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Chen J, Bu H, Zhang Z, Chu R, Qi G, Zhao C, Wang Q, Ma X, Wu H, Dou Z, Wang X, Kong B. Clinical features and prognostic factors analysis of intravenous leiomyomatosis. Front Surg 2023; 9:1020004. [PMID: 36793517 PMCID: PMC9922872 DOI: 10.3389/fsurg.2022.1020004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/30/2022] [Indexed: 01/31/2023] Open
Abstract
Background The treatment and prognostic factors of intravenous leiomyomatosis (IVL) remain lacking systematic evidence. Methods A retrospective study was conducted on IVL patients from the Qilu Hospital of Shandong University, and IVL cases were published in PubMed, MEDLINE, Embase and Cochrane Library databases. Descriptive statistics were used for the basic characteristics of patients. The Cox proportional hazards regression analysis was used to assess the high-risk factors related to the progression-free survival (PFS). The comparison of survival curves was performed by Kaplan-Meier analysis. Results A total of 361 IVL patients were included in this study, 38 patients from Qilu Hospital of Shandong University, and 323 patients from the published literature. Age ≤45 years was observed in 173 (47.9%) patients. According to the clinical staging criteria, stage I/II was observed in 125 (34.6%) patients, and stage III/IV was observed in 221 (61.2%) patients. Dyspnea, orthopnea, and cough were observed in 108 (29.9%) patients. Completed tumor resection was observed in 216 (59.8%) patients, and uncompleted tumor resection was observed in 58 (16.1%) patients. Median follow-up period was 12 months (range 0-194 months), and 68 (18.8%) recurrences or deaths were identified. The adjusted multivariable Cox proportional hazard analysis showed age ≤45 years (vs. >45) (hazard ratio [HR] = 2.09, 95% confidence interval [CI] 1.15-3.80, p = 0.016), and uncompleted tumor resection (vs. completed tumor resection) (HR = 22.03, 95% CI 8.31-58.36, p < 0.001) were high-risk factors related to the PFS. Conclusion Patients with IVL have a high probability of recurrence after surgery and a poor prognosis. Patients younger than 45 years and with uncompleted tumor resection are at higher risk of postoperative recurrence or death.
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Affiliation(s)
- Jingying Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Hualei Bu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhaoyang Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Gonghua Qi
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Chen Zhao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Qiuman Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Xinyue Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Huan Wu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Zhiyuan Dou
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Xia Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Correspondence: Xia Wang Beihua Kong
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China,Correspondence: Xia Wang Beihua Kong
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Li J, Zhu H, Hu SY, Ren SQ, Li XL. Case report: Cardiac metastatic leiomyoma in an Asian female. Front Surg 2022; 9:991558. [PMID: 36081592 PMCID: PMC9445419 DOI: 10.3389/fsurg.2022.991558] [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: 07/11/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Uterine leiomyomas are the most common gynecological tumors in women of child-bearing age and premenopausal women, while benign metastasizing leiomyomas of the heart are rare. Case presentation We report a rare case of metastasizing leiomyoma in the heart of a 54-year-old woman 10 years after a uterine leiomyoma was discovered during hysterectomy. Echocardiography, cardiac plain scan and enhanced MRI at presentation showed a soft tissue signal mass in the right ventricle. A large cardiac mass attached to the chordae of the tricuspid valve and later shown to be histopathologically consistent with uterine leiomyoma was successfully resected through a right atriotomy. Conclusions Our case report highlights a rare type of tumor of the heart and suggests that metastasizing leiomyoma should be considered in the differential diagnosis of right-sided cardiac tumors. The complete surgical resection of the tumor was considered to be the best treatment.
