Ligation-assisted endoscopic enucleation for treatment of esophageal subepithelial lesions originating from the muscularis propria: a preliminary study.

An innovative ligation-assisted endoscopic enucleation (EE-L) technique was developed for the diagnosis and treatment of esophageal subepithelial lesions (smaller than 12 mm) originating from muscularis propria by combining endoscopic band ligation and endoscopic enucleation techniques. The aim of the study was to evaluate efficacy and safety of EE-L technique in the treatment of esophageal subepithelial lesions (smaller than 12 mm) originating from muscularis propria. Forty-seven esophageal subepithelial lesions (smaller than 12 mm) originating from the muscularis propria in 44 patients were treated with EE-L between September 2010 and September 2012. The lesion was first aspirated into the transparent cap attached to the tip of endoscope. The elastic band was then released around its base. The purpose of ligation was to force the lesion to assume a polypoid form with a pseudostalk. Endoscopic enucleation was then performed until the tumor was completely enucleated from muscularis propria using a hook knife and forceps. All tumors (median diameter: 8.2 ± 2.3 mm, range: 4-12 mm) were enucleated completely. Histopathology identified 45 tumors (95.7%) as leiomyoma, 2 (4.3%) tumors as gastrointestinal stromal tumor with very low risk. The mean time of the EE-L procedure was 12.5 ± 4.6 minutes (range: 6-23 minutes). Two patients experienced self-limiting, non-life-threatening hemorrhage after EE-L. No perforation and massive hemorrhage requiring further endoscopic or surgical intervention occurred. There were no recurrences during the 6-24 months follow-up period. EE-L offers the option of localized treatment of small esophageal muscularis propria tumors (smaller than 12 mm) with relatively few complications and low mortality, and provides the advantage of allowing a histopathological diagnosis. All the resected lesions in this study had a benign pathology.

Review of the pathophysiology, diagnosis, and therapy of vulvar leiomyoma, a rare gynecological tumor.

The objective of this article is to discuss the pathophysiology, diagnosis, differential diagnosis, and therapy of vulvar leiomyoma. We performed a review of all English-language reports of vulvar leiomyoma published in PubMed from 1978 to 2015 using the following search terms: "vulval leiomyoma," "vulvar leiomyoma," "vulval smooth muscle tumor," and "external genitalia smooth muscle tumor." Vulvar leiomyomas, which are rare benign monoclonal tumors, most commonly occur in the fourth and fifth decades of life. The genetics of vulvar leiomyoma remain undefined. Three principal histological patterns have been identified: spindled, epithelioid, and myxoid. Imaging tests such as ultrasound, endoscopic ultrasound, and magnetic resonance imaging are used in diagnosis. Surgical excision is the only curative treatment for vulvar leiomyomas. Establishment of a full differential diagnosis list and correct final diagnosis before surgery are essential for optimal clinical management. Although recurrence of vulvar leiomyoma is extremely rare, long-term follow-up of all cases is advisable.

Epithelioid gastric stromal tumors (leiomyoblastomas): a study of fifty-five cases.

BACKGROUND: Epithelioid gastric stromal tumors form a distinct histologic subset of gastric tumors whose malignant potential and prognosis are controversial. METHODS: Fifty-five patients with epithelioid gastric stromal tumors accounted for 11.5% of patients undergoing definitive operations for gastric stromal tumors from 1960 to 1986. Medical records and pathology slides were reviewed, and immunohistochemical staining and flow cytometry were performed. The Kaplan-Meier method was used to estimate survival. Survival curves were compared with log-rank tests and Cox proportional hazards model. RESULTS: Of the 55 tumors, 40 were benign and 15 (27%) were malignant. Mean follow-up was 10.5 years. Ten patients died of their disease. No patient with a benign tumor had recurrence of metastasis, but all patients with high-grade malignancy had died of disease within 3 years after diagnosis. Seventy-five percent of proximal tumors were malignant. Extent of resection had no impact on survival (p = 0.5). CONCLUSIONS: The best determinant of tumor behavior was histologic grade. Twenty-seven percent of patients had malignant tumors, and 67% of these died of disease. Other significant prognostic factors included a mitotic count greater than 5/10 high-power fields, size larger than 6 cm, aneuploidy, and higher S-phase fraction (p < 0.01). Proximal lesions were more likely to be malignant. Extent of surgical treatment had no effect on survival.

