Polypoid adenomyomas: sonohysterographic and color Doppler findings with histopathologic correlation

Effects of Low Intensity Focused Ultrasound on Liposomes Containing Channel proteins

The ability to reversibly and non-invasively modulate region-specific brain activity in vivo suggests Low Intensity Focused Ultrasound (LIFU) as potential therapeutics for neurological dysfunctions such as epilepsy and Parkinson's disease. While in vivo studies provide evidence of the bioeffects of LIFU on neuronal activity, they merely hint at potential mechanisms but do not fully explain how this technology achieves these effects. One potential hypothesis is that LIFU produces local membrane depolarization by mechanically perturbing the neuronal cell membrane, or activating channels or other proteins embedded in the membrane. Proteins that sense mechanical perturbations of the membrane, such as those gated by membrane tension, are prime candidates for activating in response to LIFU and thus leading to the neurological responses that have been measured. Here we use the bacterial mechanosensitive channel MscL, which has been purified and reconstituted in liposomes, to determine how LIFU may affect the activation of this membrane-tension gated channel. Two bacterial voltage-gated channels, KvAP and NaK2K F92A channels were also studied. Surprisingly, the results suggest that ultrasound modulation and membrane perturbation does not induce channel gating, but rather induces pore formation at the membrane protein-lipid interface. However, in vesicles with high MscL mechanosensitive channel concentrations, apparent decreases in pore formation are observed, suggesting that this membrane-tension-sensitive protein may serve to increase the elasticity of the membrane, presumably because of expansion of the channel in the plane of the membrane independent of channel gating.

The role of three-dimensional power Doppler hysterosonography (3-DPDS) in distinguishing atypical polypoid adenomyomas (APAs) from other intrauterine tumors: correlation with pathologic findings

OBJECTIVE

This study was undertaken to describe the sonographic characteristics of atypical polypoid adenomyomas (APAs) of the uterus and to determine the value of three-dimensional power Doppler hysterosonography (3-DPDS) in distinguishing APA from other polypoid uterine tumors.

METHODS

Ninety-five women with a mean age of 37 years (range 28-45) with a suspicious polypoid uterine tumor were referred for preoperative evaluation with 3-DPDS. Sonographic criteria used for the diagnosis of APA were based on a system that consisted of morphological characteristics, histological evaluation and power Doppler imaging. Biopsy samples of the intrauterine tumors were obtained via operative hysteroscopy.

RESULTS

Fifteen lesions were histopathologically diagnosed as APAs, 25 as endometrial polyps and 55 as submucous myomas. In the present study, the sensitivity and specificity of 3-DPDSs in discriminating APA from other polypoid tumors was 82.5 and 86.7%, respectively.

CONCLUSIONS

APAs can be accurately distinguished from other polypoid tumors of the uterus with the use of 3-DPDS demonstrating the following characteristics: lobular tumor with inhomogeneous echotexture, echogenicity similar to myometrium, broad base, acoustic shadow and linear vessel arrangement.

MR manifestations of uterine polypoid adenomyoma

PURPOSE

Polypoid adenomyoma (PA) is an uncommon benign tumor of the uterus appearing as a submucosal polypoid mass, or rarely as a subserosal polypoid mass. PA should be differentiated from atypical polypoid adenomyoma or malignant uterine tumors. The purpose of our case series is to evaluate magnetic resonance (MR) manifestations of PA for the differential diagnosis.

METHODS

Seven cases with surgically proven PA, five submucosal, and two subserosal, were evaluated. MR imaging findings including contrast enhancement in six cases (four cases with dynamic contrast-enhanced MR study), diffusion-weighted imaging (DWI) in five cases, and susceptibility weighted imaging (SWI) in two cases were retrospectively reviewed.

