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1.
Pan Afr Med J ; 33: 211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693718

RESUMO

Introduction: Different diagnostic tools are available to evaluate endometrial focal lesion such as hysteroscopy, sonohystrography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with Abnormal Uterine Bleeding (AUB). Methods: This cross-sectional study recruited 100 married women with chief complain of AUB referred to gynecologic clinics at the Amir Al-Momenin hospital, Semnan, Iran from March 2014 to February 2016. All participants were in the reproductive age and post-menopausal period that showed abnormal endometrial thickness or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus focal lesion resection and endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist. Results: Mean±SD age of women was 41.2±11.3 years. To diagnose the overall focal lesions, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SIS were 79.6, 89.1, 89.6, and 78.8% respectively. These figures were 75.0, 87.5, 82.5 and 81.7%, respectively to diagnose polyps. The SIS sensitivity, specificity, PPV and NPV values to diagnose the myomas were 60.0, 97.8, 75.0, and 95.7% respectively. Conclusion: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.


Assuntos
Histeroscopia/métodos , Solução Salina/administração & dosagem , Doenças Uterinas/diagnóstico , Hemorragia Uterina/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Leiomioma/diagnóstico , Leiomioma/patologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/patologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Ultrassonografia/métodos , Doenças Uterinas/patologia , Doenças Uterinas/cirurgia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
2.
BMC Surg ; 19(1): 140, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590641

RESUMO

BACKGROUND: Primary hepatic leiomyoma (PHL) is a rare manifestation of tumors in the liver; it is mainly characterized by its origin in the mesenchymal tissue. To date, the mechanisms underlying the pathogenesis of this disease remain unclear, however most reported PHL patients suffer from acquired immunity deficiency syndrome (AIDS) or take immunosuppressive medications after organ transplantation. CASE PRESENTATION: In this case report we describe a rare case of PHL in a middle-aged Chinese woman who was asymptomatic with no history of hepatitis or other liver disease. She had no history of immune suppression medication therapy. In view of the benign features of the hepatic lesion, along with our implementation of the respecting the patience choices, a laparoscopic partial hepatectomy of the right lower liver was performed, which appeared to be highly effective and give a good prognosis. CONCLUSIONS: Clinical characteristics of the patient should be compared to previously reported aspects of this disease to reach a clear diagnosis. Moreover, although PHL is extremely rare, it should still be considered a possibility. Surgical intervention is effective in treating this disease.


Assuntos
Hepatectomia/métodos , Leiomioma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Feminino , Humanos , Laparoscopia , Leiomioma/cirurgia , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade
3.
Pol J Pathol ; 70(2): 148-152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31556568

RESUMO

Fibrosarcomas are placed among the most infrequent malignant tumors of the uterus. We present a case of a 38 years-old woman, whose benign looking uterine mass was primary diagnosed as a sclerosing leiomyoma. However, the tumor relapsed in two years with multisite metastases in the abdomen. The complex differential diagnosis excluded the most common mesenchymal tumors of the gynecological tract. Finally, we diagnosed the tumor as an epithelioid sclerosing fibrosarcoma arising from the uterine.


Assuntos
Fibrossarcoma/diagnóstico , Leiomioma/diagnóstico , Útero/patologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos
4.
In Vivo ; 33(5): 1393-1401, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471384

RESUMO

Power morcellation remains one of the most significant developments in minimal access surgery over the past decade, allowing many more patients to benefit from the least invasive surgical route. However, its use is not without controversy, particularly with regards to the risks of an undiagnosed leiomyosarcoma. Increased media and, in particular, on-going social media coverage since events in 2014 have only served to intensify the debate, culminating in the Food and Drug Administration essentially 'banning' its use in the USA. Practice however continues to vary and this technique remains widely used in Europe and in particular the UK. The aim of this article was to review the development of power morcellation in gynaecology and the underlying risks, including that of undiagnosed leiomyosarcoma, as well as appraise the evolving literature on patient awareness and informed consent and the wider implications of morcellation restriction.


