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Kiran N, Ramanarasimhaiah R, Khan S, Mody K. Angiomyolipoma of Uterine Cervix: Report of a Rare Case. Cureus 2023; 15:e38950. [PMID: 37313068 PMCID: PMC10258073 DOI: 10.7759/cureus.38950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
Angiomyolipoma (AML) is classified as perivascular epithelioid cell neoplasm (PEComas) and is commonly seen in the kidney. AML is a solid mesenchymal neoplasm rarely encountered at the extrarenal site. Extrarenal AML is infrequently seen in the female genital tract. Four cases of AML of the cervix have been reported in the literature to our knowledge. We report a case of a 44-year-old female patient who presented with complaints of "lower abdominal pressure" and a history of post-coital bleeding and human papillomavirus (HPV) infection. A cyst in the uterine cervix was found incidentally on computerized tomography (CT) scan of the abdomen and pelvis. The patient underwent a loop electrosurgical excision procedure. The histologic and immunohistochemical features of the cervical biopsy favored the diagnosis of AML. The patient underwent a laparoscopic hysterectomy with bilateral salpingectomy. Grossly, a 4 cm white soft-to-firm mass was identified within the anterior lip of the cervix. Microscopy of the mass showed smooth muscle proliferation with prominent blood vessels, and scant mature adipose tissue trapped in between the smooth muscle bundles. Immunohistochemical stains showed smooth muscle actin (SMA) and desmin highlighting the smooth muscle component of AML. The histology and immunohistochemistry of the cervical mass in the surgical specimen were identical to the biopsy specimen and a diagnosis of AML was made.
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Affiliation(s)
- Nfn Kiran
- Pathology and Laboratory Medicine, Northwell Health, Staten Island, USA
| | | | - Shahbaz Khan
- Gastrointestinal, Hepatobiliary and Transplant Pathology, Indiana University School of Medicine, Indianapolis, USA
- Hematopathology, Northwell Health, New York, USA
- Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
- Pathology and Laboratory Medicine, Northwell Health, Staten Island, USA
| | - Kokila Mody
- Pathology and Laboratory Medicine, Northwell Health, Staten Island, USA
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Wang Z, Liu X, Wang W, Xu J, Sun H, Wei J, Yu Y, Zhao Y, Wang X, Liao Z, Sun W, Jia L, Zhang Y. UPLC-MS based integrated plasma proteomic and metabolomic profiling of TSC-RAML and its relationship with everolimus treatment. Front Mol Biosci 2023; 10:1000248. [PMID: 36891236 PMCID: PMC9986496 DOI: 10.3389/fmolb.2023.1000248] [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: 07/21/2022] [Accepted: 02/10/2023] [Indexed: 02/22/2023] Open
Abstract
Aim: To profile the plasma proteomics and metabolomics of patients with renal cysts, sporadic angiomyolipoma (S-AML) and tuberous sclerosis complex related angiomyolipoma (TSC-RAML) before and after everolimus treatment, and to find potential diagnostic and prognostic biomarkers as well as reveal the underlying mechanism of TSC tumorigenesis. Materials and Methods: We retrospectively measured the plasma proteins and metabolites from November 2016 to November 2017 in a cohort of pre-treatment and post-treatment TSC-RAML patients and compared them with renal cyst and S-AML patients by ultra-performance liquid chromatography-mass spectrometer (UPLC-MS). The tumor reduction rates of TSC-RAML were assessed and correlated with the plasma protein and metabolite levels. In addition, functional analysis based on differentially expressed molecules was performed to reveal the underlying mechanisms. Results: Eighty-five patients with one hundred and ten plasma samples were enrolled in our study. Multiple proteins and metabolites, such as pre-melanosome protein (PMEL) and S-adenosylmethionine (SAM), demonstrated both diagnostic and prognostic effects. Functional analysis revealed many dysregulated pathways, including angiogenesis synthesis, smooth muscle proliferation and migration, amino acid metabolism and glycerophospholipid metabolism. Conclusion: The plasma proteomics and metabolomics pattern of TSC-RAML was clearly different from that of other renal tumors, and the differentially expressed plasma molecules could be used as prognostic and diagnostic biomarkers. The dysregulated pathways, such as angiogenesis and amino acid metabolism, may shed new light on the treatment of TSC-RAML.