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Affiliation(s)
- Juan Li
- Department of Pathology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Hong Zhu
- Department of Pathology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Shuang-Ye Hu
- Department of Pathology, Longquanyi District of Chengdu Maternity and Child Health Care Hospital, Chengdu, China
| | - Shang-Qing Ren
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xing-Lan Li
- Department of Pathology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Correspondence: Xing-Lan Li
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Pure Uterine Lipoma with a Combined Mucinous Cystic and Brenner Ovarian Tumor in a Postmenopausal Woman: A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2021; 2021:5512951. [PMID: 33859851 PMCID: PMC8024087 DOI: 10.1155/2021/5512951] [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: 02/05/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022] Open
Abstract
Lipomatous tumors are rare among uterine mesenchymal tumors. Due to their rarity, information on the clinical development and histological origin are lacking. We report a pure uterine lipoma and present a review of the relevant literature. We encountered a 72-year-old postmenopausal woman who was referred to our hospital. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations revealed degenerative uterine tumors and a left ovarian cystic tumor with a solid portion. Total hysterectomy and bilateral salpingo-oophorectomy were performed, and postoperative histological examination revealed a uterine lipoma and adenomyosis. The cystic portion was a mucinous cystadenoma, and the solid portion was classified as a Brenner tumor. The postoperative course was uneventful, and the patient was discharged and remained well until follow-up. Our observations suggest that imaging examinations are sufficient for the diagnosis of uterine lipomatous tumors. To the best of our knowledge, the coexistence of a pure uterine lipoma and a mucinous Brenner ovarian tumor has not been documented in the existing literature. The histogenesis of uterine lipomas remains unclear. However, our results, and those from the existing literature, indicate that the mesenchymal stem cells surrounding the perivascular tissue may be implicated, because lipomas of the skin are reported to originate from these cells.
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Abstract
RATIONALE Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can develop from the pelvic or uterine veins and spread into the central veins and heart. Here, we report a case of recurrent IVL in a 48-year-old woman. To the best of our knowledge, this is the first case report of IVL that describes the characteristic ultrasound features of the tumor, including the rainbow sign. PATIENT CONCERNS A 48-year-old woman developed a solid-cystic lesion in the inferior vena cava (IVC) 3 years after undergoing a right heart tumor resection and 5 years after undergoing hysterectomy. DIAGNOSES Physical examination was unremarkable. However, ultrasonography showed a solid-cystic lesion in the IVC, and a diagnosis of IVL was made. INTERVENTIONS The patient underwent complete surgical removal of the tumor by a multidisciplinary team. The tumor was resected successfully. OUTCOMES Pathological examination confirmed that the IVC tumor thrombus was consistent with IVL. During follow-up, there were no signs of local or distant recurrence. LESSONS The preoperative diagnosis of IVL is difficult, and the tumor is usually misdiagnosed as a thrombus or right atrial myxoma. A thorough understanding of the characteristic imaging features of IVL is essential for an accurate preoperative diagnosis. The lesion in our patient showed multiple tracts, a honeycomb appearance, and vividly colorful blood flow that resembled a rainbow, which we termed the rainbow sign.
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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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Ghanem M, Meyer F, Jechorek D, Schoeder V, Ignatov A, Fadel M, Halloul Z. Intravascular (post-hysterectomy) leiomyoma (IVL) as late tumor thrombus within the inferior vena cava (IVC)-A rare case primarily imposing as IVC thrombus originating from left renal vein after former left nephrectomy status. Pathol Res Pract 2019; 215:152359. [PMID: 30853174 DOI: 10.1016/j.prp.2019.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/28/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Intravascular leiomyoma is a rare type of myoma. It was firstly described by Birch-Hirschfeld in 1896, however, its intracardiac subtype was firstly reported by Durck in 1907. Most patients are asymptomatic. The tumor invades mostly the tributaries of the inferior vena cava (IVC) with upward extension that may approach the intracardiac space. AIM By means of a scientific case report, a patient with the very rare diagnosis of an endocaval leiomyoma thrombus post-hysterectomy is described based on the clinical experiences obtained in the specific case management and selective references from the literature. CASE PRESENTATION A 48-years old female was diagnosed with intravascular tumor growth within the IVC with intracardiac extension using chest and abdominal CT scan, ECG and echocardiography which was approached by an interdisciplinary (vascular and cardiothoracic) surgical intervention (278 min) including heart-lung machine (99 min) with favorable postoperative result (R0 resection status with mid-term outcome, no recurrent tumor growth). Histopathological investigation diagnosed leiomyoma origin already from ovarian vein most likely in context to the former hysterectomy (3 years ago). DISCUSSION AND CONCLUSION Intravascular leiomyoma is a benign tumor with invasive tendency, which can be considered a diagnostic and therapeutic challenge. It should be thoroughly investigated to be planned for a radical surgical removal. By possible adherence to the intraabdominal or -thoracic organs, an interdisciplinary and eventually step-wise surgical approach (combining vascular, abdominal, thoracic and heart surgery as well as gynecology and urology), which can be demanding, is recommended to be seriously considered to i) reliably achieve R0 resection status and, thus, ii) provide best outcome, quality of life and prognosis.