Assuntos
Leiomioma/cirurgia , Morcelação , Animais , Gerenciamento Clínico , Prática Clínica Baseada em Evidências , Feminino , Humanos , Incidência , Leiomioma/diagnóstico , Leiomioma/epidemiologia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/epidemiologia , Leiomiossarcoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Morcelação/efeitos adversos , Morcelação/métodos , Melhoria de Qualidade , /epidemiologia
5.
Int J Mol Sci ; 20(15)2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31387281

RESUMO

Utilization of liquid biopsy in the management of cancerous diseases is becoming more attractive. This method can overcome typical limitations of tissue biopsies, especially invasiveness, no repeatability, and the inability to monitor responses to medication during treatment as well as condition during follow-up. Liquid biopsy also provides greater possibility of early prediction of cancer presence. Corpus uteri mesenchymal tumors are comprised of benign variants, which are mostly leiomyomas, but also a heterogenous group of malignant sarcomas. Pre-surgical differentiation between these tumors is very difficult and the final description of tumor characteristics usually requires excision and histological examination. The leiomyomas and malignant leiomyosarcomas are especially difficult to distinguish and can, therefore, be easily misdiagnosed. Because of the very aggressive character of sarcomas, liquid biopsy based on early diagnosis and differentiation of these tumors would be extremely helpful. Moreover, after excision of the tumor, liquid biopsy can contribute to an increased knowledge of sarcoma behavior at the molecular level, especially on the formation of metastases which is still not well understood. In this review, we summarize the most important knowledge of mesenchymal uterine tumors, the possibilities and benefits of liquid biopsy utilization, the types of molecules and cells that can be analyzed with this approach, and the possibility of their isolation and capture. Finally, we review the typical abnormalities of leiomyomas and sarcomas that can be searched and analyzed in liquid biopsy samples with the final aim to pre-surgically differentiate between benign and malignant mesenchymal tumors.


Assuntos
Biomarcadores Tumorais , Leiomioma/diagnóstico , Sarcoma/diagnóstico , Neoplasias Uterinas/diagnóstico , Micropartículas Derivadas de Células , Aberrações Cromossômicas , DNA Tumoral Circulante , Metilação de DNA , Diagnóstico Diferencial , Feminino , Humanos , Leiomioma/genética , Leiomioma/metabolismo , Biópsia Líquida , MicroRNAs/sangue , Mutação , Estadiamento de Neoplasias , Células Neoplásicas Circulantes/metabolismo , Células Neoplásicas Circulantes/patologia , Sarcoma/genética , Sarcoma/metabolismo , Neoplasias Uterinas/genética , Neoplasias Uterinas/metabolismo
6.
Virchows Arch ; 475(6): 763-770, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410559

RESUMO

Myopericytomas (MPC) are rare mesenchymal tumors, originating from the perivascular myoid cells. They predominantly occur in the skin and superficial soft tissues of the extremities, while visceral involvement is rare. Histological features and clinical course are usually benign. To the best of our knowledge, MPC is still an uncharacterized tumor entity of the female internal genital tract. We describe three MPC cases involving the female internal genital tract: (1) a uterine wall MPC arising in a 49-year-old woman with progressive pelvic/abdominal pain; (2) a cervix MPC of a 49-year-old woman who presented with metrorrhagia, and (3) a MPC presenting as a simple ovarian cyst in a 26-year-old woman with pain located in the left iliac fossa. All patients were surgically treated, and recurrence occurred in two cases. The histological and immunohistochemical findings, supporting the diagnosis of MPC, are presented; in particular, one case showed characteristics pointing towards an uncertain biological behavior/low-grade malignancy. A literature search was conducted to identify previous reports of gynecological MPC and for possible alternative diagnoses. Leiomyoma, epithelioid leiomyoma, angioleiomyoma, perivascular epithelioid cell tumor, solitary fibrous tumor, and low-grade endometrial stromal sarcoma should be considered in the differential diagnosis. Awareness of possible occurrence of this rare neoplasm in the female genital tract is important to reach a correct diagnosis in the spectrum of mesenchymal tumors. Considering the risk of recurrence, we recommend careful evaluation of surgical margins and complete surgical removal whenever possible.


