Leiomioma orbitario gigante en un paciente pediátrico: reto diagnóstico y terapéutico / Giant orbital leiomyoma in a pediatric patient: Diagnostic and therapeutic challenge

Este manuscrito presenta un caso de un leiomioma orbitario de larga evolución en un joven de 14años. El tumor era inusualmente grande y causaba una proptosis severa y una afectación importante de la musculatura ocular. El paciente presentaba amaurosis, una oftalmoplejía completa, dolor ocular espontáneo e incapacidad para cerrar los párpados. Debido al tamaño del tumor y a su progresión, se realizó una exenteración orbitaria derecha para eliminar todo el contenido orbitario, incluyendo el tumor y el globo ocular. El procedimiento quirúrgico tenía como objetivo prevenir la recurrencia del tumor y mejorar la calidad de vida del paciente. El análisis histopatológico confirmó el diagnóstico de leiomioma orbitario. Este caso presenta un interés particular por el grado de evolución que ha alcanzado. La extirpación completa del tumor y un seguimiento a largo plazo son necesarios para prevenir la recurrencia y garantizar resultados óptimos para el paciente. Además, este caso refleja las grandes diferencias en el acceso a la sanidad en las diferentes regiones del mundo. (AU)

This manuscript describes an exceptional case of a long-standing orbital leiomyoma in a 14-year-old male. The tumor was unusually large, causing severe proptosis and significant involvement of the ocular muscles. The patient presented with amaurosis, complete ophthalmoplegia, spontaneous eye pain, and the inability to close the eyelids, leading to psychological distress. Due to the tumor's size and progression, a right orbital exenteration was performed to remove all orbital contents, including the tumor and the eyeball. The surgical procedure aimed to prevent tumor recurrence and improve the patient's quality of life. The histopathological analysis confirmed the diagnosis of orbital leiomyoma. This case presents a particular interest due to the degree of evolution it has reached. Complete tumor excision and long-term follow-up are necessary to prevent recurrence and ensure optimal patient outcomes. This report underscores global healthcare disparities and the complexity of managing rare orbital neoplasms in diverse country settings. (AU)

Giant orbital leiomyoma in a pediatric patient: diagnostic and therapeutic challenge.

This manuscript describes an exceptional case of a long-standing orbital leiomyoma in a 14-year-old male. The tumor was unusually large, causing severe proptosis and significant involvement of the ocular muscles. The patient presented with amaurosis, complete ophthalmoplegia, spontaneous eye pain, and the inability to close the eyelids, leading to psychological distress. Due to the tumor's size and progression, a right orbital exenteration was performed to remove all orbital contents, including the tumor and the eyeball. The surgical procedure aimed to prevent tumor recurrence and improve the patient's quality of life. The histopathological analysis confirmed the diagnosis of orbital leiomyoma. This case presents a particular interest due to the degree of evolution it has reached. Complete tumor excision and long-term follow-up are necessary to prevent recurrence and ensure optimal patient outcomes. This report underscores global healthcare disparities and the complexity of managing rare orbital neoplasms in diverse country settings.

Importância do diagnóstico por imagem em pacientes com sangramento uterino anormal / Importance of diagnostic imaging in patients with abnormal uterine bleeding

O sangramento uterino anormal é diagnóstico sindrômico comum no consultório do ginecologista e pode comprometer substancialmente a qualidade de vida. O objetivo no diagnóstico de sangramento uterino anormal é distinguir pacientes com causas estruturais (anatômicas), como pólipo, adenomiose, leiomioma, malignidade e hiperplasia, de pacientes que apresentam anatomia normal, nas quais o sangramento pode ser devido a alteração dos mecanismos de coagulação, distúrbios ovulatórios, distúrbios primários do endométrio, iatrogenia, ou ter outra causa não classificada. O diagnóstico se inicia a partir de anamnese detalhada e exame físico geral e ginecológico completos, seguidos da solicitação de exames complementares (laboratoriais e de imagem), conforme indicado. O exame de imagem de primeira linha para identificação das causas estruturais inclui a ultrassonografia pélvica. Histerossonografia, histeroscopia, ressonância magnética e amostragem endometrial para exame de anatomia patológica são opções que podem ser incluídas no diagnóstico a depender da necessidade. O objetivo deste artigo é apresentar a relevância dos exames de imagem na investigação das causas de sangramento uterino anormal.

Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office and may substantially affect quality of life. The aim in the diagnosis of abnormal uterine bleeding is to distinguish women with anatomic causes such as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia from women with normal anatomy where the cause may be coagulopathy, ovulatory disorders, endometrial, iatrogenic and not otherwise classified. Diagnosis begins with a thorough history and physical examination followed by appropriate laboratory and imaging tests as indicated. The primary imaging test for the identification of anatomic causes include ultrasonography. Saline infusion sonohysterography, magnetic resonance, hysteroscopy, endometrial sampling are options that can be included in the diagnosis depending on the need. The aim of this article is to present the relevance of imaging exams in the investigation of the causes of abnormal uterine bleeding.

Extrauterine leiomyomatosis, the great mimicker.

OBJECTIVES: Describe the radiographic features of the different forms of extrauterine leiomyomatosis. CONCLUSIONS: Leiomyomas with a rare growth pattern occur most often in women of reproductive age and with a history of hysterectomy. Extrauterine leiomyomas present a greater diagnostic challenge because they may mimic malignancies, and serious diagnostic errors may result.

Leiomiomatosis extrauterina, la gran simuladora / Extrauterine leiomyomatosis, the great mimicker

Objetivos: Definir el concepto de leiomiomatosis extrauterina y describir sus formas de aparición. Realizar una revisión de los hallazgos radiológicos de los distintos tipos de leiomiomatosis extrauterina a partir de casos de nuestro centro. Conclusiones: La leiomiomatosis extrauterina es una entidad rara, típica de mujeres premenopáusicas histerectomizadas. Conocer los hallazgos radiológicos de esta patología permite incluirla en el diagnóstico diferencial de una masa pélvica, una enfermedad peritoneal o una invasión vascular de aspecto tumoral.(AU)

Objectives Describe the radiographic features of the different forms of extrauterine leiomyomatosis. Conclusions: Leiomyomas with a rare growth pattern occur most often in women of reproductive age and with a history of hysterectomy. Extrauterine leiomyomas present a greater diagnostic challenge because they may mimic malignancies, and serious diagnostic errors may result.(AU)

Leiomioma ovárico primario

El leiomioma es un tumor mesenquimal benigno común que puede desarrollarse allí donde haya músculo liso; raro como tumor ovárico primario, su origen aún es controversial. El leiomioma ovárico primario es uno de los tumores benignos más raros del ovario, representa 0,5% a 1% de los tumores benignos y suele observase en mujeres entre 20 y 65 años. Generalmente, son asintomáticos y se les encuentra de forma incidental durante el examen pélvico o la cirugía por otra causa, pero en ocasiones puede manifestarse por dolor abdominal y masa palpable. El diagnóstico definitivo es difícil antes de la extirpación quirúrgica. Debido a que no existen síntomas patognomónicos ni tiene imágenes características, los principales diagnósticos diferenciales incluyen fibroma, tecoma, tumor estromal esclerosante y leiomiosarcoma. La tinción inmunohistoquímica es fundamental para el diagnóstico preciso y debe considerarse en el diagnóstico diferencial de los tumores ováricos de células fusiformes. Se presenta un caso de leiomioma ovárico primario.

Leiomyoma is a common benign mesenchymal tumor that can develop wherever smooth muscle is present; rare as a primary ovarian tumor, its origin is still controversial. Primary ovarian leiomyoma is one of the rarest benign ovarian tumors, accounting for 0.5% 1% of benign tumors and is usually seen in women between 20 and 65 years of age. They are usually asymptomatic and appear incidentally during a pelvic examination or surgery for another cause but can occasionally manifest by abdominal pain and palpable mass. Definitive diagnosis is difficult before surgical removal. Because there are no pathognomonic symptoms and no characteristic imaging, the main differential diagnoses include fibroma, thecoma, sclerosing stromal tumor and leiomyosarcoma. Immunohistochemical staining is essential for accurate diagnosis and should be considered in the differential diagnosis of ovarian spindle cell tumors. A case of primary ovarian leiomyoma is presented.

Reporting of uterine fibroids on ultrasound examinations: an illustrated report template focused on surgical planning / Relato de miomas uterinos em exames de ultrassonografia: um modelo de relatório ilustrado com foco no planejamento cirúrgico

Abstract Uterine fibroids are the most common benign gynecologic tumors in women of reproductive age, and ultrasound is the first-line imaging modality for their diagnosis and characterization. The International Federation of Gynecology and Obstetrics developed a system for describing and classifying uterine fibroids uniformly and consistently. An accurate description of fibroids in the ultrasound report is essential for planning surgical treatment and preventing complications. In this article, we review the ultrasound findings of fibroids, detailing the main points to be reported for preoperative evaluation. In addition, we propose a structured, illustrated report template to describe fibroids, based on the critical points for surgical planning.

