1
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Trivedi S, Gothwal M, Binit S, Singh P. Disseminated peritoneal leiomyoma: a diagnostic dilemma. BMJ Case Rep 2024; 17:e259093. [PMID: 38862186 DOI: 10.1136/bcr-2023-259093] [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] [Indexed: 06/13/2024] Open
Abstract
Disseminated peritoneal leiomyomatosis (DPL) is a rare and benign clinical entity. It is also known as leiomyomatosis peritonealis disseminata (LPD). Here, we report and discuss a case of a primiparous woman in her early 40s who presented with heavy, prolonged, painful menses and heaviness in her lower abdomen. She underwent a laparoscopic myomectomy for a fibroid uterus, 12 months ago for similar complaints. On workup, she was diagnosed with DPL. We performed a total abdominal hysterectomy with bilateral salpingectomy, low anterior resection with stapled colorectal anastomosis and excision of peritoneal tumour deposits in consortium with the gastrosurgery team. Her postoperative period was uneventful, and the patient was discharged on postop day 6. Her histopathology report was consistent with leiomyoma; the follow-up period was uneventful.
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Affiliation(s)
- Swati Trivedi
- Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Meenakshi Gothwal
- Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Sureka Binit
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Pratibha Singh
- Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
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2
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Liu S, Zhou W, Fu W. Multiple Leiomyomas in a Patient with Benign Metastasizing Leiomyoma: A Case Report. Curr Med Imaging 2022; 18:996-999. [PMID: 35339186 DOI: 10.2174/1573405618666220325094428] [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: 11/03/2021] [Revised: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Benign metastasizing leiomyoma (BML) is a rare disease and mostly affects females with a history of uterine leiomyoma, particularly the presence of multiple leiomyomas in BML patients is extremely rare. CASE PRESENTATION This paper reported the clinical and imaging data of a BML patient with multiple leiomyomas involving bilateral pulmonary, mediastinum, pericardium, spine, peritoneum, and left thigh. Multiple BML lesions exhibited consistent imaging examinations, significantly improving the delayed phase enhancement. After multi-stage targeted therapy for multiple systemic metastases and the development of drug resistance, the patient was treated with hysterectomy and bilateral adnexectomy along with letrozole-based endocrine therapy. BML lesions, both pulmonary and mediastinum, became significantly smaller than before. CONCLUSION This paper aims to analyze the imaging and clinical features of multiple leiomyomas in this BML case, thus strengthening the understanding of the rare type of leiomyoma for effective preoperative diagnosis and clinical treatment. Furthermore, it is noteworthy that gynecologists should avoid the manifestation of BML when performing uterine fibroids surgery.
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Affiliation(s)
- Shuangjiao Liu
- Department of Radiology, YueYang Central Hospital, Hunan Province, China
| | - Wenming Zhou
- Department of Radiology, YueYang Central Hospital, Hunan Province, China
| | - Weidong Fu
- Department of Radiology, YueYang Central Hospital, Hunan Province, China
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3
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Elsherif SB, Agely A, Gopireddy DR, Ganeshan D, Hew KE, Sharma S, Lall C. Mimics and Pitfalls of Primary Ovarian Malignancy Imaging. Tomography 2022; 8:100-119. [PMID: 35076619 PMCID: PMC8788482 DOI: 10.3390/tomography8010009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
The complex anatomy and similarity of imaging features of various pathologies in the pelvis can make accurate radiology interpretation difficult. While prompt recognition of ovarian cancer remains essential, awareness of processes that mimic ovarian tumors can avoid potential misdiagnosis and unnecessary surgery. This article details the female pelvic anatomy and highlights relevant imaging features that mimic extra-ovarian tumors, to help the radiologists accurately build a differential diagnosis of a lesion occupying the adnexa.
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Affiliation(s)
- Sherif B. Elsherif
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
- Correspondence:
| | - Ali Agely
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Dheeraj R. Gopireddy
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
| | | | - Karina E. Hew
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA;
| | - Smita Sharma
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
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4
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Araki H, Yoshizako T, Yoshida R, Maruyama M, Ishikawa N, Kitagaki H. MR Imaging of Parasitic Leiomyoma with Red Degeneration. Magn Reson Med Sci 2020; 19:87-88. [PMID: 31061267 PMCID: PMC7232031 DOI: 10.2463/mrms.ici.2019-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Hisayoshi Araki
- Department of Radiology, Shimane University Faculty of Medicine
| | | | - Rika Yoshida
- Department of Radiology, Shimane University Faculty of Medicine
| | | | | | - Hajime Kitagaki
- Department of Radiology, Shimane University Faculty of Medicine
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5
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Abstract
Intravenous leiomyomatosis (IVLM) is an unusual neoplasm derived from uterine smooth muscle cells seen in patients with uterine leiomyomas. The typical histological features of IVLM consist of benign smooth muscle cells present within venous vascular spaces of the uterine wall. Increasing intravascular and intracardial spread of IVLM may lead to life-threatening clinical complications. Thorough pathological study of routine hysterectomy specimens may lead to the diagnosis of IVLM. Most affected patients will be cardiologically asymptomatic at the time of diagnosis. Herein, the relatively unknown clinical and morphological aspects of IVLM are presented and discussed.
