Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
- Endobronchial Leiomyoma in a Patient Presenting With Chronic Cough After Treatment for Pneumonia. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):660A.
Cancer Student/Resident Case Report Posters IISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Endobronchial leiomyoma is a rare benign tumor of the lung. We describe an adult male found to have endobronchial leiomyoma presenting with chronic cough.CASE PRESENTATION: A 54 year-old male from the Philippines presented with 6 months of persistent cough following antibiotic treatment for right lower lobe pneumonia. Due to persistent symptoms and a 10 pack-year smoking history, a chest CT was performed to rule out malignancy, revealing a right lower lobe endobronchial lesion. The patient underwent bronchoscopy, where a near-obstructing avascular lesion was found in the right lower lobe bronchus with extension into the bronchus intermedius. Pathology demonstrated nodular smooth muscle tissue consistent with leiomyoma.DISCUSSION: Primary pulmonary leiomyoma is a rare benign tumor accounting for less than 2% of all benign lung tumors. Of these, endobronchial leiomyomas make up one-third of reported cases with approximately 100 patients identified in literature. Patients typically present in the fourth decade of life with a female predominance. Endobronchial leiomyoma is thought to arise from smooth muscle within the bronchial tree, and histologically, tissue stains are positive for smooth muscle actin low mitotic activity. Although these lesions are benign, they demonstrate potential for complication. Clinical symptoms often vary with the degree of bronchial obstruction, which include cough, dyspnea, wheezing, hemoptysis, and recurrent pneumonia. Radiographic findings range from atelectasis to more discrete consolidations and lobar collapse. Given the benign nature of this entity, prognosis is favorable, and treatment often hinges on control of symptoms related to obstruction. While surgical resection has demonstrated favorable long-term outcomes, recent literature suggests nonsurgical bronchoscopic removal techniques including APC, snare removal, and forceps extirpation may be performed with similar outcomes. In situations where lesions are large, wide based, or located in distal airway or lung parenchyma, surgical options including lobectomy or pneumonectomy are often necessary to achieve complete resection.CONCLUSIONS: After a multi-disciplinary discussion of various treatments, our patient elected to pursue non-surgical tumor resection. Argon plasma coagulation and snare removal were performed with adequate tumor debulking and overall improvement of clinical symptoms.Reference #1: Park JS et al. Primary leiomyoma of the trachea, bronchus, and pulmonary parenchyma - a single-institutional experience. European Journal of Cardio-Thoracic Surgery. 41: 41-45. 2012DISCLOSURE: The following authors have nothing to disclose: Zhou Zhang, Vincent Chan, Luis Moreta-SainzNo Product/Research Disclosure Information.
- "Uterus in My Lung?!" A Case of Pulmonary Leiomyomatosis as a Presentation of Uterine Intravenous Leiomyomatosis. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):645A.
