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1.
Medicine (Baltimore) ; 100(10): e24024, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725815

RESUMO

INTRODUCTION: Uterine fibroids, which are common benign tumors, rarely cause acute complications. We herein report a case of hemoperitoneum associated with uterine fibroid that could be diagnosed preoperatively with contrast-enhanced computerized tomography (CT). PATIENT CONCERNS: A 48-year-old woman with uterine fibroid developed extremely severe lower abdominal pain on the first day of her menstrual period. DIAGNOSIS: Ultrasonography and contrast-enhanced CT revealed a uterine fibroid and extravasation from the dilated vessels of the uterine fibroid. INTERVENTION: Emergent abdominal hysterectomy was performed. OUTCOMES: The total amount of bleeding was 4,600 mL. Intraoperative blood salvage (1,357 mL), 6 units of red blood cells, 4 units of fresh frozen plasma, and 20 units of platelet concentrates were transfused. The postoperative course was uneventful. Pathological examination confirmed a benign uterine fibroid. CONCLUSION: CT could be useful to determine a diagnosis for bleeding from ruptured subserosal uterine fibroid.


Assuntos
Dor Abdominal/diagnóstico , Hemoperitônio/diagnóstico , Leiomioma/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Meios de Contraste/administração & dosagem , Feminino , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Histerectomia , Leiomioma/complicações , Leiomioma/cirurgia , Pessoa de Meia-Idade , Recuperação de Sangue Operatório , Cavidade Peritoneal/diagnóstico por imagem , Cavidade Peritoneal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Útero/irrigação sanguínea , Útero/diagnóstico por imagem , Útero/cirurgia
2.
Vet Q ; 40(1): 250-257, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33045934

RESUMO

Following its capture in March 2014, an adult female Sumatran rhinoceros frequently showed profuse vaginal bleeding. An ultrasonography suggested the presence of multiple reproductive lesions, including two uterine masses which were suspected to be leiomyomas. Soon after, an open pyometra was confirmed. Later in November 2019, the patient died and necropsy confirmed the presence of two uterine masses; one was located at the cervico-uterine junction and another in the uterine body, with pyometra, and cystic endometrial hyerplasia. Based on histological, special stains, and immunohistochemical examination, it was shown that one of the masses was composed of large, ovoid and polyhedral neoplastic mesenchymal cells with eosinophilic cytoplasm and a few binucleated cells surrounded by collagen fibres. It was tested positive for SMA and vimentin, while negative for desmin, cytokeratin AE1/AE3, EMA, CD34, and S100. The other mass was composed of mesenchymal cells undergoing myxoid degeneration as evidenced by the presence of glycosaminoglycan-rich matrix. It was tested positive for SMA, vimentin, partially positive for desmin, and negative for the other markers. With the aid of human medical nomenclature, these masses were diagnosed as epithelioid leiomyoma and myxoid leiomyoma, respectively. This report provides a clinical presentation, and histologic descriptions of the two variants of leiomyomas that have not been reported in veterinary medicine.


Assuntos
Leiomioma/veterinária , Perissodáctilos , Neoplasias Uterinas/veterinária , Animais , Bornéu , Diagnóstico Diferencial , Evolução Fatal , Feminino , Leiomioma/diagnóstico , Malásia , Neoplasias Uterinas/diagnóstico
3.
Medicine (Baltimore) ; 99(27): e20859, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629673