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6
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Shaukat I, Yassin S, Paudel A, Höti N, Mustafa S. Unusual presentation of parasitic leiomyoma; a tale of twists and turns. J Community Hosp Intern Med Perspect 2019; 9:168-170. [PMID: 31044051 PMCID: PMC6484481 DOI: 10.1080/20009666.2019.1591899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 03/01/2019] [Indexed: 01/01/2023] Open
Abstract
Uterine leiomyoma is the most common benign pelvic tumor of the myometrium, as the prevalence could be as high as 70%. Major risk factors include age between 40–60 years and African descent. It usually presents with abnormal uterine bleeding and/or pelvic pain or pressure. Extra-uterine cases of leiomyoma have been reported including Leiomyomatosis Peritonealis Disseminata (LPD), in which multiple nodules are found in the pelvis, peritoneum, or intestine. The term parasitic leiomyoma has been used in literature to describe a non-disseminating pattern . There is no clear explanation for pathogenesis; however, some reports linked it to previous uterine procedures. We are presenting here a case report of an unusual presentation of extra-uterine leiomyoma in a patient with a remote history of hysterectomy for uterine fibroids.
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Affiliation(s)
- Irfan Shaukat
- Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA
| | - Sayf Yassin
- Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Amrit Paudel
- Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Naseruddin Höti
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Urology, University of Texas Health Science CenterSan Antonio, San Antonio, TX, USA
| | - Sadaf Mustafa
- Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
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7
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Bhargava P, Haque K, Vea R, Turbat-Herrera E, Chu Q, Sangster G, D'Agostino H. Parasitic leiomyoma presenting as an inguinal hernia in a postmenopausal woman. Radiol Case Rep 2018; 13:767-771. [PMID: 29887930 PMCID: PMC5991889 DOI: 10.1016/j.radcr.2018.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/08/2018] [Indexed: 12/03/2022] Open
Abstract
Uterine leiomyomas are one of the most common tumors affecting reproductive-age women. Leiomyomas can present as an intrauterine mass or rarely as an extrauterine tumor. Depending on its location, the diagnosis of extrauterine leiomyoma can be challenging, and multiple imaging modalities may be needed for correct identification and differentiation from malignant entities. We report the case of a 48-year-old-postmenopausal female who presented with a painful left inguinal mass, which was clinically diagnosed as inguinal hernia. Ultrasound, computed tomography, magnetic resonance imaging, and percutaneous biopsy were used to characterize the mass. Surgical resection and histopathological analysis revealed the mass to be a parasitic leiomyoma, a very rare cause of inguinal hernia, especially in a postmenopausal woman.
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Affiliation(s)
- Peeyush Bhargava
- Department of Radiology, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Kabiul Haque
- Department of Family Medicine, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Romulo Vea
- Department of Radiology, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Elba Turbat-Herrera
- Department of Pathology, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Quyen Chu
- Department of Surgery, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Guillermo Sangster
- Department of Radiology, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Horacio D'Agostino
- Department of Radiology, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
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8
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Abstract
There are 3 histologically benign smooth muscle neoplasms that have unusual growth patterns. These include intravascular leiomyomatosis, benign metastasizing leiomyoma, and leiomyomatosis peritonealis desseminata. We report a unique case of perivascular leiomyomatosis. The tumor showed multiple nodules of benign smooth muscle with some of the nodules closely associated with the periphery of the medial muscle layer of venous channels. All the neoplastic nodules were located on the outer surface of venous channels, thus precluding a diagnosis of intravascular leiomyomatosis. To the best of our knowledge, this is the first documentation of such an entity.
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9
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Sizzi O, Manganaro L, Rossetti A, Saldari M, Florio G, Loddo A, Zurawin R, van Herendael B, Djokovic D. Assessing the risk of laparoscopic morcellation of occult uterine sarcomas during hysterectomy and myomectomy: Literature review and the ISGE recommendations. Eur J Obstet Gynecol Reprod Biol 2018; 220:30-38. [DOI: 10.1016/j.ejogrb.2017.10.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/16/2017] [Accepted: 10/30/2017] [Indexed: 02/07/2023]
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10
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Jalaguier-Coudray A, Allain-Nicolai A, Thomassin-Piana J, Villard-Mahjoub R, Delarbre B, Rua S, Lambaudie E, Houvenaeghel G. Radio-surgical and pathologic correlations of pelvic intravenous leiomyomatosis. Abdom Radiol (NY) 2017. [PMID: 28643137 DOI: 10.1007/s00261-017-1225-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Intravenous leiomyomatosis has an unusual growth pattern characterized by proliferation of smooth muscle in uterine and systemic veins. Although histologically benign, this condition could eventually have a clinically aggressive course. At an early stage, the disease is often misdiagnosed on preoperative imaging because of its low prevalence, non-specific initial clinical manifestation, and poorly known radiological characteristics. An early, accurate diagnosis is needed for appropriate surgical management that could result in a good prognosis, reducing the risk of recurrence and morbidity. Magnetic resonance imaging is a particularly valuable technique for assessing intravenous leiomyomatosis preoperatively.