Resumo Os miomas uterinos são os tumores ginecológicos benignos mais comuns em mulheres em idade reprodutiva, sendo a ultrassonografia a modalidade de imagem de primeira linha para seu diagnóstico e caracterização. A Federação Internacional de Ginecologia e Obstetrícia desenvolveu um sistema para descrever e classificar os miomas uterinos de forma uniforme e consistente. Uma descrição precisa dos miomas no laudo ultrassonográfico é essencial para o planejamento do tratamento cirúrgico e prevenção de complicações. Neste artigo, revisamos os achados ultrassonográficos de miomas, detalhando os principais pontos a serem relatados para avaliação pré-operatória. Além disso, propomos um modelo de relatório estruturado e ilustrado para descrição de miomas, com base nos pontos críticos para o planejamento cirúrgico.

Técnicas de radiología intervencionista para el manejo del sangrado uterino anormal (SUA) / Interventional radiology techniques for the management of abnormal uterine bleeding (AUB)

El sangrado uterino anormal (SUA) es una de las patologías ginecológicas más comunes en mujeres en edad reproductiva. El sistema de clasificación de la Federación Internacional de Ginecología y Obstetricia (PALM-COEIN) armoniza las definiciones de los síntomas de hemorragia normal y anormal y clasifica las posibles causas subyacentes en causas estructurales y no estructurales. El objetivo de este manuscrito es revisar el diagnóstico radiológico de cada una de las causas estructurales de sangrado uterino anormal, examinar las indicaciones de las técnicas de radiología vascular intervencionista en el manejo del SUA y conocer el procedimiento de embolización de arterias uterinas, así como sus posibles complicaciones y contraindicaciones.(AU)

Abnormal uterine bleeding is one of the most common gynaecological pathologies in women of reproductive age. The classification system of the International Federation of Gynaecology and Obstetrics (PALM-COEIN) harmonizes the definitions of normal and abnormal bleeding symptoms and classifies possible underlying causes as structural and non-structural. The aim of this manuscript is to review the radiological diagnosis of each of the structural causes of abnormal uterine bleeding, to examine the indications for interventional vascular radiology techniques in the treatment of abnormal uterine bleeding, and to learn about the uterine artery embolization procedure, as well as its possible complications and contraindications.(AU)

When Heart Team Really Counts: Radical Excision of Intracardiac Leiomyomatosis.

Intravenous leiomyomatosis (IVL) are rare and complex tumors, characterized by high rates of recurrences after surgical removal and the capability of multi-organ involvement including pulmonary embolization. Regarding the surgical treatment of Intracardiac Leiomiomatosis (ICL), only few articles have been published and no controlled data are available. A combined approach that involves a Team of Cardiologists, Heart Surgeons, Vascular surgeons and Radiologists seems to be successful in treating ICL.

Torsión uterina causada por miomatosis: reporte de un caso / Uterine torsion caused by myomatosis: A case report

Resumen ANTECEDENTES: La torsión uterina es una rotación del útero sobre su eje mayor de más de 45°; por lo general sucede en torno del istmo uterino. Los leiomiomas son el factor predisponente más frecuente en úteros no grávidos. OBJETIVO: Reportar el caso de una paciente con torsión uterina cervical y miomatosis de grandes elementos. CASO CLÍNICO: Paciente de 42 años, nuligesta, con antecedente de miomatosis uterina de grandes elementos de 27 x 27 cm. Los síntomas se iniciaron con síndrome doloroso abdominal intenso, tipo cólico, localizado en el hipogastrio y la fosa iliaca. En la exploración física el abdomen se percibió doloroso a la palpación superficial y profunda, con una tumoración cercana a la cicatriz umbilical (25 cm), móvil y dolorosa. En la laparotomía exploradora se encontró líquido peritoneal hemorrágico y se observó una torsión uterina (una vuelta) cerca del cuello del útero, además de un mioma subseroso en la cara posterior, de 27 x 27 cm. El útero, los anexos y las salpinges se advirtieron con datos francos de daño vascular, con áreas de isquemia. Por lo anterior se decidieron la histerectomía total abdominal y la salpingooforectomia bilateral. El informe histopatológico reportó: útero con cambio isquémico extenso panmural, sin evidencia de neoplasia maligna. CONCLUSIONES: El dolor abdominal es el síntoma más común de la torsión uterina que puede variar de leve a agudo. El diagnóstico preoperatorio rápido y preciso de torsión uterina es decisivo y se justifica la intervención quirúrgica de urgencia.

