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Ziani H, El Idrissi Jallal N, Lahbabi Y, Slaihi Z, Lahbabi S, Oudghiri N, Tachinante R. A case report: intravenous leiomyomatosis extending from the uterus to the right atrium. Ann Med Surg (Lond) 2024; 86:1766-1770. [PMID: 38463091 PMCID: PMC10923348 DOI: 10.1097/ms9.0000000000001783] [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: 12/06/2023] [Accepted: 01/23/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Intra veinous leiomyomatosis (IVL) is one pathology of a known group of ectopic leiomyomatosis that gathers many entities all defined by the presence of benign tumours arising from uterine smooth muscle cells. The authors aim through this case report to address the underdiagnosis of IVL in pre-menopausal women and the potential confusion with other cardiac tumours. Case presentation A 48-year-old woman initially treated for a suspected intracardiac myxoma underwent two surgeries. Seeking gynaecological care for menometrorrhagia related to a polymyomatous uterus, she was scheduled for radical surgery. Unexpectedly, extended explorations during a hysterectomy revealed a tumour originating from the pelvis, extending to the right atrium and inferior vena cava, indicative of intravascular leiomyomatosis. Clinical discussion IVL's diagnosis is often incidental during hysterectomy analysis, with symptoms mimicking uterine fibroids. Treatment involves radical surgery, emphasizing the importance of complete resection to reduce the significant risk of recurrence. Conclusion Pre-menopausal women with a history of hysterectomy or myomectomy and a detected right chamber mass should be screened for intravascular leiomyomatosis. Diagnosis relies on histological examination, guiding tailored treatment choices such as surgical resection with a focus on bilateral adnexectomy for optimal outcomes.
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Affiliation(s)
- Hicham Ziani
- Department of Intensive Care Unit of Maternity, CHU IBN SINA, Mohammed V Souissi University, Rabat, Morocco
| | - Nora El Idrissi Jallal
- Department of Intensive Care Unit of Maternity, CHU IBN SINA, Mohammed V Souissi University, Rabat, Morocco
| | - Yassir Lahbabi
- Department of Intensive Care Unit of Maternity, CHU IBN SINA, Mohammed V Souissi University, Rabat, Morocco
| | - Zakariae Slaihi
- Department of Intensive Care Unit of Maternity, CHU IBN SINA, Mohammed V Souissi University, Rabat, Morocco
| | - Sophia Lahbabi
- Department of Intensive Care Unit of Maternity, CHU IBN SINA, Mohammed V Souissi University, Rabat, Morocco
| | - Nezha Oudghiri
- Department of Intensive Care Unit of Maternity, CHU IBN SINA, Mohammed V Souissi University, Rabat, Morocco
| | - Rajae Tachinante
- Department of Intensive Care Unit of Maternity, CHU IBN SINA, Mohammed V Souissi University, Rabat, Morocco
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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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Boavida Ferreira J, Cabrera R, Santos F, Relva A, Vasques H, Gomes A, Guimarães A, Moreira A. Benign Metastasizing Leiomyomatosis to the Skin and Lungs, Intravenous Leiomyomatosis, and Leiomyomatosis Peritonealis Disseminata: A Series of Five Cases. Oncologist 2022; 27:e89-e98. [PMID: 35305104 PMCID: PMC8842467 DOI: 10.1093/oncolo/oyab019] [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: 08/18/2020] [Accepted: 09/09/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Benign metastasizing leiomyomatosis (BML) is a rare disease that typically occurs in women with a history of uterine leiomyomatosis. Benign metastasizing leiomyomatosis occurs more frequently in the lungs but may also develop in other organs and tissues. Other unusual variants of extra-uterine leiomyomatosis include intravenous leiomyomatosis (IVL) and leiomyomatosis peritonealis disseminata (LPD). In this article, three cases of BML are presented. One case, in a premenopausal woman, presented cutaneous metastases. We also present a case of IVL and a case of LPD, which occurred in postmenopausal women. Given the rarity of BML, IVL, and LPD, the authors reviewed the literature and herein discuss the implications for treatment in all five cases. Evidence for treating BML, IVL, and LPD is still scarce, and data available from our series and other small series seem to point to the patient’s hormonal status playing a fundamental part in the treatment plan. Furthermore, a collecting bag when performing excision of uterine leiomyomas may help avoid the potential spreading of leiomyomatosis. Hysterectomized patients with chronic cough, frequent respiratory infections, abdominal discomfort, right heart failure, or non-specific symptoms should be actively screened for BML, IVL, and LPD. Treatment should be individualized according to each patient’s hormonal status and desires.
