To Evaluate the Efficacy and Safety of Mifepristone in Reducing the Size & Symptoms of Uterine Leiomyoma/Fibroids.

Background and Study Objective: Uterine leiomyomas, or fibroids, are prevalent benign gynecological tumors affecting many women during their reproductive years. While surgical excision has long been the gold standard for fibroid treatment, the pharmacological management, including progesterone receptor modulators like mifepristone (RU 486), has garnered attention due to the reduced surgical approaches. However, there is a notable paucity of research on the effectiveness of mifepristone, on the same. This study seeks to evaluate the safety and efficacy of mifepristone in reducing uterine leiomyoma size and alleviating associated symptoms. Methodology: Conducted prospectively, the study enrolled 20 pre-menopausal women, aged 18 years or older, from Nanavati Max Super Speciality Hospital Mumbai, Maharashtra, India. Participants were selected based on specific inclusion criteria, including the presence of at least one uterine myoma with a minimum diameter of 2.5 cm as confirmed by ultrasound. Participants had an average age of 39.75 years and an average BMI of 27.58 kg/m2. Results: The study found that mifepristone significantly reduced uterine volume by 75%, with hemoglobin levels substantially improving from 9 gm/dL initially to 12.51 gm/dL after six months. Pain intensity, assessed using the Visual Analog Scale (VAS) score, gradually decreased from baseline to three-month, with all 20 patients reporting the complete absence of pelvic pain by six months. Conclusion: This prospective study highlights mifepristone's promise as a non-surgical approach to effectively reduce uterine fibroid volume, improve hemoglobin levels, and mitigate uterine blood loss in patients.

Spontaneous isolated iliac artery dissection in a young male: Case report and review of literature.

Spontaneous isolated dissection of the iliac artery (SID-IA) is a rare vascular condition typically associated with trauma or connective tissue disorders. We present a unique case of a 39-year-old male without known risk factors or trauma history who presented with lower abdominal pain. Diagnostic imaging revealed SID-IA involving the right external iliac artery with thrombus formation. Despite negative findings for connective tissue disorders, the patient underwent successful endovascular stenting following initial medical management. Vigilance in diagnosis and prompt intervention are crucial in managing SID-IA to prevent complications such as limb ischemia and aneurysm formation. This case emphasizes the importance of considering SID-IA in young patients presenting with abdominal pain, even in the absence of traditional risk factors, and highlights evolving treatment options for this rare condition.

Liver histopathology in scope of hematological disorders.

Liver involvement is commonly seen in various haematological disorders. They present clinically with elevation of liver enzymes and organomegaly, with or without mass lesions. However, liver involvement may be silent in many hematological disorders or there may be specific findings in liver biopsy that can lead to the diagnosis of clinically inapparent hematological disorders. Present review highlights features of hepatic manifestations in various hematological diseases with special emphasis on histopathological findings. Among RBC disorders, secondary hemochromatosis is the commonest among patients with hemolytic anemia; whereas Sickle Cell Hepatopathy is a well known complication in Sickle Cell Disease, characterised by sequestration of sickled RBCs in sinusoids. Vascular complications such as Budd Chiari syndrome and portal venopathy with portal vein thrombosis are seen in patients with myeloproliferative neoplasms. However, sometimes primary hematological disease may remain occult. Various lymphomas show characteristic pattern of hepatic involvement, most common being sinusoidal and portal infiltration. Pattern of infiltration may give clues to different types of lymphomas. Amongst all lymphomas, Diffuse large B cell lymphoma is the most common lymphoma involving liver. Disseminated intravascular coagulation is a fatal systemic condition and liver involvement by widespread fibrin thrombi, is not an exception. Assessing liver histopathology in context of hematological conditions makes better understanding of pathophysiology and progress of these diseases. It is important for hematologists and hepatologist to be aware of possible liver involvement in various hematological diseases presenting with elevated LFTs and have a logical approach to abnormal LFTs.

Recurrent Meningeal Melanocytoma of Cervical Spine: A Rare Case.

Melanocytomas of the central nervous system are rare benign or intermediate grade localized melanocytic tumors. Despite its benign nature, it can follow a locally aggressive course with propensity to recur. We present the case of a 29 years old female who presented with a recurrent lesion in cervical spine and rapidly progressing quadriparesis. On examination, there was loss of power in right-sided extremities and reduction in sensations in left-sided extremities. Magnetic resonance imaging spine revealed a homogeneously enhancing intradural extramedullary dumbbell-shaped mass lesion at C4/5 level with extension through right C4 neural foramina to the extraforamina space, causing severe spinal cord compression. Intraoperatively, bluish-colored tumor was identified along with underlying hematoma. Gross total excision of the tumor was done. Tumor was received in the histopathology department in multiple black-colored fragments. Microscopically, a heavily pigmented tumor was seen with the sheets and nodules of polygonal cells with large nuclei and prominent nucleoli. Differentials considered were meningeal melanocytoma and malignant melanoma. On immunohistochemistry, the tumor cells showed diffuse positivity for HMB 45 and S100. Ki 67 index was around 1%. On radiological review, the tumor was fairly well circumscribed and did not infiltrate the adjacent tissues. There was no evidence of any lesions elsewhere in the body. Considering these features, the tumor was diagnosed with meningeal melanocytoma. Postoperatively, there was significant immediate improvement in quadriparesis and patient could walk with minimal support.

Primary ovarian leiomyoma: Imaging in a rare entity.

Primary ovarian leiomyoma is a very rare benign mesenchymal tumor arising from the smooth muscle of walls of ovarian blood vessels. It is usually seen between 20 65 years of age. Being asymptomatic in many patients, these are incidentally detected. Ultrasonography and magnetic resonance imaging are preferred modality while imaging these lesions. Hereby we present a case of a 35-year-old female with incidentally detected right ovarian mass lesion which was hypointense on ultrasonography, hypointense on both T1W and T2W images, and on histopathology confirmed as primary ovarian leiomyoma. T1- and T2-weighted hypointensity on MRI with early homogenous postcontrast enhancement help in its diagnosis, though many a time it is difficult to differentiate it from other mesenchymal fibrous tumors such as fibroma and fibrothecoma. Histopathology and immunohistochemistry remain the mainstay in final confirmatory diagnosis. It is important to keep this entity in the differential diagnosis of solid T1 and T2 hypointense lesions of the ovary.