Cancer Student/Resident Case Report Posters ISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Intravenous leiomyomatosis (IVL) is an uncommon intraluminal tumor of benign smooth muscle cells, usually seen in conjunction with uterine fibroids. We report a rare case of uterine IVL presenting as pulmonary leiomyomatosis (PL).CASE PRESENTATION: A 47 year-old female, active smoker, presented with a chief complaint of increasing abdominal girth, associated with mild dyspnea on exertion. Her medical history included uterine fibroids with subsequent total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectemy (BSO) in March 2012. Physical examination was significant for a distended, firm abdomen, with no tenderness. Chest radiography showed bilateral patchy opacities, and CT imaging of the chest and abdomen revealed a large 25cm pelvic mass, with multiple bilateral pulmonary opacities. A CT-guided tissue biopsy of a pulmonary lesion confirmed spindle cell neoplasm with minimal mitosis and no necrosis. Immunohistochemical staining showed the neoplasm to be TTF1(-), chromogrannin(-), synaptophysin(-), CAM 5.2(-), vimentin(+), desmin(+), and smooth muscle actin(+). Pathology from her prior hysterectomy was reviewed again, and had shown a 9cm mass with wormlike extensions into the large veins of the uterus, thus differentiating IVL from typical leiomyoma. Immunohistochemical staining showed the mass to be morphologically and phenotypically similar to the pulmonary lesion. Surgical report confirmed that due to extensive vascularization, part of the tumor was unable to be resected. She was treated with leuprolide, a GnRH analog, for a total of six months. A follow-up CT scan in January 2014 showed increase in the size of the pelvic mass, with increased pulmonary nodules and masses. A repeat CT guided biopsy of a lung mass ruled out sarcomatous transformation, and confirmed the diagnosis of PL. She is being treated with chemoembolization of the pelvic mass to decrease vascularity, followed by staged surgical resection of the pelvic mass. She has been continued on leuprolide for medical therapy.DISCUSSION: IVL, despite its benign histology, can behave in a malignant fashion by extensive spread (1). Studies have shown these tumors to be estrogen-dependent (2). The mainstay of therapy is surgical, with TAH and BSO, or medically with progestins, tamoxifen or gonadatropin agonists (3).CONCLUSIONS: PL is a rare presentation of uterine IVL. Knowledge of these rare entities is important for accurate diagnosis and treatment, and need to be differentiated from malignant lesions.Reference #1: Bodner-Adler B, et al. Intravenous leiomyomatosis of the uterus with pulmonary metastases or a case with benign metastasizing leiomyoma? Anticancer Res 2009, 29:495-496.Reference #2: Clement PB, et al. Intravenous leiomyomatosis of the uterus: A clinicopathological analysis of 16 cases with unusual features. Am J Surg Pathol 12: 932-945, 1988.Reference #3: Banner AS, et al. Efficacy of oophorectomy in lymphangioleiomyomatosis and benign metastasizing leiomyoma. N Engl J Med. 1981 Jul 23;305(4):204-9DISCLOSURE: The following authors have nothing to disclose: Jay Patel, Amy Coan, Alexander Hindenburg, Kent Chan, Girish NairNo Product/Research Disclosure Information.
- Inflammatory Myofibroblastic Tumor Presenting as an FDG Avid Lung Nodule. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):638A.
Cancer Global Case ReportsSESSION TYPE: Global Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Inflammatory myofibroblastic tumor (IMT) of the lung, also known as plasma cell granuloma, is a rare diagnosis in adults, accounting for less than 1 % of all lung tumors. They often present as pulmonary nodules but can also be locally invasive. Although its exact origin is unknown, recent studies favor a true neoplasm rather than an inflammatory process. Diverse and non-specific clinical and radiologic manifestations make the diagnosis difficult. In most cases, surgical resection is needed for diagnosis.CASE PRESENTATION: A 78-year- old asymptomatic female former smoker underwent shoulder arthroplasty. A postoperative chest x-ray showed a right pulmonary nodule. Computerized tomography (CT) confirmed the presence of a 1.3 x 1.2 cm well circumscribed pulmonary nodule. Image-guided biopsy was nondiagnostic. Positron emission tomography (PET) showed hypermetabolic activity of the lesion. In the clinical setting suspicious for stage IA lung cancer, she underwent an uneventful robotic assisted right middle lobe lobectomy with mediastinal lymphadenectomy. Final pathology showed a well-circumscribed nodule composed of spindle cells admixed with lymphomononuclear infiltrate with scattered atypical cells, consistent with an inflammatory myofibroblastic tumor.DISCUSSION: Discussion: Inflammatory myofibroblastic tumor is defined by the World Health Organization as a myofibroblastic spindle cell soft tissue tumor with infiltrative plasma cells, lymphocytes, and eosinophils. It can occur in any age group but more common in