RESUMO

RATIONALE: Extra osseous Ewing sarcoma (ES), an uncommon malignant neoplasm, accounts for about 15% of Ewing sarcoma, which mainly affects paravertebral region, lower extremity, chest wall, retroperitoneum, pelvis, and hip. Here is a 54-year-old woman of primary vaginal Ewing sarcoma with uterine fibroid, which has been fewly known or reported. PATIENT CONCERNS: The patient was admitted to our hospital because of vaginal pain. Her uterus showed as parallel position and enlarged as about 3 months of pregnancy size. DIAGNOSIS: Magnetic resonance imaging (MRI) and ultrasonography (US) demonstrated 2 heterogeneous masses in the vagina and uterus, respectively. Ultrasound-guided puncture biopsy revealed a malignant tumor in the right lateral vaginal wall. INTERVENTIONS: The patient was treated by hysterectomy, bilateral salpingo-oophorectomy, and tumors excision, with the subsequent treatment of chemotherapy. OUTCOMES: The patient recovered well without local recurrence for >1 year. LESSONS: Primary vaginal Ewing sarcoma is extremely rare. The treatments of uterine fibroid include uterine artery embolization and surgical options, While wide local excision followed by adjuvant chemotherapy and/or radiotherapy should be recommended for the vaginal ES.


Assuntos
Leiomioma/complicações , Sarcoma de Ewing/complicações , Sarcoma de Ewing/diagnóstico , Neoplasias Vaginais/complicações , Neoplasias Vaginais/diagnóstico , Feminino , Humanos , Leiomioma/diagnóstico , Pessoa de Meia-Idade , Sarcoma de Ewing/patologia , Neoplasias Vaginais/patologia
4.
Pathologe ; 41(5): 515-522, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32458047

RESUMO

The nipple-areola complex is the origin of various morphologically distinct tumors and tumor-like lesions, which can be delineated from the special structures of the nipple, in particular the intramammary ducts, skin-appendages, and the intramammary stroma. Benign tumors are most frequent and this includes epithelial tumors such as mammary adenoma and syringomatous tumor of the nipple. Less commonly observed are benign mesenchymal tumors such as leiomyoma of the nipple, or tumor-like lesions like pseudo-lymphoma. With excess formations of the nipple, the different forms of polythelia and polymastia have to be considered.


Assuntos
Adenoma , Neoplasias da Mama , Leiomioma , Mamilos , Adenoma/diagnóstico , Neoplasias da Mama/diagnóstico , Humanos , Leiomioma/diagnóstico , Mamilos/patologia , Pele
5.
Ann R Coll Surg Engl ; 102(6): e141-e144, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326731

RESUMO

Deep vein thrombosis is a common clinical condition, with well-known risk factors. An unusual case of venous leiomyoma manifesting as a deep vein thrombosis in the left femoral vein of a 55-year-old man was managed successfully at our institution with anticoagulation, en-bloc excision and reconstruction of the femoral vein with spiral vein graft.


Assuntos
Veia Femoral/transplante , Leiomioma/diagnóstico , Neoplasias Vasculares/diagnóstico , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Veia Femoral/diagnóstico por imagem , Veia Femoral/patologia , Humanos , Canal Inguinal , Leiomioma/complicações , Leiomioma/patologia , Leiomioma/cirurgia , Masculino , Pessoa de Meia-Idade , Músculo Liso Vascular/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Enxerto Vascular/métodos , Neoplasias Vasculares/complicações , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgia , Trombose Venosa/etiologia
7.
Sci Rep ; 10(1): 3621, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-32108150

RESUMO

Leiomyomas, adenomyosis, and endometriosis are reported to be risk factors for endometrial carcinoma (EC), and adenomyosis and endometriosis also for ovarian carcinoma (OC). We aimed to describe the prevalence of these conditions in EC patients with or without an OC diagnosis, and to investigate their relationship with EC risk and prognostic factors in these patients. We evaluated the co-existence of these three conditions in 1399 EC patients, and compared the prevalence of epidemiological risk factors and tumor prognostic features in patients with each condition versus not. Prevalence of conditions was also assessed in the subset of patients with prior/concurrent OC. The observed coexistence of leiomyomas, adenomyosis and endometriosis significantly deviated from that expected (P = 1.2 × 10-8). Patients were more likely to: report a younger age at menarche (PTrend = 0.004) if they had leiomyomas; have used oral contraceptives (P = 6.6 × 10-5) or had ≥2 full-term pregnancies (PTrend = 2.0 × 10-9) if they had adenomyosis; be diagnosed with EC at younger age (P = 5.0 × 10-11) if they had endometriosis. Patients with prior/concurrent OC were more likely to be diagnosed at younger age (P = 5.0 × 10-5), have endometriosis (P = 9.9 × 10-7), and present with higher stage EC (PTrend = 6.6 × 10-5). These findings justify further consideration of these gynecologic conditions as independent risk and prognostic factors for EC.