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Affiliation(s)
- A Jalaguier-Coudray
- Department of Radiology, Service d'Imagerie de la Femme, Institute Paoli-Calmettes, 232 boulevard Sainte-Marguerite, 13009, Marseille, France.
| | - A Allain-Nicolai
- Department of Radiology, Service d'Imagerie de la Femme, Institute Paoli-Calmettes, 232 boulevard Sainte-Marguerite, 13009, Marseille, France
| | - J Thomassin-Piana
- Department of Histopathology, Institute Paoli-Calmettes, Marseille, France
| | - R Villard-Mahjoub
- Department of Radiology, Service d'Imagerie de la Femme, Institute Paoli-Calmettes, 232 boulevard Sainte-Marguerite, 13009, Marseille, France
| | - B Delarbre
- Department of Radiology, Service d'Imagerie de la Femme, Institute Paoli-Calmettes, 232 boulevard Sainte-Marguerite, 13009, Marseille, France
| | - S Rua
- Department of Gynecology, Institute Paoli-Calmettes, Marseille, France
| | - E Lambaudie
- Department of Gynecology, Institute Paoli-Calmettes, Marseille, France
| | - G Houvenaeghel
- Department of Gynecology, Institute Paoli-Calmettes, Marseille, France
- CRCM and Université Aix-Marseille, Marseille, France
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11
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Cystic pulmonary benign metastasizing leiomyoma: case report. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Zeng H, Xu Z, Zhang L, Luo YI, Chen H, Zhu H, Peng L, Yu J. Intravenous leiomyomatosis with intracardiac extension depicted on computed tomography and magnetic resonance imaging scans: A report of two cases and a review of the literature. Oncol Lett 2016; 11:4255-4263. [PMID: 27313775 DOI: 10.3892/ol.2016.4499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/15/2016] [Indexed: 02/05/2023] Open
Abstract
Intravenous leiomyomatosis (IVL) is defined as a benign smooth muscle tumor, growing within systemic veins. IVL with intracaval and intracardiac extension has rarely been reported in radiological and oncological journals. The present study describes 2 cases of IVL extending from the inferior vena cava to the right atrium and ventricle, and discusses the imaging findings and differential diagnosis of this tumor entity. The two patients, who complained of palpitations, shortness of breath or syncope, were surgically treated, with complete resection of the cardiac and intracaval tumors. Pathological examinations were suggestive of IVL. The postoperative course of the two patients was uneventful, and no signs of recurrence were observed on follow-up. Computed tomography and magnetic resonance imaging played a vital role in the diagnostic process and presurgical assessment. The results of the present study indicate that IVL should be considered upon presentation of a soft mass in systemic veins, even when the mass extends to the right cardiac chambers, in female patients, particularly in patients with a history of uterine myoma.
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Affiliation(s)
- Hanjiang Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhongzi Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Lizhi Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Y I Luo
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hui Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hongji Zhu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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13
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Lete I, González J, Ugarte L, Barbadillo N, Lapuente O, Álvarez-Sala J. Parasitic leiomyomas: a systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 203:250-9. [PMID: 27359081 DOI: 10.1016/j.ejogrb.2016.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/27/2016] [Accepted: 05/13/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Parasitic leiomyomas were first described as early as 1909 but are a rare condition. In recent years, due to the rise of laparoscopic surgery and power morcellation, several cases of parasitic leiomyomas associated with this surgical procedure have been reported. METHODS A literature search was performed using PubMed, Embase and Google Scholar with the following combination of keywords: leiomyoma OR uterine neoplasms OR uterine myomectomy OR laparoscopy OR hysterectomy OR peritoneal neoplasms AND parasitic. Papers describing parasitic leiomyomas were included. The results of these studies are summarized herein. RESULTS We retrieved abstracts of 756 papers. Of these, 591 were excluded for not fulfilling the inclusion criteria and 54 were removed as duplicates; after full-text assessment, 8 were rejected for presenting cases of malignancy and finally 103 were included in our systematic review. From these, we present information about 274 patients with parasitic leiomyomas. The mean age of women was 40 years (range 18-79 years); and 154 (56%) had no history of uterine surgery, the others (120, 44%) having had a previous myomectomy or hysterectomy. Of the total, 106 (39%) women had a history of power morcellation. The most frequent clinical symptom was abdominal pain (49%) and the most frequent presentation was disseminated peritoneal leiomyomatosis. CONCLUSIONS While parasitic leiomyoma was first described a century ago, the recent introduction of laparoscopic power morcellation has increased the number of reported cases.
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Affiliation(s)
- Iñaki Lete
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain; School of Medicine, Basque Country University, Vitoria, Spain; BioAraba Research Unit, Vitoria, Spain.
| | - Janire González
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Lorea Ugarte
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Nagore Barbadillo
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Oihane Lapuente
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Javier Álvarez-Sala
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
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14
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Nogami Y, Yamagami W, Maki J, Banno K, Susumu N, Tomita K, Matsubara K, Obara H, Kitagawa Y, Aoki D. Intravenous low-grade endometrial stromal sarcoma with intracardiac extension: A CASE OF inaccurate tumor location on contrast-enhanced computed tomography. Mol Clin Oncol 2016; 4:179-182. [PMID: 26893856 DOI: 10.3892/mco.2015.691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/17/2015] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of low-grade endometrial stromal sarcoma with intracardiac extension in a 58-year-old woman with a uterine tumor with intravascular involvement. The tumor was suspected preoperatively to be an endometrial stromal sarcoma by magnetic resonance imaging. The extent of intravascular involvement was determined to be below the level of the renal veins on preoperative contrast-enhanced computed tomography (CT). However, perioperative echography revealed that the tumor extended to the right atrium. An emergency cardiotomy with extracorporeal circulation was required. The risk of tumor embolism was reduced through transection of the inferior vena cava, but the tumor was difficult to remove completely. Postoperative hormonal therapy reduced the size of the residual tumor and no recurrence was detected for 1 year. The preoperative contrast-enhanced CT was unable to detect the free-floating intravascular tumor. This case illustrates a limitation of CT and indicates that accurate determination of the tumor extent for planning a surgical strategy in similar cases should be performed using multiple imaging methods.
