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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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An Extremely Rare Case of Disseminated Peritoneal Leiomyomatosis with a Pelvic Leiomyosarcoma and Omental Metastasis after Laparoscopic Morcellation: Systematic Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12123219. [PMID: 36553227 PMCID: PMC9777378 DOI: 10.3390/diagnostics12123219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Minimally invasive treatment of uterine fibroids usually requires a power morcellation, which could be associated with several complications. A rare sequela is disseminated peritoneal leiomyomatosis. Indeed, recurrence or metastasis in these cases could be attributed to iatrogenic or under-evaluation of primary tumors, although a subset of cases is a sporadic sample of biological progression. We present an extremely rare case of a patient who underwent laparoscopic morcellation and after 12 years developed a pelvic leiomyosarcoma with two omental metastases, disseminated peritoneal leiomyomatosis with a parasite leiomyoma with bizarre nuclei and a parasite cellular leiomyoma simultaneously. The diagnosis was predicted preoperatively by an expert sonographer who recognized the ultrasound characteristics of uterine sarcoma and the localization of some of the masses, so the patient was referred to the gynaecological oncologists who could appropriately treat her. We present here a case report and a systematic review that could be a useful tool for further discussion and future clinical practice guidelines.
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Ye Z, Chen L. Leiomyomatosis peritonealis disseminata with low-grade malignant change: A case report. Medicine (Baltimore) 2022; 101:e30528. [PMID: 36086674 PMCID: PMC10980496 DOI: 10.1097/md.0000000000030528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Leiomyomatosis peritonealis disseminata (LPD) is a rare disease characterized by multiple leiomyomas spread all over the peritoneal cavity. It is commonly described as benign in women of reproductive age. Malignant LPD is much rarer. METHODS We present a case of LPD with low potential malignant change in a 43-year-old female, who felt a lump in her abdomen after laparoscopic myomectomy 10 years ago and laparoscopic hysterectomy 8 years ago. The patient underwent exploratory laparotomy and salpingectomy, greater omentectomy, and pelvic and abdominal mass resection were performed during the surgery. The pathological findings revealed LPD with low potential malignant change, with strong expression of estrogen receptor and progesterone receptor. The patient refused oophorectomy and chose gonadotropin-releasing hormone agonists injection postoperatively. RESULTS No recurrence was found during the follow-up to date. CONCLUSION Surgery is the main treatment for LPD, and endocrine therapy is another choice. Although it is reported mostly benign, we need to be alert to the possibility of malignancy.
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Affiliation(s)
- Zhongxue Ye
- Department of Gynecology, Hwa Mei Hospital of University of Chinese Academy of Sciences, Ningbo, China
| | - Lu Chen
- Department of Gynecologic Oncology, Cancer Hospital of University of Chinese Academy of Sciences, China
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
- Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, Hangzhou, China
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Inhibiting effect of miR-29 on proliferation and migration of uterine leiomyoma via the STAT3 signaling pathway. Aging (Albany NY) 2022; 14:1307-1320. [PMID: 35113040 PMCID: PMC8876902 DOI: 10.18632/aging.203873] [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: 08/04/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
Aim: Uterine leiomyoma is the most common benign tumor of female genitalia, and the incidence is rising gradually. This study explores the mechanism of miR-29 and STAT3 signaling pathways on uterine leiomyoma. Methods: GSE64763 and GSE5244 datasets were downloaded. Enrichment analyses were performed in GSE64763. PPI network was constructed, and the significant module was identified. Uterine leiomyoma cell lines were divided into NC, miR-29 mimic, anti-NC, and miR-29 inhibitor groups. Plate clone formation and Transwell assays detected the proliferation, invasion, and migration of cells. The expression levels of STAT3, proliferation, EMT, invasion-associated proteins were determined by Western blotting. Results: Differently expressed genes were mainly enriched in positive regulation of cell migration and gene expression, cell proliferation. Through GSEA, JAK-STAT is a significantly correlated enrichment pathway. A Venn diagram was drawn to identify the common miRNA (miR-29-3p). miR-29 inhibitors promoted protein expression of STAT-3, Cyclin D1, and c-Myc compared with the anti-NC control (P < 0.01), and miR-29 inhibitors promoted cell proliferation in uterine leiomyoma cells (P < 0.05). Furthermore, miR-29 inhibitors promoted the protein expression of MMP-2 and MMP-9 (P < 0.01), and EMT promoting proteins N-cadherin, snail, vimentin, and Transwell assay showed that miR-29 inhibitors promoted cell migration in uterine leiomyoma (P < 0.01). Conclusions: High expression of miR-29 could inhibit cell proliferation, invasion, and metastasis in uterine leiomyoma, which might be related to the inhibition of the STAT3 signaling pathway, and could provide a novel target for the treatment of uterine leiomyoma.