Assuntos
Leiomioma/patologia , Miopericitoma/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias de Tecidos Moles/patologia , Adulto , Biomarcadores Tumorais/análise , Diagnóstico Diferencial , Feminino , Humanos , Leiomioma/diagnóstico , Pessoa de Meia-Idade , Miopericitoma/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias de Células Epitelioides Perivasculares/diagnóstico , Neoplasias de Células Epitelioides Perivasculares/patologia , Neoplasias de Tecidos Moles/diagnóstico , Tumores Fibrosos Solitários/diagnóstico , Tumores Fibrosos Solitários/patologia
7.
Arch. esp. urol. (Ed. impr.) ; 72(6): 612-615, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-187667

RESUMO

Los leiomiomas vesicales son tumores benignos infrecuentes, causan sintomatología miccional y su tratamiento es quirúrgico. Objetivo: Presentar nuestra experiencia en el diagnóstico y tratamiento del leiomioma vesical. Material y metodo: Serie de 3 casos clínicos. Resultados: De los 3 casos, 2 fueron mujeres y 1 fue hombre. La edad media fue 33 años. Las dos mujeres presentaron síntomas miccionales irritativos y palpación de una masa pélvica, y el hombre cursó asintomático. La ecografía halló una masa anexial e hidronefrosis izquierdas en una paciente, tumoración vesical en otra paciente y masa pélvica de etiología no definida en el paciente varón. La tomografía y la resonancia magnética demostraron el origen vesical de la lesión. La biopsia confirmó el diagnóstico de leiomioma. Se realizó cistectomía parcial en todos los casos, con nefrectomía en uno de ellos. Durante el seguimiento no ocurrió recidiva tumoral. Conclusiones: Los estudios de imagen nos orientan al diagnóstico. La resección transuretral está indicada en lesiones menores de 3 cm. y la enucleación o cistectomía parcial en lesiones de mayor tamaño. Su pronóstico es bueno


Bladder leiomyomas are rare benign tumors; their common presentation are irritative and obstructive urinary symptoms. The treatment is complete surgical resection. Objective: To present our experience in the diagnosis and the treatment of bladder leiomyoma. Methods: A series of three clinical cases. Results: In our series, two patients were women and one was man. The mean age was 33 years. Two women presented with irritative urinary symptoms and palpation of a pelvic mass, and the man was asymptomatic. Ultrasound showed the presence of an adnexal mass with left hydronephrosis in a female patient, bladder tumor in another female patient and pelvic mass of unknown etiology in the male patient. CT scan and MRI demonstrated the bladder origin of the lesion. A biopsy confirmed a bladder leiomyoma. Surgical treatment was partial cystectomy in all patients, and in one of them, nephrectomy was performed. During follow-up, all patients were asymptomatic and without recurrence. Conclusions: Imaging studies guide to diagnosis. Transurethral resection is recommended in lesions smaller than 3 cm. and enucleation or partial cystectomy in larger lesions. Prognosis is good


Assuntos
Humanos , Masculino , Feminino , Adulto , Leiomioma/diagnóstico , Leiomioma/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/cirurgia , Tomografia Computadorizada por Raios X , Imagem por Ressonância Magnética , Ultrassonografia , Biópsia , Cistectomia , Nefrectomia , Seguimentos , Resultado do Tratamento
8.
Taiwan J Obstet Gynecol ; 58(4): 552-556, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307750

RESUMO

OBJECTIVE: Patients with Long QT syndrome (LQTS) P may present with torsades de pointes, ventricular tachycardia (VT), or ventricular fibrillation (VF) and are at risk of sudden cardiac death. MATERIALS AND METHODS: A 38 y/o female patient with uterus myoma developed VF during laparoscopic assisted vaginal hysterectomy surgery. Defibrillation was delivered and the electrocardiogram (ECG) returned to sinus rhythm after CPR. RESULTS: Patient survived and implantable cardioverter-defibrillator was implanted and received beta-blocker therapy. ECG obtained in out-patient clinic still showed QT interval prolongation, but revealed no prolongation few months after persistent beta-blocker therapy. LQTS type 8 (CACNA1C E768del mutation) was identified by genetic DNA sequencing study. CONCLUSIONS: Patients with concealed LQTS may have normal QT interval unless exposing to stress or specific stimuli. Unexpected ventricular arrhythmia may happen during any medical management. We should avoid triggers of QT prolongation, and get familiar with management of the episode.


