完全腔镜下与腔镜辅助小切口食管平滑肌瘤切除术的临床疗效比较

目的比较完全腔镜下与腔镜辅助小切口食管平滑肌瘤切除术的临床效果。方法 56例食管平滑肌瘤患者,其中行完全腔镜下食管平滑肌瘤切除术26例,腔镜辅助小切口食管平滑肌瘤切除术30例,全部采用剥离摘除食管平滑肌瘤,操作方法与开胸手术基本相同。比较两组患者的临床治疗效果。结果两组间一般资料、手术效果比较差异均无统计学意义（P均〉0.05）。所有患者术后恢复顺利,无手术死亡及其它严重并发症,术后病理诊断均为食管平滑肌瘤。随访2-36个月,无肿瘤复发及食管憩室。结论两种手术方式均安全、有效,手术效果无差异,但完全腔镜下较腔镜辅助小切口更安全、快捷,且创伤性小。     

食管巨大平滑肌瘤1例

食管巨大平滑肌瘤１例黄伟良患者女，１１岁，５年来常有梗噎伴吞咽困难，吃硬食常需饮水冲服。餐后有饱胀、压迫感，时常进食后呕吐，近１周症状加重伴咳嗽。无呕血、黑便史。体检：颈静脉轻度怒张，胸廓无畸形，右侧呼吸运动减弱伴呼吸音低，右背部叩诊呈浊音。食管餐钡...     

食管淋巴管瘤并食管平滑肌瘤1例

淋巴管瘤是淋巴系统的先天性畸形,实质是淋巴管内皮细胞异常增殖,常为良性肿瘤,多见于儿童,成人罕见。该例发生在成人食管的淋巴管瘤。同时合并食管平滑肌瘤;超声检查：病灶处呈异常回声改变,起源于黏膜肌层;     

良性转移性平滑肌瘤5例临床病理分析

目的探讨良性转移性平滑肌瘤(benign metastasizing leiomyoma, BML)的临床病理学特征、诊断及鉴别诊断。方法回顾性分析5例BML的临床病理特征及免疫表型,并复习相关文献。结果 5例患者均有子宫肌瘤病史,分别出现肺转移、腿部转移、乳腺及腹壁转移。镜下为梭形细胞肿瘤,呈编织状、束状、漩涡状排列,部分富于细胞性,异型性小,未见明显核分裂象及坏死。免疫表型:SMA、h-Caldesmon、desmin、vimentin、ER、PR、WT-1均阳性,S-100、CD117、CD34均阴性,Ki-67增殖指数1%～5%。结论 BML多发于育龄期合并子宫肌瘤手术史的女性患者,具有良性的子宫外生长模式,亦可发生于除肺以外的其他部位,最终诊断应基于组织病理检查。     

超声内镜诊断与内镜下微创治疗食管平滑肌瘤

目的 评价超声内镜对食管平滑肌瘤的诊断及治疗中的价值.探讨内镜黏膜切除术(EMR)、内镜黏膜下剥离术(ESD)治疗食管平滑肌瘤的疗效和安全性.方法 对内镜检查中发现的40例食管黏膜下肿瘤行超声内镜检查,其中30例为起源于黏膜肌层的食管平滑肌瘤,4例为起源于同有肌层的食管平滑肌瘤.对30例起源于黏膜肌层的食管平滑肌瘤,根据病变大小决定行内镜下EMR或ESD治疗,完整切除病变.对4例起源于固有肌层的食管平滑肌瘤,考虑穿孔可能性大,未予内镜下治疗.结果 40例食管黏膜下肿瘤,病变直径0.4～2.5 cm(中位直径1.45 cm).24例行内镜下EMR治疗,6例病变直径超过1.5 cm行内镜下ESD治疗,ESD手术时间15～45 min(中位时间30min).2例术中出血较多.经内镜喷洒止血药物、电凝、氩离子束凝固治疗及金属钛夹钳夹止血,无术后出血,无ESD穿孔.所有EMR或ESD切除病变送检病理确诊,基底和切缘未见病变累及.术后1.5个月及6个月随访,创面愈合,无病变残留和复发.结论 超声内镜能够准确地诊断食管平滑肌瘤并指导其治疗.大多数食管平滑肌瘤的EMR治疗是简便和安全的.对于病灶较大、EMR难以完整切除的病变可行ESD治疗,也是安伞有效的,它可以完整切除食管病变,并提供完整的病理诊断资料.     

