Benign "metastasizing" lipoleiomyoma of the uterus.

A 62-year-old woman presented with an enlarged uterus and numerous pulmonary nodules. On histological examination, the multiple uterine and lung tumors were lipoleiomyomas and histologically identical. Tumors in both sites were immunoreactive for estrogen and progesterone receptors and had a low MIB index. Although intrapulmonary emboli from a benign lipoleiomyoma of the uterus cannot be entirely excluded, the theory of synchronous multifocal lipoleiomyomatous proliferation may provide a more satisfactory explanation in this case.     

Uterine bizarre epithelioid lipoleiomyoma with a myxoid stroma

The first case of uterine bizarre epithelioid lipoleiomyoma with a myxoid component occurring in an 86-year-old woman is described. An intramural 22 cm mass in the anterior wall of the uterine body had a lipoma-like appearance with strands of fibrous tissue. Histologically, the tumor consisted of adipocytes which varied in size and shape, and epithelioid smooth muscle cells with nuclear atypia within a myxoid stroma. No mitotic features were noted despite an extensive search. The patient was well without disease 24 months after hysterectomy. Patients with this type of tumor need close and long-term follow-up because of the paucity of clinical information.     

Plexiform lipoleiomyoma of the uterus: first case report

We describe the first report of plexiform lipoleiomyoma with amyloid stroma. A 57-year-old woman underwent an abdominal hysterectomy for methrorragia. The hysterectomy specimen exhibited a soft, rubbery, encapsulated 11 cm ovoid mass with aciniform, white cut surface on the right edge of the uterus. The histology was distinctive and typical of plexiform lipoleiomyoma: long cords, strands and small nests of cells embedded in a collagenous matrix. The neoplastic cells showed eosinophilic cytoplasm, crumpled, bland nuclei. Scattered islands of mature adipocytes were distributed throughout the leiomyomatous proliferation. Immunohistochemistry showed positivity for smooth muscle actin in the plexiform component, and for S100 in the adipocytes. Histogenesis and origin of the cellular neoplastic component are discussed.     

Perivascular epithelioid cell tumor of the uterus: a case report.

A case of perivascular epithelioid cell tumor (PEComa) arising in the subserosa of the uterus of a 32-year old woman is presented. The lesion, removed by local excision, was an unencapsulated rubbery mass 5.0 cm in diameter. The tumor was composed of round to polygonal cells with round nuclei and abundant clear to slightly eosinophilic cytoplasm containing glycogen, and the cells were arranged in short fascicles focally in a perivascular location. There were scattered foci of necrosis and hemorrhage. The tumor cells showed mild atypia and low mitotic activity, and they were strongly immunoreactive for vimentin, h-caldesmon, and HMB45. Ultrastructural examination showed no melanosomes or premelanosomes. The patient had no evidence of disease 8 months postoperatively. Uterine PEComas should be regarded as tumors with an uncertain malignant potential.     

Perivascular epithelioid cell tumor of the uterus: report of four cases.

Uterine perivascular epithelioid cell tumor (PEComa) is very rare, and there have been only 27 reported cases. The differentiation of the tumor has been enigmatic, and the biologic behavior remains unclear. This study describes the clinical, histologic, and immunohistochemical features of four cases of uterine PEComa. The patients were 30, 32, 36, and 40 years old, and none of them had tuberous sclerosis complex. The size of the tumors ranged from 1 to 30 cm in diameter, and 3 of the 4 tumors were confined in the uterus. One tumor involved the left ovary and omentum. Microscopically, the tumors were characterized by an epithelioid arrangement of tumor cells, which had abundant clear to eosinophilic pale granular cytoplasm, and one tumor had moderately atypical nuclei. Coagulative necrosis was found in two cases. The mitotic figures ranged from 0 to 11 per 10 high power fields. Immunohistochemically, the tumors were positive for vimentin (4/4), HMB45 (4/4), h-caldesmon (4/4), alpha-smooth muscle actin (3/4), muscle actin (2/4), and desmin (3/4). They were uniformly negative for Melan A, CD10, and S-100 protein. Ultrastructural examinations were performed on one case and revealed no melanosomes, premelanosomes, or evidence of smooth muscle differentiation. One patient died of intestinal metastases 17 months after surgery. The other patients have been well with no evidence of disease 8, 12, and 36 months after surgery. Uterine PEComa should be regarded as tumors with an uncertain malignant potential until long-term outcome data for a larger number of patients become available.     

