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Annicchiarico A, Montali F, Baldinu M, Casali L, Virgilio E, Costi R. Leiomyosarcoma of the rectum: A systematic review of recent literature. J Surg Oncol 2024; 129:365-380. [PMID: 37814590 DOI: 10.1002/jso.27481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
Leiomyosarcomas (LMSs) are rare tumors originating from the muscular layer. We performed a literature review of cases of confirmed rectal leiomyosarcomas (rLMSs) to clarify the history of such an infrequent tumor arising at such an uncommon location. In this research local recurrence was related to poorly differentiated rLMS and no other association between recurrence and any criteria was found. Concerning overall survival (OS), rLMS patients developing recurrence presented shorter longevity compared with the group without.
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Affiliation(s)
- Alfredo Annicchiarico
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Filippo Montali
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Manuel Baldinu
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lorenzo Casali
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Edoardo Virgilio
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Renato Costi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
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Shilo Yaacobi D, Bekhor EY, Khalifa M, Sandler TE, Issa N. Trans-anal endoscopic microsurgery for non- adenomatous rectal lesions. World J Gastrointest Surg 2023; 15:2406-2412. [PMID: 38111779 PMCID: PMC10725552 DOI: 10.4240/wjgs.v15.i11.2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/29/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Trans-anal endoscopic microsurgery (TEM) enables a good visualization of the surgical field and is considered the method of choice for excision of adenomas and early T1 rectal cancer. The rectum and retro-rectal space might be the origin of uncommon neoplasms, benign and aggressive, certain require radical trans-abdominal surgery, while others can be treated by a less aggressive approach. In this study we report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years. AIM To report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years. METHODS Between January 2008 to December 2019 a retrospective analysis was completed for all patients who underwent TEM for non-adenomatous rectal lesion or retro-rectal mass in our institution. Patients were discharged once diet was well tolerated and no complications were identified. They were evaluated at 3 wk post operatively, then at 3-mo intervals for the first 2 years and every 6 mo depending on the nature of the final pathology. Clinical examination and rectoscopy were performed during each of the follow-up visits. RESULTS Out of 198 patients who underwent TEM during the study period, 18 had non-adenomatous rectal or retro-rectal lesions. Mean age was 47 years. The mean size of the lesions was 2.9 mm, with a mean distance from the anal margin of 7.9 cm. Mean surgical time was 97.8 min. There were no intra-operative neither late post-operative complications. Mean length of stay was 2.5 d. Mean patient follow-up duration was 42 mo. CONCLUSION TEM allows for reduced morbidity given its minimally invasive nature. Surgeons should be familiar with the technique but careful patient selection should be considered. It can be used safely for uncommon rectal and selected retro-rectal lesions without compromising outcomes. We believe that it should be reasonably considered as one of the surgical methods when treating rare lesions.
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Affiliation(s)
- Dafna Shilo Yaacobi
- Department of Plastic Surgery and Burns, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Eliahu Y Bekhor
- Department of Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Muhammad Khalifa
- Department of Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Tal E Sandler
- Department of Anesthesiology, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Nidal Issa
- Department of Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel
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Liver metastasis or a pseudocyst? A rare presentation of leiomyosarcoma's metastasis in the liver. Contemp Oncol (Pozn) 2022; 26:306-309. [PMID: 36816396 PMCID: PMC9933358 DOI: 10.5114/wo.2022.124595] [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: 10/18/2022] [Accepted: 12/14/2022] [Indexed: 02/12/2023] Open
Abstract
Gastrointestinal neoplasms most commonly metastasize to the liver, where they are typically found as solid and hypervascular lesions. Here, we describe a case of a 44-year-old man with a leiomyosarcoma of the rectum, who at the time of diagnosis presented with a small (5 mm in diameter) cyst-like lesion in the liver. Positron emission tomography demonstrated no increased metabolism in the area of the cyst, suggesting a benign character of the lesion. However, after 3 years, CT scans revealed enlargement of the cyst, and local surgical excision was performed. The results of histopathological examination of the resected material were consistent with metastatic leiomyosarcoma. Subsequently, the patient developed lung metastases and died within 2 years. Our case describes a very rare presentation of leiomyosarcoma's metastasis that led to an ill-fated misdiagnosis and dismal disease outcome.