食管间质瘤与平滑肌肿瘤对照性研究

目的 探讨食管间质瘤与平滑肌肿瘤临床病理、免疫组织化学及分子生物学特点。方法 24例食管间叶源性肿瘤用CD117、CD34等一组抗体重新进行分类,部分病例同时测定c-kit基因11外显子序列。结果 此组肿瘤分别为间质瘤3例（交界性1例、恶性2例）,年龄71、56、60岁,均为男性,瘤体直径4、8、14cm,源于固有肌层。瘤细胞梭形,上皮样多角形及印戒样,呈交叉束状、栅栏状及弥漫片状排列,免疫表型为CD117、CD34弥漫强阳性。平滑肌瘤20例,年龄30－60岁,平均41.6岁,男性12例,女性8例,15例源于固有肌层,直径0.8-10.5cm（平均4.5cm),5例源于黏膜肌层,直径为0.2-1.0cm(平均0.6cm)。平滑肌肉瘤1例,男性,61例,瘤体直径5cm,源于黏膜肌层。平滑肌（肉）瘤胞质丰富,嗜伊红,交叉束状排列,免疫表型为平滑肌肌动蛋白、肌特异性肌动蛋白、结蛋白弥漫强阳性。恶性间质瘤有c-kit基因11外显子的突变,平滑肌瘤无突变。结论 食管间叶源性肿瘤仍以平滑肌瘤多见,可发生与胃肠道间质瘤相同形态与免疫表型的间质瘤,典型平滑肌肉瘤极为罕见,食管间质瘤与平滑肌瘤具有不同的临床病理学及分子生物学特征。     

子宫平滑肌腺瘤样瘤8例临床病理分析

目的探讨子宫平滑肌腺瘤样瘤(leiomyoadenomatoid tumour of uterine,LATU)的命名、临床病理学特征、诊断及鉴别诊断。方法回顾性分析8例LATU的临床资料、病理学及免疫表型特征,并复习相关文献。结果患者年龄39~52岁,平均45岁。眼观:LATU类似子宫平滑肌瘤,肿瘤直径1.2~6 cm,平均2.5 cm。6例肿瘤界限清楚,2例界限不清,切面灰白色,实性,质均,1例切面可见微囊。镜下见肿瘤性增生的平滑肌组织中混杂有大小形态不一的腺样腔隙,腔隙内衬扁平或立方上皮细胞,大多内衬上皮不明显。免疫表型:腺瘤样瘤细胞表达Calretinin、HBME-1、D2-40,不表达CD31和CD34。平滑肌细胞表达SMA。上皮样细胞和平滑肌细胞Ki-67增殖指数均<1%。术后随访无复发或恶变。结论 LATU是由肿瘤性平滑肌和间皮组织构成的良性混合性肿瘤,其生物学行为呈良性,预后良好。     

食管结核误诊为食管平滑肌瘤1例

食管结核较为罕见,据报道其发病率为0．04％-0．2％,其常见症状为吞咽困难、胸痛,消瘦和发热,部分患者可能存在消化道功能紊乱症状,如烧心、嗳气、恶心、呕吐、返酸、腹部胀痛等,这些临床表现与食管平滑肌瘤比较无特异性,术前诊断较困难,常于术中或术后确诊。本文就我院食管结核误诊为食管平滑肌瘤1例报告如下。     

乳腺平滑肌瘤1例

患者女性,41岁,发现右乳肿物9个月余而就诊于我院.查体:全身状况良好,心、肝、肺均无明显阳性体征.乳腺专科检查:右侧乳晕旁1 cm处可触及一核桃大小肿物,表面皮肤如常,偶伴疼痛,与周围界限尚清,活动度尚可,临床考虑为乳腺纤维腺瘤而行局部病灶楔形切除术,术中冷冻,病理报告为乳腺平滑肌瘤.     

子宫静脉内平滑肌瘤7例临床病理观察

了宫静脉内平滑肌瘤（intravenous leiomyomatosis,IVL）是子宫肌瘤中极为少见的种类,来源于子宫肌瘤或子宵血管壁扩散至静脉,具有转移和浸润生长的特性,可以生长在盆腔静脉和下腔静脉,甚至出现在右侧心脏处。目前国内外对本病多为散在个案报道,我院于1996年6月至2006年3月间收治并经病理检查证实的7例子宫IVL,现结合相关文献对其进行讨论。[第一段]     

Primary leiomyoma of the ovary co-existing with serous cystadenofibroma

A 48-year-old woman with a 14 cm left ovarian mass had total abdominal hysterectomy and bilateral salpingo-oophorectomy. On cut section the tumor had a solid and a cystic component. There was a 2.5 cm nodule attached to the cyst wall. Sections taken from the solid component revealed a tumor composed of interlacing bundles of fusiform cells, resembling a leiomyoma. Smooth muscle actin positivity confirmed the diagnosis. Sections taken from the nodule in the cystic part revealed an adenofibroma. There was an SMA positive area in the cyst wall which we think is the possible origin of the leiomyoma. As far as we know, this is the first case of a co-existing leiomyoma and serous cystadenofibroma in the ovary, and we think it will broaden the histological spectrum of primary ovarian leiomyomas.     