Abstract BACKGROUND: Uterine torsion is a rare entity that is defined as a rotation of the uterus on its major axis of more than 45°, generally occurring at the level of the uterine isthmus. Leiomyomas are the most frequent predisposing factor in non-gravid uterus. OBJECTIVE: Report of a case of a gynecological patient with uterine torsion at the cervical level in a uterus with uterine myomatosis of large elements. CLINICAL CASE: A 42-year-old patient, nulliparous, with a history of uterine myomatosis with large elements of 27 x 27 cm. The symptoms began with intense abdominal pain syndrome, colic type, located in the hypogastrium and the iliac fossa. On physical examination, the abdomen was perceived as painful on superficial and deep palpation, with a mobile and painful tumor close to the umbilical scar (25 cm). In the exploratory laparotomy, hemorrhagic peritoneal fluid was found and a uterine torsion (one turn) was observed near the cervix, as well as a subserous myoma on the posterior face, measuring 27 x 27 cm. The uterus, the annexes and the salpinges were noted with frank data of vascular damage, with areas of ischemia. Therefore, total abdominal hysterectomy and bilateral salpingo-oophorectomy were decided. The histopathological report reported: uterus with extensive panmural ischemic change, without evidence of malignancy. CONCLUSIONS: In uterine torsion, abdominal pain is the most common symptom and can range from mild to severe abdominal symptoms. Therefore, a prompt and accurate preoperative diagnosis of uterine torsion is crucial and urgent surgical intervention is warranted.

Leiomioma submucoso de gran tamaño: una presentación inusual. Reporte de Caso / Large submucosal leiomyoma: an unusual presentation

Se ha postulado que más del 70 % de las mujeres antes de la menopausia son diagnosticadas de leiomiomas; de estas un 25 % presentan sintomatología grave. La ecografía es la modalidad de imagen de primera elección para su estudio. Se tiene registros de progresión de leiomiomas a leiomiosarcomas, que conllevan a un mal pronóstico y son responsables de una cuarta parte de las muertes por neoplasias uterinas, con una sobrevida a 5 años que van desde 46-53 %, lo cual incentiva el diagnóstico precoz y eficaz de masas uterinas. El caso reportado es una presentación inusual de un leiomioma de gran tamaño, que por los hallazgos de imagen se reportó como una neoplasia maligna, su aspecto macroscópico totalmente atípico reforzaba la sospecha imagenológica. Solo se pudo determinar el diagnóstico definitivo mediante estudio histopatológico posterior a histerectomía. Las evaluaciones ginecológicas de rutina deben incluir exámenes especializados de imagen pélvica, la ausencia de presentación típica o síntomas característicos de una patología no debe ser motivo para obviar exámenes complementarios que permitan un diagnóstico oportuno y tratamiento eficiente de leiomiomas, incluso en casos de presentaciones inusuales y desafiantes para el diagnóstico, como el que se ha reportado en esta obra.

It has been postulated that more than 70% of premenopausal women are diagnosed with leiomyomas; Of these, 25% have severe symptoms. Ultrasound is the imaging modality of choice for its study. There are reports of progression from leiomyomas to leiomyosarcomas, which leads to a poor prognosis, and is responsible for a quarter of deaths from uterine neoplasms, with a 5-year survival ranging from 46-53%; this should encourage early and effective diagnosis of uterine masses. The reported case is an unusual presentation of a large leiomyoma, which due to its imaging characteristics, was reported as a malignant neoplasm. Its completely atypical macroscopic appearance reinforced the imaging diagnosis suspicion. The definitive diagnosis could only be determined by histopathological study after hysterectomy. Routine gynecological evaluations should include specialized pelvic imaging exams, the absence of a typical presentation or characteristic symptoms of a pathology should not be a reason to obviate ancillary testing that would allow a timely diagnosis and effective treatment of leiomyomas, even in unusual and challenging presentations, such as with the patient in this case report.

Uterine artery embolization with highly compressible calibrated microspheres for the treatment of uterine fibroids / Embolização de miomas uterinos com microesferas calibradas de alta compressibilidade