Assuntos
Adenomiose/complicações , Neoplasias do Endométrio/complicações , Endometriose/complicações , Leiomioma/complicações , Adenomiose/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Neoplasias do Endométrio/diagnóstico , Endometriose/diagnóstico , Feminino , Humanos , Leiomioma/diagnóstico , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
8.
J Nippon Med Sch ; 87(2): 80-86, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31902853

RESUMO

Pseudo-Meigs syndrome is defined as secondary accumulation of ascites and hydrothorax associated with a pelvic tumor other than benign ovarian tumors such as fibroma, which usually resolve after surgical removal of the tumor. Here we report a case of pseudo-Meigs syndrome caused by a giant uterine leiomyoma, which was initially suspected to be ovarian cancer. A 37-year-old nulliparous woman presented with a 5-month history of abdominal distension and anorexia. Abdominal ultrasonography revealed a giant cystic lesion and solid mass in the peritoneal cavity, along with plentiful ascites. Chest X-ray images showed a small pleural effusion on the right side. The patient was referred to our hospital for treatment of suspected ovarian cancer and peritonitis carcinomatosis. Although serum CA125 level was elevated (up to 331.8 U/mL), magnetic resonance imaging showed a giant sub-serosal uterine leiomyoma with cystic degeneration (27 × 15 × 13 cm). A small dermoid cyst was also detected in the right ovary. Ascites was drained and the patient underwent myomectomy and ovarian cystectomy. The patient had a degenerated leiomyoma with no pathological evidence of malignancy. Because symptoms disappeared postoperatively and serum CA125 returned to normal, without recurrence of ascites, pseudo-Meigs syndrome was diagnosed.


Assuntos
Cistos/complicações , Leiomioma/complicações , Síndrome de Meigs/etiologia , Doenças Ovarianas/complicações , Neoplasias Uterinas/complicações , Adulto , Biomarcadores Tumorais/sangue , Antígeno Ca-125/sangue , Cistos/diagnóstico , Cistos/patologia , Feminino , Humanos , Leiomioma/diagnóstico , Leiomioma/patologia , Síndrome de Meigs/diagnóstico , Síndrome de Meigs/patologia , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/patologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia
9.
BMC Womens Health ; 20(1): 12, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31964370

RESUMO

BACKGROUND: In the literature under review there are about 300 reported cases of vaginal leiomyomas with none from Cameroon. We report a case of vaginal leiomyoma and highlight the diagnostic challenges faced at the Douala Referral Hospital (DRH), Cameroon. CASE PRESENTATION: A 36-year-old G3P3002 sexually active Cameroonian married woman reported dysuria, dyspareunia, cessation of sexual intercourse and offensive smelling vaginal discharge for 6 months and a 3-year history of a vaginal tumour; she was misdiagnosed despite ultrasonography and magnetic resonance imaging (MRI) but was corrected by an experienced radiologist. She underwent first look laparoscopy, surgical excision of the tumour through the vagina and histopathology analysis that confirmed leiomyoma. CONCLUSION: Posterior location of vaginal leiomyomas found in this case is a rare occurrence. The diagnosis is based on careful examination and preoperative imaging (ultrasonography and MRI). However, the definitive diagnosis is usually made intra-operatively. We combined laparoscopic exploration of the internal genital organs and per vaginal excision of the vaginal leiomyoma. Thus, we recommend frozen section biopsy to exclude leiomyosarcoma.