RESULTS

All seven lesions exhibited isointensity compared with the myometrium and 4 of 7 lesions (57%) contained high signal intensity hemorrhagic areas on T1-weighted images. On T2-weighted images, signal intensity was variable and all seven lesions contained cysts. None of five lesions with DWI exhibited high signal intensity compared with the normal myometrium. All six lesions showed intense contrast enhancement similar to that of the myometrium on post-contrast T1-weighted images. Punctate low intensity areas reflecting blood contents were revealed in all two lesions with SWI.

CONCLUSIONS

Submucosal or subserosal polypoid masses containing hemorrhagic areas, and cysts reflecting functional endometrium and dilatation of endometrial glands are suggestive for PA. Intense contrast enhancement similar to that of the myometrium may be another characteristic finding for PA.

Polypoid adenomyoma of endocervical type

We report herein a 53-year-old Japanese female case of polypoid adenomyoma of endocervical type. A sessile 16 mm sized cervical polyp, hard in consistency, was surgically removed. Histologically, the polypoid lesion was composed of smooth muscle bundles and scattered benign-looking endocervical glands. The mucin was diffusely alcianophilic. Immunohistochemically, some mucous glands were positive for MUC1 (CA15-3) and MUC5AC, and the other small glands were immunoreactive for MUC6. MUC2 and mucin characteristic of gastric gland mucous cells (M-GGMC-1 or HIK1083) were negative. Carcinoembryonic antigen was consistently expressed along the apical surface. Estrogen receptor was positive, while progesterone receptor was negative. Ki-67 labeling index was low. These findings were consistent with the endocervical nature of the mucin-producing columnar cells. This is the 18th case of adenomyoma of endocervical type reported in the English literature.

[Atypical polypoid adenomyoma: retrospective study about 8 cases from Jeanne-de-Flandre Hospital between 1996 and 2008]

OBJECTIVES

To propose a therapeutic approach and follow-up of patients with atypical polypoid adenomyoma (APA) wishing to remain fertile.

PATIENTS AND METHOD

We are presenting a retrospective study of eight APA cases.

RESULTS

Two patients immediately received radical treatment, and one patient had an endometrial thermocoagulation. The remaining five patients received a conservative treatment with ultrasound and hysteroscopic monitoring. Among them, two had full-term pregnancies, one is being treated for infertility, in one case, the APA disappeared after three hysteroscopy-curettages and macroprogestative treatment. Lastly, one of our patients died from an aggressive endometrioid ovarian bilateral tumour associated with an endometrial adenocarcinoma.

DISCUSSION AND CONCLUSION

Radical treatment is necessary for cases of APA in women no longer wishing to remain fertile. For those wishing to remain fertile, we can offer a conservative treatment once they have been informed regarding the associated risk of relapse, degeneration, and ovarian lesions which necessitate stricter follow-up.

Magnetic Resonance Imaging of Typical Polypoid Adenomyoma of the Uterus in 8 Patients

OBJECTIVE

To study the magnetic resonance imaging findings of typical polypoid adenomyoma and correlate radiological findings with histopathologic findings.

METHODS

Magnetic resonance imaging and histopathologic findings were retrospectively reviewed in 8 patients. The size, location, polyp's shape, and signal intensity of magnetic resonance imaging findings were evaluated.

RESULTS

The polyp's shape of 8 cases is pedunculated in 7 and sessile in 1, and all 8 cases are well circumscribed. Four cases (50%) show an isointense mass relative to the myometrium with small or large hyperintense foci on T1-weighted imaging (T1WI) or T2-weighted imaging (T2WI), reflecting the fascicle of smooth muscle with islands of hemorrhagic endometrial tissue. One case forms a large hemorrhagic cavity, being hyperintense on T1WI and hypointense on T2WI. Three cases (37%) show almost homogeneous isointense or hyperintense mass on T2WI.

CONCLUSIONS

When there is a well-defined polypoid mass protrusion into the uterine endometrial cavity that is isointense relative to the myometrium with small or large foci of high signal on T1WI or T2WI in a premenopausal woman, typical polypoid adenomyoma can be considered in the differential diagnosis.