Assuntos
Morte Súbita Cardíaca , Cardioversão Elétrica/métodos , Histerectomia/métodos , Leiomioma/cirurgia , Síndrome do QT Longo/complicações , Neoplasias Uterinas/cirurgia , Adulto , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Reanimação Cardiopulmonar/métodos , Desfibriladores Implantáveis , Eletrocardiografia/métodos , Feminino , Humanos , Laparoscopia/métodos , Leiomioma/complicações , Leiomioma/diagnóstico , Síndrome do QT Longo/congênito , Síndrome do QT Longo/diagnóstico , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Resultado do Tratamento , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico
9.
Pan Afr Med J ; 32: 208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312320

RESUMO

Leiomyomas represent about 3.8% of all benign soft tissue tumors. Vulvar localization is very rare. We present a case of a vulvar leiomyoma and discuss diagnostic and therapeutic features of this disease. A 30-year-old female patient with no medical history, had a 5cm mass located in the left large lip causing a discomfort at the perineum especially in sitting and walking. She underwent a complete surgical excision of the mass. The pathological examination confirmed the diagnosis of a leiomyoma. There was no recurrence after 24-months' follow-up. The vulvar leiomyoma is a rare benign tumor. The diagnosis is made only postoperatively after resection of the mass. The treatment is essentially based on total excision of the mass with a good prognosis.


Assuntos
Leiomioma/diagnóstico , Neoplasias Vulvares/diagnóstico , Adulto , Feminino , Seguimentos , Humanos , Leiomioma/patologia , Leiomioma/cirurgia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/cirurgia
10.
Exp Mol Pathol ; 110: 104284, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31301306

RESUMO

Leiomyosarcomas are rare, aggressive tumors, which exhibit a poor prognosis regardless of stage. Pre-operative diagnosis can be difficult as leiomyosarcoma can mimic features of the more common, benign uterine leiomyoma. The goal of this study was to identify specific molecular markers to discriminate between uterine leiomyosarcomas and leiomyomas to facilitate timely, accurate diagnosis and treatment. Gene expression profiles of three leiomyosarcomas, leiomyomas, and normal myometrial tissue samples were analyzed using the Affymetrix Human Gene 1.0 ST Array. GC-robust multiarray average calculation and ANOVA statistical testing were used to identify differentially expressed genes. Sixty genes, with functional roles in tumor progression or suppression, exhibited divergent expression profiles in leiomyosarcomas and leiomyomas, compared to normal myometrium. Differential RNA and protein levels of seven genes, with the most discriminatory expression patterns, were confirmed by RTPCR and immunohistochemistry in an additional 10 leiomyosarcoma and 20 leiomyoma independent samples. CHI3L1, MELK, PRC1, TOP2A, and TPX2 were overexpressed in leiomyosarcomas, while HPGD and TES were overexpressed in leiomyomas. Distinguishing leiomyosarcomas from leiomyomas represents a diagnostic challenge, particularly in the context of minimally invasive surgery. The unique gene expression signatures identified in this study may accurately differentiate between these tumor types at the earliest stage and provides potential prognostic factors and novel therapeutic targets for the treatment of leiomyosarcoma.


Assuntos
Biomarcadores Tumorais/genética , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Leiomioma/genética , Leiomiossarcoma/genética , Neoplasias Uterinas/genética , Idoso , Biomarcadores Tumorais/metabolismo , Proteínas de Ciclo Celular/genética , Proteínas de Ciclo Celular/metabolismo , Proteína 1 Semelhante à Quitinase-3/genética , Proteína 1 Semelhante à Quitinase-3/metabolismo , Proteínas do Citoesqueleto/genética , Proteínas do Citoesqueleto/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Oxirredutases Intramoleculares , Leiomioma/diagnóstico , Leiomioma/metabolismo , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/metabolismo , Proteínas Associadas aos Microtúbulos/genética , Proteínas Associadas aos Microtúbulos/metabolismo , Pessoa de Meia-Idade , Proteínas de Ligação a RNA/genética , Proteínas de Ligação a RNA/metabolismo , Sensibilidade e Especificidade , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/metabolismo
12.
Int J Surg Pathol ; 27(7): 798-803, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31131653

