PEComa-A Rare Uterine Neoplasm: A Case Report.

Background: Perivascular Epithelioid Cell Tumors (PEComas) are rare mesenchymal tumors originating from perivascular epithelioid cells. The second common affected organ is uterine. Most of PEComas are benign and patients have good prognosis. At the present time, surgery is the main treatment and adjuvant chemotherapy is used in malignant cases, although the best diagnostic and management method is yet to be discovered considering the rarity of this neoplasm. Case Presentation: The patient was a 53 year old lady with a history of two vaginal deliveries and no previous surgery. She had severe pelvic pain and underwent MRI with the primary impression of sarcoma. In MRI, she had a 7 cm mass in lower segment of uterus. The patient underwent laparoscopic hysterectomy, bilateral oophorectomy, lymphadenectomy, and omental biopsy in Jam Hospital. Pathologic report of the patient revealed malignant PEComa without lymph node and omentum involvement. Conclusion: Diagnosis of PEComa before surgery is difficult and its differential diagnoses form uterine leiomyoma or leiomyosarcoma. Final diagnosis can be made after surgical biopsy and immunohistochemistry evaluation. Surgery is still the main treatment and adjuvant therapy is used in high risk patients.

Preventing retrograde stone displacement during pneumatic lithotripsy for ureteral calculi using lidocaine jelly.

OBJECTIVES: To assess the efficacy of lubricating jelly instillation proximal to the upper ureteral calculi during lithotripsy on the prevention of retrograde stone displacement and the stone-free rate. METHODS: Thirty-four patients with upper ureteral calculi of less than 2 cm were randomized into two groups: jelly instillation (n = 16) and controls (n = 18). Ureteroscopy was performed using a 9.8F semirigid ureteroscope. A 5F ureteral stent was advanced beyond the stone. Lidocaine jelly (2 mL) was instilled, and lithotripsy was done with a Swiss Lithoclast. A 5F ureteral catheter was left in place for 24 hours, and patients were followed up at 24 hours with radiography of the kidneys, ureters, and bladder and at 2 weeks with intravenous urography. RESULTS: Both groups were comparable in terms of mean age and stone size. Stone or stone fragment migration occurred in 12.4% of the treatment group and 44.4% of the controls, statistically significantly different (P = 0.046). The stone-free rate was 93.7% and 83.3% in the treatment and control groups, respectively. The rates did not improve after 2 weeks, and the difference was not statistically significant between the two groups (P = 0.384). The mean operative time was also comparable between the two groups. CONCLUSIONS: Lidocaine jelly instillation proximal to the ureteral calculi during lithotripsy is an effective method to prevent retrograde stone displacement, but its effect on improving the stone-free rate was not significant in our study. Larger studies are needed to disclose more details about the efficacy of this method.