Assuntos
Laparoscopia/métodos , Leiomioma/diagnóstico , Imagem por Ressonância Magnética , Ultrassonografia , Neoplasias Vaginais/diagnóstico , Adulto , Biópsia , Camarões , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Leiomiossarcoma/diagnóstico , Centros de Atenção Terciária , Vagina/diagnóstico por imagem , Vagina/patologia , Vagina/cirurgia
10.
Endocr J ; 67(1): 91-94, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31534059

RESUMO

Uterine sarcomas are rare and aggressive gynecologic tumors with poor prognosis; therefore, early diagnosis is crucial for therapy. However, it is very difficult to distinguish uterine sarcomas from leiomyomas which are common benign uterine tumors. Therefore, the development of a diagnostic method that utilizes reliable biomarkers to distinguish uterine sarcomas from leiomyomas is important so as to identify the rare tumors. The candidate factors as novel biomarkers were searched for in public databases and a pilot study was performed for confirmation. Growth differentiation factor-15 (GDF15), progranulin, and osteopontin were identified as candidate biomarkers for diagnosing uterine sarcoma. Thus, developing a rapid and easy method to measure these factors could help establish a screening system for uterine sarcomas. In this study, we developed a novel measurement system for these factors using a compact chemical luminescence immunological automatic analyzer POCubeTM. This assay system, which is based on the flow-through membrane immunoassay, completes the whole process and generates results within 15 min. Serum concentrations of these factors measured via POCubeTM correlated well with those measured using enzyme-linked immunosorbent assay (r = 0.994 for GDF15, r = 0.992 for progranulin, and r = 0.976 for osteopontin). The POCubeTM system provides rapid and easy measurement of these factors, thereby facilitating uterine sarcoma diagnosis.


Assuntos
Fator 15 de Diferenciação de Crescimento/sangue , Leiomioma/sangue , Osteopontina/sangue , Progranulinas/sangue , Sarcoma/sangue , Neoplasias Uterinas/sangue , Diagnóstico Diferencial , Feminino , Humanos , Imunoensaio , Leiomioma/diagnóstico , Projetos Piloto , Curva ROC , Sarcoma/diagnóstico , Sensibilidade e Especificidade , Fatores de Tempo , Neoplasias Uterinas/diagnóstico
11.
Gastrointest Endosc ; 91(1): 172-177.e2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31539527

RESUMO

BACKGROUND AND AIMS: EUS elastography is a real-time imaging technique that analyzes tissue elasticity. The aim of this study was to investigate the applicability of quantitative EUS elastography in the differential diagnosis of gastric subepithelial tumors (SETs). METHODS: We prospectively registered 41 consecutive patients with gastric SETs and measured their strain ratios with EUS elastography. The strain ratios of gastric SETs were compared with the histopathologic diagnosis. RESULTS: Thirty-one patients (mean age, 51.4 ± 12.6 years) were included in the analysis. The mean size of the SETs was 2.3 ± 0.7 cm. Lipomas had the lowest strain ratio of 1.6 (1.1-2.0), followed by leiomyomas 6.0 (2.0-29.0), ectopic pancreas 11.8 (1.7-29.3), gastrointestinal stromal tumors (GISTs) 51.1 (29.0-67.0), and schwannomas 62.0. With a cut-off value of 22.7, EUS elastography could differentiate GISTs from leiomyomas with sensitivity and specificity of 100% and 94.1%, respectively (P = .001; 95% confidence interval, 0.979-1.000). CONCLUSIONS: EUS elastography could be a promising diagnostic adjunct for the assessment of gastric SETs, especially in differentiating GISTs from leiomyomas.


