Ultra-structure changes and survivin expression in uterine fibroids after radiofrequency ablation.

PURPOSE: To explore the reliability and validity of radiofrequency (RF) ablation in treating uterine fibroids. MATERIALS AND METHODS: We evaluated 63 patients who underwent hysterectomy to treat multiple fibroids. Thirty patients immediately underwent abdominal hysterectomy after the fibroids were ablated under direct vision. Thirty-three patients first experienced trans-vaginal ablation with the guidance of a baseline ultrasound. We performed abdominal or trans-vaginal hysterectomy 72 h later. The tissues in the centre of the ablated lesion (group A), at the edge of the ablated lesion (group B), 1 cm away from the ablated edge (group C) and the control group were sampled. We observed ultra-structure changes by transmission electron microscopy and detected survivin expression with Western blot analysis. RESULTS: According to transmission electron microscopy, the ultra-structure of fibroid cells in groups A and B was damaged. However, in group C, the ultra-structure was normal. Compared with the control group, survivin expression was significantly decreased. Meanwhile survivin expression was significantly increased with the distance to the ablated centre (p < 0.05). CONCLUSIONS: Radiofrequency ablation caused permanent and irreversible damage to fibroid cells and decreased survivin expression, which provided reliable clinical evidence for the success of radiofrequency ablation treating uterine fibroids.

Quality of corrosion specimens prepared from material obtained during autopsies - a preliminary study.

AIM: Aim of this study was to assess the quality of the corrosion specimens obtained during autopsies of human body for scanning electron microscopy procedures. MATERIALS AND METHOD: Ninety seven uteri were obtained upon autopsy of women aged 25-56 years, deceased due to causes not related to disorders of the reproductive system. Fourty three of them contained large subserosal uterine leiomyomata. twenty uteri were injected with acrylic emulsion Liquitex R via the arteries or veins. Five of these uteri were next dissected and cut into slides on a microtom. the remaining uteri were injected with 60-80 ml of mercox CL-2r resin, next macerated and studied under scanning electron microscope (JEOL SEM 35-CF scanning electron microscope at 20-25 kV). RESULTS: Best human specimens were obtained from the autopsies carried out possibly early after the deceased, young aged (between 25 and 45) and died because of multitrauma not associated with the pelvic injury. CONCLUSIONS: Specimens obtained from autopsies can be used for scanning electron microscopy however under several conditions, specially the time between death and undertaking the injection procedures and the age of the individual, because of the process of artherosclerosis.

Blood vessels of the intratumoral septa in uterine leiomyomata.

The angioarchitecture of fibroid intratumoral septa was studied using 32 uteri obtained during necropsies of the females aged between 35-57. The whole vascular bed of 16 uteri was injected with synthetic resin Mercox CL-2R and then the uteri were corroded in potassium hydroxide. Next 16 uteri were injected with acrylic emulsion, Liquitex R. Their vascular bed was studied using immunohistochemistry for von Willebrandt's factor. Immunohistochemistry allowed to visualize the vessels within the intratumoral septa, while SEM allowed to differentiate the vessels, which were mainly the venules and the veins. Apart from the veins the intratumoral septa were consisted of small arteries and capillaries.

Vascular structure of outer myometrial uterine leiomyomata - a preliminary SEM and immunohistochemical study.

AIM: The main goal of this study was assessment of vascular structure of uterine leiomyomata localized between outer myometrium and endometrium. MATERIALS AND METHODS: The study was carried out on thirty two human uteri collected upon autopsy. Vessels were injected with synthetic resin, next corroded and coated with gold, finally observed using scanning electron microscope. Next ten uteri were injected with acrylic emulsion and studies using immunohistochemical staining for von Willebrandt's factor. RESULTS: Vascular structure of outer myometrial leiomyomata was quite similar to those observed in the middle of muscular layer of uterus, characterized by relatively dense 'vascular capsule', consisted of flattened vein, arterioles and capillaries. CONCLUSIONS: Structure of outer myometrial uterine leiomyomata was similar to those observed during growth within myometrium.

Three cases of laparoscopic myomectomy performed during pregnancy for pedunculated uterine myomas.

PURPOSE: Laparoscopic myomectomy during pregnancy is indicated when symptoms related to uterine myomas persist despite pharmacologic therapy; however, currently there is very little information concerning its safety. METHODS: We report three cases of antepartum laparoscopic myomectomy performed to manage complicated myomas requiring surgical intervention. RESULTS: In particular, we report for the first time in literature the laparoscopic removal of two myomas in a patient during a single surgery performed in the 19th week of pregnancy followed by additional multiple myomectomy at the time of the cesarean section. All surgeries were without complication. CONCLUSIONS: Our experience suggests that laparoscopic myomectomy may be performed safely during pregnancy; even more studies are needed to establish the exact rate of adverse events.

