Leiomyosarcoma of the vagina

Vaginal leiomyoma is uncommon and borderline leiomyoma of the vagina is an extreme rarity. Leiomyoma of the vagina may undergo malignant change to become borderline malignancy or leiomyosarcoma. A 38-year-old woman, complaining of foul vaginal discharge and dyspareunia with 2 months duration, underwent total excision of tumor. The removed tumor was diagnosed as borderline case of leiomyoma histologically. Unfortunately, she had tumor recurrence within 4 months. Thus, it was more likely that the primary diagnosis was incorrect and that the diagnosis leiomyosarcom has been missed. She underwent total abdominal hysterectomy, bilateral salphingo-oophorectomy and total vaginectomy. The final diagnosis was leiomyosarcoma. Three months later tumor recurred again and re-excision followed by chemotherapy was performed. However, she died of her disease on her 5th month following three courses of chemotherapy.     

Leiomyoma of the female urethra and bladder: Report of twenty-three patients and review of the literature

OBJECTIVES: Our purpose was to review what may be the largest experience of bladder and urethral leiomyomas from a single institution.STUDY DESIGN: A retrospective review was done of 23 female patients with emphasis on presentation, symptoms, and operative approach for excision.RESULTS: The majority of bladder and urethral leiomyomas in this series were asymptomatic, nonobstructive, or incidental (discovered at surgery for another entity). Ten patients had a palpable mass on physical examination. Two patients had pain as a presenting complaint. The route of operative excision was transvaginal (10 patients), transurethral (6 patients), or abdominal (6 patients). One patient had the leiomyoma removed elsewhere with a resultant vesicovaginal fistula.CONCLUSIONS: Corollaries should be sought with the experience of uterine leiomyomas, which are histologically identical to bladder leiomyomas. Asymptomatic, nonobstructive, and nonproblematic leiomyomas should not serve as an indication for primary operation. Pedunculated endovesical lesions may be an exception because of the ease of transurethral removal and their tendency to cause future symptoms. Ultrasonographic imaging, cystoscopy, and biopsy should be considered to allow observation and follow-up of leiomyomas. Future investigative cytogenetic studies should be considered on these mesenchymal tumors. (Am J Obstet Gynecol 1997;176:1278-85.)     

The management of an unusually sited isthmicocervical leiomyoma and a huge prolapsed pedunculated submucous leiomyoma

We present two case studies: an unusually sited isthmicocervical leiomyoma and a huge prolapsed pedunculated submucous leiomyoma of the uterus. Case 1 was a 25-year-old virginal woman with a diagnosis of cervical leiomyoma with symptoms of anemia and menorrhagia. Magnetic resonance imaging revealed a mass impinging on the bladder and rectum. Myomectomy was the selected operation because of the patients age and her desire to preserve fertility, even though the tumors size and location increased the risk of operative blood loss and would make the surgical procedure difficult to perform. The pathological specimen was benign. Case 2 was a 43-year-old patient with a chief complaint of difficulty in voiding plus severe vaginal bleeding. The gynecological examination revealed a necrotic mass that filled the vagina completely and stretched its walls. The sonographic findings were consistent with a pedunculated submucous leiomyoma. Total abdominal hysterectomy and bilateral salpingoophorectomy were performed. The histopathological evaluation was benign leiomyoma of the uterus. Cervical and pedunculated submucous leiomyomas are uncommon and represent a technicosurgical difficulty due to location and huge size. However, in order to regress the complications and improve the patients quality of life regarding desire to preserve fertility, conservative surgical regimens should be chosen.     