Assuntos
Técnicas de Imagem por Elasticidade , Endossonografia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/patologia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Adulto , Idoso , Coristoma/diagnóstico , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Humanos , Leiomioma/diagnóstico , Lipoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Pâncreas , Projetos Piloto , Sensibilidade e Especificidade , Neoplasias Gástricas/diagnóstico
12.
J Minim Invasive Gynecol ; 27(1): 195-199, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30936030

RESUMO

STUDY OBJECTIVE: Our primary goal was to uncover preoperative and intraoperative risk factors that prevented same-day discharge (SDD) after myomectomy in a setting where SDD was the standard of care. Uncovered predictors would serve to enhance patient counseling and medical optimization before surgery. DESIGN: Single-center retrospective cohort study. SETTING: Urban university hospital center, by fellowship-trained minimally invasive gynecologic surgeons. PATIENTS: A total of 315 consecutive patients undergoing minimally invasive myomectomy between March 2012 and May 2018. INTERVENTION: Minimally invasive myomectomy. MEASUREMENTS AND MAIN RESULTS: Preoperative and intraoperative characteristics were collected for analysis as predictors of SDD vs overnight admission. Comparisons of demographic, clinical, imaging, and operative characteristics were made using appropriate statistical methods for normally distributed, skewed, and categorical variables. Length of stay was analyzed as a categorical variable, SDD vs overnight admission. A logistic regression model was used to evaluate SDD vs any overnight stay. Out of the 315 patients undergoing laparoscopic myomectomy, 208 (66.03%) were discharged on the same day, and 107 (33.96%) were admitted for at least 1 day after surgery. The patients were more likely to be admitted overnight if they were of Asian ethnicity (p = .01), or if they had a lower preoperative Hct (36.15 vs 37.57; p < .003). An increase in any myoma characteristic metric was associated with overnight stay after surgery; these included mean myoma weight (512.0 g vs 310.1 g; p < .001), estimated size of the largest myoma on imaging (9.01 cm vs 7.77 cm; p < .001), and number of myomas removed (6.59 vs 5.57; p = .021). Other statistically significant differences between the overnight admission and SDD groups were mean estimated blood loss (599.4 mL vs 221.9 mL; p < .001), operative time (224.4 minutes vs 140.9 minutes; p < .001), and surgery end time (15:02 hours vs 12:43 hours; p < .001). Intraoperative complications associated with overnight admission were estimated blood loss >1 L (p < .001) and any intraoperative transfusion (p < .001). The adjusted logistic regression model identified an increase in operative time (by 60 minutes) and later surgery end time (by 60 minutes) as predictors of an overnight stay, whereas an 5% increase in preoperative hematocrit was associated with a 34% decrease in odds for an overnight stay. CONCLUSION: Perioperative factors, such as preoperative hematocrit, and myoma characteristics, as well as intraoperative factors, such as prolonged operative time and surgery end-time, are independent predictors of overnight hospital admission after minimally invasive myomectomy. Our present data can be used to provide better patient counseling before surgery.


Assuntos
Leiomioma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Admissão do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Miomectomia Uterina/efeitos adversos , Neoplasias Uterinas/cirurgia , Adulto , Instituições de Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Estudos de Coortes , Feminino , Hospitais com Alto Volume de Atendimentos/normas , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais Universitários/normas , Hospitais Universitários/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Leiomioma/diagnóstico , Leiomioma/epidemiologia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Miomectomia Uterina/métodos , Miomectomia Uterina/estatística & dados numéricos , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/epidemiologia
13.
J Minim Invasive Gynecol ; 27(3): 646-654, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31034977