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Liu X, Hu Y, Chen L, Zhou Q. Disseminated peritoneal leiomyomatosis: a case report and review of the literature. J Int Med Res 2021; 49:3000605211033194. [PMID: 34369191 PMCID: PMC8358528 DOI: 10.1177/03000605211033194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Disseminated peritoneal leiomyomatosis (DPL), also known as leiomyomatosis peritonealis disseminata, is a rare disease characterized by multiple benign smooth muscle tumors proliferating along the peritoneal surfaces. The cause of the disease is unclear, and possible factors include iatrogenic and hormonal stimulation. The patient was a 41-year-old Chinese woman with a history of laparoscopic myomectomy and subsequent pregnancy. Multiple abdominal masses were identified and required surgical intervention. The patient had no tenderness or other discomfort. The clinical and imaging diagnosis was gastrointestinal stromal tumor, but DPL was confirmed by postoperative pathological examination. The patient had a good prognosis, and no recurrence was observed during follow-up. Iatrogenic and hormonal stimulation leading to DPL is very rare, and we believe that multiple factors led to DPL in this case. Clinicians should be aware of such potential patients.
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Affiliation(s)
- Xu Liu
- Institute of Pathology, China Three Gorges University, Yichang, China.,Department of Pathology, Yichang Central People's Hospital, Yichang, China
| | - Yuchang Hu
- Institute of Pathology, China Three Gorges University, Yichang, China.,Department of Pathology, Yichang Central People's Hospital, Yichang, China
| | - Lu Chen
- Institute of Pathology, China Three Gorges University, Yichang, China.,Department of Pathology, Yichang Central People's Hospital, Yichang, China
| | - Quan Zhou
- Department of Gynecology and Obstetrics, the People's Hospital of China Three Gorges University, Yichang, China
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Disseminated peritoneal leiomyomatosis and malignant transformation: A case series in a single referral center. Eur J Obstet Gynecol Reprod Biol 2021; 262:21-27. [PMID: 33989940 DOI: 10.1016/j.ejogrb.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to describe one of the largest series of disseminated peritoneal leiomyomatosis (DPL) and its malignant counterpart, evaluating possible risk factors for both the benign and malignant condition, and highlighting any differences between them in terms of surgical and clinical management. STUDY DESIGN Clinical, surgical and histopathological characteristics of patients diagnosed with DPL (group 1) and malignant-DPL (group 2), between July 2010 and July 2020, were retrospectively retrieved. RESULTS A total of 14 benign and 5 malignant cases were selected. The duration of preoperative hormonal therapy was significantly longer in the benign condition while malignant DPL showed significantly larger lesions (median nodule size: 12 cm). However, surgical procedures and surgical outcomes did not differ among the two conditions, with highly complex surgery and relatively high post-operative complications in both groups. CONCLUSION Preoperative discrimination between benign and malignant DPL is challenging. Given the high surgical complexity required in both cases, addressing patients to referral cancer centers is strictly recommend, in order to offer them the best possible treatment and allowing a continuous and accurate collection of clinical information that might be crucial for further studies.