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Affiliation(s)
- João Boavida Ferreira
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Rafael Cabrera
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Filipa Santos
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Andreia Relva
- Serviço de Ginecologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Hugo Vasques
- Serviço de Cirurgia Geral, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - António Gomes
- Serviço de Ginecologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - António Guimarães
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - António Moreira
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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Liang J, Lei R, Xie M, Lin S, Xu J, Ling X, Xie Q. The role of estrogen deprivation therapy in premenopausal women with primary unresectable intracardiac leiomyomatosis: a systematic review and meta-analysis. Orphanet J Rare Dis 2021; 16:453. [PMID: 34715881 PMCID: PMC8555203 DOI: 10.1186/s13023-021-02087-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/17/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Intracardiac leiomyomatosis (ICLM) is a rare life-threatening form of intravenous leiomyomatosis (IVLM). The incomplete resection and recurrence are associated with high morbidity and mortality. The objective of this study is to identify that whether estrogen deprivation therapies, including bilateral salpingo-oophorectomy (BSO)-based surgery and gonadotrophin releasing hormone agonists (GnRHa) administration, could bring benefits to patients with primary unresectable ICLM. METHODS PubMed/MEDLINE (Ovid) was searched (up to May 2021) for studies reporting individual patient data on demographics, clinicopathological features, treatment, and follow-up information. Exclusion criteria were patients who may have been included in two or more publications. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 114 patients from 70 papers were included. Several reports showed that the tumor in the right atrium and inferior vena cava shrank dramatically after BSO-based surgery, or GnRHa administrated preoperatively in premenopausal women. The rate of complete resection was 64.04% in patients with ICLM, which was 85.25% in no/slight adhesion and no pulmonary nodules group, while 22.22% in firm/extensive adhesion and/or pulmonary nodules group (p < 0.0001). Meanwhile, the recurrence rates in patients with complete resection and incomplete resection were 4.29% and 37.84% respectively (p < 0.0001). Furthermore, complete resection with BSO had the lowest recurrence rate of 3.13%, incomplete resection with BSO had a progression rate of 45.45%, while incomplete resection with ovarian preservation had the highest progression rate of 75.00%. CONCLUSIONS The recurrence rate of ICLM was closely related to firm/extensive adhesion in IVC or above, and/or pulmonary nodules. BSO-based surgery might reduce the recurrence rate no matter ICLM could be completely resected or not. In addition, estrogen deprivation therapies could decrease tumor burden as a primary treatment, and further make a secondary complete resection feasible in premenopausal women with initially unresectable ICLM.
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Affiliation(s)
- Jinxiao Liang
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Ruilin Lei
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Mingwei Xie
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Shaodan Lin
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Jing Xu
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Xiaoting Ling
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China.
| | - Qingsheng Xie
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China.
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Mathey MP, Duc C, Huber D. Intravenous leiomyomatosis: Case series and review of the literature. Int J Surg Case Rep 2021; 85:106257. [PMID: 34343794 PMCID: PMC8350006 DOI: 10.1016/j.ijscr.2021.106257] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/17/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Intravenous leiomyomatosis (ILV) is a rare pathology, part of leiomyoma beyond the uterus (LBU), characterized by benign smooth muscle cell tumor outside of the uterus and mainly affecting premenopausal woman with a medical history of leiomyoma or gynecologic surgical treatment. The treatment depends on the localization of the tumor, age of the patient, initial size, symptoms and the suitability for surgery but should always aims in toto surgical resection. Case presentation Retrospective case series and review of literature. Clinical discussion Symptoms presented by the patient were aspecific and only localized in the pelvic area. All cases were fortuitous histopathological diagnosis. No relapse was. Two out of 5 patients have pulmonary nodules, only one was biopsied and diagnosed with PBML (pulmonary benign metastasizing leiomyoma). Conclusion IVL and BML are rare disease that can co-exist. Because of tumoral hormonal receptors, hormonotherapy could be an optional treatment but to date no clear efficacy is demonstrated. In case of high recurrence risk such as voluminous initial mass, impairment of broad ligament, failure of total surgical resection, adjuvant hormonotherapy could be useful. Recurrence rate is about 16.6-30% and can occur even dozen years later and even after radical surgery, justifying a regular follow up. Leiomyomas beyond the uterus (LBU) is defined by benign smooth muscle cell tumor outside of the uterus. Sub classification of this entity are intravenous leiomyomatosis (IVL), benign metastasizing leiomyomas (BML), diffuse peritoneal leiomyomatosis (DPL), retroperitoneal leiomyomas and parasitic leiomyomas. The differential diagnosis of IVL should include benign myoma, thrombus, leiomyosarcoma, soft tissue sarcoma, lymphoma, cardiac myxoma, tumor thrombosis of Wilms tumor or metastasis. Treatment of IVL is usually surgery but there is no consensus about the the optimal approach. Adjuvant therapy sur as bilateral salpingoophorectomy followed by hormonothetherapy have to be balanced with their side effects. Despite being histologically benign, BML shows the metastatic potential of LBU. Because of a high rate of recurrence estimated of 16.6% to 30%, long term follow up is recommended even after radical surgery.
