Pancreatic and gastric metastases of leiomyosarcoma arising in the left leg

Pancreatic or gastric metastases from other primary malignancies are rare, especially from leiomyosarcoma. We report a case of leiomyosarcoma in the left lower leg with metastases to the pancreas and stomach. A 61-year-old man had liver cirrhosis caused by hepatitis C virus infection and was followed up by his primary physician. Two years before presentation at our hospital, he had undergone surgical resection of leiomyosarcoma in the left lower leg and systemic chemotherapy for multiple metastatic tumors in the lung. On admission, endoscopic examination and computed tomography were performed for a routine checkup to exclude esophageal varices and liver tumor. Although the patient had no specific symptoms, multiple gastric and pancreatic metastases were identified by endoscopy and computed tomography, respectively. In general, metastases to the pancreas and stomach are rare. We discuss the clinical and diagnostic findings of pancreatic and gastric metastases by reviewing previously reported cases.     

Leiomyosarcoma of the inferior vena cava: Angiographic and computed tomography findings

Leiomyosarcoma, a highly malignant tumor of the inferior vena cava, is rare. Only 55 cases have been reported in the world literature, and of these only 18 were evaluated with a special vascular procedure, either arteriography or inferior vena cavography. In two cases of leiomyosarcoma of the inferior vena cava, we performed arteriography and inferior vena cavography. In one, computed tomographic studies were also carried out. Cavography showed a lobulated filling defect in one case and complete caval occlusion with collateral circulation in the other. In the one case in which it was performed, computed tomography clearly demonstrated the tumor's size and its relationship to surrounding organs. Arteriographic studies, however, allowed only an indistinct delineation of the extent of tumor growth in one case. Venography followed by computed tomography should permit adequate assessment of most leiomyosarcomas of the inferior vena cava, with arteriography reserved for tumors involving the upper cava in which hepatic involvement must be evaluated.     

Perforated Leiomyosarcoma of Meckel's Diverticulum: Report of a Case

We report herein a case of leiomyosarcoma of Meckel's diverticulum which presented as a rare manifestation of perforation. A previously healthy 63-year-old man was referred to the Tetsujinkai Eniwa hospital following the sudden development of acute abdominal pain. Abdominal computed tomography revealed a solid mass in the pelvic cavity, and an emergency operation was performed under a provisional diagnosis of peritonitis associated with a pelvic tumor. A perforated tumoral mass was found in Meckel's diverticulum. Segmental resection of the ileum, including the tumor-bearing diverticulum, was performed along with regional lymph node dissection. Histologic examination revealed the lesion to be leiomyosarcoma. Received: August 6, 1999 / Accepted: September 26, 2000     

皮肤平滑肌肉瘤组织学类型及来源——附7例临床病理及免疫组化研究

目的探讨皮肤平滑肌肉瘤的病理类型，组织来源和预后。方法集7例皮肤平滑肌肉瘤进行临床，组织病理和免疫组化分析。结果①皮肤平滑肌肉瘤有结节性和弥漫性两种生长方式。组织学上结节性高度异型，弥漫型异型小。②免疫组化：7例肿瘤均表达Vimentin，SMA，HHF－35；4例表达S-1000p；1例Cytokeratin异型表达。肿瘤局部复发率57．1％，多次复发后组织学异型性增大，1例弥漫性肿瘤发生远处转移，1年后死亡。结论皮肤平滑肌肉瘤可分为坚毛肌和非竖毛肌来源，形态学上相应地表现为弥漫性和结节性两种不同的生长方式。弥漫性瘤细胞异型小，与皮肤附件关系密切，复发率高，个别多次复发可去分化。结节性组织学高度异型。本组远处转移率为14．5％。     

胃平滑肌肿瘤的诊断和外科治疗

目的 探讨胃平滑肌肿瘤的诊断及治疗方法。方法 对34例经手术治疗的胃平滑肌肿瘤的临床资料进行回顾性分析。结果 胃平滑肌肉瘤肿块较大，本组中最大直径≥5cm者占68％，≥10cm者占50％；胃平滑肌肉瘤大多位于胃底体区，占94％；胃平滑肌肉瘤有三大临床表现：上腹痛、上腹包块、出血。胃镜、钡剂X线透视、CT有助于诊断。随访结果：本组3、5、10年生存率分别是87％、52％及26％。结论 对胃平滑肌肉瘤应积极考虑手术治疗。根据肿块大小、部位和浸润程度决定手术方式。     