RESUMO

The occurrence of smooth muscle differentiation in a liposarcoma is a very uncommon phenomenon, even in dedifferentiated liposarcomas. In dedifferentiated liposarcomas, the leiomyosarcomatous component frequently displays high-grade cytologic features, increased mitotic activity, and tumor necrosis. Even more unusual are rare reported cases of low-grade smooth muscle differentiation in atypical lipomatous tumors/well-differentiated liposarcomas (WDLS). The current case describes a 39-year-old female with a large retroperitoneal WDLS harboring a well-demarcated mass composed of benign-appearing smooth muscle fascicles completely lacking cytologic atypia and mitotic activity. In conjunction with the immunopositivity for estrogen and progesterone receptors, the morphology of this nodule was highly reminiscent of a uterine-type leiomyoma. Of note, the lipomatous component largely displayed a lipoma-like appearance with only rare foci of mildly atypical spindle cell proliferation among the adipocytes and few fibrous septae harboring atypical stromal cells. Immunohistochemical and fluorescence in situ hybridization studies revealed MDM2 gene amplification in both the lipomatous and leiomyoma-like areas, thus confirming the diagnosis of a WDLS with smooth muscle differentiation. A literature review on the subject of sarcomas with dual adipocytic and low-grade smooth muscle differentiation provided sufficient supporting evidence to categorize the tumor as a WDLS with "leiomyomatous" differentiation. Pathologists should be aware of the occurrence of uterine-type leiomyomatous differentiation in retroperitoneal WDLS to avoid potential diagnostic errors.


Assuntos
Leiomioma/diagnóstico , Lipossarcoma/diagnóstico , Neoplasias Complexas Mistas/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Adulto , Biomarcadores Tumorais/análise , Diferenciação Celular , Feminino , Humanos , Leiomioma/patologia , Leiomioma/cirurgia , Lipossarcoma/patologia , Lipossarcoma/cirurgia , Gradação de Tumores , Neoplasias Complexas Mistas/patologia , Neoplasias Complexas Mistas/cirurgia , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Presse Med ; 48(4): 440-446, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31036388

RESUMO

The most common indication for selective uterine artery angiography is embolisation of symptomatic uterine fibroids (leiomyomas or leiomyomata). It is a safe and effective treatment with worldwide acceptance and may be considered a first-line therapy for women who are finished with childbearing and interested in a minimally invasive uterine-sparing therapy, with only few relative and absolute contraindications remaining. Women interested in pregnancy may be offered embolisation, but only after careful counselling and consideration of other possibilities and patient's reasonable expectations, needs and preferences.


Assuntos
Leiomioma/terapia , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Cateterismo , Contraindicações de Procedimentos , Feminino , Humanos , Leiomioma/diagnóstico , Embolização da Artéria Uterina/efeitos adversos , Embolização da Artéria Uterina/métodos , Neoplasias Uterinas/diagnóstico
14.
Surg Pathol Clin ; 12(2): 397-455, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097110

RESUMO

Smooth muscle tumors are the most common mesenchymal tumors of the female genital tract. However, awareness of tumor variants and unconventional growth patterns is critical for appropriate classification and patient management. For example, recognition of fumarate hydratase-deficient leiomyomas allows pathologists to alert providers to the potential for hereditary leiomyomatosis and renal cell carcinoma. Furthermore, myxoid and epithelioid smooth muscle tumors have different thresholds for malignancy than spindled tumors and should be classified by criteria specific to these variants. This article provides an overview of smooth muscle tumors of each major organ of the gynecologic tract and discusses diagnostic challenges.


Assuntos
Neoplasias dos Genitais Femininos/patologia , Tumor de Músculo Liso/patologia , Diagnóstico Diferencial , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Humanos , Leiomioma/diagnóstico , Leiomioma/patologia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/patologia , Prognóstico , Tumor de Músculo Liso/diagnóstico , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia
15.
J Ayub Med Coll Abbottabad ; 31(2): 192-195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094115