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Affiliation(s)
- M P Mathey
- Department of Gynaecological Surgery, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland.
| | - C Duc
- Department of Pathology, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland
| | - D Huber
- Department of Gynaecological Surgery, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland; Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Genève (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
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6
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Yano M, Katoh T, Nakajima Y, Iwanaga S, Kin R, Kozawa E, Yasuda M. Uterine intravenous leiomyomatosis with an isolated large metastasis to the right atrium: a case report. Diagn Pathol 2020; 15:4. [PMID: 31926551 PMCID: PMC6954539 DOI: 10.1186/s13000-019-0913-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/06/2019] [Indexed: 12/21/2022] Open
Abstract
Background An intravenous leiomyomatosis is a special type of uterine leiomyoma characterized by the formation of benign leiomyomatous tissue within the vascular wall. Although histologically benign, intracardiac metastasis can lead to circulatory failure, and death, if untreated. Herein, we report on a case of a uterine intravenous leiomyomatosis with an isolated large adherent metastasis in the right atrium of the heart. Case Presentation A 52-year-old Japanese woman sought medical attention at our hospital for lower abdominal pain. A 27-cm uterine mass was detected on clinical imaging, with a 78 × 47-mm mass in the right atrium detected on preoperative echocardiography. Intracardiac mass resection and tricuspid annuloplasty were performed as the first-stage surgery. The pedicle of the tumor was adherent to the wall of the atrium. On histological examination, the tumor was found to consist of spindle-shaped cells with eosinophilic cytoplasm, without atypia, but with a myxoid change, and rich microvascularization of the pedicle. Total abdominal hysterectomy was performed as the second-stage surgery, with confirmation of the diagnosis as uterine intravenous leiomyomatosis with an isolated metastasic lesion to the right atrium. There has been no evidence of tumor recurrence in the 15 months since surgery. Conclusion We report a unique case in which a large right atrial leiomyoma was identified following a uterine intravenous leiomyomatosis. Our case exemplifies that intravenous leiomyomatosis metastatic tumors have the potential to grow via their vascularization.
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Affiliation(s)
- Mitsutake Yano
- Department of Pathology, Saitama Medical, University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.,Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Tomomi Katoh
- Department of Pathology, Saitama Medical, University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Yoshie Nakajima
- Department of Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Rei Kin
- Department of Pathology, Saitama Medical University Hospital, 38 Morohongo, Iruma-Gun, Moroyama, Saitama, 350-0495, Japan
| | - Eito Kozawa
- Department of Diagnostic Radiology, Saitama Medical University Hospital, 38 Morohongo, Iruma-Gun, Moroyama, Saitama, 350-0495, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical, University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.
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7
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Declas E, Lucot JP. [Extra uterine leiomyomatosis: Review of the literature]. ACTA ACUST UNITED AC 2019; 47:582-590. [PMID: 31255836 DOI: 10.1016/j.gofs.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Indexed: 11/24/2022]
Abstract
Extra-uterine leiomyomatosis is a rare pathology defined by the presence of benign smooth uterine muscle cells in unusual localizations, including different entities. It mainly affects premenopausal women with a medical history of uterine myoma with or without surgical treatment. Three main types are discribed: intraveinous leiomyomatosis, benign metastatisizing leiomyoma and leiomyomatosis peritonealis disseminata. The diagnosis may be complex with many differential diagnosis, and relies on histology. The treatment depends on multiple factors such as age, localization, size, symptoms and associated comorbidities. It is based on surgical resection and hormonal privation, surgical (adnexectomy) or medical (hormonotherapy). There is a high risk of recurrence. Some malignant evolutions have been reported, mostly leiomyosarcoma following peritoneal disseminated leiomyomatosis. Long term follow-up of these patients is mandatory. A particular manifestation of extra-uterine leiomyomatosis is the hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome. It is an autosomal dominant disorder which confers an increased risk of cutaneous and uterine leiomyomas and renal cell cancer, with a poor prognosis due to the urologic tumor.