pediatrics. There are no gender, ethnicity, or geographical preferences. Although half of patients are asymptomatic, symptoms may include dyspnea, cough, chest tightness, and hemoptysis. The majority of cases are diagnosed via surgical lung biopsy. The pathogenesis of IMT is unclear and several hypotheses have been proposed such as recurrent respiratory infections or auto-immune mechanisms. In more than 50% chromosomal rearrangement at band 2p23 has been observed, the site of the anaplastic lymphoma kinase (ALK). ALK is mainly positive in extrapulmonary cases. Treatment of choice is complete resection and there is no need for chemotherapy with resection. Incomplete resection or size more than 3 cm increases risk of recurrence. The differential diagnosis includes fibrosarcoma, leiomyoma, malignant fibrosis histiocytoma, lymphoma, organizing pneumonia, desmoid fibromatosis and angiomyofibroblastoma.CONCLUSIONS: Inflammatory myofibroblastic tumor is a rare tumor in adults usually diagnosed at surgical resection. Only histological and immunohistochemical studies can confirm diagnosis due to variable and non-specific clinical and radiologic presentations. Complete surgical resection has a favorable outcome.Reference #1: Inflammatory pseudotumor of the lung in adults. Melloni G,et al. Ann Thorac Surg. 2005 Feb;79(2):426-32. PMID: 15680808Reference #2: Inflammatory myofibroblastic tumor of the aortic valves causing sudden cardiac death: a case report and review of the literature. . Xu B1 et al. Pediatr Dev Pathol. 2014 Mar 20.Reference #3: A rare tumor of the lung: inflammatory myofibroblastic tumor. Hammas N et al, Diagn Pathol. 2012 Jul 17;7:83. doi: 10.1186/1746-1596-7-83. PMID: 22805416DISCLOSURE: The following authors have nothing to disclose: Ali Rad, Michael Reed, Christopher Gilbert, Negar Rassaei, Jennifer TothNo Product/Research Disclosure Information.
- Unbiased and Efficient Estimation of the Volume of the Fibroid Uterus Using the Cavalieri Method and Magnetic Resonance Imaging. [JOURNAL ARTICLE]
- Reprod Sci 2014 Oct 20.
The aim of our study was to develop a reliable technique for measuring volume of the fibroid uterus using Magnetic Resonance Imaging. We applied the Cavalieri method and standard calliper technique to measure the volume of the uterus and largest fibroid in 26 patients, and results were compared with "gold-standard" planimetry measurements. We found Cavalieri measurements to be unbiased, while calliper measurements systematically underestimated uterine volume (- 13.2%, P < 10(-5)) and had greater variance. Repeatability was similar for the 2 techniques (standard deviation [SD] = 4.0%-6.9%). Reproducibility of Cavalieri measurements was higher for measurement of uterine (SD = 9.0%) than fibroid volume (SD = 19.1%), whereas the reproducibility of calliper measurements was higher for fibroid (SD = 9.1%) than uterine volume (SD = 15.9%). The additional measurement time for the Cavalieri method was approximately 1 to 2 minutes. In conclusion, the Cavalieri method permits more accurate measurement of uterine and fibroid volumes and is suitable for application in both clinical practice and scientific research.
- Injectable Clostridium Histolyticum Collagenase as a Potential Treatment for Uterine Fibroids. [JOURNAL ARTICLE]
- Reprod Sci 2014 Oct 20.
Purified Clostridium histolyticum collagenase (CHC), an Food and Drug Administration-approved drug that does not affect nerves or blood vessels, was assessed as a potential treatment for fibroids in this proof-of-principle study. Fibroids (1-4 cm, capsules intact) and myometrial specimens from 5 patients were injected posthysterectomy with CHC or vehicle containing methylene blue and incubated for 24 hours. Percentage of collagen-stained area was estimated using Masson-Trichrome-stained slides. Collagen fibers were observed with picrosirius staining. Tissue stiffness was objectively measured by rheometry (complex shear modulus [Pa]). Injected materials spread within and beyond fibroids as visualized by methylene blue. Of the 8 treated fibroids, 7 were softened and some contained liquefied centers. Relative percentage of collagen-stained area (mean ± standard deviation) in treated fibroids (38 ± 12%; n = 7) was less than that in control fibroids (66 ± 17%; n = 5). Treated myometrium (40 ± 30% collagen; n = 3) was similar to control myometrium (53 ± 8%; n = 2). Picrosirius staining demonstrated loss of collagen fibers in treated fibroids. Treated fibroids were less stiff (3630 ± 2410 Pa; n = 4) than controls (5930 ± 830 Pa; n = 4). Treated and control myometrium had similar stiffness (2149 ± 927 Pa; n = 3 and 3314 ± 494 Pa; n = 2, respectively) and were never liquefied. In conclusion, injections of CHC into encapsulated fibroids are feasible and effective. Heterogeneity of collagen types and quantities within individual fibroids may contribute to varied responses and need additional investigation. Further study of collateral effects on myometrium is indicated. Injected CHC has potential for treatment of fibroids.