Retrospective immunohistochemical investigation of suspected non-visceral leiomyosarcoma in dogs.

Visceral leiomyosarcoma is well described in dogs, but information about non-visceral locations and prevalence is lacking. The diagnosis of leiomyosarcoma is challenging without a gold standard, and often includes the use of immunohistochemical (IHC) stains. We used defined histopathologic patterns, histochemical staining, and IHC staining for smooth muscle actin (SMA), desmin, and laminin to characterize suspected non-visceral leiomyosarcoma in dogs at a single academic institution. In a retrospective search, we identified 24 dogs with a definitive or suspected histologic diagnosis of leiomyosarcoma in a non-visceral location. Histopathology results and clinical details were obtained. Biopsy sections were reviewed by a single pathologist using standardized histologic criteria, including light microscopic appearance, immunohistochemistry (more than two-thirds of neoplastic cells labeled with SMA and desmin or laminin), and histochemical staining (minimal-to-mild matrix deposition by Masson trichrome). Of the 24 cases of possible non-visceral leiomyosarcomas, 4 were consistent with a definitive diagnosis of non-visceral leiomyosarcoma (3) or leiomyoma (1) based on the established criteria. Only the leiomyoma had more than two-thirds of neoplastic cells label with all 3 markers; all 3 leiomyosarcomas had more than two-thirds of neoplastic cells label with SMA and laminin. Our data highlight the uncommon nature of non-visceral leiomyosarcoma and the importance of IHC for their diagnosis. A definitive diagnosis could not be made based on SMA alone, and desmin was not useful in this cohort. Further studies are needed to clarify the histopathologic, IHC, and clinical features of canine non-visceral SMA-positive mesenchymal tumors.

Morphologic patterns of human endometrial epithelium in women with uterine myomata treated with leuprorelin acetate.

AIM: We studied morphologic modifications of the endometrium induced by leuprorelin acetate, a gonadotropin-releasing hormone agonist, in women with uterine myomata. METHODS: Transmission and scanning electron microscopy observations were performed after 2 or 6 cycles of therapy (every 28 days). RESULTS: A near-normal endometrium was observed after 2 months of therapy, while treatment with 6 cycles of leuprorelin acetate induced a uniform morphologic regression of the uterine mucosa. CONCLUSIONS: The study demonstrates that leuprorelin acetate induces a unique and time-dependent regression of the endometrial mucous membrane.

A leiomyomatoid angiomatous neuroendocrine tumor of the myometrium: case study with ultrastructural analysis.

Leiomyomatoid angiomatous neuroendocrine tumor (LANT) is a possible new disease entity that was described as a dimorphic neurosecretory tumor with a leiomyomatous vascular component; it was found in the pituitary. We describe here a second case of LANT in a 45-year-old woman with a myometrial tumor, diagnosed clinically as uterine leiomyoma. She underwent laparoscopic myomectomy. The tumor consisted of hyalinized vasculature, containing factor VIII-positive endothelium and smooth muscle actin-positive vascular smooth muscle cells, and stromal cells, expressing neuroadhesion molecules. Both vascular and stromal components diffusely expressed chromogranin A and, as evidenced by electron microscopy, possessed smooth muscle actin filaments and electron-dense neurosecretory granules, which contained the neurosecretory hormone somatostatin. Although no cytokeratin-positive cells were observed, some tumor cells had positive Grimelius staining for argyrophilic granules. These findings meet the definition of LANT, and the occurrence of our case suggests that LANT is a special type of neuroendocrine neoplasm and is not organ specific.

Cotyledonoid dissecting leiomyoma of the uterus with intravascular growth: report of two cases.

We present two cases of cotyledonoid dissecting leiomyoma of the uterus with intravascular involvement, which occurred in women aged 73 and 48 years. Grossly and microscopically, both neoplasms had an extrauterine cotyledonoid part and intrauterine dissecting fascicles of disorganized, swirled neoplastic smooth muscle with hydropic degeneration and foci of an intravascular growth (the latter was identified histologically). To our knowledge, the intravascular component of such a neoplasm is a very rare feature that has previously been described only in three cases in the literature.

Uterine leiomyomas with inclusion bodies: an immunohistochemical and ultrastructural analysis of 12 cases.