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Affiliation(s)
- Yuya Nogami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Junko Maki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Nobuyuki Susumu
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Koichi Tomita
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kentaro Matsubara
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
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15
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Merino Serra EM, Sánchez Márquez A. [Intravenous leiomyomatosis: an unusual growth pattern in uterine myomas]. RADIOLOGIA 2016; 58:157-8. [PMID: 26850648 DOI: 10.1016/j.rx.2015.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/20/2015] [Accepted: 12/28/2015] [Indexed: 11/25/2022]
Affiliation(s)
- E M Merino Serra
- Institut de Diagnòstic per la Imatge (IDI), Hospital Universitario de Bellvitge-Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, España.
| | - A Sánchez Márquez
- Institut de Diagnòstic per la Imatge (IDI), Hospital Universitario de Bellvitge-Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, España
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16
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Jain N, Rissam HK, Mittal UK, Sharma A. Intravenous leiomyomatosis with intracardiac extension: an unusual presentation of uterine leiomyoma and evaluation with 256-slice dual-source multidetector CT and cardiac MRI. BMJ Case Rep 2015; 2015:bcr-2015-211712. [PMID: 26643185 DOI: 10.1136/bcr-2015-211712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 40-year-old woman who presented with breathlessness, palpitations and vague pelvic pain for 6 months. The dyspnoea was non-exertional and episodic. She was a non-diabetic, non-hypertensive and had no history of prior surgeries. ECG and chest radiograph were normal. Cardiac MRI and 256-slice dual-source multidetector CT evaluation revealed the presence of a uterine and left adnexal mass with intravenous extension into the inferior vena cava via the gonadal veins, and further cephalad extension into the right atrium and ventricle. The patient was referred to the cardiothoracic surgery department and underwent two-stage surgical procedures. The first stage consisted of thoracotomy and tumour removal from the right atrium and inferior vena cava. In the second stage, hysterectomy and bilateral salpingo-oophorectomy was performed. The histological analysis of the excised specimen was consistent with an intravascular leiomyoma.
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Affiliation(s)
- Neeraj Jain
- Department of Radiology, GB Pant Hospital, New Delhi, India
| | | | - Umesh Kumar Mittal
- Department of Radiodiagnosis, GB Pant Institute of Post Graduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ashok Sharma
- Department of Radiodiagnosis, GB Pant Hospital, New Delhi, India
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17
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18
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Van den Bosch T, Dueholm M, Leone FPG, Valentin L, Rasmussen CK, Votino A, Van Schoubroeck D, Landolfo C, Installé AJF, Guerriero S, Exacoustos C, Gordts S, Benacerraf B, D'Hooghe T, De Moor B, Brölmann H, Goldstein S, Epstein E, Bourne T, Timmerman D. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:284-98. [PMID: 25652685 DOI: 10.1002/uog.14806] [Citation(s) in RCA: 378] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/18/2015] [Accepted: 01/27/2015] [Indexed: 05/14/2023]
Abstract
The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented.
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Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - M Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L Sacco, University of Milan, Milan, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C K Rasmussen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - A Votino
- Department of Obstetrics and Gynecology, Brugmann University Hospital, Brussels, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - C Landolfo
- Department of Obstetrics and Gynecology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A J F Installé
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - S Guerriero
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria of Cagliari and University of Cagliari, Cagliari, Italy
| | - C Exacoustos
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Gordts
- L.I.F.E. (Leuven Institute for Fertility & Embryology), Leuven, Belgium
| | - B Benacerraf
- Departments of Radiology and Obstetrics & Gynecology, Harvard Medical School, Boston, MA, USA
| | - T D'Hooghe
- Leuven University Fertility Centre, University Hospitals KU Leuven, Leuven, Belgium
| | - B De Moor
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - H Brölmann
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - E Epstein
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - T Bourne
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
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Leursen G, Gardner CS, Sagebiel T, Patnana M, de CastroFaria S, Devine CE, Bhosale PR. Magnetic Resonance Imaging of Benign and Malignant Uterine Neoplasms. Semin Ultrasound CT MR 2015; 36:348-60. [PMID: 26296485 DOI: 10.1053/j.sult.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Benign and malignant uterine masses can be seen in the women. Some of these are asymptomatic and incidentally discovered, whereas others can be symptomatic. With the soft tissue contrast resolution magnetic resonance imaging can render a definitive diagnosis, which can further help streamline patient management. In this article we show magnetic resonance imaging examples of benign and malignant masses of the uterus and their treatment strategies.
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Affiliation(s)
- Gustavo Leursen
- Department of Abdominal Radiology, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Tara Sagebiel
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX
| | - Madhavi Patnana
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX
| | | | | | - Priya R Bhosale
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX.