Minimally invasive surgery for posterior gastric stromal tumors.

BACKGROUND: Because involvement is extremely rare, surgery for gastric stromal tumors consists of local excision with clear resection margins. The aim of this study was to report the results of a consecutive series of nine patients with posterior gastric stromal tumors that were excised using a minimally invasive method. METHODS: Patients received a general anesthetic before placement of three laparoscopic ports- a 10-mm (umbilical) port for the telescope and two working ports, a 12-mm port (left upper quadrant) and a 10-mm port (right upper quadrant). Grasping forceps were placed through an anteriorly placed gastrotomy to deliver the tumor through the gastrotomy into the abdominal cavity, thus allowing an endoscopic linear cutter to excise the tumor with a cuff of normal gastric tissue. RESULTS: Nine consecutive patients with a median age of 73 years (range, 47-83) were treated. In seven patients, laparoscopic removal of the tumor was achieved. Two patients required conversion to an open operation because the tumor could not be delivered into the abdominal cavity. The median length of postoperative stay for the seven patients in whom the procedure was completed laparoscopically was 3 days (range, 2-6). CONCLUSIONS: Posterior gastric stromal tumors can be removed safely using this minimally invasive method. Delivery of the tumor through the gastrotomy is essential for success.

Leiomyoma of the male urethra: a case report and review of the literature.

We describe the case of a 48-year-old quadriplegic black man with history of C4-C5 cervical spine and cord injury secondary to a fall, who presented to the University of Cincinnati Medical Center Urology Service with obstructive symptoms at urination. A bulbous urethral stricture was diagnosed and subsequently resected with primary urethral reanastomosis. On pathologic examination, the surgical specimen contained an epithelioid leiomyoma at the site of the urethral stricture. Although leiomyomas of the female urethra are relatively common, we identified only 2 previously reported cases of leiomyomas of the male urethra in the English-language medical literature. To the best of our knowledge, we describe the third case of leiomyoma of the male urethra, the first of the epithelioid type.

Partial resection for leiomyoblastoma of stomach.

We herein report the case of a 51-year-old male with a submucosal tumor of the stomach which was histopathologically demonstrated to have features compatible with leiomyoblastoma. As the submucosal tumor of the posterior wall of the antrum, which was initially found in the upper gastrointestinal series done during a health examination, had grown 3.8 cm in diameter, the partial resection of the full thickness of the gastric wall containing the tumor with a sufficient tumor margin was performed.

Hemoperitoneum secondary to exogastric leiomyosarcoma: a case report.

We present the case of a 50-year-old man with hemoperitoneum secondary to a bleeding exogastric leiomyosarcoma. The patient underwent emergency laparotomy and resection of the mass en block with a segment of the lesser curvature was successfully performed.

Epithelioid leiomyoma of the vulva.

Smooth muscle tumors are uncommon lesions of the vulva and represent a variety of histologic types. When encountered, surgical treatment is guided by the malignant potential of the tumors. This article presents the case of a 45-year-old woman who underwent conservative excision of a 10-cm vulvar lesion consistent with benign epithelioid leiomyoma. This unusual case provides an opportunity to review the clinical and pathologic features of this uncommon variant of leiomyoma and to describe the recently suggested pathologic criteria for determining the malignant potential of smooth muscle tumors arising in the vulva. Knowledge of these criteria can guide the clinician in selecting the appropriate management.

Gastric leiomyoblastoma: report of three cases.

Leiomyoblastoma is a rare smooth muscle tumor characterized by epithelioid cells with clear cytoplasms and an unknown biological behaviour. Since pre-operative diagnosis is difficult, the optimum strategy during the operation could be determined only by having a thorough knowledge about it beforehand. Leiomyoblastoma can be exogastric, intramural or endogastric. In the mostly benign exogastric leiomyoblastomas, total excision with resection of full thickness of gastric wall around the tumor is appropriate. Partial or total gastrectomy should be performed for intramural or endogastric tumors. We report one exogastric and two intramural gastric leiomyoblastoma cases treated in our hospital.

An unusual cause of haemorrhagic ascites following blunt abdominal trauma.