Primary intracranial leiomyoma: a case report and literature review

We report a case of primary intracranial leiomyoma in 29-year-old woman presented with severe headache. The radiology diagnosis was consistent with meningioma. However, histologically, the tumor had the characteristic appearance of benign smooth muscle. This was confirmed by immunohistochemistry and electron microscopy. Benign metastasizing leiomyoma was excluded by thorough imaging. Although rare, leiomyoma should be considered in the differential diagnosis of well-circumscribed intracranial lesion.     

Leiomyomatosis with vascular invasion. A unified pathogenesis regarding leiomyoma with vascular microinvasion,benign metastasizing leiomyoma and intravenous leiomyomatosis

Three uterine leiomyomas with vascular invasion (LWVI), two of which were associated with pulmonary leiomyomatous nodules, and a case of intravenous leiomyomatosis (IVL) invading the vena cava and extending to the right atrium, are described. Despite their histological benignity, these lesions have a strong tendency to metastasize and are closely related to the socalled benign metastasizing leiomyoma (BML). From a clinical point of view, the pulmonary nodules of LWVI are stable or slowly-growing. The IVL was a wormlike tumour that presented as a cardiac mass. On the basis of their histological and immunohistological features, a unified histogenetic view of LWVI, IVL and BML of the uterus is proposed. LWVI and BML may be the same pathological entity and microscopic vascular invasion may represent the metastatic mechanism of BML. Alternatively, LWVI may be the initial stage of IVL. In rare instances, IVL may be associated with distant parenchymal (pulmonary) metastases. LWVI seems to be the precursor of both BML and IVL.This work was supported in part by a grant from the Associazione Italiana per la Ricerca sul Cancro (A.I.R.C.), Milan, Italy     

Calcified leiomyoma of deep soft tissue. Report of a case in childhood

This report illustrates a calcified leiomyoma of deep soft tissue in the left leg of a 6-year-old boy. The tumour was composed of spindle cells arranged in interlacing bundles, between which were multiple small and large areas of calcification. Tumour cells were positive for vimentin, desmin and smooth muscle actin. Ultrastructurally, the cells showed numerous pinocytotic vesicles and bundles of intracytoplasmic filaments with smooth muscle dense bodies. Only four calcified leiomyomas have been previously reported in the deep soft tissues of limbs. Here we report a new case and suggest a new pathogenetic scheme involving alkaline phosphatase in the origin of these calcifications.     

Immunolocalization of VEGF, VEGF receptors, EGF-R and Ki-67 in leiomyoma, cellular leiomyoma and leiomyosarcoma

Angiogenic factors, such as vascular endothelial growth factor (VEGF), its receptors and epidermal growth factor receptor (EGF-R), are involved in increased progression in many carcinomas. The aim of this study was to investigate the role of angiogenesis and immunolocalization of VEGF, its receptors, EGF-R and Ki 67 in leiomyomas and leiomyosarcomas using an indirect immunohistochemical method. Samples from patients with leiomyoma, cellular leiomyoma and cellular leiomyosarcoma (n=20 per group) were fixed in 10% formalin and processed using routine paraffin protocols. Following initial histological analysis, samples were immunostained with primary antibodies for VEGF, VEGFR-1, VEGFR-2, EGF-R and Ki-67 using an indirect avidin-biotin peroxidase method. Immunostaining intensities were evaluated as mild, moderate or strong and a semi-quantitative method (H-Score) was used to compare the samples. While mild/moderate EGF-R immunostaining and moderate immunostaining for VEGF and its receptors were observed in samples of leiomyomas, much less immunoreactivity was observed in cellular leiomyomas. All immunoreactivities and immune-stained cells increased in leiomyosarcomas. When scores of intensity and percentage of positive staining cells were compared, all immunoreactivities were shown to be significantly increased in leiomyosarcomas compared to leiomyomas.These results suggest that in leiomyosarcoma, angiogenic factors, such as VEGF, its receptors and EGF-R, may be involved in tumor angiogenesis. Active tumor cells can trigger angiogenesis, interaction with surrounding tissue and in the tissue itself initiating angiogenic activity. Angiogenic growth factors play an important role and induce malignant transformation through both autocrine and paracrine mechanisms. Anti-angiogenic agents may provide a novel therapeutic approach for the treatment of leiomyosarcoma.     

Unusual leiomyoma of the vulva with fibroma-like pattern and pseudoelastin production

Summary A unique case of a 71-year old woman with an unusual fibromalike leiomyoma of the vulva in the region of the left Bartholin's gland is reported. Light microscopically the tumor resembled a fibroma, but electron microscopically the cells corresponded to modified smooth muscle cells. The great number of vessels and their intimate relation to the tumor cells is remarkable. In the intercellular space granular and fibrillar pseudoelastic material was found and thus the presence of collagen type III in addition to type I is suggested. In the region of the right Bartholin's gland a mesenchymal proliferation with similar histological features was seen but there was more resemblance to a conventional leiomyoma. The histogenesis remains obscure so that the designation of these lesions should include light microscopic and electron microscopic appearances as well as the localization.     

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.