Low-dose mifepristone in treatment of uterine leiomyoma: A randomised double-blind placebo-controlled clinical trial

Aims: To evaluate the effect of low-dose mifepristone on leiomyoma-related symptoms, uterine and leiomyoma in women with symptomatic leiomyomata.
Methods: In a double-blind placebo-controlled trial, 40 patients with symptomatic leiomyoma and normal endometrial histology were randomised to receive 10 mg mifepristone (group 1) or placebo (group 2) daily for three months. Leiomyoma-related symptoms, uterine, leiomyoma and largest leiomyoma volumes were assessed at baseline and every month for three months. Endometrial biopsy was repeated at the end of therapy.
Results: Significant change was noticed between the two groups for mean menstrual blood loss (MBL) by first month. Menstrual blood loss declined by 94.8% in group 1 at three months and 84.2% patients attained amenorrhoea in this group. In group 1 complete relief of dysmenorrhoea occurred in significant number of women (80%) but only 33% patients got rid of pelvic pain. There was no change in these symptoms in group 1 Backache, urinary complaints and dyspareunia were not relieved in either group. Uterine, leiomyoma and largest leiomyoma volume declined by 26–32% in group 1 as compared to none in group 2, and this difference was statistically significant only by the end of the third month of therapy. Mean haemoglobin increased from 9.5  to 11.2 g/dL in group 1. In group 1, at the end of therapy, 63.1% of patients had endometrial hyperplasia without atypia.
Conclusions: Ten milligrams mifepristone for three months is effective in reducing MBL, increasing haemoglobin and reducing uterine and leiomyoma volume with side-effect of endometrial hyperplasia.     

Benign abdominal and pulmonary metastasizing leiomyoma of the uterus

Background: Benign metastasizing leiomyoma (BML) is a rare disease in which the lung is described to be the most afflicted extrauterine organ. Methods: We report of a 42-year-old African woman with a BML in the abdomen and lung who had undergone a hysterectomy for uterine leiomyoma 10 years ago. She was admitted to our hospital for investigation of a huge tumor mass in the pelvis consisting of multiple nodules in the abdomen and left lung. Assuming an advanced intraperitoneal malignancy was present, a ‘palliative’ limited tumor debulking and due to a tumor compressing the sigmoid a Hartmann’s procedure was performed. Results: The histopathologic examination showed a leiomyoma positive for estrogen receptor. Treatment was started with GnRH analoga. In the presence of a stable disease after 12 months, the patient underwent a re-laparotomy with a reanastomosis of the colon. Treatment was continued with GnRH analoga and the residual nodules have not increased in size during 36 months of follow-up. Conclusions: The review of the literature supports the concept that the primary tumor of BML is located in the uterus and that leiomyomas in the uterus can metastasize leading via hematogenous spread to BML. However, the origin of the tumor remains controversial.     

Intravascular leiomyomatosis and benign metastasizing leiomyoma: an unusual case

Benign metastasizing leiomyoma (BML) and intravascular leiomyomatosis (IVL) are rare variants of uterine leiomyomas. In our search of available literature, there have been only two reports of these conditions occurring in the same patient. We report a case of a 42-year-old female presenting with a left L4 nerve root lesion, left paravesical lesion, left ovarian cyst, multiple pulmonary metastases, and an intracaval lesion. Histology confirmed these to be leiomyomata strongly positive for estrogen receptors. Treatment included surgery, in two stages, to remove the L4 nerve root, left paravesical lesion, intracaval lesion, and a single pulmonary nodule. The remaining tumor was treated with a gonadotrophin-releasing hormone agonist, resulting in significant reductions in tumor size. It was concluded that the lesions in the lungs were an example of BML arising from the initial diagnosis of uterine leiomyoma, and the caval lesion was an IVL. Long-term follow-up is recommended, and familiarity with rare forms of benign smooth muscle uterine tumors is essential in avoiding misdiagnosis and overtreatment.     

Epithelioid vascular leiomyoma of the uterus mimicking glomangiomyoma

Case report: An unusual case of epithelioid vascular leiomyoma mimicking glomangiomyoma arising in the uterine corpus of a 55-year-old Japanese woman is presented. The surgically resected uterine mass, measuring 4.0 × 3.5 cm², demonstrated a dark red well-circumscribed tumor. Histologically, the rounded epithelioid cells around the dilated vessels showed gradual transition to spindled smooth muscle cells. Immunohistochemistry was positive for smooth muscle actin, but negative for collagen IV. Conclusion: The experience in this case emphasizes that glomangiomyoma-like feature is interesting and might indeed be a new histological variant of uterine leiomyomas.     