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Barison GAS, Alvarenga-Bezerra V, Maranhão DDA, Gomes MTV. Tricky Diagnosis and Robot-laparoscopic Surgical Approach to Disseminated Peritoneal Leiomyomatosis. J Minim Invasive Gynecol 2021; 28:1566-1567. [PMID: 33878492 DOI: 10.1016/j.jmig.2021.04.006] [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: 03/09/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To show the challenging diagnosis of, and safe robotic surgical approach to, a rare case of disseminated peritoneal leiomyomatosis (DPL). DESIGN A clinical case shown by a sequential demonstration of investigation, diagnosis, and surgical approach, with narrated video footage. SETTING DPL is a rare disease, with only a little more than 150 cases reported in the literature [1]. It is defined by subperitoneal proliferation of benign smooth muscle cell nodules, macroscopically mimicking peritoneal carcinomatosis [2]. The etiology remains unclear, but different hypotheses have been put forward, such as subperitoneal mesenchymal stem cell metaplasia and iatrogenic origin after myomectomy [3]. Despite its usual benign behavior, DPL can rarely present with malignant degeneration, and therefore a complete resection of multiple lesions is recommended [4]. This case involves a 45-year-old patient presenting with dysmenorrhea, abdominal pain, and major abnormal uterine bleeding, requiring previous blood transfusion and no response after 2 years of clinical treatment. She had a previous cesarean delivery, with no reproductive desire at present and no history of other pelvic surgeries. Pelvic examination showed an enlarged mobile uterus at the height of the pubic symphysis, and both ultrasonography and magnetic resonance imaging confirmed an enlarged uterus due to multiple myomas. INTERVENTIONS (1) Diagnostic laparoscopy with implant biopsies and uterine curettage for investigation of DPL and its differential diagnoses, followed by robot-assisted laparoscopic approach, with key strategies for a safe performance. (2) Radical hysterectomy with bilateral salpingo-oophorectomy, omentectomy, and wide pelvic peritoneal resection were performed. (3) For this complex procedure, the identification and preservation of important landmarks and pelvic anatomy were mandatory, as well as removal of all surgical specimens in monobloc. Final pathology report: disseminated leiomyomatosis with no evidence of malignancy. The patient had no complications after surgery and was discharged on the second postoperative day with mild abdominal pain. CONCLUSION DPL diagnosis can be tricky owing to its macroscopic similarity to peritoneal carcinomatosis and the difficulty of identification in imaging examinations. Moreover, the robotic platform can be a helpful and safe tool for the surgical treatment of DPL and complete resection of all peritoneal lesions.
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Eccher A, Carraro A, Girolami I, Villanova M, Borin A, Violi P, Paro B, Mescoli C, Malvi D, Novelli L, D'Errico A, Rossini G, Ungari M. Diffuse Micro-Nodules on Peritoneal Surfaces at Donor Organ Procurement: Highlights on the Diagnostic Challenge and Transplant Management. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929348. [PMID: 33579891 PMCID: PMC7888240 DOI: 10.12659/ajcr.929348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Female, 41-year-old Final Diagnosis: Diffuse leiomyomatosis Symptoms: None Medication:— Clinical Procedure: — Specialty: Pathology
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Amedeo Carraro
- General Surgery and Liver Transplant Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Ilaria Girolami
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Manuela Villanova
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Alex Borin
- General Surgery and Liver Transplant Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Paola Violi
- Department of Vascular Surgery, ASST Hospital Trust of Brescia, Brescia, Italy
| | - Barbara Paro
- Department of Vascular Surgery, ASST Hospital Trust of Brescia, Brescia, Italy
| | - Claudia Mescoli
- Pathology Unit, Department of Medicine, University and Hospital Trust of Padua, Padua, Italy
| | - Deborah Malvi
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Policlinico St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luca Novelli
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Antonietta D'Errico
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Policlinico St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe Rossini
- North Italy Transplant Program, Fondazione IRCCS "Ca' Granda Ospedale Maggiore Policlinico", Milan, Italy
| | - Marco Ungari
- Department of Pathology, ASST Hospital Trust of Cremona, Cremona, Italy
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Bu H, Jin C, Fang Y, Ma Y, Wang X, Chen J, Chen L. Successful pregnancy after complete resection of leiomyomatosis peritonealis disseminate without recurrence:a case report with next-generation sequencing analysis and literature review. World J Surg Oncol 2020; 18:85. [PMID: 32359372 PMCID: PMC7196235 DOI: 10.1186/s12957-020-01857-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/20/2020] [Indexed: 12/29/2022] Open
Abstract
Background Peritoneal leiomyomatosis disseminate (LPD) is a rare disease characterized by widespread dissemination of leiomyomas nodules throughout the peritoneal and omental surfaces. Reports of pregnancy with LPD are even rarer. Therefore, there is no clear consensus on the treatment of LPD on pregnancy, and the pathogenesis is still unclear. Case presentation We reported a case of LPD patient who developed during pregnancy. The patient underwent a cesarean section at 32 weeks of gestation while removing all visible tumors, and no LPD lesions were seen in the subsequent cesarean section at full term. NGS of LPD lesions detected 4 mutations with focal high-level amplifications of CDK4 (cyclin-dependent kinases 4), NBN (Nibrin), DAXX (death domain associated protein), and MYC (myelocytomatosis oncogene). Immunohistochemistry staining analysis among benign leiomyoma, LPD, and leiomyosarcoma verified that LPD was an unusual intermediate between benign and malignant uterine smooth muscle tumors. Besides, LPD is a hormonal-dependent leiomyoma. After a detailed literature search, we summarized the detailed clinical features and follow-up information of patients with LPD during pregnancy. Conclusions This is the first reported LPD case of successful term pregnancy without recurrence, following resection of all visible lesions in a prior pregnancy. LPD is an unusual intermediate between benign and malignant uterine smooth muscle tumors.