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Affiliation(s)
- M Ghanem
- Division of Vascular Surgery, Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - F Meyer
- Division of Vascular Surgery, Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - D Jechorek
- Institute of Pathology, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - V Schoeder
- Institute of Pathology, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - A Ignatov
- Dept. of Gynecology and Obstetrics, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - M Fadel
- Dept. of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - Z Halloul
- Division of Vascular Surgery, Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Otto-von-Guericke University at Magdeburg, Germany.
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7
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Intracardiac leiomyomatosis presenting as an intraoperative consultation. Pathol Res Pract 2016; 212:578-81. [DOI: 10.1016/j.prp.2016.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/07/2016] [Accepted: 03/18/2016] [Indexed: 11/20/2022]
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8
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Oh SR, Cho YJ, Han M, Bae JW, Park JW, Rha SH. Uterine Lipoleiomyoma in Peri or Postmenopausal Women. J Menopausal Med 2015; 21:165-70. [PMID: 26793683 PMCID: PMC4719092 DOI: 10.6118/jmm.2015.21.3.165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/02/2015] [Accepted: 10/08/2015] [Indexed: 12/01/2022] Open
Abstract
Lipoleiomyoma is an uncommon neoplasm of the uterus, composed of smooth muscles intermixed with mature adipocytes. These tumors are considered a benign variant of uterine leiomyomas. Herein, we report six cases of lipoleiomyoma experienced in our institution from January 2005 to March 2015. The patients ranged in age from 45 to 70 years; the etiology may be related to estrogen deficiency occurring after menopausal transition. Except for one lipoleiomyoma in the broad ligament, all others were found in the uterine corpus. The presenting symptoms were nonspecific, and most cases were incidentally diagnosed during surgery for other reasons. We performed preoperative imaging studies, including abdominal and pelvic computed tomography and magnetic resonance imaging. Preoperatively, four patients were diagnosed as having a pelvic mass and one patient was diagnosed as having a right ovarian mature teratoma. In one case, we found a gynecologic malignancy (cervical cancer 1A1). Histologically, there was no gross or microscopic contiguity between the lipoleiomyoma and the malignancy. Lipoleiomyomas seem to have a benign clinical course. In our study, there were no recurrences of or deaths attributed to the lipoleiomyomas during a mean follow-up period of 16.17 ± 23.80 months.
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Affiliation(s)
- So Ra Oh
- Department of Obstetrics and Gynecology, Dong-A University College of Medicine, Busan, Korea
| | - Yeon Jean Cho
- Department of Obstetrics and Gynecology, Dong-A University College of Medicine, Busan, Korea
| | - Myoungseok Han
- Department of Obstetrics and Gynecology, Dong-A University College of Medicine, Busan, Korea
| | - Jong Woon Bae
- Department of Obstetrics and Gynecology, Dong-A University College of Medicine, Busan, Korea
| | - Jung-Woo Park
- Department of Obstetrics and Gynecology, Dong-A University College of Medicine, Busan, Korea
| | - Seo-Hee Rha
- Department of Pathology, Dong-A University College of Medicine, Busan, Korea
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Williams M, Salerno T, Panos AL. Right ventricular and epicardial tumors from benign metastasizing uterine leiomyoma. J Thorac Cardiovasc Surg 2015; 151:e21-4. [PMID: 26578179 DOI: 10.1016/j.jtcvs.2015.09.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/02/2015] [Accepted: 09/14/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Matthew Williams
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Fla
| | - Tomas Salerno
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Fla
| | - Anthony L Panos
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Fla.
