVIEW 2016; 15:165-169. [PMID: 27980528 PMCID: PMC5137480 DOI: 10.5114/pm.2016.63496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/29/2016] [Indexed: 11/20/2022]
Abstract
Introduction Uterine angioleiomyoma (AL) is an extremely rare variant of uterine leiomyoma. It is composed of smooth muscle cells and thick-walled blood vessels. Angioleiomyoma usually occurs in middle-aged women, 40-60 years old. Aim of the study was to review of literature research reports on uterine AL. Discussion of nine case reports of uterine AL in the patients operated on in our ward. Material and methods The paper presents analysis of accessible research reports on uterine AL, and medical records of the patients operated on in our ward. Results Mean age of the patients with uterine AL was 47.11 ±5.21, body mass index (BMI) 25.88 ±3.95. All women had given birth (1-5 natural deliveries, 2.44 mean). Uterine AL occurred in 0.34% to 0.40% cases of leiomyomas. Angioleiomyoma were located intramurally and subserosally in six and three patients (respectively, 66.7% and 33.3%). Laparotomy was undertaken in seven cases (77.8%), transvaginal access in two cases (22.2%), and myomectomy in one case (11.1%). Blood transfusion was required in four cases (44.4%). Conclusions In the group of uterine leiomyomas, uterine ALs occurred in 0.34-0.40% of cases. Angioleiomyoma cases posed a greater risk of complications threatening the patient’s health and life. Preoperative differentiation of AL with ovarian tumour was more difficult due to frequent degenerative lesions in the course of uterine AL.
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12
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McCluggage WG, Boyde A. Uterine Angioleiomyomas: A Report of 3 Cases of a Distinctive Benign Leiomyoma Variant. Int J Surg Pathol 2016; 15:262-5. [PMID: 17652533 DOI: 10.1177/1066896907302226] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We report 3 cases of a distinctive uterine leiomyoma containing numerous thick-walled vascular channels, which we term angioleiomyoma. The leiomyomas occurred in women aged 33, 44, and 49 and ranged from 1.5 to 6.0 cm. They were composed of bland, spindle-shaped cells with numerous evenly distributed, arteriole-like vessels with thick muscular walls throughout. The spindle cells often swirled around the vessels. In 1 case, fibrin was present within vessel walls. The spindle cells were positive with smooth-muscle markers and negative with HMB45. We believe angioleiomyoma should be recognized as a distinct entity and included in the World Health Organization classification of tumors of the female genital tract as a benign leiomyoma variant, similar to cellular and atypical leiomyoma. Uterine angioleiomyoma has a close morphological resemblance to the similarly named skin tumor. We review uterine smooth-muscle and other mesenchymal neoplasms in which prominent vascular channels are a feature.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Belfast, and University of Wales, Cardiff, UK.
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13
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Garg G, Mohanty SK. Uterine Angioleiomyoma: A Rare Variant of Uterine Leiomyoma. Arch Pathol Lab Med 2014; 138:1115-8. [DOI: 10.5858/arpa.2013-0315-rs] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Uterine angioleiomyoma is an extremely rare and unique variant of leiomyoma. It usually occurs in middle-aged women, who commonly present with menorrhagia, abdominal pain, or abdominal mass. The lesions are either single or multiple and manifest as submucosal, intramural, or subserosal whorled nodules. Microscopy of the individual nodule shows interlacing fascicles of spindle cells swirling around thick-walled blood vessels. Angioleiomyoma usually lacks mitotic figures, pleomorphism, or necrosis, although cases with marked nuclear atypia and multinucleated giant cells have been reported. The tumor cells are immunoreactive for smooth muscle actin, desmin, h-caldesmon, and progesterone receptor, with a low Ki-67 labeling index. Because these lesions are vascular, they may undergo spontaneous rupture and pose a life-threatening emergency, especially in pregnancy. There are no specific imaging findings; therefore, a preoperative diagnosis is extremely difficult. It is important to recognize this entity and differentiate it from a malignancy, particularly when angioleiomyoma shows significant cytologic atypia or raised cancer antigen 125 levels by thorough sampling. When required, a proper immunohistochemical panel should be used to arrive at a correct diagnosis. In this review, we discuss the current knowledge on uterine angioleiomyoma and its clinical relevance.