原发性小肠肿瘤112例临床分析

目的：探讨原发性小肠肿瘤的临床特点以及诊断方法。方法 回顾性分析了112例原发性小肠肿瘤的临床资料，病理特点及术前诊断方法。结果：小肠肿瘤多位于十二指肠，占62．5％（70／112），良性肿瘤以平滑肌瘤为主，多位于回肠，空肠，恶性肿瘤以腺癌最常见，其次为恶性淋巴瘤，平滑肌肉瘤。首选的检查方法为X线钡餐，尤其是低张小肠灌肠造影，内镜检查可提高十二指肠肿瘤的诊断率，对诊断困难的消化道出血可行选择性肠系膜上动脉造影，CT对判断肿瘤的良恶性，术前分期及术后有无复发有独特的意义。结论：十二指肠腺癌是最常见的原发性小肠肿瘤，其次为恶性淋巴瘤，平滑肌瘤及平滑肌肉瘤。低张小肠灌肠造影是诊断和定位最为有效的方法，CT，内镜及肠系膜上动脉造影有助于诊断。     

Rapidly growing esophageal leiomyosarcoma: case report and review of the literature

We evaluated a 72-year-old woman who was experiencing dysphagia. Esophageal leiomyosarcoma was diagnosed by barium meal study, upper gastrointestinal endoscopy, endoscopic ultrasonography (EUS), by computed tomography (CT). A barium meal study and esophagoscopy performed 3 months before the diagnosis of esophageal leiomyosarcoma showed no abnormalities. Therefore, the tumor appeared to have grown rapidly during the 3-month period.     

子宫平滑肌肉瘤中血管生成拟态现象及MMP-2蛋白的表达

目的 探讨血管生成拟态现象(vasculogenic mimicry VM)及MMP-2蛋白对子宫平滑肌肉瘤发生发展的影响.方法 应用免疫组化Elivision法及双染法分别检测35例子宫平滑肌肉瘤、20例子宫平滑肌瘤及20例正常子宫肌壁中VM及MMP-2蛋白的表达情况.结果 VM在予宫平滑肌肉瘤与正常子宫、子宫平滑肌瘤之间差别有显著统计学意义(P＜0.01).MMP-2在子宫平滑肌肉瘤与正常子宫、子宫平滑肌瘤之间差别均有显著统计学意义(P＜0.01).VM在子宫平滑肌肉瘤中与患者的年龄和肿瘤的大小相关(P＜0.05).MMP-2与患者的年龄、肿瘤的大小及核分裂的多少均无关.子宫平滑肌肉瘤中VM和MMP-2蛋白的表达没有相关性(P＞0.05).结论 VM和MMP-2蛋白在子宫平滑肌肉瘤的发生发展中可能起到了一定的作用.     

Comparative clinicopathologic and immunohistochemical analysis of uterine sarcomas diagnosed using the World Health Organization classification system

Uterine sarcomas are rare tumors that account for 3% to 7% of uterine cancers. Their histopathologic classification was revised by the World Health Organization (WHO) in 2003. The objectives of this study were to determine the frequency of different subtypes of uterine sarcoma applying the WHO criteria to a series of cases, compare the outcome of patients with different subtypes, and compare their immunoprofiles using a panel of immunomarkers. Thirty-four uterine sarcomas were identified for a 20-year period (1988-2008). Eighteen benign tumors of smooth muscle or endometrial stromal origin served as a comparison group. A tissue microarray was prepared and immunostaining performed for 10 selected oncoproteins involved in cell proliferation (Ki-67, P53, p16, and phosphatase and tensin homolog [PTEN]), cell differentiation (CD10, h-caldesmon, estrogen receptor, and progesterone receptor), and apoptosis (bcl-2 and Twist). Hierarchical clustering analysis of the immunohistochemical results was performed. The uterine sarcomas were classified as follows: 20 leiomyosarcomas, 9 endometrial stromal sarcomas, and 5 undifferentiated endometrial sarcomas. The outcome for patients with uterine sarcoma was poor, irrespective of histologic type, even for those with stage I tumors. Of the patients with follow-up available, 12 (67%) of 18 with leiomyosarcoma, 4 of 5 with undifferentiated sarcoma, and 4 of 7 with endometrial stromal sarcoma experienced recurrence and 8 patients with high-grade sarcomas died of tumor. In our series, most uterine sarcomas were leiomyosarcomas. Comparison was made between leiomyosarcomas that recurred and those with a favorable outcome and 3 patients with leiomyosarcoma without evidence of recurrence on long-term follow-up had tumors that were negative/low expressors of Ki-67, p53, p16, and Twist, with strong expression of bcl-2. A subset of undifferentiated endometrial sarcomas composed of cells with uniform nuclei may be a separate entity from those with nuclear anaplasia and may be related to low-grade endometrial stromal sarcomas. It may be possible to identify a subset of leiomyosarcomas with a favorable prognosis based on staining with a panel of immunomarkers for cell proliferation and apoptosis.