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10
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Martínez-Jiménez S, Rosado-de-Christenson ML, Walker CM, Kunin JR, Betancourt SL, Shoup BL, Pettavel PP. Imaging features of thoracic metastases from gynecologic neoplasms. Radiographics 2015; 34:1742-54. [PMID: 25310428 DOI: 10.1148/rg.346140052] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Gynecologic malignancies are a heterogeneous group of common neoplasms and represent the fourth most common malignancy in women. Thoracic metastases exhibit various imaging patterns and are usually associated with locally invasive primary neoplasms with intra-abdominal spread. However, thoracic involvement may also occur many months to years after initial diagnosis or as an isolated finding in patients without evidence of intra-abdominal neoplastic involvement. Thoracic metastases from endometrial carcinoma typically manifest as pulmonary nodules and lymphadenopathy. Thoracic metastases from ovarian cancer often manifest with small pleural effusions and subtle pleural nodules. Thoracic metastases to the lungs, lymph nodes, and pleura may also exhibit calcification and mimic granulomatous disease. Metastases from fallopian tube carcinomas exhibit imaging features identical to those of ovarian cancers. Most cervical cancers are of squamous histology, and while solid pulmonary metastases are more common, cavitary metastases occur with some frequency. Metastatic choriocarcinoma to the lung characteristically manifests with solid pulmonary nodules. Some pulmonary metastases from gynecologic malignancies exhibit characteristic features such as cavitation (in squamous cell cervical cancer) and the "halo" sign (in hemorrhagic metastatic choriocarcinoma) at computed tomography (CT). However, metastases from common gynecologic malignancies may be subtle and indolent and may mimic benign conditions such as intrapulmonary lymph nodes and remote granulomatous disease. Therefore, radiologists should consider the presence of locoregional disease as well as elevated tumor marker levels when interpreting imaging studies because subtle imaging findings may represent metastatic disease. Positron emission tomography/CT may be helpful in identifying early locoregional and distant tumor spread.
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Affiliation(s)
- Santiago Martínez-Jiménez
- From the Department of Radiology (S.M.J., M.L.R.d.C., C.M.W., J.R.K.), Department of Gynecology and Obstetrics, Division of Gynecologic Oncology (B.L.S.), and Department of Pathology (P.P.P.), Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111; and Department of Radiology, MD Anderson Cancer Center, University of Texas, Houston, Tex (S.L.B.)