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Affiliation(s)
- Garima Garg
- From the Departments of Pathology and Laboratory Medicine, Pushpanjali Crosslay Hospital, Ghaziabad, Uttar Pradesh, Delhi National Capital Region, India
| | - Sambit K. Mohanty
- From the Departments of Pathology and Laboratory Medicine, Pushpanjali Crosslay Hospital, Ghaziabad, Uttar Pradesh, Delhi National Capital Region, India
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14
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Sharma C, Sharma M, Chander B, Soni A, Soni PK. Angioleiomyoma uterus in an adolescent girl: a highly unusual presentation. J Pediatr Adolesc Gynecol 2014; 27:e69-71. [PMID: 24119657 DOI: 10.1016/j.jpag.2013.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 06/28/2013] [Accepted: 07/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Uterine angioleiomyoma is a very rare gynecologic tumor; only a few such cases have been reported to date and we have found no such tumor reported in an adolescent girl. CASE We report the case of a uterine angioleiomyoma in an adolescent girl. It presented as a huge abdomino-pelvic mass. The girl had severe menorrhagia and severe anemia. Intra-operatively no distinct planes were found between myoma and myometrium. Due to severe hemorrhage, she underwent sub-total abdominal hysterectomy. SUMMARY AND CONCLUSION Uterine angioleiomyoma is an extremely rare tumor since only 16 such cases have been reported to date. Its appearance in an adolescent girl seems to be the first case of its kind. So it is being reported not only to familiarize the managing physicians with the possibility of such a tumor and its variable presentation, but also to highlight the need for inclusion of this tumor in WHO classification of tumors of the female genital tract.
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Affiliation(s)
| | | | | | | | - P K Soni
- DR RPGMC Kangra at Tanda (HP), India
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15
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Kamath MS, Acharya M, Kamath V, Tk A. Uterine Angioleiomyoma with Hypofibrinogenemia: A Rare Presentation. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohan S. Kamath
- Reproductive Medicine Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Mousumi Acharya
- Reproductive Medicine Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Vandana Kamath
- Department of Transfusion Medicine and Immunohaematology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Aleyamma Tk
- Reproductive Medicine Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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16
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Affiliation(s)
- L Sahu
- Department of Obstetrics and Gynecology, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India.
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17
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Uterine Angioleiomyoma with Atypia, Raised CA-125 Levels, and Pseudo-Meigs Syndrome: An Alarming Presentation. Case Rep Pathol 2012; 2012:519473. [PMID: 22953135 PMCID: PMC3420638 DOI: 10.1155/2012/519473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 04/09/2012] [Indexed: 11/29/2022] Open
Abstract
Angioleiomyomas are benign mesenchymal tumours commonly occurring in the subcutis of extremities. They are typically composed of interlacing fascicles of smooth muscle cells with intersecting vascular channels. Angioleiomyomas of the uterus are rare with only very few case reports available in literature. Herein, we report a case of this rare entity in a 47-year-old woman owing to its highly unusual features of cellular atypia, raised CA-125 levels, and pseudo Meigs syndrome.
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Handler M, Rezai F, Fless KG, Litinski M, Yodice PC. Uterine angioleiomyoma complicated by consumptive coagulopathy. GYNECOLOGIC ONCOLOGY CASE REPORTS 2012; 2:89-91. [PMID: 24371629 DOI: 10.1016/j.gynor.2012.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 03/31/2012] [Indexed: 11/30/2022]
Abstract
► We present a rare case of consumptive coagulopathy secondary to a large degenerated uterine angioleiomyoma. ► Pathological examination showed features of angioleiomyoma, which are rarely found in the uterus. ► After removal of the neoplasm, the patient's consumptive coagulopathy, along with her vaginal bleeding, subsequently resolved.
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Affiliation(s)
- G A Al-Sannaa
- Department of Histopathology, Regional Lab and Blood Bank, Dammam, Saudi Arabia.
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Koleskas D, Karagiannis G, Beukenholdt RW. A case of a cervical angioleiomyoma presenting with menorrhagia and pelvic pain: a common presentation of a rare tumour. J OBSTET GYNAECOL 2009; 29:161-3. [PMID: 19274563 DOI: 10.1080/01443610802633841] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- D Koleskas
- Department of Obstetrics and Gynaecology, County Durham and Darlungton Acute Hospitals, NHS Trust, Darlungton, UK.
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Hsu TL, Changchien CC, Huang CC, Lin H. Angioleiomyoma originating from the ovary of an eleven-year-old premenarchal girl. Gynecol Obstet Invest 2008; 65:262-5. [PMID: 18196910 DOI: 10.1159/000113083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 08/09/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Angioleiomyoma (ALM) is a rare, benign neoplasm involving the peripheral soft tissues. ALM has not previously been described to originate from the ovary. We present a case herein of a premenarchal girl with a large ALM originating from the ovary. CASE An 11-year-old girl underwent a laparotomy during the course of evaluation and treatment of a palpable, painless, abdominal mass. The mass was shown to have a strong blood flow by sonography. A solid mass left ovarian was identified and resected. The final pathologic report of the resected tumor was consistent with an ALM. CONCLUSION To our knowledge, this is the first report of an ALM arising from the ovary. The treatment of choice for such an ovarian mass is surgical excision, which is usually a curative measure.
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Affiliation(s)
- Tian-Lun Hsu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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