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Wang Y, Xu S, Wang C, Li W, Xu J, Zhu Z, Liu Q, Zhu L. Intravascular Leiomyoma Considered Preoperatively as Uterine Sarcoma: A Rare Case. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:334-339. [PMID: 38596477 PMCID: PMC11002323 DOI: 10.1089/whr.2023.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 04/11/2024]
Abstract
Intravascular leiomyoma (IVL) is usually defined as a histologically benign leiomyoma that originates in a uterine fibroid or the intrauterine vein wall and grows and expands intravenously. We report a case in which pelvic IVL was detected early and discuss the early diagnosis of and best treatment for this tumor.
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Affiliation(s)
- Yingyao Wang
- Department of Gynecology, Kunshan Maternity and Children's Health Care Hospital, Suzhou, China
| | - Song Xu
- Department of Pathology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Caibo Wang
- Department of Gynaecology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Wenjuan Li
- Department of Gynaecology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Jianhao Xu
- Department of Pathology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Zhiwei Zhu
- Department of Gynaecology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Qin Liu
- Department of Gynecology, Kunshan Maternity and Children's Health Care Hospital, Suzhou, China
- Department of Gynaecology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Lixia Zhu
- Department of Gynecology, Kunshan Maternity and Children's Health Care Hospital, Suzhou, China
- Department of Gynaecology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
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Zhou X, Qi X, Zhao X, Yang F. Update on clinical characteristics and molecular insights for uterine intravenous leiomyomatosis (Review). Oncol Lett 2024; 27:31. [PMID: 38108079 PMCID: PMC10722539 DOI: 10.3892/ol.2023.14165] [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: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
Intravenous leiomyomatosis (IVL) is a rare benign disease, which typically develops along vascular vessels and extends to the inferior vena cava and right atrium of the heart. In the early stages of the disease, the clinical manifestations and the results of imaging examinations are not uniform among patients. Thus, a high rate of misdiagnosis and missed diagnosis is common. When the tumor extends along the venous system to the pelvic floor vein or through the inferior vena cava involving the right atrium of the heart or the pulmonary artery, severe symptoms occur, such as ascites, dyspnea, heart failure and even sudden mortality. Improving the understanding of IVL to identify and evaluate this disease in its early stages is important. Complete tumor resection remains the primary treatment option for IVL. The recurrence rate of the disease varies depending on multiple factors, such as type of surgical procedure performed. Therefore, long-term follow-up is necessary for patients with IVL. The review of recent findings on the molecular and clinicopathological characterization of IVL is important to understand the pathogenesis of IVL. In the present study, the clinical manifestations, pathogenesis, differential diagnosis, treatment and prognosis of IVL are summarized in order to provide a single source of insightful information on IVL.
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Affiliation(s)
- Xiaoting Zhou
- Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiaorong Qi
- Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xia Zhao
- Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Fan Yang
- Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Hayashi T, Sano K, Yaegashi N, Abiko K, Konishi I. Characteristic of Endometrial Stromal Sarcoma by Algorithm of Potential Biomarkers for Uterine Mesenchymal Tumor. Curr Issues Mol Biol 2023; 45:6190-6201. [PMID: 37623209 PMCID: PMC10453212 DOI: 10.3390/cimb45080390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023] Open
Abstract
The benign tumor uterine leiomyoma (UL) develops from the smooth muscle tissue that constitutes the uterus, whereas malignant tumor uterine sarcoma develops from either the smooth muscle tissue or stroma and is different from UL and endometrial cancer. Uterine sarcoma is broadly classified into three types: uterine leiomyosarcoma, endometrial stromal sarcoma (ESS), and carcinosarcoma. Although uterine leiomyosarcoma and ESS are both classified as uterine sarcoma, they significantly differ in terms of their sites of occurrence, symptoms, and treatment methods. Uterine leiomyosarcoma develops from the muscle tissue constituting the wall of the uterus and accounts for approximately 70% of all uterine sarcoma cases. In contrast, ESS develops from the stromal tissue beneath the endometrium and accounts for approximately 25% of all uterine sarcoma cases. ESS is classified as either low grade (LG) or high grade (HG). This case report aimed to highlight the importance of histopathologic examinations based on surgical specimens. Herein, we reported the case of a 45-year-old woman suspected of having submucosal leiomyoma of the uterus based on imaging results. Transvaginal ultrasonography and endometrial biopsy or partial dilation and curettage were performed. Contrast-enhanced magnetic resonance imaging (MRI) revealed a 32-mm mass projecting from the posterior wall of the uterus into the uterine cavity. T2-weighted imaging revealed a low signal within the mass; thus, submucosal UL was suspected. Histopathologic examination of surgical specimens obtained from a patient suspected of having submucosal UL after contrast-enhanced MRI indicated that the patient had ESS. Despite the remarkable advancements in medical imaging technology, the accuracy of contrast-enhanced MRI for detecting uterine mesenchymal tumors is limited. Therefore, histopathologic diagnosis based on surgical specimens should be performed when medical grounds for diagnosing a benign tumor on contrast-enhanced MRI are lacking.