子宫富于细胞型平滑肌瘤55例临床分析

目的研究子宫富于细胞型平滑肌瘤的临床特征和病理特点。方法对1998年2月~2005年4月经病理诊断为子宫富于细胞型平滑肌瘤的患者55例(研究组)及随机抽取普通平滑肌瘤120例(对照组),就其症状、体征、手术所见、大体标本及预后进行对照分析。结果子宫富于细胞平滑肌瘤的发病年龄、肿瘤的增长速度、大小、质地与普通平滑肌瘤之间存在明显差异:子宫富于细胞平滑肌瘤发病年龄相对较轻,增长速度较快,较易向阔韧带内生长,质地偏软。随访有3例复发,5例妊娠或生育。结论子宫富于细胞平滑肌瘤发病年龄相对较轻,增长速度较快,瘤体较大,向阔韧带内生长,术中易出血,术后应加强随访。     

F-18 fluorodeoxyglucose uptake in leiomyomatous uterus

Leiomyomas of uterus are common disease in gynecology. It is important to differentiate leiomyoma from leiomyosarcoma at the decision of treatment methods, especially in the case of the conservative treatment for uterine leiomyoma. But the exact diagnosis of benign leiomyoma is often difficult due to the degeneration of myoma by imaging modalities including magnetic resonance imaging. Recently, whole-body positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) has been used for a diagnosis of malignant tumors. There is a growing body of evidence for the use of FDG in differentiating malignant from benign disease. But optimal utilization in gynecology remains unclear. Our case represents increased uptake of FDG in myomatous uterus, which is pathologically confirmed benign leiomyoma by the hysterectomy. Immunohistochemical analysis of glucose transporter-1 showed positive in endometrial tissue and negative in leiomyoma. Our case indicates that myomatous uterus in premenopausal women shows the potential pitfall of a positive result of FDG-PET.     

米非司酮配伍与不配伍三苯氧胺治疗子宫肌瘤的临床观察

目的：探讨米非司酮酯伍或不配伍三苯氧胺治疗子宫肌瘤的临床效果。方法：将绝经前有症状的子宫肌瘤患者173例随机分成两组,A组：米非司酮组,88例,每天口服米非司酮25mg;B组,米非司酮配伍三苯氧胺组,85例,每天口服米非司酮25mg,同时口服三苯氧胺10mg,每日两次,从月经周期第一天开始,连服3个月。在治疗前后B超测量子宫体积、肌瘤体积;行子宫内膜病检观察子宫内膜变化;检测雌、孕激素水平,血红蛋白,肝肾功能,观察服药后的副反应。结果：两组患者治疗期间均闭经,子宫内膜及雌孕激素水平维持于增殖早期,血红蛋白上升。两组治疗后子宫体积、最大肌瘤的平均体积缩小。治疗后两组之间差异有显著性（P＜0.01),B组子宫和最大肌瘤的体积缩小较小。两组副反应类似且无需特殊处理。结论：米非司酮配伍或不配伍三苯氧胺治疗子宫肌瘤均有较好的临床效果,米非司酮配伍三苯氧胺是更合理的方法。     