Abstract Objective: To evaluate the safety and efficacy of using highly compressible calibrated microspheres in uterine artery embolization (UAE) for the treatment of uterine fibroids. Materials and Methods: This was a prospective multicenter study. Thirty-two women with symptomatic uterine fibroids were selected for UAE between January 2019 and March 2020. The participants completed the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire, underwent contrast-enhanced pelvic magnetic resonance imaging (MRI), and were submitted to anti-Müllerian hormone measurement, subsequently undergoing UAE with Embosoft microspheres. After six months, the patients again completed the UFS-QOL questionnaire and underwent pelvic MRI. Results: The most common symptoms were abnormal uterine bleeding (in 81.3% of the cases), pelvic pain (in 81.3%), and compression (in 46.9%). Of the 32 patients evaluated, 12 (37.5%) had anemia due to abnormal uterine bleeding. Thirty patients completed the study. Among those patients, we observed median reductions of 21.4% in uterine volume and 15.9% in dominant fibroid volume. We identified no adverse events that could be attributed to the material itself, although there were events attributed to the UAE procedure in general. Conclusion: For the treatment of uterine fibroids, UAE using Embosoft microspheres shows satisfactory results, providing reductions in uterine and dominant fibroid volumes, with a low rate of adverse events, and improving patient quality of life, as well as demonstrating safety and efficacy.

Resumo Objetivo: Avaliar a eficácia e segurança da embolização da artéria uterina (EAU) com microesferas calibradas de alta compressibilidade no tratamento de miomas uterinos. Materiais e Métodos: Este foi um estudo prospectivo e multicêntrico. Foram selecionadas 32 mulheres com miomas uterinos sintomáticos para EAU de janeiro de 2019 a março de 2020. As participantes preencheram o questionário Uterine Fibroid Symptom and Quality of Life (UFS-QOL), realizaram ressonância magnética (RM) pélvica com contraste e teste para medição dos hormônios antimüllerianos, seguido de embolização de miomas com microesferas Embosoft. Após seis meses, as pacientes novamente preencheram o UFS-QOL e realizaram RM pélvica. Resultados: Os sintomas mais relatados foram sangramento uterino anormal (81,3%), dor pélvica (81,3%) e compressão (46,9%). Doze pacientes (37,5%) apresentaram anemia consequente a sangramento uterino anormal. Nas 30 pacientes que completaram o estudo, observou-se redução mediana de 21,4% no volume uterino e 15,9% no volume do mioma dominante. Não foram identificados eventos adversos possivelmente relacionados ao material utilizado, apenas em relação ao procedimento de EAU. Conclusão: EAU com microesferas Embrosoft mostrou resultados satisfatórios no tratamento de miomas uterinos, com redução dos volumes uterino e do mioma dominante, baixa taxa de eventos adversos e melhora na qualidade de vida, demonstrando segurança e eficácia.

Urethral leiomyoma: combined vaginal and abdominal approach - a case report / Mioma uretral: abordagem combinada vaginal e abdominal - um relato de caso

Abstract Introduction: leiomyomas are benign mesenchymal tumors of smooth muscle origin that can develop in various locations. Urethral leiomyomas are rare, with approximately only 120 cases reported in the literature. These tumors often occur in the third and fourth decades of life but are rare in menopausal patients. In general, treatment involves surgery, only three recurrence reports in the literature. Description: a case report on a 56-year-old woman; the patient had type II diabetes mellitus and chronic high blood pressure, was overweight (body mass index, 27.1 kg/m2), and a smoker. Besides this, the patient presented symptoms of urinary obstruction and had a large urethral leiomyoma. The tumor was completely removed with no associated urethral lesions using a complex, combined abdominalvaginal surgical approach. Discussion: the management and treatment on urethral leiomyomas is challenging and have not been established yet due to the rarity of these tumors.

Resumo Introdução: os leiomiomas são tumores mesenquimais benignos de origem muscular lisa, podendo manifestar-se em diversas localizações. Os leiomiomas uretrais são raros, tendo apenas aproximadamente 120 casos relatados na literatura. São mais comuns na terceira e quarta décadas de vida, sendo raros em pacientes menopausadas. Em geral, são tratados cirurgicamente, com apenas três relatos de recidivas na literatura. Descrição: relato de caso de uma paciente do sexo feminino, 56 anos, portadora de diabetes mellitus do tipo II, hipertensão arterial crônica, sobrepeso (IMC 27,1Kg/m2) e tabagismo. Além disso, com quadro de sintomas obstrutivos urinários e portadora de um grande leiomioma uretral, este que foi completamente removido, através de uma desafiadora abordagem cirúrgica combinada (abdominal e vaginal), sem lesões uretrais associadas. Discussão: os leiomiomas uretrais são tumores raros e seu manejo é desafiador e ainda não foi estabelecido.