Slow intraperitoneal haemorrhage following blunt abdominal trauma may present as haemorrhagic ascites. Such haemorrhage is usually due to rupture of spleen, liver or damage to small bowel mesenteric vasculature. We encountered a patient with bleeding from ruptured exogastric leiomyoblastoma. Two cases of traumatic rupture of gastric leiomyosarcomas have been reported previously. The operative treatment is usually delayed and the diagnosis established only at laparotomy. We suggest a high level of suspicion and early laparotomy.

[100 years after Billroth... Laparoscopic Billroth I and Billroth II distal stomach resection]. / 100 Jahre nach Billroth... Laparoskopische distale Magenresektion Billroth I und Billroth II).

In the period October 1993-February 1994, we performed three distal stomach resection operations laparoscopically (two Billroth-II anastomoses, one Billroth-I anastomosis combined with truncal vagotomy). The first patient, 83-year old, presented a stenosing, bleeding, prepyloric, malignant Non-Hodgkin lymphoma. The second patient, 84-year old, presented an ulcerated, non-malignant leiomyoblastoma of the antrum. Due to the histological type of the tumors a radical lymphadenectomy was not performed. The partially resected stomach (two thirds) was removed in a lap sac through a 3.5 cm infraumbilical incision. The third patient presented a persisting, prepyloric ulcer combined with an almost complete stenosis of the pylorus. In all three cases, it was possible to follow the principles of conventional open surgery. The anastomoses were all stapled intracorporally, no intraabdominal complications occurred. However, the first patient died on the 21st postoperative day from cardiopulmonary failure, the remaining two patients were discharged on day 11/day 12 postoperatively.

Leiomyoblastoma of small intestine.

Gastrointestinal tumours are rare in children and leiomyoblastoma of small intestine is still rarer. We report a case of leiomyoblastoma of small intestine in a child who presented with acute intestinal obstruction.

[Gastric epithelioid leiomyoblastoma. Description of a clinical case and considerations]. / Leiomioblastoma gastrico epitelioide. Descrizione di un caso clinico e considerazioni.

The authors present one case of gastric epithelioid leiomyoblastoma making some clinic considerations. Denominated also bizarre leiomyoblastoma or epithelioid leiomyoma or leiomyosarcoma, it is a rare malignant neoplasm of the stomach originating from mesenchyma. Symptomatology is extremely variable, often with asymptomatic; that gives a difficult pre-operative diagnosis. The most useful diagnostic tests are: ultrasonography and computed tomography scan; they allow besides the valuation of eventual metastasis and they are absolutely necessary in the follow-up of the patient. Macroscopically is a multilobular neoplasm, capsulated. Histologically is characterized with round cells with a central nucleus and plentiful clear cytoplasm. The principal elements about to determinate the malignity are the mitotic index and the cellularity. Surgery is the elective therapy. It consists in the complete removal of cancer with minimal exeresis of healthy tissue. Chemotherapy and radiotherapy haven't an unequivocally efficient role. Prognosis of the tumors with 5 years survival is inferior to 50%. Malignant prognosis is in patients with metastasis.

[Bizarre gastric leiomyoblastoma. A case report and review of the literature]. / Leiomioblastoma gastrico bizzarro. Analisi di un caso e revisione della letteratura.

Gastric leiomyoblastoma of Martin's myoid tumour or Stout's smooth muscle cell bizarre tumour is a rare benign mesenchymal neoplasia, that may become malignant. A personal clinical case is reported and the most important clinical and anatomopathological aspects are reviewed, stress being laid on the importance of identifying the macroscopic and histological features that can point with certainty to malignity and so influence the choice of surgery.

[Gastric leiomyoblastoma. Its preoperative diagnosis by echo-guided needle aspiration. A report of 2 clinical cases]. / Il leiomioblastoma gastrico. Diagnosi preoperatoria con agoaspirato ecoguidato. Descrizione di due casi clinici.

The authors report two cases of gastric leiomyoblastoma, one benign and one malignant, come to clinical observation for digestive hemorrhage; in both cases a preoperating diagnosis of benignity or malignity was made and in one case even of histotype, thanks to fine needle biopsy. After a short introduction regarding some historical notes, the predictive parameters of malignity, the classification of this rare myoid tumor, the authors discuss the distribution of the pathology in the population, the symptomatology, the diagnostic "iter" with particular regard to the needle biopsy, the surgical treatment, and the indispensable parameters for formulating a correct prognosis.