RESUMO

BACKGROUND: Abnormal uterine bleeding is a common problem encountered by the gynaecologists, leiomyoma being one of the most common causes. An accurate knowledge of the different variants and secondary changes occurring in leiomyoma is essential as some of these may mimic malignancy clinically, radiologically and histologically. Some important examples being atypical, cellular and mitotically active leiomyoma. Similarly, hydropic and myxoid change can be misdiagnosed as malignancy. While dealing with these variants and changes, leiomyosarcoma although a rare tumour has to be excluded because of the difference in management. Hence a comprehensive knowledge of all the variants is mandatory to avoid misdiagnosis. METHODS: This study was carried out at the Pathology Department of Ayub Medical College Abbottabad where 964 cases of leiomyoma of the female genital tract were studied. These cases were received during the period January 2013 to December 2017. RESULTS: The most common variant of leiomyoma was cellular leiomyoma while hyaline degeneration was the most common secondary change identified. CONCLUSIONS: Accurate knowledge of these variants and degenerative changes in leiomyomas are mandatory to prevent misdiagnosis and over treatment along with undue stress to the patient. Secondly it is important to identify variants which require follow-up.


Assuntos
Leiomioma , Neoplasias Uterinas , Estudos de Coortes , Erros de Diagnóstico , Feminino , Humanos , Leiomioma/diagnóstico , Leiomioma/patologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia
16.
J Drugs Dermatol ; 18(5): 465-467, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31141855

RESUMO

We report a rare case of leiomyoma of the fingernail in a 59-year-old woman. She presented with red discoloration, lifting, and distal splitting of her left 2nd fingernail for several months. She reported sensitivity at baseline which became more painful in the cold. Histopathology sections from the nail matrix biopsy specimen showed a dermal proliferation of bland appearing spindle shaped cells with elongated, blunt ended nuclei (SMA and caldesmon positive), arranged in fascicles, which is typical of leiomyomas. Interestingly, our patient had a history of uterine leiomyoma, requiring hysterectomy. To our knowledge, this case is the first report in which a subungual leiomyoma is associated with another leiomyoma in the same patient. J Drugs Dermatol. 2019;18(5):465-467.


Assuntos
Dedos , Leiomioma/diagnóstico , Doenças da Unha/diagnóstico , Neoplasias Cutâneas/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Leiomioma/cirurgia , Pessoa de Meia-Idade , Doenças da Unha/cirurgia , Neoplasias Cutâneas/cirurgia
17.
Fertil Steril ; 111(4): 629-640, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30929720

RESUMO

Endometrial polyps, adenomyosis, and leiomyomas are commonly encountered abnormalities frequently found in both fertile women and those with infertility. The clinician is frequently challenged to determine which of these entities, when found, is likely to impair fertility, and which are "innocent bystanders" unrelated to the problem at hand. Although removing an endometrial polyp may be seen as a relatively benign and safe intervention, myomectomy, and in particular adenomyomectomy, can be substantive surgical procedures, associated with their own potential for disrupting fertility. One of the mechanisms thought to be involved when these entities are contributing to infertility is an adverse impact on endometrial receptivity. Indeed polyps, adenomyosis, and leiomyomas have all been associated with an increased likelihood of abnormal endometrial molecular expressions thought to impair implantation and early embryo development. This review is designed to examine the relationship of these common entities to endometrial receptivity and to identify evidence gaps that should be considered when strategizing research initiatives. It is apparent that we have the tools necessary to fill these gaps, but it will be necessary to approach the issue in a strategic and coordinated fashion. It is likely that we will have to recognize the limitations of imaging alone and look to the evidence-based addition of molecular analysis to provide the individualized phenotyping of disease necessary for patient-specific treatment decisions.


Assuntos
Adenomiose/fisiopatologia , Implantação do Embrião/fisiologia , Endométrio/fisiologia , Leiomioma/fisiopatologia , Pólipos/fisiopatologia , Doenças Uterinas/fisiopatologia , Neoplasias Uterinas/fisiopatologia , Adenomiose/complicações , Adenomiose/diagnóstico , Adenomiose/terapia , Endométrio/patologia , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/patologia , Infertilidade Feminina/terapia , Leiomioma/complicações , Leiomioma/diagnóstico , Leiomioma/terapia , Pólipos/complicações , Pólipos/diagnóstico , Pólipos/terapia , Gravidez , Doenças Uterinas/complicações , Doenças Uterinas/diagnóstico , Doenças Uterinas/terapia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia
18.
Indian J Pathol Microbiol ; 62(2): 293-295, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30971559

RESUMO

Epstein-Barr virus (EBV) promotes the development of undifferentiated carcinomas of the upper aerodigestive tract and different types of lymphomas. This ability of tumorigenesis is heightened in many immunocompromised patients who have an increased incidence of lymphoproliferative disorders. The virus also induces smooth muscle proliferation, and those occurring following transplantation are designated as EBV-associated post-transplant smooth muscle tumors. We report multifocal miliary-sized leiomyomas in the lungs in a renal transplant recipient as an incidental finding.