- Rare case of endometrioid adenocarcinoma arising from cystic adenomyosis. [JOURNAL ARTICLE]
- J Obstet Gynaecol Res 2014 Oct 20.
Few reports on malignant transformation of adenomyosis are available, and endometrioid adenocarcinoma arising from cystic adenomyosis is further rarely reported. We report a case of a 67-year-old asymptomatic woman who was referred to our hospital for evaluation of a cystic lesion in the pelvis, which had been diagnosed as cystic degeneration of leiomyoma for 3 years. Magnetic resonance imaging revealed a cystic mass measuring 11 cm in diameter, which was contiguous with uterine myometrium. The lesion contained solid areas enhanced on gadolinium-enhanced T1 -weighted imaging. Transabdominal simple total hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological examination revealed endometrioid adenocarcinoma arising from cystic adenomyosis. The patient underwent six courses of adjuvant combination chemotherapy with paclitaxel and carboplatin. No metastasis or recurrence has been demonstrated for 16 months following surgery. Our case demonstrates that cystic adenomyoma possesses the risk of malignant transformation, indicating the importance of long-term follow-up with imaging examination.
- Knowledge of uterine fibroid symptoms and presentation among African-American women: a pilot study. [Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't]
- J Reprod Med 2014 Sep-Oct; 59(9-10):448-54.
To assess awareness and knowledge of fibroid symptoms and presentation among African-American women.This was a cross-sectional survey study completed by a convenience sample of African-American women attending a community fair. Questions covered demographics, medical history, technology use, and fibroid knowledge. A total of437 surveys were distributed, 320 were returned, and 199 met eligibility criteria.Participants' mean age was 48.8 +/- 12.9 years. Of them, 65.8% lacked college degrees and 43.2% had annual household incomes of < $25,000. The prevalence of inadequate health literacy was 14.1%. Most knew that fibroids are more common in African-American women (74.9%), can cause menorrhagia (80.9%), and can increase odds of miscarriage (74.4%). Many thought that fibroids are cancerous (47.2%), increase the risk of heart disease (32.7%), or are diagnosable via blood test (46.2%). Internet usage and education had highest correlations with fibroid awareness. Health literacy status showed no significant correlation with cumulative fibroid knowledge.African-American women's knowledge of the symptoms of fibroids is intact; however, they are less familiar with the systemic impact of the tumors. Additional research is needed to further assess women's knowledge offibroids and to develop interventions for patient education.
- Quantitative Proteome Profiling of human Myoma and Myometrium tissue reveals kinase expression signatures with potential for therapeutic intervention. [JOURNAL ARTICLE]
- Proteomics 2014 Oct 18.
Uterine leiomyomas are benign tumors affecting a large proportion of the female population. Despite the very high prevalence, the molecular basis for understanding the onset and development of the disease are still poorly understood. In this study, we profiled the proteomes and kinomes of leiomyoma as well as myometrium samples from patients to a depth of >7000 proteins including 200 kinases. Statistical analysis identified a number of molecular signatures distinguishing healthy from diseased tissue. Among these, nine kinases (ADCK4, CDK5, CSNK2B, DDR1, EPHB1, MAP2K2, PRKCB, PRKG1 and RPS6KA5) representing a number of cellular signaling pathways showed particularly strong discrimination potential. Preliminary statistical analysis by receiver operator characteristics plots revealed very good performance for individual kinases (area under the curve, AUC of 0.70 to 0.94) as well as binary combinations thereof (AUC 0.70 to 1.00) which might be used to assess the activity of signaling pathways in myomas. Of note, the receptor tyrosine kinase DDR1 holds future potential as a drug target owing to its strong links to collagen signaling and the excessive formation of extracellular matrix typical for leiomyomas in humans. This article is protected by copyright. All rights reserved.