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11
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Intravenous leiomyomatosis: A rare cause of intracardiac mass. Rev Port Cardiol 2014; 33:735.e1-5. [DOI: 10.1016/j.repc.2014.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/30/2014] [Accepted: 04/27/2014] [Indexed: 11/17/2022] Open
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Cruz I, João I, Stuart B, Iala M, Bento L, Cotrim C, Nobre Â, Pereira H. Intravenous leiomyomatosis: A rare cause of intracardiac mass. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Akbulut M, Gündoğan M, Yörükoğlu A. Clinical and pathological features of lipoleiomyoma of the uterine corpus: a review of 76 cases. Balkan Med J 2014; 31:224-9. [PMID: 25625021 DOI: 10.5152/balkanmedj.2014.13079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 06/10/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Uterine lipoleiomyoma is a rare and specific type of leiomyoma with a considerable amount of adipocytes. AIMS The aim of the study was to investigate the clinical, pathological and immunohistochemical features of lipoleiomyoma of the uterine corpus, and review its histogenesis and differential diagnosis from other neoplastic and non-neoplastic lesions in order to obtain a detailed profile of this somewhat uncommon lesion. STUDY DESIGN Descriptive study. METHODS This study is a retrospective analysis of 70 consecutive women with 76 lipoleiomyomas, who underwent surgery mainly for uterine leiomyoma and gynecological carcinomas between January 2000 and April 2013. Clinical and pathological information was obtained from medical records. Immunohistochemistry was applied in selected cases. Parametric methods were used to compare clinical and pathologic features. RESULTS The patients ranged in age from 34 to 77 years (mean 55.49 years). Lipoleiomyomas ranged from 0.5 to 55 cm in diameter (mean 5.50 cm). Typical macroscopic and microscopic features were noted. Sixty-nine (90.7%) tumors were in the uterine corpus and five (6.5%) were in the cervix. One broad ligament tumor and one retroperitoneal tumor were also studied. No tumors displayed cytologic atypia, mitosis, necrosis, calcification, or other degenerative changes. Immunohistochemically, the adipose tissue element was positive for vimentin, desmin, S100 protein, estrogen (ER), progesterone (PR), and Ki-67. Among patients with lipoleiomyomas, 53 cases (75.7%) had different types of lesions associated with hyperestrogenic status, such as adenomyosis, endometriosis, endometrial hyperplasia, and polyps, complex atypical endometrial hyperplasia, and gynecologic carcinomas. The follow-up period ranged from one to eight years (mean 4.6 years). There were no recurrences or tumor-related fatalities. CONCLUSION In the present study, the lipoleiomyomas were seen more frequently in patients with adenomyosis, endometriosis, endometrial hyperplasia, polyps, and various gynecologic carcinomas. Lipoleiomyoma of the uterus seems to have a benign clinical course.
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Affiliation(s)
- Metin Akbulut
- Department of Pathology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Mehmet Gündoğan
- Department of Pathology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Aygün Yörükoğlu
- Department of Pathology, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Gardrat S, Azarine A, Alsac JM, Bruneval P. [Unusual tumor of the inferior vena cava]. Ann Pathol 2014; 34:247-51. [PMID: 24950877 DOI: 10.1016/j.annpat.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/16/2013] [Accepted: 03/18/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Sophie Gardrat
- Service d'anatomie et de cytologie pathologiques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Arshid Azarine
- Service d'imagerie cardiovasculaire, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - Jean-Marc Alsac
- Service de chirurgie cardiovasculaire, hôpital européen Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, 75005 Paris, France
| | - Patrick Bruneval
- Service d'anatomie et de cytologie pathologiques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, 75005 Paris, France.
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Kim ML, Luk A, Cusimano RJ, Paul N, Butany J. Intracardiac extension of intravenous leiomyomatosis in a woman with previous hysterectomy and bilateral salpingo-oophorectomy: A case report and review of the literature. HUMAN PATHOLOGY: CASE REPORTS 2014. [DOI: 10.1016/j.ehpc.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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16
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Xia M, Liu J, Xiang X, Xu M, He M. Intravenous leiomyomatosis with intracardiac involvement. Arch Gynecol Obstet 2014; 290:595-9. [DOI: 10.1007/s00404-014-3278-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 04/28/2014] [Indexed: 11/24/2022]
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Intravascular adenomyomatosis: expanding the morphologic spectrum of intravascular leiomyomatosis. Am J Surg Pathol 2013; 37:1395-400. [PMID: 24076777 DOI: 10.1097/pas.0b013e31828b2c99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Intravascular leiomyomatosis (IVL) is characterized by the presence of smooth muscle in venous and lymphatic spaces within the myometrium. Although the intravascular component usually consists solely of typical smooth muscle or variants of smooth muscle differentiation, we report 5 cases in which the intravascular component also included endometrioid glandular and stromal elements. We propose the term "intravenous adenomyomatosis" to describe this unusual variant of IVL. The mean age of the patients in this series was 50.2 years, slightly older than that of patients with conventional IVL. In addition to intravenous adenomyomatosis, both adenomyosis and leiomyomas were identified in all of our cases, supporting the hypothesis that the intravascular smooth muscle component in IVL is derived from associated myometrial pathology rather than from vessel walls. In our series, intravenous adenomyomatosis had a similar benign clinical behavior to most cases of IVL with no metastatic or recurrent disease identified at follow-up in 4 cases for which follow-up information was available. The main differential diagnoses are adenomyosis with vascular involvement, low-grade endometrial stromal sarcoma (ESS), including ESS with smooth muscle and glandular differentiation, and adenosarcoma with lymphovascular invasion. The possibility of intravenous adenomyomatosis should be borne in mind when considering these diagnoses, particularly ESS and adenosarcoma, which have different implications for patient management and prognosis.