Angioleiomioma en cavidad oral «una neoplasia rara en un sitio poco común¼. Reporte de un caso y revisión de la literatura / Angioleiomyoma in the oral cavity «a rare neoplasm in an unusual site¼. Case report and literature review

El angioleiomioma (AL) es una neoplasia benigna, bien circunscrita y de crecimiento lento, que representa 5% de las neoplasias de tejidos blandos y cuya etiología es desconocida. Se origina del músculo liso, mayormente de las paredes de los vasos sanguíneos; su localización es más frecuente en extremidades, siendo raros en la región de cabeza y cuello, y más aún en cavidad bucal. Histológicamente la lesión se caracteriza por ser un nódulo bien encapsulado con proliferación de fascículos de músculo liso maduro alrededor de la luz de los vasos sanguíneos, cuyas células suelen ser positivas a marcadores de inmunohistoquímica como alfa actina de músculo liso, desmina, HHF35, miosina, calponina y H-caldesmon. El tratamiento actual es la escisión quirúrgica completa con una tasa de recurrencia prácticamente nula. El objetivo es resaltar la importancia del diagnóstico y el manejo correcto de las lesiones intraorales a través de la presentación de un caso clínico de un leiomioma vascular localizado en región nasolabial, además de hacer la revisión de la literatura correspondiente (AU)

The angioleiomyoma (AL) is a benign neoplasm, well circumscribed and slow growing, that represents 5% of the soft tissue neoplasms, whose etiology is unknown. It originates from smooth muscle, mostly from the walls of blood vessels; regarding its location, it more frequently appears in the extremities, being rare in the head and neck region, and even more so in the oral cavity. Histologically, the lesion is characterized by being a well encapsulated nodule with proliferation of mature smooth muscle bundles around the lumen of the blood vessels, whose cells are usually positive for immunohistochemical markers such as alpha smooth muscle actin, desmin, HHF35, myosin, calponin and H-caldesmon. The current treatment is complete surgical excision having zero recurrence rate. The objective of the following article is to educate on the importance of correct diagnosis and management of intraoral lesions through the presentation of a clinical case of a vascular leiomyoma located in the nasolabial region, in addition to reviewing the corresponding literature (AU)

Leiomioma disecante cotiledóneo del útero / Cotyledonoid dissecting leiomyoma of the uterus

RESUMEN Los tumores benignos de músculo liso son los tumores más frecuentes en el aparato genital femenino. El leiomioma disecante cotiledóneo del útero es una variante rara de leiomioma benigno, que presenta patrones de crecimiento inusuales y comparte algunas características con otras variantes de leiomioma disecante. Tiene un patrón de crecimiento inusual caracterizado por disección intramural dentro del miometrio y con apariencia similar de sus componentes extrauterinos a los cotiledones placentarios. Su aspecto sarcomatoide y carácter inusual dan la impresión de malignidad. El diagnóstico se realiza por los hallazgos histopatológicos característicos de la lesión. Se presenta un caso de leiomioma disecante cotiledóneo del útero.

ABSTRACT Benign smooth muscle tumors are the most common tumors in the female genital tract. Cotyledonoid dissecting leiomyoma of the uterus is a rare variant of benign leiomyoma, which presents unusual growth patterns and shares some features with other variants of dissecting leiomyoma. It has an unusual growth pattern characterized by intramural dissection within the myometrium and with similar appearance of its extrauterine components to placental cotyledons. Its sarcomatoid appearance and unusual character give the impression of malignancy. The diagnosis is made by the characteristic histopathologic findings of the lesion. A case of cotyledonoid dissecting leiomyoma of the uterus is presented.

Leiomioma primario de páncreas en una gestante: presentación de caso / Primary pancreatic leimyoma in a pregnant woman: case report

RESUMEN Introducción: Los tumores pancreáticos en el embarazo son muy raros, el diagnóstico y tratamiento en este grupo de pacientes es complejo. Objetivo: Presentar el primer caso de un leiomioma primario del páncreas en una gestante. Caso clínico: Embarazada de 26 años de edad, sin antecedentes relevantes. Primigesta, que se encontraba cursando la semana 13 de gestación. Durante una evaluación ecográfica de rutina, se le detecta una tumoración en la glándula pancreática. Se remitió a la consulta multidisciplinaria de atención a la materna y en conjunto deciden realizar la interrupción voluntaria del embarazo. Luego la paciente fue remitida a la consulta de la especialidadde Cirugía General. Al recibir a la misma, se quejaba de dolor en epigastrio e hipocondrio izquierdo, además de hipo ocasional. Al examen físico se encontró una tumoración palpable en epigastrio. Se realizaron exámenes analíticos básicos sin encontrarse alteraciones, en los estudios de imagen realizados, ecografía abdominal y tomografía contrastada de abdomen se demostró una tumoración en el cuerpo y cola del páncreas. Se planificó tratamiento quirúrgico electivo, se realizó pancreatectomía distal con esplenectomía, por invasión del estómago, se complementó con gastrectomía subtotal. La paciente evoluciona sin complicaciones. La biopsia informó un tumor mesenquimal benigno primario de páncreas, tipo leiomioma, bien encapsulado. Conclusiones: Se presenta el primer caso de un leiomioma primario del páncreas en una gestante. Los tumores pancreáticos en embarazadas son enfemedades raras, el manejo por un equipo multidisciplinario es la mejor forma de obtener resultados satisfactorios para la paciente.