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20
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Tirosh D, Tirosh NB, Goldstein D, Sheizaf B. Large Parasitic Myoma Post Laparoscopic Subtotal Hysterectomy with Morcellation: Case Report and Literature Review. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dan Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Neta Benshalom Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David Goldstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Boaz Sheizaf
- Department of Obstetrics and Gynecology, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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21
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Wei WT, Chen PC. Benign metastasizing leiomyoma of the lung: A case report and literature review. Oncol Lett 2015; 10:307-312. [PMID: 26171020 DOI: 10.3892/ol.2015.3224] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 04/14/2015] [Indexed: 11/06/2022] Open
Abstract
Pulmonary benign metastasizing leiomyoma (BML) is a rare event characterized by benign soft-tissue tumors that occur when uterine leiomyomas metastasize to the lung. The present study reports the case of a 47-year-old female patient who presented with multiple bilateral pulmonary nodules on a chest X-ray during a health checkup nine years after a hysterectomy due to uterine fibroids. Chest computed tomography (CT) revealed multiple well-defined nodular shadows in the lung. One tumor of the left upper lung was resected by thoracoscopic surgery. Pathologically, the resected lesion consisted of benign spindle cells and was diagnosed as BML. The post-operative course was uneventful. Other lung nodules have been meticulously monitored at follow-up, and repeat CT two years later showed that these nodules had not increased at all in size and that no new lobe nodules had appeared. The present study indicates that pulmonary BML occurs in a low proportion of female with a history of uterine leiomyoma and treatment methods for it are diverse and controversial.
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Affiliation(s)
- Wei-Tian Wei
- Department of Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310000, P.R. China
| | - Peng-Cheng Chen
- Department of Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310000, P.R. China
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22
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Shwayder J, Sakhel K. Imaging for Uterine Myomas and Adenomyosis. J Minim Invasive Gynecol 2014; 21:362-76. [DOI: 10.1016/j.jmig.2013.11.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/16/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022]
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23
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Rabischong B, Beguinot M, Compan C, Bourdel N, Kaemmerlen AG, Pouly JL, Canis M, Mage G, Botchorishvili R. Complication à long terme du morcellement utérin par voie cœlioscopique : les myomes parasitiques iatrogènes. ACTA ACUST UNITED AC 2013; 42:577-84. [DOI: 10.1016/j.jgyn.2013.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/28/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
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24
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Affiliation(s)
- Nisha Singh
- Department of Obstetrics and Gynecology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Uma Singh
- Department of Obstetrics and Gynecology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Bhumika Bansal
- Department of Obstetrics and Gynecology, King George Medical University, Lucknow, Uttar Pradesh, India
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25
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Chen S, Zhang Y, Zhang J, Hu H, Cheng Y, Zhou J, Shen L, Chen H. Pulmonary benign metastasizing leiomyoma from uterine leiomyoma. World J Surg Oncol 2013; 11:163. [PMID: 23866077 PMCID: PMC3722006 DOI: 10.1186/1477-7819-11-163] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 07/07/2013] [Indexed: 11/10/2022] Open
Abstract
Background Benign metastasizing leiomyoma (BML) occurs in a low proportion of uterine leiomyomas and treatment methods for BML are diverse and controversial. The study introduces preliminary experiences in the diagnosis and treatment of BML with the purpose of finding a suitable management strategy for these patients. Methods Three patients with BML were treated in our department from April 2008 to July 2012. Each of these patients presented with multiple nodules in both lungs, where we performed video-assisted thoracoscopic wedge resection to harvest enough tissue for histopathologic and immunohistochemical examination. The patients were treated with medical castration or surgical castration after the diagnosis of BML. Results The ultimate pathologic results ruled out the possibility of leiomyosarcoma and other metastatic diseases, and confirmed that the pulmonary lesions were BML. The lung lesions remained stable in two patients who were treated by surgical castration, and the lung nodules regressed in one patient treated with gonadotropin-releasing hormone analogues. Conclusions The diagnosis of BML is based on the medical history of uterine myomas and histopathologic and immunohistochemical examination of lung nodules. Video-assisted thoracoscopic wedge resection is the best way to harvest tissue for diagnosis. The better outcomes in BML seem to call for medical intervention, either chemical or surgical, after diagnosis is made.
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Affiliation(s)
- Sufeng Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai 200032, China
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26
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Liu W, Liu M, Xue J. Detection of intravenous leiomyomatosis with intracardiac extension by ultrasonography: A case report. Oncol Lett 2013; 6:336-338. [PMID: 24137326 PMCID: PMC3788829 DOI: 10.3892/ol.2013.1387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/02/2013] [Indexed: 11/20/2022] Open
Abstract
Intravenous leiomyomatosis (IVL) is characterized by histologically benign tumors that exhibit aggressive clinical behavior. On rare occasions, the tumors may extend into the regional and systemic veins, thus reaching the heart. This may subsequently cause intracardiac leiomyomatosis (ICL), which may lead to congestive heart failure and occasionally, sudden fatalities. Due to its rarity and diffuse symptoms, the misdiagnosis of ICL is common and as a result, the condition may be under-reported. The present study reports a 33-year-old female who was admitted to Shandong Provincial Hospital Affiliated to Shandong University for myomectomy due to a rapidly growing myoma of the uterus. In routine pre-operative abdominal ultrasonography, a moderately sized echoic mass in the right internal iliac vein was observed, which extended to the common iliac vein, the inferior vena cava and the orifice of the right atrium. A presumptive diagnosis of ICL was made. The patient underwent a well-prepared one-stage thoraco-abdominal surgical procedure and the pathological report confirmed ICL. This case illustrates that the early detection of ICL may prevent a potential emergency situation and abdominal ultrasonography may be considered a useful tool in the diagnosis of ICL.