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Affiliation(s)
- Takuma Hayashi
- Cancer Medicine, National Hospital Organization Kyoto Medical Centre, Kyoto 612-8555, Japan
- Department of Medical R&D Promotion Project, Japan Agency for Medical Research and Development (AMED), Tokyo 103-0022, Japan
| | - Kenji Sano
- Department of Medical R&D Promotion Project, Japan Agency for Medical Research and Development (AMED), Tokyo 103-0022, Japan
- Department of Pathology, Shinshu University Hospital, Nagano 390-8621, Japan
| | - Nobuo Yaegashi
- Department of Medical R&D Promotion Project, Japan Agency for Medical Research and Development (AMED), Tokyo 103-0022, Japan
- Section of Assistant Director, Sendai Red Cross Hospital, Miyagi 982-8501, Japan
| | - Kaoru Abiko
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Centre, Kyoto 612-8555, Japan
| | - Ikuo Konishi
- Cancer Medicine, National Hospital Organization Kyoto Medical Centre, Kyoto 612-8555, Japan
- Department of Medical R&D Promotion Project, Japan Agency for Medical Research and Development (AMED), Tokyo 103-0022, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Nishikawa S, Hayashi T, Amano Y, Yaegashi N, Abiko K, Konishi I. Characteristic of Concurrent Uterine Lipoleiomyoma and Hemangioma by Algorithm of Candidate Biomarkers for Uterine Mesenchymal Tumor. Diagnostics (Basel) 2022; 12:diagnostics12102468. [PMID: 36292158 PMCID: PMC9600651 DOI: 10.3390/diagnostics12102468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background/Aim: In clinical practice, uterine lipoleiomyomas are variants of uterine leiomyomas that are often found incidentally and do not require surgical treatment unless the patient is symptomatic. Therefore, these should be clinically differentiated from lesions that need surgical treatment. Conversely, hemangiomas, or blood vessel benign tumors, rarely develop in the uterus; however, many clinical complications such as abdominal pain and excessive vaginal bleeding result from a uterine hemangioma. Hemangiomas can occur at any age and primarily affect pregnant women. (2) Materials and Methods: The oncological properties of uterine lipoleiomyoma and hemangioma in adults were investigated using molecular pathological examination on tissue excised from patients with a uterine tumor. (3) Results: Through molecular pathological studies, which included potential biomarkers for uterine mesenchymal tumors, a differential diagnosis was established for a case of mesenchymal tumor. Herein, we report a 54-year-old non-pregnant woman who presented with vaginal bleeding and underwent hysterectomy after detection of a 140 × 100 mm intramural mass diagnosed as a concurrent uterine hemangioma and lipoleiomyoma after molecular histopathologic examinations. (4) Conclusion: As far as we know, our case is the first patient of concurrent uterine hemangioma and lipoleiomyoma. Hence, the possibility of several types of mesenchymal tumors must be considered in the differential diagnosis of patients with abnormal vaginal bleeding. As such, molecular pathological examination and close monitoring of the MRI results should be conducted by medical staff while considering the patient’s desire for pregnancy, including surgical treatment options for uterine hemangioma.