ABSTRACT Introduction: Pancreatic tumors during pregnancy are very rare, diagnosis and treatment are always difficult. Objective: To present the first case of a primary pancreatic leiomyoma in a pregnant woman. Case report: A 26 years old primiparous pregnant is reported, with no relevant backgrounds. She was in her first trimesters of pregnancy. Diagnosed with a pancreatic tumor during a routine evaluation. She was referred to a multidisciplinary consult, deciding the voluntary interruption of pregnancy, then she is evaluated by the General Surgery specialty clinic for complaining of epigastric pain and hiccup. On physical examination an epigastric tumor was found. Auxiliary exams were normal. Imagenologic studies confirm a tumor in the pancreatic body and tail. Surgical treatment was scheduled, distal pancreatectomy with splenectomy, due to invasion of gastric wall subtotal distal gastrectomy was performed. Patient evolution without complications. Biopsy reported a well capsulated, leiomyoma type, primary mesenchymal pancreatic tumor. Conclusions: The first case of a primary pancreatic leiomyoma in a pregnant woman is presented. Pancreatic tumors during pregnancy are rare. Multidisciplinary approach is the best way to improve results.

Leiomioma parasitario retroperitoneal: reporte de un caso / Retroperitoneal parasitic leiomioma: A case report

Resumen ANTECEDENTES: Los leiomiomas parasitarios son una variante poco común de la miomatosis uterina. Se han identificado en la pared abdominal, intestino delgado, muñón cervical o vaginal, vasos iliacos, ovarios, colon sigmoides y en el omento mayor. OBJETIVO: Reportar un caso clínico de leiomioma parasitario retroperitoneal y revisar la bibliografía al respecto. CASO CLÍNICO: Paciente de 57 años, con diagnóstico de NIC-III y hemorragia uterina anormal. Acudió a consulta debido a una sensación de masa y dolor abdominal, pérdida de peso subjetiva, hiporexia, disfagia y plenitud gástrica de cuatro meses de evolución. En los estudios de extensión se documentó una masa retroperitoneal grande y elevación de los marcadores tumorales Ca 125 y Ca 19-9. La resección de la masa se efectuó mediante laparotomía, con hallazgo histopatológico de mioma parasitario. CONCLUSIÓN: Los leiomiomas parasitarios deben considerarse en el diagnóstico diferencial de pacientes con antecedente de histerectomía o miomectomía, sobre todo en el contexto de la morcelación. El tratamiento consiste en cirugía o inhibidores de la aromatasa y análogos de la hormona liberadora de gonadotropina (leiomiomatosis peritoneal diseminada).

Abstract BACKGORUND: Parasitic leiomyomas are a rare entity, defined as an unusual variant of uterine myomatosis. Have been documented in the abdominal wall, small intestine, cervical or vaginal stump, iliac vessels, ovaries, sigmoid colon, and greater omentum. OBJECTIVE: To report a clinical case of retroperitoneal parasitic leiomyoma and review the literature. CLINICAL CASE: A 57-year-old patient with a diagnosis of CIN-III and secondary abnormal uterine bleeding, who consulted for a sensation of abdominal mass and pain, subjective weight loss, hyporexia, dysphagia and gastric fullness, of four months of evolution. Extension studies document a large retroperitoneal mass and elevation of tumor markers Ca 125 and Ca 19-9. We practice surgical management of her gynecological pathology and resection of the mass by laparotomy, with histopathological finding of myoma. CONCLUSION: Parasitic leiomyomas should be suspected in patients with a detected mass and a history of hysterectomy or myomectomy, especially in the context of morcellation. The treatment of this condition is surgical and, in cases of disseminated peritoneal leiomyomatosis, pharmacological treatments have been used with aromatase inhibitors and gonadotropin-release hormone analogues.