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Affiliation(s)
- Wei Liu
- Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, P.R. China
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28
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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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29
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Kahveci V, Ogur T, Cipe G, Ozdemir S, Hazinedaroglu S. Symplastic leiomyoma in the suprarenal inferior vena cava. IRANIAN JOURNAL OF RADIOLOGY 2013; 10:33-6. [PMID: 23599711 PMCID: PMC3618903 DOI: 10.5812/iranjradiol.10158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 08/08/2012] [Accepted: 10/03/2012] [Indexed: 01/12/2023]
Abstract
Leiomyomas are benign tumors of the soft tissue and may develop in any location where smooth muscle is present. Leiomyoma in the inferior vena cava is a rarely seen pathology, and symplastic leiomyoma is also a rare histological variant of leiomyoma. In this case, we present a rare histological variant of symplastic leiomyoma in the inferior vena cava (IVC). This is the first radiologically reported case of a symplastic leiomyoma of the IVC.
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Affiliation(s)
- Volkan Kahveci
- Department of Radiology, Etlik Training and Research Hospital, Ankara, Turkey
| | - Torel Ogur
- Department of Radiology, Etlik Training and Research Hospital, Ankara, Turkey
- Corresponding author: Torel Ogur, Department of Radiology, Etlik Training and Research Hospital, Ankara, Turkey. Tel.: +90-3125672000, Fax: +90-3123234270, E-mail:
| | - Gokhan Cipe
- Department of Surgery, Medical Faculty, University of Ankara, Ankara, Turkey
| | - Sevim Ozdemir
- Department of Radiology, Etlik Training and Research Hospital, Ankara, Turkey
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30
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An unusual presentation of pelvic leiomyomatosis misdiagnosed as disseminated malignancy. Case Rep Pathol 2012. [PMID: 23198231 PMCID: PMC3502812 DOI: 10.1155/2012/394106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is an exceedingly rare, usually benign condition that clinically simulates a disseminated malignancy, occurring predominantly in women of childbearing age. We present a case of LPD in a postmenopausal woman who had undergone hysterectomy 8 years back for fibroids along with simultaneous presence of pelvic metastasis from breast carcinoma.
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31
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Mazziotti S, Ascenti G, Racchiusa S, Mileto A, Gaeta M. Retroperitoneal growth of degenerated myxoid uterine leiomyoma mimicking sarcoma. Clin Radiol 2012; 67:616-7. [DOI: 10.1016/j.crad.2011.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/14/2011] [Accepted: 12/21/2011] [Indexed: 02/07/2023]
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32
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Young-onset peri-anorectal leiomyomatosis: report of a case. Surg Today 2012; 43:329-34. [PMID: 22610456 DOI: 10.1007/s00595-012-0201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 11/23/2011] [Indexed: 10/28/2022]
Abstract
A 23-year-old female was referred with constipation that lasted for 2 years. Preoperative examinations revealed multiple submucosal tumors beside the anorectum, along with subcutaneous tumors in the left buttock. The pathological diagnosis was leiomyoma. Low anterior resection of the rectum with regional lymph node dissection, along with the resection of the subcutaneous tumors in the left buttock through the transdermal approach, was performed, since multiple tumor formation indicated a high malignant potential. The tumors were diagnosed as multiple leiomyomas with no malignancy. Disease categories such as intravenous leiomyomatosis, leiomyomatosis peritonealis disseminata, Alport syndrome, and Currarino syndrome have been reported to be associated with leiomyomatosis; however, the current case of "peri-anorectal leiomyomatosis" was not classified into any of these. The patient was monitored with careful checkups, and the postoperative course was satisfactory for over 5 years without any sign of recurrence or metastasis. Although the clinicopathological features of this case are quite rare and no therapeutic guidelines for such a disease have yet been established, radical resection should be considered, and the elucidation of the histogenesis of this disease will help establish future therapeutic guidelines.
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33
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Successful one-stage surgical removal of intravenous leiomyomatosis with cardiac extension in an elderly patient. Gen Thorac Cardiovasc Surg 2012; 60:153-6. [DOI: 10.1007/s11748-011-0791-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 02/09/2011] [Indexed: 10/28/2022]
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Bender LC, Mitsumori LM, Lloyd KA, Stambaugh LE. AIRP Best Cases in Radiologic-Pathologic Correlation: Intravenous Leiomyomatosis. Radiographics 2011; 31:1053-8. [DOI: 10.1148/rg.314115013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Malignant Tumors of the Female Pelvic Floor: Imaging Features That Determine Therapy:Pictorial Review. AJR Am J Roentgenol 2011; 196:S15-23 Quis S24-7. [DOI: 10.2214/ajr.09.7209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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36
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Wilson M, Evans F, Mylona E, Murray C, Govind A. Microscopic intravenous leiomyomatosis: An incidental finding at myomectomy. J OBSTET GYNAECOL 2011; 31:96-7. [DOI: 10.3109/01443615.2010.513458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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37
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M’rabet FZEL, kacemi HE, Mesbahi OE, Hassouni KE, Gueddari BKE. Primary breast leiomyosarcoma: case report and literature review. Health (London) 2011. [DOI: 10.4236/health.2011.310104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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Hwang JH, Modi GV, Jeong Oh M, Lee NW, Hur JY, Lee KW, Lee JK. An unusual presentation of a severely calcified parasitic leiomyoma in a postmenopausal woman. JSLS 2010; 14:299-302. [PMID: 20932391 PMCID: PMC3043590 DOI: 10.4293/108680810x12785289144962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Laparoscopic removal of a “parasitic” leiomyoma separate from the uterus was found to constitute effective management of this rare condition. We report the case of a calcified parasitic leiomyoma in a 51-year-old postmenopausal woman with lower abdominal discomfort. She had no history of surgery. Workup confirmed a calcified leiomyoma. On laparoscopy, the mass was separate from the uterus and adhered to the bowel and bladder. Histopathological examination confirmed a calcified leiomyoma. A calcified parasitic leiomyoma in a postmenopausal woman is rare. Most prior cases were in persons with a history of a laparoscopic myomectomy. The diagnosis can be made by radiological findings. Laparoscopic excision is the treatment of choice in such cases.