Bizarre leiomyoblastoma (epithelioid leiomyosarcoma) of the uterus--a case with a malignant clinical course

A case of a bizarre leiomyoblastoma (epithelioid leiomyosarcoma) which developed in the uterus of a 64-year-old woman and showed a malignant clinical course was reported. Histologically, the tumor in the present case had a number of bizarre giant cells, while the portion showing an epithelioid pattern was minor. Since the existence of an intimate inter-relationship between tumor cells and the smooth muscles of the blood vessel wall was a characteristic finding in the present case, a possible role of vascular smooth muscles as a tumorigenic matrix was suggested. Because of the closure of the internal os of the uterus by the tumor, the uterus had a cystomorphous appearance, and contained about 800ml of intrauterine fluid. The highest number of mitosis observed was 7 per 10 HPF. In view of abundant existence of intranuclear cytoplasmic inclusions, the malignancy of the present case was strongly suspected from a histological diagnostic point of view. The patient died 5 months after surgery because of metastases to the lumbar vertebra and to the lung.     

Huge lipoleiomyoma of the uterine cervix

Introduction  

Vulvar sarcomatoid squamous cell carcinoma has been rarely reported.     

Giant lipoleiomyoma of the uterine corpus

OBJECTIVE: Lipoleiomyoma is a rare and easily recognized, benign uterine fatty tumor, composed of an admixture of mature adipocytes and smooth-muscle cells. They may associate with metabolic disorders and rarely reach giant size. CASE: We report a case of symptomatic giant lipoleiomyoma of the uterine corpus that may be associated with diabetes mellitus and hypothyroidism. CONCLUSION: Lipoleiomyoma must be thought in the differential diagnosis of the giant uterine tumors and should be removed when diagnosed, because malignancy cannot otherwise be excluded. Also the peculiar features of this giant neoplasm, histogenesis, concomitant metabolic disorders and the diagnostic methods are discussed.     

CT and MRI of uterine lipoleiomyoma

Uterine lipoleiomyomas are rare tumors containing variable amounts of fat. Diganostic considerations usually include ovarian fatty tumors and benign and malignant degeneration in ordinary leiomyomas. A case in which a preoperative diagnosis was made using computed tomography (CT) and magnetic resonance imaging (MRI) is presented. The fatty nature of the lesion was demonstrated with CT and standard spin echo MRI and further supported using inversion recovery MRI. MRI also clearly depicted the intrauterine location of the tumor.     

CT and MRI of uterine lipoleiomyoma

Uterine lipoleiomyomas are rare tumors containing variable amounts of fat. Diganostic considerations usually include ovarian fatty tumors and benign and malignant degeneration in ordinary leiomyomas. A case in which a preoperative diagnosis was made using computed tomography (CT) and magnetic resonance imaging (MRI) is presented. The fatty nature of the lesion was demonstrated with CT and standard spin echo MRI and further supported using inversion recovery MRI. MRI also clearly depicted the intrauterine location of the tumor.     

Bizarre leiomyoma of the vagina: report of a case.

Smooth muscle tumors are the most common mesenchymal tumors of the adult vagina, but no case of bizarre (also referred to as atypical, symplastic, or pleomorphic) leiomyoma has been described at this site. We present such a case in a 44-year-old woman.     

Rupture of the uterus.

Sixty-four cases of rupture of the uterus were managed from March 1967 to March 1977. The maternal morbidity was 81.0%, and there were six maternal deaths (9.4%). Fifty-two patients (85.5%) had hysterectomies. The average hospital stay for patients who survived was 15.5 days. The fetal mortality rate was 89%. The etiology, diagnostic evaluation and the mode of prevention are discussed.     

Recurrent perivascular epithelioid cell tumor of the uterus (PEComa): an immunohistochemical study and review of the literature

BACKGROUND: Neoplasms of the perivascular epithelioid cell, first described in 1992, comprise a family of tumors known as "PEComas." To the best of our knowledge, this is the third case of uterine PEComa reported in the literature to behave in a malignant fashion. The purpose of this report is to provide information that may be used to predict the future behavior of this tumor. CASE: The patient was a 79-year-old woman with a large uterine mass which recurred 2 years following resection. The patient died within months after resection of the recurrent tumor. Retrospective immunohistochemical staining with newly commercially available antibodies including MART-1 was done on both the original and the recurrent tumor, confirming the diagnosis of uterine PEComa. CONCLUSION: Uterine PEComas should be regarded as tumors with uncertain malignant potential.     