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Takagi T, Saito S, Yokota S, Kaneko Y, Takahashi K, Kanamaru R, Kurashina K, Hosoya Y, Kitayama J, Kawata H, Osawa H, Sata N. Laparoscopic and endoscopic cooperative surgery for leiomyosarcoma of the stomach: a case report with a review of the literature. Surg Case Rep 2021; 7:146. [PMID: 34143361 PMCID: PMC8212316 DOI: 10.1186/s40792-021-01218-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/26/2021] [Indexed: 11/12/2022] Open
Abstract
Background Leiomyosarcoma is a rare tumor that could originate from the gastrointestinal tract, uterus, kidney, retroperitoneum, and the soft tissues of the extremities. It accounts for only 1% of all gastrointestinal mesenchymal tumors and primary leiomyosarcoma of the stomach is extremely rare. Most cases reported as leiomyosarcoma of the stomach before the development of KIT immunohistochemistry might be gastrointestinal stromal tumors (GISTs) of the stomach and only 18 cases of leiomyosarcoma of the stomach have been reported since early 2000s. We report here a patient with leiomyosarcoma of the stomach treated by laparoscopic and endoscopic cooperative surgery (LECS). Case presentation A 59-year-old man was referred to our hospital for an early gastric cancer, which was initially treated by endoscopic submucosal dissection. Six months after his initial treatment, a follow-up esophagogastroduodenoscopy revealed a small polypoid lesion at the lesser curvature of the proximal stomach, which appeared to be a hyperplastic polyp. However, one and a half years later, the lesion grew and showed more irregular surface. Biopsy at the time revealed smooth muscle cell proliferation suggestive of leiomyoma. Three years later, the lesion grew even larger and biopsy showed pleomorphic spindle cells. Immunohistochemical study showed positive staining for alpha-smooth muscle actin and desmin, but negative for c-kit and CD34. Ki-67 labeling index was nearly 60%. Based on these findings, the diagnosis of leiomyosarcoma was established. The patient subsequently underwent a partial gastrectomy by LECS. The patient is currently in good condition without recurrence or metastasis at 12 months after surgery. Conclusions Leiomyosarcoma of the stomach is extremely rare. This is the first report of leiomyosarcoma of the stomach treated by LECS. We could also follow its appearance change through endoscopic examination for 3 years.
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Affiliation(s)
- Toru Takagi
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shin Saito
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Shinichiro Yokota
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.,Department of Surgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 1521, USA
| | - Yuki Kaneko
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kazuya Takahashi
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Rihito Kanamaru
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kentaro Kurashina
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yoshinori Hosoya
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Joji Kitayama
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hirotoshi Kawata
- Department of Pathology, Jichi Medical University, Shimotsuke, Japan
| | - Hiroyuki Osawa
- Department of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Koyama R, Maeda Y, Minagawa N, Shinohara T. A case of laparoscopic resection of leiomyosarcoma arising in the mesentery of descending colon: a case report and review of the literature. Clin Case Rep 2020; 8:3344-3348. [PMID: 33363931 PMCID: PMC7752332 DOI: 10.1002/ccr3.3174] [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: 05/24/2020] [Revised: 06/21/2020] [Accepted: 07/05/2020] [Indexed: 11/12/2022] Open
Abstract
Leiomyosarcoma of mesenteric origin is rare and may be managed by laparoscopic surgery as a less invasive procedure, on the condition that the tumor can be resected with a safe margin.
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Affiliation(s)
- Ryota Koyama
- Department of Gastrointestinal SurgeryHokkaido Cancer CenterSapporoJapan
| | - Yoshiaki Maeda
- Department of Gastrointestinal SurgeryHokkaido Cancer CenterSapporoJapan
| | - Nozomi Minagawa
- Department of Gastrointestinal SurgeryHokkaido Cancer CenterSapporoJapan
| | - Toshiki Shinohara
- Department of Gastrointestinal SurgeryHokkaido Cancer CenterSapporoJapan
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Mesenteric Lymph Node Recurrence of a Primary Colorectal Leiomyosarcoma. Case Rep Surg 2020; 2020:6935834. [PMID: 32257499 PMCID: PMC7125469 DOI: 10.1155/2020/6935834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/16/2020] [Indexed: 12/14/2022] Open
Abstract
Primary colorectal leiomyosarcoma is an excessively rare entity. It is associated with an aggressive behavior and typically favor hematogenous spread. The current standard of care is surgical resection. A 49-year-old patient presented with a 2-month history of fever. A PET-scan revealed a hypermetabolic mass in the transverse colon, and colonoscopy confirmed a tumor. A right hemicolectomy was performed. Histopathological diagnosis was of a leiomyosarcoma. Fourteen months after the surgery, a follow-up abdominal scan revealed a 2 cm mesenteric lymph node that was hypermetabolic on PET-scan. The mesenteric lymph node was resected and histopathology confirmed a leiomyosarcoma metastasis. This case opens the controversy on the management of rare lymph node recurrences in colorectal leiomyosarcoma.