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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39
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Agarwal R, Goel N, Rajaram S, Mehta S, Agarwal S. Intravenous Leiomyoma: An Enigma in Management. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2009.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rachna Agarwal
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Neerja Goel
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Shalini Rajaram
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Sumita Mehta
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Sarla Agarwal
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
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Larraín D, Rabischong B, Khoo CK, Botchorishvili R, Canis M, Mage G. "Iatrogenic" parasitic myomas: unusual late complication of laparoscopic morcellation procedures. J Minim Invasive Gynecol 2010; 17:719-24. [PMID: 20655285 DOI: 10.1016/j.jmig.2010.05.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/22/2010] [Accepted: 05/28/2010] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To describe our experience in diagnosing and managing parasitic myomas developing as an unexpected late complication of laparoscopic morcellation. DESIGN Observational study (Canadian Task Force classification II-3). SETTING University hospital. PATIENTS Retrospective chart review of all patients found to have parasitic myomas that developed after previous morcellation. INTERVENTION Laparoscopic morcellation. Review of the recent literature correlated with clinical, surgical, and pathologic features of our cases. MEASUREMENTS AND MAIN RESULTS Four patients had heterogeneous pelvic masses after morcellation. In 3 patients, symptoms developed between 2 and 16 years after the primary surgery. One patient had no symptoms, and was referred because of a suspect pelvic mass. Vaginal examination revealed painful pelvic masses in the pouch of Douglas in 2 patients, and painless masses fixed to the vaginal vault and anterior vaginal wall, respectively, in the other 2 patients. Laparoscopic examination confirmed the presence of parasitic masses in 3 patients. In 1 patient, the mass was excised vaginally. Histologic analysis confirmed leiomyoma fragments in all patients. A well-differentiated endometrial carcinoma was incidentally found in 1 patient after hysterectomy. CONCLUSION These masses probably resulted from growth of missed fragments of uterine tissue after previous morcellation, culminating in development of symptomatic iatrogenic parasitic myomas. If morcellation is anticipated or required, exclusion of malignancy is mandatory. Meticulous inspection of the abdominal cavity is necessary after morcellation. In patients with a history of morcellation who have pelvic masses, iatrogenic parasitic myomas should be considered in the differential diagnosis.
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Affiliation(s)
- Demetrio Larraín
- CHU Clermont-Ferrand, CHU Estaing, Department of Obstetrics-Gynecology and Reproductive Medicine, University of Auvergne, Clermont I, Clermont-Ferrand, France.
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41
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Affiliation(s)
- W Parry-Smith
- Emergency Department, The Royal Infirmary, University Hospital of North Staffordshire, Stoke-On-Trent, UK.
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42
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MRI appearance of mesenchymal tumors of the uterus. Eur J Radiol 2010; 74:241-9. [DOI: 10.1016/j.ejrad.2009.03.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 03/05/2009] [Indexed: 01/19/2023]
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43
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MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. AJR Am J Roentgenol 2010; 194:311-21. [PMID: 20093590 DOI: 10.2214/ajr.09.3522] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the role of MR, CT, and PET/CT in the detection of ovarian cancer and the evaluation of adnexal lesions. CONCLUSION The goal of imaging in ovarian cancer detection is to expeditiously distinguish benign adnexal lesions from those requiring further pathologic evaluation for malignancy. For lesions indeterminate on ultrasound, MRI increases the specificity of imaging evaluation, thus decreasing benign resections. CT is useful in diagnosis and treatment planning of advanced cancer. Although (18)F-FDG-avid ovarian lesions in postmenopausal women are considered suspicious for malignancy, PET/CT is not recommended for primary cancer detection because of high false-positive rates.
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44
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Zampolin RL, Shi A. Radiologic Evaluation of Mesenchymal Tumors of the Female Genital Tract. Surg Pathol Clin 2009; 2:581-602. [PMID: 26838772 DOI: 10.1016/j.path.2009.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mesenchymal neoplasms of the female genital tract are a diverse group of tumors, of which the most common are smooth muscle tumors. There is a significant overlap in the imaging characteristics of benign and malignant tumors and final diagnosis often requires pathologic correlation. However, familiarity with typical radiologic features, common imaging pitfalls, and the utility of different imaging modalities can be valuable in the evaluation of mesenchymal tumors. This article highlights the imaging features of the most commonly encountered mesenchymal tumors in the female genital tract.