We describe 12 cases of leiomyoma with intracytoplasmic inclusion bodies, which were detected in a group of 447 leiomyomas examined at our institution between December 2005 and March 2006. Ten of these tumors were typical leiomyomas, and two cases represented atypical (bizarre) leiomyoma. In some cases, the presence of intracytoplasmic inclusion bodies resulted in a rhabdoid or skeletal muscle-like appearance of the tumor cells. Ultrastructurally, there were two types of inclusions. One of them consisted of an abnormal aggregation of intermediate and actin filaments. Another type of inclusions was composed of dense granular material without an apparent fibrillar structure. The ultrastructure of the inclusions correlates with immunohistochemical and histochemical stainings. The inclusions with apparent fibrillar arrangements were PAS negative, stained red by trichrome, and were, at least at the periphery, actin-, desmin-, and h-caldesmon-positive. The dense granular inclusions were at least focally PAS-positive, stained red by trichrome, and were negative immunohistochemically. The intracytoplasmic inclusions were found in atypical (bizarre) leiomyomas of the uterus and occasionally in epithelioid leiomyomas and leiomyosarcomas. However, to the best of our knowledge, these inclusions have not been found in typical uterine leiomyomas to date.

Inguinal canal spermatic cord leiomyoma presenting as an incarcerated inguinal hernia.

Leiomyoma is a benign neoplasm originating from smooth muscle cells and is most commonly seen in the uterus, followed by the small bowel and oesophagus. We report a rare case of a 41-year-old male patient with a spermatic cord leiomyoma that presented as an inguinal canal mass mimicking an irreducible inguinal hernia without scrotal involvement. This report highlights the rare presentation and workup of an inguinal mass, importance of intraoperative decision making based on operative findings and the significance of postoperative pathology findings.

A new hypothesis about the origin of uterine fibroids based on gene expression profiling with microarrays.

This article will discuss some recent insights based on our microarray studies that have emphasized the role the extracellular matrix, transforming growth factor beta, and collagen structure in fibroid formation. These studies led to appreciation of molecular similarities between fibroids and keloids. Collectively, these observations suggest a model of fibroid development based on an abnormal response to tissue repair, resulting in disordered healing and formation of an altered extracellular matrix.

Smooth muscle and bone neoplasms in transgenic mice expressing SV40 T antigen.

Transgenic mice carrying the SV40 early region fused to the Drosophila hsp70 promoter developed smooth muscle and bone neoplasms. The smooth muscle tumors appeared in aged mice and were preferentially located on the muzzle or eyelids. Multiple neoplasms were often present and each appeared to be an independent proliferation. In contrast, the bone tumors typically developed in the petrous ridge and had all the features of osteogenic sarcomas, displaying distant metastasis and invasion of the brain. Cells in both types of tumors exhibited nuclear expression of SV40 T antigen. Mice homozygous for the transgene had a shorter latency for appearance of smooth muscle tumors and developed osteosarcomas more frequently than hemizygous mice. This model system implicates the cellular T antigen-binding proteins, such as Rb and p53, in the pathogenesis of bone and soft tissue neoplasms in mice.

CD10- and CD34-positive periglandular stromal cells in pulmonary benign metastasizing leiomyoma with metaplastic adenomyomatous glands: an ultrastructural and immunohistochemical study.

Two Japanese females, 36 years and 52 years old, with episodes of uterine leiomyoma, were operated on for pulmonary benign metastasizing leiomyomas (PBMLs) in their peripheral lung. Conventional light microscopic, ultrastructural, and immunohistochemical studies revealed that the PBMLs possessed an adenomyomatous histology, consisting of metaplastic glandular structures and stromal or smooth-muscle cell proliferation. In the tumorous nodules of the PBMLs, epithelial cells with the characteristics of lung epithelial cells of type-II pneumocytes were observed, together with ciliated and non-ciliated bronchiolar epithelial cells in the entrapped and metaplastic glands. The present study pointed out the unique periglandular stromal cells of fibroblastic cells, which were lacking the immunohistochemically conventional characteristics of normal lung smooth muscle cell but showed unique characteristics-ultrastructurally: fibroblastic lacking well-developed myofilaments with dense patches and well-developed external lamina; but immunohistochemically: CD10+, CD34+, alpha-smooth-muscle actin+, desmin-, estrogen receptor+, and progesterone receptor+. It was speculated that glandular metaplasia from entrapped respiratory epithelia cells might be introduced by the possible inductive interactions of periglandular mesenchymal stromal cells. Putative microenvironmental inductive roles were postulated for the periglandular stromal fibroblasts to induce a metaplastic change toward the glands from pre-existing lung epithelial cells revealing adenomyomatous features.

Phosphor/sulphur ratio: an indicator of malignant uterus change.

The purpose of the present study was to establish a correlation between gynaecological diseases (myoma, adenocarcinoma) and phosphor/sulphur (P/S) ratios of different regions of the uterus. Routine histological specimens were reexamined with the intention to select representative regions of the uteruses for element analysis. Conventional hematoxylin-eosin-stained sections were used to identify histological alterations by light microscopy. Scanning electron microscopic (SEM) and energy-dispersive spectroscopic (EDS) investigations were carried out to analyze the morphology and the related element composition of the samples. The results of the nonparametric statistical test (Wilcoxon rank-sum test) indicate that the P/S ratios were significantly higher in adenocarcinoma (0.8891 +/- 0.0757) than in myoma (0.4713 +/- 0.0306). P/S ratios of different pathologic regions of uteruses seem worth examining in a larger study population. Combination of routine histological examinations with element analysis of specimens may have useful applications in patients who have undergone radiation therapy and may identify a pattern for local recurrence at certain sites.