[Myoid tumors of the stomach. Our experience]. / I tumori mioidi dello stomaco. Nostra esperienza.

The authors analyse the incidence of myoid tumours of the stomach in comparison to bowl cancer as a whole and identify the different anatomopathological varieties (benign leiomyoma, leiomyosarcoma and Martin-Stout's bizarre leiomyoma). Symptoms are usually subtle and development slow: important factors are the site of onset (antro-pyloric in 60% of cases, body 25% and cardias 15%), the type of tumour growth (intra- or extraluminal or mixed) and tumour size which may sometimes be considerable. Four categories of patients are identified on the basis of symptoms shown: a) asymptomatic (chance diagnosis), b) aspecific (vague symptoms such as epigastralgia, dyspepsia, ecc.), c) symptomatic (presence of abdominal mass, chronic anemia, ecc.), d) complicated (onset of complications the most frequent of which is acute hemorrhage). The clinical data reported here refers to 4 patients (3 males and 1 female) aged between 53 and 75 years old. In one case diagnosis was made by chance, in 2 cases diagnosis followed acute hemorrhage of the upper digestive tract, and in the case of the woman clinical controls began following the finding of a voluminous abdominal mass. Diagnosis was based on traditional radiology and EGDscopy, as well as ultrasonography and CT. Treatment was surgical in all cases (two enucleations of the lesion and two atypical gastric resections). In the light of the authors' personal experience and data reported in the literature, the discussion focuses attention on the problems of diagnosis and therapy, in particular the various options facing the surgeon in the form of operating tactics.

[Imaging features of gastric stromal tumors: radiologic-pathologic correlation. Report of 4 cases]. / Imagerie des tumeurs stromales gastriques: corrélations radio-anatomopathologiques. A propos de quatre cas.

GOAL: This study concerns the new anatomo-pathologic semantics of the ancient gastric leiomyoblastoma that become gastric stromal tumors (GST) and identified as stemming of "pace-maker" cells of Cajal related to the immunohistochemical characterization of the phenotype. MATERIAL: and methods. We limited the study to the mesenchymatous tumors to "pacemaker" cells. For this purpose, we report four documented observations of gastric stromal tumors correlated to the histology and to the immunohistochemical study. RESULTS: Although some signs are often described (exogastric development, heterogeneity with cystic and necrotic component, predominating peripheral enhancement...), radiological aspects of these tumors are not specific because, analogues to the other mesenchymal tumors (leiomyoma or schwannoma). The topographic diagnosis is difficult, realized by echoendoscopy, CT scan and MRI. The irregularity of contours evokes the malignancy as hemoperitoneum. GST do not show lymphophilic behavior that differentiates them from the adenocarcinomas and gastric lymphomas. The surgical treatment is the best treatment, allowing the immuno-histological diagnosis of certainty from the complete operative specimen. CONCLUSION: Some tumors are difficult in classifying despite classic histology necessitating immunohistochemical tests for the identification of muscular, nervous, autonomous nervous system flexion of mesenchymatous tumors with epithelioid or spindle cells of the gastrointestinal tract. Then a radio-clinical follow-up is therefore indicated: the evolution is the alone real marker of malignancy.

[A case of epithelioid leiomyoma (leiomyoblastoma) of the urethra].

A 25-year-old woman was admitted to our hospital because of a painless, slow growing mass arising from the external genitalia. The mass had been developing for a few years. She did not have difficulty voiding nor was there hematuria. Magnetic resonance imaging revealed a well-circumscribed, 4 cm, solid tumor between the urethra and the anterior vaginal wall. After needle biopsy confirmed a benign tumor arising from the smooth muscle, the tumor was removed by a transvaginal approach. The histopathological diagnosis was epithelioid leiomyoma (leiomyoblastoma), which often occurs in the stomach or uterus, but seldom around the urethra. The patient has remained well without recurrence for 20 months after surgery.

[Gastric leiomyoblastoma, 2 case reports with a selective literature review]. / Leiomyoblastome gastrique, à propos de deux observations avec revue sélective de la littérature.

The gastric Leiomyoblastoma is a smooth muscle described in 1960 by Martin and in 1962 by Stout. These rare tumors are generally benign but may have a sarcomatous evolution in 11% of cases. They are characterized by the presence of large round or polygonal cells. Thin filaments are visible on electronic microscopy. Treatment of choice is the surgical resection.