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Affiliation(s)
- Shoko Nishikawa
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto 606-8501, Japan
| | - Takuma Hayashi
- Section of Cancer Medicine, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
- Seeds Development and Research Infrastructure Division, Japan Agency for Medical Research and Development (AMED), Tokyo 100-0004, Japan
- Correspondence: ; Tel.: +81-263372629
| | - Yasuaki Amano
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto 606-8501, Japan
| | - Nobuo Yaegashi
- Seeds Development and Research Infrastructure Division, Japan Agency for Medical Research and Development (AMED), Tokyo 100-0004, Japan
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Miyagi 980-8575, Japan
| | - Kaoru Abiko
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto 606-8501, Japan
| | - Ikuo Konishi
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto 606-8501, Japan
- Seeds Development and Research Infrastructure Division, Japan Agency for Medical Research and Development (AMED), Tokyo 100-0004, Japan
- Department of Obstetrics and Gynecology, Kyoto University School of Medicine, Kyoto 606-8501, Japan
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Tamura S, Hayashi T, Ichimura T, Yaegashi N, Abiko K, Konishi I. Characteristic of Uterine Rhabdomyosarcoma by Algorithm of Potential Biomarkers for Uterine Mesenchymal Tumor. Curr Oncol 2022; 29:2350-2363. [PMID: 35448164 PMCID: PMC9027675 DOI: 10.3390/curroncol29040190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background/Aim: Patients with uterine sarcoma comprise 2–5% of all patients with uterine malignancies; however, the morbidity of uterine sarcoma is low compared with that of other gynecological cancers. For many cases, malignant uterine tumors are diagnosed during follow-up of benign uterine leiomyoma. Of the uterine sarcomas, rhabdomyosarcoma is considered a mixed tumor containing components of epithelial cells and mesenchymal cells. Therefore, the onset of primary uterine rhabdomyosarcoma during follow-up of uterine leiomyoma is extremely rare. Rhabdomyosarcoma is a relatively common malignant tumor in children, but rhabdomyosarcoma in adults is extremely rare, accounting for approximately 3% of all patients with soft tissue sarcoma. Rhabdomyosarcoma in children is highly sensitive to chemotherapy and radiation therapy; however, the response to chemotherapy and radiation therapy in adult rhabdomyosarcoma is low and survival in adult rhabdomyosarcoma with metastatic lesions to other organs is approximately 14 months. We experienced a case of pleomorphic rhabdomyosarcoma during the follow-up of a uterine leiomyoma. Materials and Methods: We examined the oncological properties of uterine rhabdomyosarcoma in adults using molecular pathological techniques on tissue excised from patients with uterine leiomyoma. Result: A differential diagnosis was made for this case by molecular pathology, which included candidate biomarkers for uterine smooth muscle tumors. The oncological nature of uterine rhabdomyosarcoma was found to be similar to the oncological properties of uterine leiomyosarcoma. However, in uterine rhabdomyosarcoma, LMP2/β1i-positive cells were clearly observed. Conclusion: It is expected that establishing a diagnostic and treatment method targeting characteristics of mesenchymal tumor cells will lead to the treatment of malignant tumors with a low risk of recurrence and metastasis.
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Affiliation(s)
- Saya Tamura
- National Hospital Organization Kyoto Medical Center, Department of Obstetrics and Gynecology, Kyoto 612-8555, Japan; (S.T.); (K.A.); (I.K.)
| | - Takuma Hayashi
- Section of Cancer Medicine, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
- START-Program, Japan Science and Technology Agency (JST), Tokyo 102-8666, Japan
- Correspondence: or ; Tel.: +81-263372629
| | - Tomoyuki Ichimura
- Department of Obstetrics and Gynecology, Osaka City University School of Medicine, Osaka 545-8586, Japan;
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Miyagi 980-8575, Japan;
| | - Kaoru Abiko
- National Hospital Organization Kyoto Medical Center, Department of Obstetrics and Gynecology, Kyoto 612-8555, Japan; (S.T.); (K.A.); (I.K.)
| | - Ikuo Konishi
- National Hospital Organization Kyoto Medical Center, Department of Obstetrics and Gynecology, Kyoto 612-8555, Japan; (S.T.); (K.A.); (I.K.)
- Department of Obstetrics and Gynecology, Kyoto University School of Medicine, Kyoto 606-8501, Japan
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