RESUMO

STUDY OBJECTIVE: To develop a preoperative calculator to predict the total operative time (TOT) for robotic-assisted laparoscopic myomectomy (RALM). DESIGN: Retrospective cross-sectional study. SETTING: University medical center. PATIENTS: Women who underwent RALM performed by 3 high-volume surgeons at a single institution between January 2014 and December 2017. INTERVENTIONS: Demographic characteristics, indication for surgery, surgical history, myoma burden on imaging, and TOT were collected. RALM operative time was classified as <3 hours, 3 to 5 hours, and >5 hours. We identified preoperative characteristics predictive of increased operative time and developed a preoperative calculator to estimate TOT. MEASUREMENTS AND MAIN RESULTS: A total of 126 women underwent RALM during the study period, with a mean TOT of 213 minutes ± 66 minutes. The mean total weight of myomas removed was 264 g ± 236 g, and mean largest myoma diameter was 8.5 cm ± 2.6 cm. Overall, mean number of myomas removed was 2.5 ± 2.4, and estimated blood loss (EBL) was 215 ± 212 mL. Five patients (4.0%) received a blood transfusion, and 4 patients (3.2%) underwent conversion to laparotomy. Preoperative factors significantly associated with TOT included patient age, personal history of diabetes mellitus, uterine volume, number of myomas, number of myomas >3 cm, diameter of the dominant myoma, and surgeon experience. The mean uterine volume was 282 cm3 for procedures with a TOT <3 hours, 461 cm3 for procedures with a TOT of 3 to 5 hours, and 532 cm3 for procedures with a TOT >5 hours (p = .004). Body mass index, personal history of hypertension, previous abdominal/pelvic surgery, surgical indication, location of dominant myoma (anterior, posterior, or fundal) and classification of dominant myoma (submucosal, intramural, subserosal, or other) were not associated with TOT. Our preoperative calculator correctly predicted TOT category in 88% of the patients and estimated TOT within a 1-hour margin in 80% of patients. CONCLUSION: RALM is becoming a more popular surgical approach for the management of uterine myomas. Preoperative radiographic evaluation and a thorough patient history may enhance patient counseling and surgical planning. Uterine volume and myoma number and size appear to be more predictive of TOT compared with myoma location.


Assuntos
Leiomioma/cirurgia , Duração da Cirurgia , Procedimentos Cirúrgicos Robóticos , Miomectomia Uterina , Neoplasias Uterinas/cirurgia , Adulto , Estudos Transversais , Feminino , Humanos , Laparoscopia/métodos , Leiomioma/diagnóstico , Leiomioma/epidemiologia , Pessoa de Meia-Idade , Modelos Teóricos , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Miomectomia Uterina/efeitos adversos , Miomectomia Uterina/instrumentação , Miomectomia Uterina/métodos , Miomectomia Uterina/estatística & dados numéricos , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/epidemiologia
14.
Eur Radiol ; 30(3): 1554-1563, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31705252

RESUMO

OBJECTIVES: To investigate the efficacy and safety of a new portable ultrasound-guided high-intensity focused ultrasound system (USgHIFU) with advanced targeting and beam steering technology for the treatment of uterine fibroids. METHODS: Fifty-nine uterine fibroids from 36 participants (mean age, 44.9 ± 4.1 years) were included from November 2013 to November 2015. All participants were treated with HIFU, with 3D electronic steering. MR imaging studies were performed before HIFU, immediately after HIFU, and 1 month and 3 (or 5) months after the HIFU treatment. The non-perfused volume ratio (NPVR), fibroid volume shrinkage (FVS), symptom improvement, quantified life quality assessment, and safety were analyzed. A long-term follow-up was conducted in July to December 2017 (mean, 32.2 months). RESULTS: The volume of the treated uterine fibroids ranged from 7.5 to 274.4 cm3 (mean, 69.8 cm3; SD, 64.3 cm3). The mean NPVR on the immediate post-HIFU MR imaging was 74.8 ± 25.2%. The mean FVS was 17.3% at 1 month, 33.3% at 3 months, and 45.1% at 5 months after HIFU treatment. The mean treatment time was 44.6 ± 28.2 min per fibroid and 72.9 ± 31.4 min per participant. Uterine fibroid-related symptoms and quality of life showed statistically significant improvement after the HIFU treatment. No significant symptoms related to safety or complications occurred. In the long-term follow-up, 78.8% of those surveyed were satisfied with their HIFU treatment. CONCLUSION: This clinical trial showed that a portable USgHIFU with advanced functions may safely and effectively treat uterine fibroids. KEY POINTS: • A portable compact ultrasound-guided high-intensity focused ultrasound (HIFU) can effectively and safely treat uterine fibroids. • Advanced functions, such as portability, targeted forecasting, electronic beam steering, and interleaved scanning, might be helpful in enhancing the clinical applicability of ultrasound-guided high-intensity focused ultrasound. • In the long-term follow-up of more than 2 years, approximately 80% of those surveyed were satisfied with their HIFU treatment.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Leiomioma/terapia , Qualidade de Vida , Terapia Assistida por Computador/métodos , Ultrassonografia de Intervenção/métodos , Neoplasias Uterinas/terapia , Adulto , Feminino , Humanos , Leiomioma/diagnóstico , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Satisfação Pessoal , Estudos Prospectivos , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico
15.
Int J Gynecol Pathol ; 39(2): 152-156, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30741845