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Grech P, Schofield JB. Spindle cell proliferations of the sigmoid colon, rectum and anus: a review with emphasis on perineurioma. Histopathology 2020; 76:342-353. [PMID: 31587346 DOI: 10.1111/his.14011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A wide range of spindle cell proliferations are found uncommonly in the sigmoid colon, rectum and anus. They usually present as polyps, and include reactive lesions and benign and malignant neoplasms which may be primary or metastatic. They are less frequently described in the literature compared to those in the upper gastrointestinal tract, and may be underdiagnosed. The widespread use of sigmoidoscopy in symptomatic patients and bowel cancer screening programmes means that histopathologists must be aware of, and adopt a logical approach to, diagnosing spindle cell proliferations in biopsy and polypectomy specimens. This is particularly relevant given the strong association of some mesenchymal polyps with hereditary cancer syndromes. This review article will focus on perineurioma and the recent debate in relation to its overlap with fibroblastic polyp. The clinical, endoscopic, histological and immunohistochemical features of spindle cell proliferations which should be considered in the differential diagnosis of perineurioma will be discussed. There is also a brief reference to malignant spindle cell tumours of diagnostic importance.
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Affiliation(s)
- Patrice Grech
- Department of Cellular Pathology, Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - John B Schofield
- Department of Cellular Pathology, Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
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Sunkara T, Then EO, Culliford A, Gaduputi V. Rectal leiomyoma, a rare entity. Clin Pract 2018; 8:1053. [PMID: 29657702 PMCID: PMC5890090 DOI: 10.4081/cp.2018.1053] [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: 12/15/2017] [Revised: 01/26/2018] [Accepted: 02/26/2018] [Indexed: 12/29/2022] Open
Abstract
Rectal tumors are often encountered as an incidental finding on screening colonoscopy. As per the World Health Organization, they are categorized according to their histologic appearance. These include epithelial tumors, mesenchymal tumors and lymphomas. Of interest, in our case, are mesenchymal tumors. These are sub-classified into leiomyomas and gastrointestinal stromal tumors. Our case is a 33-year old male who was diagnosed with a rectal leiomyoma. The uncommon incidence and subsequent management of a rectal leiomyoma in a male, make this case worthy for literature review.
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Affiliation(s)
- Tagore Sunkara
- Division of Gastroenterology & Hepatology, The Brooklyn Hospital Center, Brooklyn, NY
| | - Eric Omar Then
- Department of Internal Medicine, SBH Health System, Bronx, NY, USA
| | - Andrea Culliford
- Department of Internal Medicine, SBH Health System, Bronx, NY, USA
| | - Vinaya Gaduputi
- Department of Internal Medicine, SBH Health System, Bronx, NY, USA
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Lysanets Y, Morokhovets H, Bieliaieva O. Stylistic features of case reports as a genre of medical discourse. J Med Case Rep 2017; 11:83. [PMID: 28285584 PMCID: PMC5346841 DOI: 10.1186/s13256-017-1247-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/20/2017] [Indexed: 11/12/2022] Open
Abstract
Background The present paper discusses the lexical and grammatical peculiarities of English language medical case reports, taking into account their communicative purposes and intentions. Methods The objective of the research is to clarify the principal mechanisms of producing an effective English language medical case report and thus to provide recommendations and guidelines for medical professionals who will deal with this genre. The analysis of medical case reports will largely focus on the most significant linguistic peculiarities, such as the use of active and passive voice, the choice of particular verb tenses, and pronouns. The selected medical case reports will be considered using methods of lexico-grammatical analysis, quantitative examination, and contextual, structural, narrative, and stylistic analyses. Results The research revealed a range of important stylistic features of medical case reports which markedly distinguish them from other genres of medical scientific writing: educational and instructive intentions, conciseness and brevity, direct and personal tone, and material presented in a narrative style. The present research has shown that the communicative strategies of the analyzed discourse, mentioned immediately above, are effectively implemented by means of specific lexical units and grammatical structures: the dominance of active voice sentences, past simple tense, personal pronouns, and modal verbs. The research has also detected the occasional use of the present perfect, present simple, and future simple tenses and passive voice which also serve particular communicative purposes of medical case reports. Conclusions Medical case reports possess a range of unique characteristics which differ from those of research articles and other scientific genres within the framework of written medical discourse. It is to be emphasized that it is highly important for medical professionals to master the major stylistic principles and communicative intentions of medical case report as a genre in order to share their findings with fellow researchers from all over the world. Hence, in the process of training future medical researchers, the analysis of the basic mechanisms of writing a medical case report should be an integral part of the curricula in English for Specific Purposes at universities.
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Affiliation(s)
- Yuliia Lysanets
- Department of Foreign Languages with Latin Language and Medical Terminology of Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
| | - Halyna Morokhovets
- Research Department of Ukrainian Medical Stomatological Academy, 23 Shevchenko Str., 36011, Poltava, Ukraine
| | - Olena Bieliaieva
- Department of Foreign Languages with Latin Language and Medical Terminology of Ukrainian Medical Stomatological Academy, Poltava, Ukraine
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