Bizarre parosteal osteochondromatous proliferation of the phalanx: report of a case.

The bizarre parosteal osteochondromatous proliferation of the hand and foot is a benign lesion which occasionally may mimic osteochondromas, chondrosarcomas or osteosarcomas clinically, radiologically and histopathologically. This rare benign entity should be recognized in order to avoid unwarranted destructive therapy. The authors report a case of this disease and discuss the differential diagnosis and the relevant features of this disease entity. A 27-year-old female patient suffered from a painful swelling at the proximal middle phalanx of the right middle finger for five months. The lesion was excised but the residual lesion developed a distinct parosteal growth by radiologic studies one-and-a-half years later. The patient underwent reexcision of the lesion twice. No recurrence was noted 11 months following the last excision. Histopathologically, the first specimen contained bizarre chondrocytes. The recurrent nodular tumors, submitted in the second and third operations, were composed of cancellous bone with fatty marrow and a few marrow elements, and focally capped by cartilage. The adjacent soft tissue contained proliferating fibrous tissue. The osteochondral junctions in the latter two specimens were irregular. We believe that the documentation of this tumor at different stages of development has helped in the further understanding of this rare entity.     

Transplantation of the human uterus.

Human uterine transplantation was performed on 6 April 2000 on a 26-year-old female who lost her uterus 6 years earlier due to post-partum hemorrhage. The donor, a 46-year-old patient with multiloculated ovarian cysts, underwent a hysterectomy modified to preserve tissue and vascular integrity. The donor uterus was connected in the orthotopic position to the recipient's vaginal vault and additional fixation was achieved by shortening the uterosacral ligament. The uterine arteries and veins were extended using reversed segments of the great saphenous vein, then connected to the external iliac arteries and veins, respectively. Immunosuppression was maintained by oral cyclosporine A (4 mg/kg/body wt.), azathioprine (1 mg/kg/body wt.) and prednisolone (0.2 mg/kg/body wt.). Allograft rejection was monitored by Echo-Doppler studies, magnetic resonance imaging (MRI), and measurement of the CD4/CD8 ratio in peripheral blood by fluorescence activated cell sorter (FACS scan). An episode of acute rejection was treated and controlled on the ninth day with anti-thymocytic globulin (ATG). The transplanted uterus responded well to combined estrogen--progesterone therapy, with endometrial proliferation up to 18 mm. The patient had two episodes of withdrawal bleeding upon cessation of the hormonal therapy. Unfortunately, she developed acute vascular thrombosis 99 days after transplantation, and hysterectomy was necessary. Macro- and microscopic histopathological examination revealed acute thrombosis in the vessels of the uterine body, with resulting infarction. Both fallopian tubes remained viable, however, with no evidence of rejection. The acute vascular occlusion appeared to be caused by inadequate uterine structure support, which led to probable tension, torsion, or kinking of the connected vascular uterine grafts.     

Puerperal inversion of the uterus.

Acute puerperal inversion of the uterus is an uncommon but potentially fatal obstetric complication. In the 15 year period ending December 31, 1974, 11 inversions have been managed at the University of Virginia Hospital. All were recognized immediately and manually replaced and there was no significant postpartum morbidity. Successful management appears to depend largely upon prompt recognition, which can be achieved by routine postpartum examination of the vagina and cervix and manual exploration of the uterus.     

Electricity inside the uterus.

Although electrosurgery has been employed for decades, few surgeons have received formal training in its proper use. The erroneous belief that electrosurgery techniques increase scar formation or impair healing processes led surgeons to use other methods to deliver energy to the living cell. At the cellular level, 1 watt is 1 watt. Knowing how to calculate and administer this amount of energy is the challenge. Laser technology fostered the development of improved electrogenerators and accessories that are easier to understand and control. The use of digital reader boards, displayed in watts rather than an arbitrary dial setting, is one example. A good electrosurgical system, with proper accessory electrodes, costs only 10% of the price of the average laser. For hysteroscopic resectoscopy procedures, a thorough knowledge and appreciation of the physics of electrosurgery is a basic requirement. In the future, I hope the power density and wattage delivered at the electrode tip will be displayed easily for surgeons using the resectoscope. One day, we may have a "laser-electrode" system to meet all our needs.     

Puerperal inversion of the uterus.

Puerperal inversion of the uterus is very rare but dramatic and life-threatening. Prompt treatment is necessary. A case is reported and the literature reviewed.