RESUMO

Inflammatory myofibroblastic tumors (IMTs) are spindle cell neoplasms of intermediate (borderline) biologic potential with tendency for local recurrence but low risk of metastasis. They affect children more than adults. The most common sites of involvement are the lung, soft tissue, peritoneum, bladder, and less commonly the gynecologic tract. IMTs are characterized by spindle to epithelioid cells with myofibroblastic differentiation, some degree of smooth muscle differentiation, myxoid stroma and usually associated with brisk lymphoplasmacytic infiltrates. In about half of the cases, IMTs are associated with rearrangements of the anaplastic lymphoma kinase (ALK) gene located at chromosome 2p23. The ALK rearrangement can be detected by immunohistochemistry for ALK protein expression (mostly cytoplasmic with or without perinuclear accentuation) or by fluorescent in situ hybridization (FISH) using dual-color break-apart probes for which the typical pattern is seen as split 3' end (red) and 5' end (green) probe signals in addition to single normal, unsplit red-green signal pair (yellow). Herein we describe a case of uterine IMT initially misdiagnosed intraoperatively as leiomyoma which showed sparse lymphocytic infiltrates, positive ALK expression by immunohistochemistry, a predominantly atypical FISH signal pattern (1 yellow and 1 red signal only) and few typical signal patterns (1 yellow, 1 red, and 1 green signal) in a smaller population of tumor cells. The RNA sequencing showed a recently described DES-ALK fusion transcript in the tumor cells, suggesting an intrachromosomal inversion and deletion as the likely underlying mechanism for the atypical FISH pattern. Familiarity with the unusual morphology and atypical FISH pattern is crucial given that this tumor has an activating ALK rearrangement and may benefit from targeted tyrosine kinase inhibitors in the future.


Assuntos
Miofibroma/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Quinase do Linfoma Anaplásico/genética , Erros de Diagnóstico , Feminino , Humanos , Hibridização in Situ Fluorescente , Leiomioma/diagnóstico , Miofibroma/genética , Miofibroma/patologia , Fusão Oncogênica , Análise de Sequência de RNA , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia
16.
Pan Afr Med J ; 37: 301, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33654520

RESUMO

Endometrial stromal sarcomas are rare tumors affecting young women. Diagnosis is most often made after surgery. We here report the case of a 22-year-old girl admitted with pelvic pain associated with metrorrhagias. Imaging objectified heterogeneous uterine mass. The diagnosis of atypical fibroid was suspected. Definitive diagnosis was based on histological examination of the surgical specimen.