Assuntos
Infecções por Vírus Epstein-Barr/complicações , Leiomioma/diagnóstico , Tumor de Músculo Liso/diagnóstico , Adulto , Antivirais/uso terapêutico , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Herpesvirus Humano 4/efeitos dos fármacos , Herpesvirus Humano 4/patogenicidade , Humanos , Hospedeiro Imunocomprometido , Transplante de Rim , Leiomioma/diagnóstico por imagem , Leiomioma/virologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Tumor de Músculo Liso/virologia
19.
Arch Ital Urol Androl ; 91(1): 51-52, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30932431

RESUMO

Leiomyoma of the bladder is a very rare disorder that accounts for 0.43% of all bladder neoplasms. Although the pathophysiology of the bladder leiomyoma is unknown, there are some theories on it. The patients can be asymptomatic; when present, clinical symptoms (lower urinary tract symptoms and\or hematuria), are associated with tumor size and location. For diagnosis, imaging plays an important role: ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI) are the examinations most frequently performed. Treatment consists of surgical removal of the tumor, and the prognosis is excellent.


Assuntos
Cistectomia/métodos , Leiomioma/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Adulto , Humanos , Leiomioma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia
20.
Diagn Pathol ; 14(1): 30, 2019 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-31010432

RESUMO

BACKGROUND: Metastatic tumors to the pancreas are uncommon, accounting for approximately 2% of pancreatic malignancies. The most common primary tumors to give rise to pancreatic metastases are carcinomas. CASE PRESENTATION: A 50-year old female patient was investigated for a cause of abdominal discomfort. She had a 2-year history of menorrhagia and dysmenorrhea which was ascribed to a fibroid uterus. On imaging, she was found to have a large solid and cystic mass in the tail of the pancreas. Imaging also confirmed a fibroid uterus. A distal pancreatectomy and splenectomy showed a 9 cm circumscribed mass within, and grossly confined to, the parenchyma of the pancreatic tail. Microscopically, the pancreatic lesion was lobulated, and well-circumscribed, but focally infiltrative. It comprised sheets of uniform spindled to epithelioid cells with round to oval nuclei, coarse to vesicular chromatin, visible nucleoli, nuclear grooves and clear to eosinophilic cytoplasm. Prominent arterioles were identified. The stroma was collagenized in areas. Occasional hemosiderin-laden macrophages were seen, and focal cystic change was present. There was no evidence of nuclear pleomorphism, mitotic activity or necrosis, and there was no evidence of endometriosis despite multiple sections being taken. Immunohistochemistry showed that the tumor cells were positive for CD10, estrogen receptor (ER), progesterone receptor (PR), Wilms tumor-1 (WT-1) and smooth muscle actin (SMA). RNA sequencing detected a PHF1 rearrangement. The morphological, immunohistochemical and molecular features were of a low-grade endometrial stromal sarcoma (LG-ESS). Subsequent total hysterectomy and bilateral salpingo-oophorectomy 3 months later, showed uterine fibroids and a 5 cm low-grade endometrial stromal sarcoma confined to the uterus, with lymphatic invasion. CONCLUSIONS: To the best of our knowledge, this is the first documented case of metastatic endometrial stromal sarcoma of uterus presenting as a primary pancreatic neoplasm. An unexpected extra-uterine location and unusual presentation of ESS may make the diagnosis challenging, despite classic histological features. Morphological, immunohistochemical and molecular findings must be combined to render the correct diagnosis.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias do Endométrio/diagnóstico , Leiomioma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Sarcoma do Estroma Endometrial/diagnóstico , Neoplasias do Endométrio/secundário , Neoplasias do Endométrio/cirurgia , Células Epitelioides/patologia , Feminino , Humanos , Histerectomia , Imuno-Histoquímica , Leiomioma/patologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Sarcoma do Estroma Endometrial/secundário , Sarcoma do Estroma Endometrial/cirurgia , Útero/patologia , Útero/cirurgia
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