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Affiliation(s)
- E Declas
- Service de gynécologie-obstétrique, hôpital Saint-Vincent-de-Paul, groupe des hôpitaux de l'institut catholique de Lille (GHICL), boulevard de Belfort, 59000 Lille, France.
| | - J P Lucot
- Service de gynécologie-obstétrique, hôpital Saint-Vincent-de-Paul, groupe des hôpitaux de l'institut catholique de Lille (GHICL), boulevard de Belfort, 59000 Lille, France
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8
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Zhang X, Wu L, Xu R, Zhu C, Ma G, Zhang C, Liu X, Zhao H, Miao Q. Identification of the molecular relationship between intravenous leiomyomatosis and uterine myoma using RNA sequencing. Sci Rep 2019; 9:1442. [PMID: 30723247 PMCID: PMC6363745 DOI: 10.1038/s41598-018-37452-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/21/2018] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to explore the potential relationship between intravenous leiomyomatosis (IVL) and uterine myoma (UM) at the molecular level. RNA-sequencing was performed on IVL tumours, UM tumours, and adjacent normal uterine muscle. We compared the gene expression levels between IVL and normal uterine muscle, UM and normal uterine muscle, to identify differentially expressed genes (DEGs). Then we used Gene Ontology Enrichment Analysis to determine the functions of the DEGs and performed specimen cluster analysis. We obtained 98 DEGs between IVL and adjacent normal uterine muscle, and 61 DEGs between UM and adjacent normal uterine muscle. Functional enrichment of both IVL and UM DEGs showed that they are associated with hormone stimulus, extracellular matrix, and cell adhesion. Unsupervised clustering analysis showed that IVL and UM could not be separated completely. Among these dysregulated genes, we found that HOXA13 showed a distinct dysregulated status between IVL and UM. HOXA13 may therefore serves as a biomarker to distinguish IVL and UM. Our results showed that IVL and UM may have similar dysregulated gene networks. They may be closely related, and HOXA13 may serves as a biomarker to distinguish between IVL and UM.
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Affiliation(s)
- Xu Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Liangcai Wu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Rongjian Xu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Chengpei Zhu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Guotao Ma
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Chaoji Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Xingrong Liu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Haitao Zhao
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
| | - Qi Miao
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
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9
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Xu J, Wei M, Miao Q, Zhu B, Yu C, Huang Y. Perioperative management of intracardiac leiomyomatosis: An observational cohort study. Medicine (Baltimore) 2017; 96:e7522. [PMID: 28723765 PMCID: PMC5521905 DOI: 10.1097/md.0000000000007522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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
Intracardiac leiomyomatosis (ICLM) is a rare condition in which the benign tumor extends into the right heart chambers through inferior vena cava. The best surgical approach still remains unclear.We present a retrospective cohort of 36 patients diagnosed with ICLM in Peking Union Medical College Hospital between 2002 and 2016.The mean patient age was 44.5 (range 25-55) years. The clinical manifestations were various, including shortness of breath, chest tightness, edema of the lower extremities, palpitations, syncope, etc. Cardiac function of 30 patients (80%) remained mildly influenced, classified as New York Heart Association (NYHA) I-II. After careful preoperative evaluation, 19 patients underwent 1-stage operation while the other 17 patients underwent 2-stage operations. The original surgical plans were changed in 5 patients (14%) due to intraoperative transesophageal echocardiography (TEE) monitoring, with the tumor directly extracted through abdominal approach or right atrium without cardiopulmonary bypass and/or deep hypothermic circulatory arrest. Complete resection was achieved in 32 patients (89%). Despite increased volume of blood loss (P < .05), patients undergoing 1-stage operation had significantly shorter operation time, anesthesia time as well as hospital length of stay (P < .05), compared with 2-stage operations. The postoperative complication rates were not different between the 2 groups (P = .684). During mean follow-up time of 36.1 months, recurrence occurred in 7 patients (23%) but all are survived.Precise and full-scale preoperative evaluation of both the tumor anatomy and the patient's tolerability to the surgery should be performed. TEE plays a crucial role in guidance of surgical decision making, and 1-stage extraction of tumor through either abdominal approach or right atrium may be possible.
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Affiliation(s)
| | - Min Wei
- Department of Anesthesiology
| | - Qi Miao
- Department of Cardiac Surgery, Chinese Academy of Medical Sciences/Peking Union Medical College Hospital
| | - Bin Zhu
- Department of Anesthesiology, Peking University International Hospital, Beijing, P.R. China
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