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- Leiomyosarcoma of the vagina: A rare entity with comprehensive review of the literature. [Journal Article]
- Int J Appl Basic Med Res 2014 Jul; 4(2):128-30.
Primary malignant lesions of the vagina are uncommon, and vaginal sarcomas are even rarer. We describe a rare case of stage I, high-grade leiomyosarcoma of the vagina treated with combined modality treatment. A 39-year-old female presented with vaginal mass and underwent resection. Histopathological examination revealed atypical leiomyoma of the vagina with definite risk of recurrence. Eleven months later, she presented with a recurrent vaginal mass and underwent exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy plus resection of recurrent tumor and partial vaginectomy. The detailed histopathological examination was suggestive of leiomyosarcoma of the vagina. The patient received adjuvant radiotherapy and chemotherapy. The patient is alive and disease-free 29 months postsurgery. Experience with vaginal leiomyosarcomas is limited. The optimal treatment methods have not yet been established because of the rarity of the tumor. We add another case of leiomyosarcoma of the vagina to the limited existing literature.
- Successful pregnancy after treatment with ulipristal acetate for uterine fibroids. [Journal Article]
- Case Rep Obstet Gynecol 2014.:314587.
This case report presents a clinical pregnancy after ulipristal acetate (UA) to decrease uterine fibroid size. A 37-year-old patient, gravida 1, abortus 1, with uterine fibroids was treated with 5 mg of UA daily for 13 weeks starting eight months after a multiple laparotomic myomectomy. Fibroid shrinkage and restoration of the morphology of endometrial cavity were evaluated in order to allow a subsequent pregnancy. A decrease of the uterine fibroids and a normal morphology of the endometrial cavity were noted by transvaginal ultrasound after treatment. An endometrial biopsy excluded histologic endometrial changes. Three months after the end of UA the patient reported amenorrhea for 5 weeks and a clinical pregnancy was confirmed with transvaginal ultrasound. She underwent a subsequent uneventful pregnancy. Thus, the spontaneous pregnancy after UA to reduce fibroid size may support the potential clinical utility of this selective progesterone receptor modulator in the management of women with pregnancy desire and uterine fibroids after a prior myomectomy. Patients who refuse a new surgical procedure and/or those who are going to undergo assisted reproductive techniques would benefit from UA. It effectively shrinks fibroids, avoids risks of a new surgical procedure, and allows an immediate attempt at conception after the end of treatment.
- Uterine Leiomyomas With Bizarre Nuclei: A Clinicopathologic Study of 59 Cases. [JOURNAL ARTICLE]
- Am J Surg Pathol 2014 Aug 19.
Leiomyoma with bizarre nuclei (LM-BN) is an uncommon tumor with histologic features (mononucleated or multinucleated bizarre cells that may have a diffuse distribution, prominent nucleoli, and karyorrhectic nuclei that may mimic atypical mitoses) that often causes confusion with leiomyosarcoma. Fifty-nine LM-BNs were collected from our consultation files over the years 2000 to 2011. Features recorded included patient age, therapy, tumor size, border, gross appearance, density and distribution of BN, mitotic count, karyorrhectic nuclei, prominent nucleoli, cells with conspicuous dense eosinophilic cytoplasm (rhabdoid-like), vascular changes and type of vasculature, and presence of necrosis and its nature. Follow-up information was obtained for all patients. Patients ranged in age from 25 to 75 (average 45) years (11 patients between 25 and 35 y, 20 between 36 and 45 y, 22 between 46 and 55 y, and 6 between 56 and 75 y). Forty-two underwent hysterectomy and 17 myomectomy. For 51 tumors gross findings were known. Forty (78%) had a solid white and whorled cut surface and 11 (22%) a yellow appearance. Five (10%) neoplasms showed prominent cystic degeneration, and hemorrhage and/or necrosis was seen in 9 (18%). Forty-five LM-BNs had a pushing margin with the surrounding myometrium, whereas 1 showed irregular borders. Margins could not be ascertained in the slides available in 13 cases. Twenty-eight (48%), 19 (32%), and 12 (20%) LM-BN showed low, intermediate, and high BN density. Eighteen (30%) tumors showed diffuse, 26 (44%) showed multifocal, and 15 (26%) had focal BN distribution. Mitotic counts ranged from 0 to 7/10 high-power fields (HPF) (average 1 to 2/10 HPF). Thirty-seven (63%) had <2/10 HPF, 19 (32%) had 2 to 5 mitoses/10 HPF, and in 3 tumors (5%) mitotic counts were 6, 7, and 7/10 HPF (2 with focal and 1 with diffuse BN). All but 4 LM-BNs showed karyorrhectic nuclei, striking in 12 neoplasms, mimicking atypical mitoses. Nineteen (32%) LMs had prominent eosinophilic nucleoli surrounded by a clear halo. Ischemic necrosis was detected in 21 (36%) LM-BN. Rhabdoid-like cells were noted in 24 (41%) tumors. All patients had no evidence of recurrence, ranging from 1 to 13 years (overall average 6 y; in patients with myomectomy 6.3 y with a range of 2.6 to 11 y). Our results corroborate that LM-BN is associated with a favorable outcome even in those patients only treated by myomectomy and highlights that a conservative approach can be undertaken in these patients, as many of them are of reproductive age. Because of the favorable outcome, the term LM-BN is preferable to alternative terminology including "atypical leiomyoma."