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Affiliation(s)
- Hualei Bu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China
| | - Chengjuan Jin
- Department of Obstetrics and Gynecology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 XinSongjiang Road, Shanghai, 201620, People's Republic of China
| | - Yan Fang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China
| | - Yana Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China
| | - Xiao Wang
- Department of Pathology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China
| | - Jingying Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China
| | - Lijun Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China.
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10
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Ma Y, Wang S, Liu Q, Lu B. A clinicopathological and molecular analysis in uterine leiomyomas and concurrent/metachronous peritoneal nodules: New insights into disseminated peritoneal leiomyomatosis. Pathol Res Pract 2020; 216:152938. [PMID: 32234244 DOI: 10.1016/j.prp.2020.152938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/25/2020] [Accepted: 03/21/2020] [Indexed: 11/18/2022]
Abstract
Disseminated peritoneal leiomyomatosis (DPL) is a rare, benign entity, but DPL following morcellation has become a major concern recently. This study aimed to investigate the molecular relationship between uterine leiomyoma and DPL. We analyzed the clinicopathological and molecular features of 8 DPL patients including 6 (#3-8) with and 2 (#1 and 2) without antecedent morcellation. Patients 1 and 2 were characterized by numerous, small peritoneal nodules whereas patients 4-8 harbored less but larger peritoneal nodules. Patient 3 had a peritoneal carcinomatosis-like dissemination, but she has been alive with disease for 68 months. Histological examination confirmed the diagnosis of leiomyomas in the uterus and extra-uterine sites. Immunohistochemistry demonstrated that both uterine and extra-uterine tumors were invariably positive for HMGA2 and MED12. MED12 mutation (c.130 G > A, p.G44S) was found in original uterine (n = 3) and peritoneal (n = 11) tumors from patients 3, 6, 7 and 8. Microsatellite instability at TPOX and D19S433 was observed in the uterine leiomyoma (patient 2) whereas LOH at CSF1PO was found in the peritoneal tumors (patient 1). D13S317 LOH was present in both uterine and peritoneal tumors detected (patient 8). However, D3S1358 LOH and D19S433 LOH was only found in the peritoneal tumors (patient 8) and recurrent tumors (patient 3), respectively. We suggested that DPLs following morcellation might be closely associated with original uterine leiomyomas. DPLs with and without prior morcellation may harbor different pathogenetic pathways. These findings are critical for the clinical intervention and prevention of DPL patients.