子宫肌瘤红色变性67例临床分析

目的　研究子宫肌瘤红色变性的临床特征及妊娠期与非妊娠期子宫肌瘤红色变性的异同 ,探讨子宫肌瘤红色变性的发生机制。方法　对 1993～ 2 0 0 2年间手术治疗的 2 3 17例子宫肌瘤患者进行回顾性研究 ,并对行子宫肌瘤切除术的患者进行随访。结果　红色变性 67例 ,占同期 2 3 17例子宫肌瘤患者的 2 89% ,子宫肌瘤合并妊娠患者中 2 1 85%发生红色变性 ,而非妊娠期子宫肌瘤患者仅 1 87%发生红色变性 ,二者差异有统计学意义(P <0 0 0 1)。子宫肌瘤红色变性患者最常见症状为月经改变 ,出现在 2 9 85%的患者 ,2 0 90 %的患者有腹痛症状 ,17 91%的患者肌瘤增大较快 ,16 42 %有肌瘤压痛 ,14 93 %的患者白细胞计数升高。B超提示肌瘤个数妊娠组少于非妊娠组患者 ,最大肌瘤妊娠组 61 54%位于浆膜下 ,而非妊娠组 82 92 %位于肌壁间 ,妊娠组最大肌瘤直径明显小于非妊娠组 ,两组分别为 4 0 8cm和 7 2 8cm ,以上差异均有统计学意义 (P <0 0 0 1)。 97 0 1%的患者最大肌瘤发生变性。行肌瘤切除术的子宫肌瘤红色变性患者术后复发率与是否合并妊娠无明显相关 ,而与肌瘤个数有关 (P =0 0 2 4)。结论　妊娠期与非妊娠期子宫肌瘤患者红色变性发生率、肌瘤大小和部位等临床病理特征存在很大差异 ,考虑其红色变性发生机制     

子宫普通平滑肌瘤和富细胞平滑肌瘤超微结构比较

目的：探讨电镜诊断子宫富细胞平滑肌瘤的价值。方法：选择由光镜诊断的普通平滑肌瘤组织标本10例和富细胞平滑肌瘤组织标本11例,分别在电镜下进行组织超微结构的观察。结果：两类平滑肌瘤细胞均表现为胞质丰富;在胞质中充满肌丝、密体、密斑。但富细胞平滑肌瘤的细胞排列紊乱、形态不规则;胞浆内线粒体、高尔基复合体、溶酶体和粗面内质网明显增多;细胞核增大、有异型性;可见核内假包涵体。结论：富细胞平滑肌瘤的超微结构与普通平滑肌瘤有一定差异,表现为代谢功能活跃,一定程度上缺乏分化。     

Diagnosis, imaging and anatomical classification of uterine fibroids

Uterine leiomyomata, commonly referred to as fibroids, are often accompanied by symptoms common to many other pelvic conditions. The correct identification of myomata and the exclusion of other diseases, especially malignancies, are imperative when evaluating therapy options. A confident diagnosis of myomata may be aided by several imaging modalities. The selection of an imaging technique should include an evaluation of both the benefits and the costs associated with the procedure. Imaging can provide information regarding precise myomata location, which may, in turn, dictate treatment options. Myomata may be classified based upon position within the uterus, and may be further described by phase of degeneration. With the increasing popularity of uterine-conserving therapy, accurate diagnosis of myomata becomes even more important.     

A uterine cavity-myoma communication after uterine artery embolization: two case reports

OBJECTIVE: To report two cases of uterine cavity-myoma fistula as a medical complication after uterine artery embolization. DESIGN: Case report. SETTING: Women's Medical Center/Viscomi Institute, Sao Paulo, Brazil. PATIENT(S): Two patients presenting with symptomatic myomatous uterus: a 40-year-old woman with increased abdominal volume and hypermenorrhea, and a 42-year-old woman with pelvic pain and infertility. INTERVENTION(S): Uterine artery embolization, hysteroscopic follow-up, and laparoscopic myomectomy. MAIN OUTCOME MEASURE(S): Hysteroscopic follow-up after uterine artery embolization. RESULT(S): The patients underwent uterine artery embolization. In the months that followed, a subsequent surgical hysteroscopic follow-up was performed to eliminate the necrotic material of the degenerated myomas. The two patients presented the same outcome 1 year after the uterine artery embolization had been performed: a communication between the uterine cavity and a degenerated myoma. Laparoscopic correction of the uterine wall defect was performed afterward. CONCLUSION(S): Because embolization is a growing option for the treatment of leiomyoma, it is important that potential complications be reported, especially if the patients want to become pregnant. The natural history of the fistula and its consequences are unknown, and physicians should be aware of these complications. Hysteroscopic follow-up was important in the diagnosis of the two cases.