- Immunohistochemical expression of CD44 standard and E-cadherin in atypical leiomyoma and leiomyosarcoma of the uterus. [JOURNAL ARTICLE]
- J Obstet Gynaecol 2014 Aug 20.:1-4.
A family of cell adhesion molecules have been associated with tumorigenesis and tumour cell invasion. Cadherins and CD44 isoforms are transmembrane glycoproteins. Uterine smooth muscle tumours range from leiomyomas to leiomyosarcomas. However, separating malignant from benign can be difficult in a subset of smooth muscle tumours. Cell adhesion molecules expression may have diagnostic utility in the distinction of leiomyosarcoma from atypical leiomyoma. The aim of this study was to evaluate the diagnostic tool role of CD44 standard and E-cadherin in atypical leiomyoma and leiomyosarcoma. Paraffin blocks of 35 atypical leiomyoma and 22 leiomyosarcoma were analysed immunohistochemically for the expression CD44 standard and E-cadherin protein. Expression of CD44 standard was positive in all cases, while E-cadherin was negative. In this study, CD44 and E-cadherin were not useful for diagnostic tool to differentiate atypical leiomyoma from leiomyosarcoma.
- Hierarchical Self-Assembly of Supramolecular Hydrophobic Metallacycles into Ordered Nanostructures. [JOURNAL ARTICLE]
- Chem Asian J 2014 Aug 19.
We describe herein the hierarchical self-assembly of discrete supramolecular metallacycles into ordered fibers or spherical particles through multiple noncovalent interactions. A new series of well-defined metallacycles decorated with long alkyl chains were obtained through metal-ligand interactions, which were capable of aggregating into ordered fibroid or spherical nanostructures on the surface, mostly driven by hydrophobic interactions. In-depth studies indicated that the morphology diversity was originated from the structural information encoded in the metallacycles, including the number of alkyl chains and their spatial orientation. Interestingly, the morphology of the metallacycle aggregates could be tuned by changing the solvent polarity. These findings are of special significance since they provide a simple yet highly controllable approach to prepare ordered and tunable nanostructures from small building blocks by means of hierarchical self-assembly.
- Enodthelin 1 is elevated in plasma and explants from patients having uterine leiomyomas. [Journal Article]
- Reprod Sci 2014 Sep; 21(9):1196-205.
To determine a role for endothelin (ET) in progression of uterine fibroids.An in vitro model of fibroid and myometrium cultivation.A total of 32 women undergoing hysterectomies for uterine fibroids and 11 women undergoing hysterectomies for abnormal uterine bleeding (control population).Women with uterine fibroids were hypertensive and displayed significantly greater circulating ET-1 compared to control patients. Secretion of ET-1 was greater from the fibroids compared to myometrium explants. Endothelin 1 secretion was attenuated with blockade of the angiotensin II type 1 or endothelinA receptors. Hypoxia stimulated ET-1 secretion from both myometrium and fibroid explants. Preproendothelin messenger RNA expression increased with hypoxia from fibroid explants compared to normoxic controls.These data support the hypothesis that uterine fibroids are associated with hypertension and increased ET-1, which is exacerbated with hypoxia. These data suggest a possible link between mechanisms of blood pressure regulation and development of uterine leiomyoma.