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Affiliation(s)
- Richard L Zampolin
- Department of Radiology, Montefiore Medical Center, 111 E210th Street, Bronx, NY 10467, USA
| | - Ann Shi
- Department of Radiology, Montefiore Medical Center, 111 E210th Street, Bronx, NY 10467, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
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Thian YL, Tan KH, Kwek JW, Wang J, Chern B, Yam KL. Leiomyomatosis peritonealis disseminata and subcutaneous myoma--a rare complication of laparoscopic myomectomy. ACTA ACUST UNITED AC 2009; 34:235-8. [PMID: 18311496 DOI: 10.1007/s00261-008-9379-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We present a case of leiomyomatosis peritonealis disseminata (LPD) after laparoscopic myomectomy with imaging features corroborating laparoscopic tract dissemination of the tumor. This would suggest a subset cases of LPD may be secondary to transcoelomic dissemination of a primary uterine leiomyoma rather than de novo peritoneal metaplasia. To our knowledge, this is the first case report of LPD and subcutaneous leiomyoma complicating laparoscopic surgery. The imaging features of LPD are reviewed. Radiologists as well as clinicians should consider LPD as a potential complication of laparoscopic myomectomy.
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Affiliation(s)
- Yee Liang Thian
- Department of Diagnostic Radiology, KK Women's and Children Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
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Role of multidetector CT in the management of acute female pelvic disease. Emerg Radiol 2009; 16:453-72. [PMID: 19326153 DOI: 10.1007/s10140-009-0808-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 03/12/2009] [Indexed: 10/21/2022]
Abstract
The purpose of this study is to highlight the role of multidetector CT (MDCT) in emergency radiology as a useful tool in the diagnosis and management of acute female pelvic disease and to describe key radiologic signs to improve differential diagnosis. We restrospectively reviewed MDCT findings of acute pelvic disease and its mimics in women reporting to the emergency room at our institution from December 2006 to August 2008. We describe MDCT findings of gynecologic and obstetric disorders such as hemorrhagic ovarian cysts, ovarian torsion, pelvic inflammatory disease, ruptured ectopic pregnancy, intravascular leiomyomatosis, blunt maternal trauma, and postpartum and post-cesarean section complications. We also briefly review gastrointestinal tract entities that may mimic these conditions. Although ultrasound is the imaging modality of choice for the evaluation of female pelvic pain, the role of MDCT remains essential in the management of patients in which gynecologic exploration is not diagnostic or undone since it is not the initial suspicion.
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AJRTeaching File: Right Atrial Mass in a Woman with Uterine Fibroids. AJR Am J Roentgenol 2009; 192:S53-6. [DOI: 10.2214/ajr.07.7080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Spanoudaki A, Oikonomou A, Dimitrova K, Prassopoulos P. Pedunculated uterine leiomyoma mimicking abdominal mass: a case report. CASES JOURNAL 2008; 1:315. [PMID: 19014628 PMCID: PMC2588583 DOI: 10.1186/1757-1626-1-315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 11/17/2008] [Indexed: 11/21/2022]
Abstract
A 48-year-old woman presented with abdominal fullness and a palpable "mass" in the left lower quadrant. Ultrasonography showed a large, rounded, hypoechoic mass. Contrast-enhanced helical CT of the abdomen demonstrated a well-circumscribed, heterogeneously but vividly enhancing mass. The uterus had a leiomyomatous configuration on CT. Uterus and mass revealed the same enhancing pattern. Thin section CT revealed a long, thin stalk connecting the mass with the body of the uterus. Surgical removal of both uterus and the mass confirmed the diagnosis of a pedunculated subserosal leiomyoma originating from a leiomyomatous uterus.
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Affiliation(s)
- Athina Spanoudaki
- Department of Radiology, University Hospital of Alexandroupolis, Democritus University of Thrace, Greece.
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Gedda MAM, Piantavinha GA, Coutinho TR, Mendonça SM, Bello GDV. Leiomiomatose peritoneal disseminada: relato de caso. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000500015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho relata-se o caso de uma paciente de 46 anos de idade com queixa de aumento de volume periumbilical e dor leve antes da menstruação. O quadro evoluiu com aumento gradativo da dor. Foram realizados ultra-som, tomografia computadorizada e ressonância magnética. Após laparotomia exploradora, foi retirado material para biópsia que confirmou o diagnóstico de leiomiomatose peritoneal disseminada.
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Wong LC, Huang PC, Luh SP, Huang CS. Primary leiomyosarcoma of the nipple-areola complex: report of a case and review of literature. J Zhejiang Univ Sci B 2008; 9:109-13. [PMID: 18257132 DOI: 10.1631/jzus.b0720246] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary leiomyosarcoma of the nipple-areola complex is extremely rare. Less than ten such cases have been reported in English literature so far. Herein we describe a 52-year-old female presenting with a 1.5 cmx1.1 cmx0.7 cm nodular lesion over her left nipple, and leiomyosarcoma was proved by pathological examination of the excised specimen. Positron emitted tomogram (PET) revealed no abnormal signal other than the primary site. Microscopically, this poorly circumscribed tumor was composed of interlacing bundles of smooth muscle cells with bizarre and pleomorphic nuclei, as well as prominent nucleoli. Its mitotic count was up to 7 mitoses per 10 high power fields (HPF). Immunohistochemical study of tumor cells revealed positive stain for alpha-smooth muscle actin and vimentin; and negative for cytokeratin, CD34 and S-100. Left simple mastectomy was undertaken and no residual mass lesion was noted on the resected specimen. Related literatures about the diagnosis and treatment for breast leiomyosarcoma will be presented here.
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Affiliation(s)
- Lai-ching Wong
- Department of Pathology, Taichung Hospital, and Department of Surgery, Chung-Shan Medical University, Taichung 401, Taiwan, China
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