Tratamiento laparoscópico de una paciente con un leiomioma uterino gigante cavitado, con cambio degenerativo mucomixoide / Laparoscopic treatment of a patient with a cavitated giant uterine leiomyoma with mucomyxoid degenerative change

Resumen INTRODUCCIÓN: Un leiomioma con cambios degenerativos poco frecuentes es un desafío diagnóstico difícil de diferenciar de sus homólogos malignos, si se pretende fundamentarlo solo en lo advertido en las imágenes. CASO CLÍNICO: Paciente de 40 años de edad, enviada al servicio de Cirugía de mínima invasión en marzo del 2021 debido al aumento del perímetro abdominal, disminución del apetito y disnea de medianos esfuerzos. El ultrasonido abdomino-pélvico reportó que el útero estaba aumentado de tamaño, con miomas intramurales de medianos elementos. El endometrio heterogéneo. El ovario derecho tenía un quiste complejo, gigante, de 276 mm x 250 mm x 276 mm, con volumen de 10 000 cc. Además, esplenomegalia, hidronefrosis derecha y litiasis renal izquierda. Los marcadores tumorales se reportaron normales. En la cirugía por laparoscopia se observó un tumor que ocupaba toda la cavidad abdominal de 40 x 30 cm, adherido a la pared posterior del útero, con ambos ovarios sin alteraciones, sin líquido libre; se procedió a la histerectomía total. CONCLUSIONES: Los cambios degenerativos en los leiomiomas uterinos pueden distorsionar la estructura habitual del tumor y reflejarla en imágenes típicas de una tumoración quística de ovario; en el estudio inicial esto representa un desafío para el cirujano y debe considerarse parte del diagnóstico diferencial de las masas anexiales. En la paciente del caso, con cirugía de mínima invasión, se consiguió la resección completa de la pieza, a pesar del tamaño aumentado, con menores riesgos de complicaciones en la herida y menos dolor posoperatorio; las incisiones son pequeñas y con desenlaces estéticos favorables y menos días de estancia intrahospitalaria.

Abstract INTRODUCTION: A leiomyoma with rare degenerative changes is a diagnostic challenge difficult to differentiate from its malignant counterparts, if it is intended to be based only on imaging findings. CLINICAL CASE: 40-year-old female patient referred to the Minimally Invasive Surgery service in March 2021 due to increased abdominal perimeter, decreased appetite and dyspnea on medium exertion. Abdomino-pelvic ultrasound reported that the uterus was enlarged, with medium-element intramural fibroids. The endometrium was heterogeneous. The right ovary had a complex, giant cyst, 276 mm x 250 mm x 276 mm, with a volume of 10,000 cc. In addition, splenomegaly, right hydronephrosis and left renal lithiasis. Tumor markers were reported normal. Laparoscopic surgery showed a tumor occupying the entire abdominal cavity measuring 40 x 30 cm and attached to the posterior wall of the uterus, with both ovaries unaltered, with no free fluid; total hysterectomy was performed. CONCLUSIONS: Degenerative changes in uterine leiomyomas can distort the usual tumor structure and reflect it in images typical of an ovarian cystic tumor; in the initial study this represents a challenge for the surgeon and should be considered part of the differential diagnosis of adnexal masses. In the case patient, with minimally invasive surgery, complete resection of the specimen was achieved, despite the increased size, with less risk of wound complications and less postoperative pain; the incisions are small and with favorable esthetic outcomes and fewer days of in-hospital stay.

Leiomioma ovárico primario en paciente posmenopáusica. Posibilidad dentro del diagnóstico diferencial de las neoplasias de ovario / Primary ovarian leiomyoma in a postmenopausal patient. Possibility within the differential diagnosis of ovarian neoplasms

El leiomioma primario de ovario es un tipo de tumor sólido muy infrecuente, detectándose como hallazgo incidental. El estudio preoperatorio por imagen es muy limitado por lo que es imprescindible el estudio anatomopatológico, que logre distinguirlo de otros tumores sólidos de ovario. Se presenta un caso atípico de leiomioma primario ovárico en una mujer posmenopáusica de 69 años, sometida a cirugía debido a una masa anexial izquierda de gran tamaño sospechosa de cistoadenocarcinoma en el estudio preoperatorio. El leiomioma ovárico primario debe ser considerado como posibilidad dentro del diagnóstico diferencial de las masas anexiales.(AU)

Primary ovarian leiomyoma is a rare, asymptomatic, ovarian tumour that is diagnosed incidentally. Preoperative study based on imaging is limited so an anatomopathological study is essential for diagnosis to differentiate it from other solid ovarian tumours. We hereby report an atypical case of a primary ovarian leiomyoma in a postmenopausal 69-year-old woman, diagnosed during surgery for suspected ovarian cancer. It is necessary to include primary ovarian leiomyoma within the differential diagnosis of the different adnexal tumours.(AU)