- Uterine Fibroid Research: A Work in Progress. [REVIEW]
- Reprod Sci 2014 Sep; 21(9):1065-1066.
- Contribution of contrast-enhanced ultrasound with Sonovue to describe the microvascularization of uterine fibroid tumors before and after uterine artery embolization. [JOURNAL ARTICLE]
- Eur J Obstet Gynecol Reprod Biol 2014 Aug 1.:104-110.
The principal objective of this study was to use contrast-enhanced ultrasonography to describe the characteristics of fibroid microvascularization before and after embolization.Forty women had contrast-enhanced ultrasonography with Sonovue(®) injections before uterine artery embolization, the day afterwards, and at 6-12 months afterwards. An MRI was also performed before and after the procedure.Two thirds of the fibroids took up the contrast product before the myometrium did, and 45.8% were vascularized along the peripheral rim of the fibroid, compared with 41.6% with a principal pedicle and from the center in three (12.6%). After embolization at day one (D1), the myometrium was fully enhanced, that is, perfusion of the myometrium was plainly visible, in 25 cases (69.4%; n=36), partially enhanced in eight (22.2%), and totally avascular in three (8.4%). Analysis of the failures according to imaging criteria the day after embolization (D1) showed failure in seven women, with partial enhancement for six, and total for one. In the imaging at 6 months (M6), contrast ultrasonography showed failure for three women, with enhancement of the largest fibroid. This enhancement was total in two cases and partial (40%) in one. There were five failures according to MRI at M6, with partial enhancement. Only two of these failures were simultaneously failures according to the contrast-enhanced ultrasonography. There were five clinical failures, two consistent with the imaging at 6 months and four predictable on D1.Contrast-enhanced ultrasonography is feasible and useful to understand fibroid vascularization and for monitoring embolization; its correlation with MRI is good, its concordance less so.
- Giant leiomyoma of the ciliary body. [Journal Article]
- Oman J Ophthalmol 2014 May; 7(2):81-3.
Leiomyoma is a rare intraocular tumor that arises from uveal smooth muscle. Herein, we report a large leiomyoma that occupied nearly 50% of the globe, closely resembling melanoma. A 40-year-old female presented with a 17 × 15 × 11 mm amelanotic ciliochoroidal mass causing visual defect in her right eye (OD). Based on transillumination features of tumor shadow and ultrasonographic features of acoustically solid mass, there was low clinical suspicion for leiomyoma or schwannoma, and a preliminary diagnosis of ciliochoroidal melanoma was rendered. Following enucleation, histopathology revealed a paucicellular tumor comprised of spindle cells, with positive immunostaining for smooth muscle actin and negative stains for melanoma markers (S-100 protein, HMB45, and MITF-2). These features were consistent with ciliochoroidal leiomyoma. Benign uveal leiomyoma can achieve an unusually large size and block light transmission on transillumination, features that simulate malignant melanoma.
- Case of concurrent benign metastasizing leiomyoma in the lung and retroperitoneum, with a focus on its etiology. [Journal Article]
- J Obstet Gynaecol Res 2014 Aug; 40(8):2010-3.
We report a rare, simultaneous occurrence of benign metastasizing leiomyoma in the lung and retroperitoneum in a 49-year-old woman who had previously undergone myomectomy at 35 years of age and hysterectomy at 45 years of age for multiple recurrences of histologically benign uterine leiomyomas. At 49 years of age, computed tomography-guided biopsy indicated benign metastasizing leiomyomas in the lung. In addition, a retroperitoneal leiomyoma was found that was resected along with both the ovaries via laparotomy. No sign or symptom of recurrence was observed 5 years later. The coexistence of benign metastasizing leiomyoma in the lung and retroperitoneum following surgery for conventional leiomyomas has rarely been reported. Further, the nature and etiology of benign metastasizing leiomyoma are still not well understood. This case is therefore worth reporting, and exploring its etiology is important.