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Affiliation(s)
- Yu Ma
- Department of Clinical Laboratory Medicine, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
| | - Su Wang
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
| | - Qin Liu
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
| | - Bingjian Lu
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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Li CJ, Chu PY, Yiang GT, Wu MY. The Molecular Mechanism of Epithelial-Mesenchymal Transition for Breast Carcinogenesis. Biomolecules 2019; 9:biom9090476. [PMID: 31514467 PMCID: PMC6770718 DOI: 10.3390/biom9090476] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 12/23/2022] Open
Abstract
The transforming growth factor-β (TGF-β) signaling pathway plays multiple regulatory roles in the tumorigenesis and development of cancer. TGF-β can inhibit the growth and proliferation of epithelial cells and induce apoptosis, thereby playing a role in inhibiting breast cancer. Therefore, the loss of response in epithelial cells that leads to the inhibition of cell proliferation due to TGF-β is a landmark event in tumorigenesis. As tumors progress, TGF-β can promote tumor cell invasion, metastasis, and drug resistance. At present, the above-mentioned role of TGF-β is related to the interaction of multiple signaling pathways in the cell, which can attenuate or abolish the inhibition of proliferation and apoptosis-promoting effects of TGF-β and enhance its promotion of tumor progression. This article focuses on the molecular mechanisms through which TGF-β interacts with multiple intracellular signaling pathways in tumor progression and the effects of these interactions on tumorigenesis.
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Affiliation(s)
- Chia-Jung Li
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
| | - Pei-Yi Chu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan
- Department of Pathology, Show Chwan Memorial Hospital, Changhua 500, Taiwan
- Department of Health Food, Chung Chou University of Science and Technology, Changhua 510, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
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12
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Gastrointestinal stromal tumor coexisting with disseminated peritoneal leiomyomatosis. Surg Case Rep 2019; 5:130. [PMID: 31410732 PMCID: PMC6692793 DOI: 10.1186/s40792-019-0690-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background A case of gastrointestinal stromal tumor (GIST) coexisting with disseminated peritoneal leiomyomatosis (DPL) is rare. We report a case of GIST coexisting with DPL. Case presentation A 50-year-old woman underwent exploratory laparoscopy under a preoperative diagnosis of gastric GIST with an ovarian tumor or peritoneal dissemination in the pelvic space. Laparoscopy showed multiple peritoneal masses in the pelvic space. Intraoperative frozen sectioning of the pelvic tumors showed multiple spindle cells, suggesting leiomyomas or retroperitoneal tumors; however, it was difficult to rule out peritoneal dissemination from GIST. No disseminated lesion was noted near GIST, and hence, we believed that GIST and pelvic lesions had different origins. We achieved R0 resection by partial resection of the stomach, total hysterectomy, and bilateral salpingo-oophorectomy. The postoperative immunohistopathological examination confirmed the final diagnosis of GIST and DPL. The patient has been recurrence free for 10 years. Conclusions Immunohistochemical examination is essential for correct diagnosis for GIST and DPL. R0 curative resection should be scheduled after immunohistochemical examination of specimens obtained from exploratory laparoscopy.
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Chiu HC, Li CJ, Yiang GT, Tsai APY, Wu MY. Epithelial to Mesenchymal Transition and Cell Biology of Molecular Regulation in Endometrial Carcinogenesis. J Clin Med 2019; 8:E439. [PMID: 30935077 PMCID: PMC6518354 DOI: 10.3390/jcm8040439] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 12/15/2022] Open
Abstract
Endometrial carcinogenesis is involved in several signaling pathways and it comprises multiple steps. The four major signaling pathways-PI3K/AKT, Ras/Raf/MEK/ERK, WNT/β-catenin, and vascular endothelial growth factor (VEGF)-are involved in tumor cell metabolism, growth, proliferation, survival, and angiogenesis. The genetic mutation and germline mitochondrial DNA mutations also impair cell proliferation, anti-apoptosis signaling, and epithelial⁻mesenchymal transition by several transcription factors, leading to endometrial carcinogenesis and distant metastasis. The PI3K/AKT pathway activates the ransforming growth factor beta (TGF-β)-mediated endothelial-to-mesenchymal transition (EMT) and it interacts with downstream signals to upregulate EMT-associated factors. Estrogen and progesterone signaling in EMT also play key roles in the prognosis of endometrial carcinogenesis. In this review article, we summarize the current clinical and basic research efforts regarding the detailed molecular regulation in endometrial carcinogenesis, especially in EMT, to provide novel targets for further anti-carcinogenesis treatment.
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Affiliation(s)
- Hsiao-Chen Chiu
- Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei 231, Taiwan.
- Department of Obstetrics and Gynecology, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
| | - Chia-Jung Li
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
| | - Andy Po-Yi Tsai
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan.
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
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