- Novel MED12 gene somatic mutations in women from the Southern United States with symptomatic uterine fibroids. [JOURNAL ARTICLE]
- Mol Genet Genomics 2014 Oct 18.
Although somatic mutations in exon 2 of the mediator complex subunit 12 (MED12) gene have been reported previously in uterine fibroids in women from Finland, South Africa, and North America, the status of these mutations was not reported in the Southern United States women. The aim of this study is to determine the MED12 somatic mutations in uterine fibroids of women from Southern Unites States, which will help to better understand the contribution of MED12 mutations in fibroid tumor biology. Herein, we determined the frequency of MED12 gene exon 2 somatic mutations in 143 fibroid tumors from a total of 135 women from the Southern United States and in 50 samples of the adjacent myometrium using PCR amplification and Sanger sequencing. We observed that the MED12 gene is mutated in 64.33 % (92/143) of uterine fibroid cases in the exon 2 (including deletion mutations). These mutations include 107T > G (4.3 %), 130G > C (2.8 %), 130G > A (7.0 %), 130G > T (2.8 %), 131G > C (2.1 %), 131G > A (20.2 %), and 131G > T (2.1 %). Interestingly, we identified four novel mutations in these patients: 107 T > C (12.8 %), 105A > T (2.1 %), 122T > A (2.1 %), and 92T > A (2.1 %). As expected, we did not observe any mutations in the normal myometrium. Moreover, we found a higher rate of deletion mutations (17.5 %, 25/143) in the above fibroid tumors. Our results clearly demonstrate that the MED12 gene exon 2 is frequently mutated in human uterine fibroids in Southern United States women. These results highlight the molecular pathogenesis of human uterine fibroids with the central role of MED12 somatic mutations.
- Inflammatory Myofibroblastic Tumor of the Uterus: Clinical and Pathologic Review of 10 Cases Including a Subset With Aggressive Clinical Course. [JOURNAL ARTICLE]
- Am J Surg Pathol 2014 Oct 15.
Inflammatory myofibroblastic tumor is currently regarded as a neoplasm with intermediate biological potential and a wide anatomic distribution. Inflammatory myofibroblastic tumors of the female genital tract are rare, and to date reported cases behaved indolently. We describe, herein, 10 cases of uterine inflammatory myofibroblastic tumor, 3 of which had an aggressive clinical course. Subject age ranged from 29 to 73 years. Tumors were composed of spindle and epithelioid myofibroblastic cells admixed with lymphoplasmacytic infiltrates in a variably myxoid stroma. Two growth patterns, myxoid and fascicular (leiomyoma-like), were noted. All tumors were positive for ALK expression by immunohistochemistry, which was stronger in the myxoid areas. Smooth muscle marker and CD10 expression was variable in extent, but typically positive. Fluorescence in situ hybridization for ALK rearrangements was positive in both fascicular and myxoid areas in all 8 cases tested. Three subjects showed clinical evidence of tumor aggressiveness as defined by extrauterine spread, local recurrence, or distant metastasis. Aggressive tumors were larger, had a higher proportion of myxoid stroma, and higher mitotic activity than indolent tumors. Tumor cell necrosis was seen only in cases with adverse outcome. This is the first report to describe aggressive biological behavior in uterine inflammatory myofibroblastic tumor. This diagnosis is often underappreciated and merits inclusion in the differential diagnosis of myxoid mesenchymal lesions of the uterus, particularly because patients with an aggressive course may benefit from targeted therapy.