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Clay TD, Dimitriou J, McNally OM, Russell PA, Newcomb AE, Wilson AM. Intravenous leiomyomatosis with intracardiac extension - a review of diagnosis and management with an illustrative case. Surg Oncol 2013; 22:e44-52. [PMID: 23642379 DOI: 10.1016/j.suronc.2013.03.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/05/2013] [Accepted: 03/27/2013] [Indexed: 12/01/2022]
Abstract
Intravenous leiomyomatosis with intracardiac extension is an uncommon pathologic progression of uterine leiomyomata. It is a histologically benign condition, however due to interfence with right sided cardiac function patients may present with marked cardiovascular compromise and present a diagnostic dilemma to clinicians who are unfamiliar with this condition. Given the rarity of this condition, experience in individual institutions is usually limited to a few cases. We present an illustrative case and provide a review of the clinical presentation, preoperative assessment, operative approach, pathology and postoperative issues. The importance of a multidisciplinary approach to diagnosis and management is highlighted. Operative management aims to completely resect all tumour in the safest manner for the patient, most commonly via single or two stage operation. Where complete resection is achieved, recurrence appears to be a rare event.
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Affiliation(s)
- Timothy D Clay
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Australia.
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Li B, Chen X, Chu YD, Li RY, Li WD, Ni YM. Intracardiac leiomyomatosis: a comprehensive analysis of 194 cases. Interact Cardiovasc Thorac Surg 2013; 17:132-8. [PMID: 23563052 DOI: 10.1093/icvts/ivt117] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Intracardiac leiomyomatosis is rare but has been increasingly reported in recent years. Owing to its rarity, intracardiac leiomyomatosis has been reported only as isolated case reports and case series. This disorder is thought to be underestimated and easily overlooked in the clinic, while it is dangerous owing to the risk of sudden death caused by total outflow tract obstruction. We performed an electronic literature search for intracardiac leiomyomatosis and identified 194 cases that were reported in English from 1974 (the first reported case) to September 2012. Our aim is to provide a detailed and comprehensive review of the clinical presentation, diagnosis, histopathological characterization, treatment and prognosis of this disorder. According to our analysis, intracardiac leiomyomatosis is most common in the fifth decade, and the mean age of detection is ~50 years. Most patients had undergone previous hysterectomy/myomectomy or had a coexisting uterine leiomyoma when admitted. The most common clinical presentations were dyspnoea, syncope, oedema of the lower extremities and palpitation. Transoesophageal echocardiography, computed tomography and magnetic resonance imaging are helpful in the preoperative diagnosis and to guide the surgical management. Complete removal guarantees an excellent outcome, with no recurrence or postoperative death, while incomplete removal leads to recurrence in one-third of patients. Anti-oestrogen therapy is not imperative after incomplete removal owing to its inability to prevent recurrence.
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Affiliation(s)
- Bin Li
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Jurek T, Czuba M, Smigiel R, Maksymowicz K, Rorat M, Halon A. Giant heart tumors in infants leading to sudden, unexpected death: description of two cases. Pediatr Int 2011; 53:1090-3. [PMID: 22181571 DOI: 10.1111/j.1442-200x.2011.03368.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tomasz Jurek
- Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland
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