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Affiliation(s)
- Zhan Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoyan Liu
- School of Basic Medical College, Core facility of instrument, Institution of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenda Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiyu Xu
- School of Basic Medical College, Core facility of instrument, Institution of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Haidan Sun
- School of Basic Medical College, Core facility of instrument, Institution of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Wei
- Clinical Research Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yuncui Yu
- Clinical Research Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yang Zhao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xu Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhangcheng Liao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei Sun
- School of Basic Medical College, Core facility of instrument, Institution of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Lulu Jia
- Clinical Research Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Mohammadzadeh N, Kohansal S, ghasemlouei A. Recurrent retroperitoneal extra-renal angiomyolipoma: A case report and review of literature. Ann Med Surg (Lond) 2022; 81:104230. [PMID: 36147106 PMCID: PMC9486440 DOI: 10.1016/j.amsu.2022.104230] [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: 05/21/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction Angiomyolipoma (AML) is the most prevalent renal mesenchymal neoplasm that almost always involves kidneys. Case presentation We present a rare condition of retroperitoneal extra-renal angiomyolipoma which relapsed after 4 years that caused acute abdominal pain. Discussion The liver is the most common site of extrarenal angiomyolipoma. Abdominal pain is the most common complaint of extra-renal angiomyolipoma. Computed tomography angiography is the best way for angiomyolipoma diagnosis and surgery and post-surgery chemotherapy is the way for its treatment. Conclusion extrarenal angiomyolipoma is an extremely rare condition that patients should be followed up for over 5 years by appropriate radiologic imaging. Angiomyolipoma almost always involves kidneys. We present a retroperitoneal extra-renal angiomyolipoma case.
extra-renal angiomyolipoma is characterized as a benign tumor. We present a recurrent retroperitoneal extra-renal angiomyolipoma.
surgery is one of the best ways to both diagnosis and treatment of retroperitoneal extra-renal angiomyolipoma.
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Affiliation(s)
- Narjes Mohammadzadeh
- Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amir ghasemlouei
- Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author.
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Braganza J, Aljwaid A, Alazzawi M, Alshami A, Patel NS. Bilateral facial cutaneous angiomyolipomas: First case in the literature and a possible correlation with human immunodeficiency virus. IDCases 2020; 21:e00909. [PMID: 32685377 PMCID: PMC7355718 DOI: 10.1016/j.idcr.2020.e00909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
Angiomyolipomas (AMLs) are benign tumors consisting of smooth muscle-like cells, adipocyte-like cells, and epithelioid cells. They are usually renal in origin, and extrarenal AMLs are rare. Cutaneous AMLs are even more rare. We present a case of 65 year old female, with no underlying genetic condition, who developed bilateral facial cutaneous AMLs. To the best of our knowledge, this is the first case in the literature. In addition, we investigate and suggest a correlation between human immunodeficiency virus and AMLs.
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Affiliation(s)
| | | | - Mohammed Alazzawi
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
- Corresponding author.
| | - Nitin S. Patel
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
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Touloumis Z, Giannakou N, Sioros C, Trigka A, Cheilakea M, Dimitriou N, Griniatsos J. Retroperitoneal perivascular epithelioid cell tumours: A case report and review of literature. World J Clin Cases 2019; 7:3524-3534. [PMID: 31750334 PMCID: PMC6854398 DOI: 10.12998/wjcc.v7.i21.3524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/26/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The perivascular epithelioid cell tumour (PEComa) family of tumours mainly includes renal and hepatic angiomyolipomas, pulmonary lymphangioleiomyomatosis and clear cell “sugar” tumour of the lung. Several uncommon tumours with similar morphological and immunophenotypical characteristics arising at a variety of sites (abdominal cavity, digestive tract, retroperitoneum, skin, soft tissue and bones) are also included in the PEComa family and are referred to as PEComas not otherwise specified.
CASE SUMMARY We present a 37-year-old female patient who underwent resection of an 8.5 cm × 8 cm × 4 cm retroperitoneal tumour, which eventually was diagnosed as PEComa of uncertain biological behaviour. Three years after the operation, the patient remains without any evidence of recurrence. A search was performed in the Medline and EMBASE databases for articles published between 1996 and 2018, and we identified 31 articles related to retroperitoneal and perinephric PEComas. We focused on sex, age, maximum dimension, histological and immunohistochemical characteristics of the tumour, follow-up and long-term outcome. Thirty-four retroperitoneal (including the present one) and ten perinephric PEComas were identified, carrying a malignant potential rate of 44% and 60%, respectively. Nearly half of the potentially malignant PEComas presented with or developed metastases during the course of the disease.
CONCLUSION Retroperitoneal PEComas are not as indolent as they are supposed to be. Radical surgical resection constitutes the treatment of choice for localized disease, while mammalian target of the rapamycin (mTOR) inhibitors constitute the most promising therapy for disseminated disease. The role of mTOR inhibitors as adjuvant or neoadjuvant therapies needs to be evaluated in the future.