[Amyloid-producing leiomyoma of the womb--a complete morphological study and possible etiology].

Case study of a 41 year old woman with tumor-related amyloidosis in a singular intramural leiomyoma of the uterine corpus. The tumor has been thoroughly revised with electron microscopy and underwent a histological, histochemical, and imunohistochemical studies. A hypothesis of its origin has been suggested. To our knowledge, this is the first documented case of amyloid-producing leiomyoma.

[Uterine endosonography with sterile serum infusion in infertile women].

UNLABELLED: Infusion of sterile serum in the uterine cavity during ultrasound examination is useful for investigation bout polyps, submucous myoma, adhesion and anatomical malformation. Examination of the patients with ultrasound is suitable to be with medicine in the infusion, menometrorrhagia sterility, all changes in the endometrium. CONTRAINDICATIONS: genital infection, pregnancy, neoplasma of cavum uteri. TECHNIQUES: investigation was between 7th and 12th day of the cycle. We used insemination catheter to put in the cervical canal. There is a syringe with infusion on the other end. The speculum was took of the vagina and put on the transducer. We performed examination of the uterus in the different scans. When the infusion was fulfilled the avum uteri we observed different findings. 24 patients with sterility were passed for ultrasound examination with sterile serum for the period of 1 year (2003--2004). We diagnosed normal cavum uteri thiken endometrium, endometrial polyp, submucous myoma amd malformation uteri.

Histogenesis of morphologic variations in tumors of the uterine wall.

We investigated seven uterine wall lesions, selected because of the presence of unexpected patterns or components, to determine their relationship to normal uterine constituents. These lesions included a bizarre leiomyoma, a palisading leiomyoma which resembled a schwannoma, two myxomas, irradiated myometrium, a plexiform tumor, and a leiomyoma with tubular structures. All of these lesions except for the epithelial component of the plexiform tumor showed ultrastructural characteristics of smooth muscle, demonstrating a common origin from the myometrium. Two tumors, the plexiform tumor and the leiomyoma with tubules, had the pattern of epithelial structures suggesting origin from müllerian mesencyme: the plexiform tumor resembled incompletely differentiated endometrium and the tubular structures in the leiomyoma had features of mesothelium. We conclude that these varied and often confusing morphologic patterns reflect the capacity of uterine smooth muscle and stroma to undergo a wide spectrum of alterations including differentiation toward epithelial structures. Changes of this type occur in benign and malignant uterine stromal neoplasms and do not in themselves have prognostic significance.

Solitary infantile myofibromatosis of bone. An immunohistochemical and ultrastructural study.

A rare case of solitary infantile myofibromatosis of bone in an 11-month-old boy is reported. Radiographically the lesion of parietal bone was round, well-circumscribed, and osteolytic with a sclerotic rim. Histologically the tumor was made up of nodules that were hyalinized or cellular and containing plump, spindle-shaped cells that were intermediate in appearance between fibroblasts and smooth-muscle cells, arranged in short bundles or whorls. Another typical feature was the presence of distended, cleft-shaped vascular spaces around the nodules. The microscopic features of this tumor were consistent with those of infantile myofibromatosis of other sites, such as the skin and deep soft tissue. The tumor cells showed immunoreactivities for vimentin and alpha-smooth muscle actin. Microfilaments with dense bodies were observed in the fibroblast-like tumor cells. In addition, many tumor cells stained for collagen type IV and were covered by incomplete external laminae, indicating infantile myofibromatosis has more advanced smooth-muscle differentiation than conventional fibromatosis.

Endometriosis occurring in leiomyomatosis peritonealis disseminata: ultrastructural study and histogenetic consideration.

Leiomyomatosis peritonealis disseminata is a pseudomalignant condition which mimics disseminated abdominal carcinoma. A new case is reported and compared to the 11 well-documented cases in the literature. All reported patients have experienced a benign clinical course. The peritoneal nodules are composed of histologically benign-appearing smooth-muscle cells, substantiated by electron-microscopic study. The histogenesis of this entity is discussed in the light of our ultrastructural findings and the observation of concurrent endometriosis. The theory of metaplasia of the subcoelomic mesenchyme in the pathogenesis of the leiomyomatous lesions is favored. The serum estrogen levels determined in our patient did not reveal any abnormal change. The inducing factor(s) remain to be identified. Also, an unusual sensitivity of the coelomic tissues in these patients, in response to metaplastic stimuli, is postulated as a possible contributing factor.