Assuntos
Neoplasias do Endométrio/diagnóstico , Dor Pélvica/etiologia , Sarcoma do Estroma Endometrial/diagnóstico , Neoplasias do Endométrio/patologia , Feminino , Humanos , Leiomioma/diagnóstico , Metrorragia/etiologia , Sarcoma do Estroma Endometrial/patologia , Adulto Jovem
17.
Ginekol Pol ; 90(11): 617-621, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31802460

RESUMO

OBJECTIVES: The aim of this study was to evaluate the safety, feasibility, and effectiveness of transvaginal myomectomy surgery. MATERIAL AND METHODS: We conducted a retrospective study in Shengjing Hospital of China Medical University. In all, 138 patients underwent transvaginal myomectomy from March 2009 to March 2019. The perioperative clinical data, suchas position and size of myomas, operative duration, blood loss, intraoperative and postoperative complications, and hospitalizationtime were retrospectively analyzed. RESULTS: All transvaginal myomectomies were performed without conversion to laparotomy. The mean vaginal operatingtime was 56.0 (± 17.2) minutes. The mean operative estimated blood loss was 89.2 (± 36.8) mL. No significant intraoperativecomplications occurred. The median time of intestinal function recovery after operation was 1 day (range 1-4 days).The median time of hospital stay was 4 days (range 3-10 days); 12 (8.7%) patients experienced postoperative morbidity. CONCLUSIONS: Transvaginal myomectomy is a minimally invasive surgery that can be performed without leaving a scar onthe body surface. It can be performed safely and effectively by a skilled surgeon in cases with a specific surgical indicationfor this approach.


Assuntos
Miomectomia Uterina , Vagina/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , China , Estudos de Viabilidade , Feminino , Humanos , Leiomioma/diagnóstico , Leiomioma/cirurgia , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Miomectomia Uterina/efeitos adversos , Miomectomia Uterina/métodos , Miomectomia Uterina/estatística & dados numéricos
18.
BMJ Case Rep ; 12(12)2019 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-31818885

RESUMO

Endometrial stromal sarcoma (ESS) is an uncommon and challenging condition comprising 10% of all uterine sarcomas and found in women 42-58 years of age. ESS is difficult to diagnose in young women as it masquerades as a leiomyoma. We report this tumour in a 20-year-old woman presenting with heavy and prolonged menses and urinary retention. She was not sexually active and did not give consent for pelvic examination. A preoperative diagnosis of a submucous leiomyoma with an adnexal mass was made. At laparotomy, the leiomyoma was found to be wedged between the cervix and the vagina, and was removed vaginally. A 5-6 cm retroperitoneal mass was adherent to the right pelvic wall, which was also removed. Histopathology of both specimens revealed ESS. The final diagnosis according to the International Federation of Gynaecology and Obstetrics classification was stage IV ESS. After oncology consult, she was referred for chemotherapy. She is now on follow-up.


Assuntos
Neoplasias do Endométrio/diagnóstico , Sarcoma do Estroma Endometrial/diagnóstico , Diagnóstico Diferencial , Dismenorreia/etiologia , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Laparotomia , Leiomioma/diagnóstico , Menorragia/etiologia , Sarcoma do Estroma Endometrial/complicações , Sarcoma do Estroma Endometrial/tratamento farmacológico , Sarcoma do Estroma Endometrial/cirurgia , Resultado do Tratamento , Retenção Urinária/etiologia , Adulto Jovem
19.
BMJ Case Rep ; 12(12)2019 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-31818892

RESUMO

Leiomyoma, a benign monoclonal tumour, is very rarely found in extrauterine sites, especially in the vulval region. Histopathology of the soft tissue tumours affecting this region is similar and immunohistochemistry (IHC) may be essential to confirm the diagnosis. We report a case of a 63-year-old postmenopausal woman who presented with a recurrent vulval mass involving the clitoris and left labia majora with suspected urethral involvement. Although the wedge biopsy was reported as peripheral nerve sheath tumour, staining with smooth muscle actin clinched the diagnosis of leiomyoma, highlighting the importance of IHC for diagnosis.


Assuntos
Erros de Diagnóstico , Leiomioma/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias da Bainha Neural/diagnóstico , Neoplasias Vulvares/diagnóstico , Feminino , Humanos , Imuno-Histoquímica , Leiomioma/patologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Resultado do Tratamento , Neoplasias Vulvares/patologia , Neoplasias Vulvares/cirurgia
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