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Affiliation(s)
- Zisis Touloumis
- Department of Surgery, Athens Medical Group, Athens 11525, Greece
| | - Niki Giannakou
- Department of Pathology, Athens Medical Group, Athens 11525, Greece
| | - Christos Sioros
- Department of Surgery, Athens Medical Group, Athens 11525, Greece
| | - Argiro Trigka
- Department of Surgery, Athens Medical Group, Athens 11525, Greece
| | - Maria Cheilakea
- Emergency Department, Konstantopouleio General Hospital, N. Ionia 14233, Greece
| | - Nikoletta Dimitriou
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - John Griniatsos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
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Touloumis Z, Giannakou N, Sioros C, Trigka A, Cheilakea M, Dimitriou N, Griniatsos J. Retroperitoneal perivascular epithelioid cell tumours: A case report and review of literature. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i21.3507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Abstract
The simultaneous presence of renal angiomyolipoma and oncocytoma is a rare occurrence. Extrarenal retroperitoneal angiomyolipoma is an even more rare neoplasm, and its simultaneous presence with renal oncocytoma has not been documented. We present herein the first case to be reported in English literature.
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Affiliation(s)
| | | | - Kamal V Kanodia
- Department of Pathology, IKDRC-ITS, Ahmedabad, Gujarat, India
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Ghimire O, Wenzheng L, Huaping L, Wenguang L, Yigang P, Jiale H. Angiomyolipoma of the Adrenal Gland: A Report of Two Cases and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:989-994. [PMID: 28904331 PMCID: PMC5608147 DOI: 10.12659/ajcr.903908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Angiomyolipoma is a benign tumor composed of blood vessels, smooth muscle cells, and adipose tissue and has been described as belonging to the group of tumors of perivascular epithelioid cell origin (PEComa), commonly found in the kidneys and strongly associated with tuberous sclerosis. Only a few cases of extra-renal angiomyolipoma have previously been reported in the literature, most commonly in the liver. Adrenal angiomyolipoma is very rare, is usually asymptomatic, and is often found incidentally, with only 14 previously reported cases identified in the literature. CASE REPORT We report two cases of adrenal angiomyolipoma that were identified by abdominal computed tomography (CT). The first case presented in a 36-year-old man and was an oval-shaped adrenal mass, measuring 5.2×4.2×3.1 cm. The second case presented in a 61-year-old woman and was a round-shaped mass measuring 8.6×9.5×8.1 cm. Both patients underwent adrenalectomy. Histopathology and immunohistochemistry confirmed the diagnosis of benign angiomyolipoma composed of adipose tissues, blood vessels, and smooth muscle cells. CONCLUSIONS We present two rare cases of adrenal angiomyolipoma. We have reviewed the literature and identified 14 other cases of adrenal angiomyolipoma, and discuss the clinical, radiological, and pathological features of this rare tumor.
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Affiliation(s)
- Obin Ghimire
- Department Of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Li Wenzheng
- Department Of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Liu Huaping
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Liu Wenguang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Pei Yigang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Hou Jiale
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
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Jawahar A, Kazan-Tannus J. Retroperitoneal extrarenal angiomyolipoma at the surgical bed 8 years after a renal angiomyolipoma nephrectomy: A case report and review of literature. Urol Ann 2017; 9:288-292. [PMID: 28794601 PMCID: PMC5532902 DOI: 10.4103/ua.ua_20_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: 12/25/2022] Open
Abstract
Retroperitoneal extrarenal angiomyolipoma (RERAML) are rare and close mimickers of retroperitoneal liposarcoma on both imaging and histopathology. However, imaging findings including heterogeneity, hyperdensity on unenhanced computed tomography, intralesional hemorrhage, absence of calcifications, low signal intensity on T2-weighted magnetic resonance imaging, and dilated intratumoral vessels can lead to the diagnosis of RERAML. Diagnosis of RERAML can avoid unnecessary surgery since conservative medical management with continued surveillance has been proven to be effective for RERAML whereas surgical resection is the treatment for liposarcoma. Imaging and laboratory follow-up for at least 5 years has been recommended in patients who underwent surgical resection of angiomyolipoma (AML). We present a case of RERAML in an asymptomatic patient whose AML recurred in the surgical bed 8 years after an ipsilateral nephrectomy for renal AML.
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Affiliation(s)
- Anugayathri Jawahar
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois 60153, USA
| | - Joao Kazan-Tannus
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois 60153, USA
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