Cotyledonoid leiomyoma of uterus: a case report

The diagnosis of uterine smooth muscle tumors is usually not difficult. Occasionally, benign tumors with an unusual growth pattern may cause some diagnostic confusion for pathologists who had not experienced such a tumor before. A fifty-one year old female patient had admitted to our gynecology outpatient clinics with abnormal uterine bleeding (menorrhagia) and undergone a surgery with a diagnosis of pelvic mass. A neoplasm consisting of spindle cell nodules with prominent hydropic degeneration was observed at pathological examination. Tumor cells were positive for vimentin, desmin and smooth muscle actin at immunohistochemical evaluation. Cotyledonoid leiomyomas are rare benign smooth muscle tumors of uterus which are recently defined in the literature. In this article we report a case of cotyledonoid leiomyoma of uterus with an exophytic growth pattern in the serosa and did not contain an intramural dissecting component.     

Pure lipoma of the uterus: a rare case report

Pure fatty tumors of the uterus are exceedingly rare. The more common lipomatous tumor is lipoleiomyoma with varying amounts of two components. Most are post-operative chance findings following hysterectomy for leiomyoma. Computed Tomography and Magnetic Resonance Imaging can assist in pre-operative diagnosis. A 60 year old post-menopausal woman presented with a mass per abdomen. Ultrasound revealed fibroid uterus with lipomatous areas. The hysterectomy specimen showed a pure intramural lipoma of the uterus. As clinical symptoms and signs of uterine lipoma are indistinguishable from uterine leiomyoma, various imaging techniques can aid in pre-operative diagnosis. The diagnosis of pure lipoma of the uterus should only be made when any smooth muscle if present is confined to the periphery of the tumor.     

三角形子宫底1例

子宫常见的变异有单角子宫、双角单颈子宫、双角双颈子宫、双子宫、中隔子宫、弓形子宫等等。而呈菱形的子宫很少见，笔者在解剖一具成年女性尸体标本（身高158cm）时，发现其子宫的形态异常，子宫的形态不是常见倒置的梨形，而整个子宫呈菱形，子宫底呈三角形，通过观察子宫颈口，判断是未产妇。现报道如下：     

Perivascular epithelioid cell tumor of the uterus: a case report

A case of a perivascular epithelioid cell tumor (PEComa) arising in the uterus of a 35-year-old woman is presented. Imaging studies revealed a 5 cm well circumscribed mass in the uterine fundus. The tumor was composed of clear to faintly eosinophilic, epithelioid and spindled cells. Immunohistochemically, most tumour cells were strongly positive for HMB-45, smooth muscle actin and desmine, but negative for epithelial markers, S-100 Protein and neuroendocrine markers. Reevaluation of the patient for signs of tuberous sclerosis complex after the diagnosis gave negative results. At the most recent follow-up 4 months later there was no evidence of recurrence.     

Tumor-like manifestation of endosalpingiosis in uterus: a case report

We report on a 50-year-old female patient affected by breast cancer and a tumorous lesion located in the subserosal and intramural part of the uterine fundus. It consisted of glandular and cystic forms lined with epithelium of the tubal type. We describe the clinical, macroscopic, and histological features of this rare non-neoplastic lesion, classified as florid endosalpingiosis (ES) and belonging to the spectrum of Müllerian lesions. The discussion focuses on its morphological characteristics, the differential diagnosis, and the potential reasons leading to its origin. To the best of our knowledge, this is the fifth case of florid ES of uterus reported in the English literature.     

Diffuse leiomyomatosis of the uterus: a case report with clonality analysis

Diffuse uterine leiomyomatosis is a rare condition distinguished from the common uterine leiomyomata by involvement of the entire myometrium by innumerable, ill-defined, often small and confluent, histologically benign smooth-muscle nodules. Fourteen cases have been previously described in the literature. We report a case of diffuse leiomyomatosis in a 39-year-old woman. Several microscopic foci of the process were microdissected for clonality analysis. All samples showed a non-random X-chromosome inactivation pattern, and thus were consistent with a monoclonal neoplastic population of cells. However, in different foci of tumor, different X chromosomes were inactivated, supporting the independent origin of neoplastic clones and rejecting the possibility of a single clonal origin of all tumor cells. The results of the molecular analysis suggest that diffuse uterine leiomyomatosis may be an exuberant example of diffuse and uniform involvement of the entire myometrium by multiple leiomyomata. HUM PATHOL 31:1429-1432.     

Leiomyoma of the uterus showing skeletal muscle differentiation: a case report

A case of uterine leiomyoma with skeletal muscle differentiation is described. The patient is a 40-year-old woman who underwent abdominal hysterectomy and left salpingo-oophorectomy for fibroids. Evidence of skeletal muscle differentiation was evident at light and electron microscopy in one out of three "ordinary" leiomyomas. This was also shown by positive immunoreactions with antiskeletal muscle actin and myoglobin antisera. To our knowledge, this is the second case reported of the occurrence of skeletal muscle differentiation within a uterine leiomyoma and highlights the divergent differentiating potential of smooth muscle cells.     

子宫绒毛叶状水泡状静脉内平滑肌瘤病一例

患者女,37岁。体检发现盆腔肿块2d,于2006年2月6日入院。体检:子宫如孕2个月大小,形态规则,表面光整。盆腔左侧6cm×5cm大小肿物,质中,活动度欠佳,与子宫分界欠清。超声检查:子宫前位、偏大,宫后壁肌层增厚,回声不均匀,内膜线前移。左附件区见一53mm×47mm×35mm大小的混合性回声团块,正常左卵巢未显示,右侧卵巢未见超声异常,考虑左侧卵巢畸胎瘤、子宫腺肌症可能。拟施腹腔镜下卵巢瘤剥除术。术中镜下见子宫增大如孕2个月,子宫左后壁见一约5cm×5cm大小囊性结节状肿块,两侧附件正常,无腹水,实施腹腔镜辅助下阴式全子宫切除术。临床初步诊断…     

Intravenous lipoleiomyomatosis of uterus with cardiac extension: a case report

A case of intravenous leiomyomatosis (IVL) with histological features of a lipoleiomyoma (intravenous lipoleiomyoma) in a 48-year-old woman is reported. The patient, with the tumor located in the uterus and extended up on the right side of the heart through the inferior vena cava, was diagnosed as having a cardiac mass. She displayed symptoms of dyspnea, chest pain due to the cardiac mass, as well as pelvic pain and dysmenorrhea. She underwent cardiac surgery because of a right atrial mass, and the histopathological diagnosis was leiomyoma without the knowledge of a uterine mass. Afterwards, a right adnexial mass was detected in the pelvis, and a total hysterectomy-bilateral salpingo-oophorectomy was performed for the adnexial mass, which was also diagnosed as leiomyoma. In this case report, we describe an intravenous lipoleiomyomatosis of the uterus which, at the initial clinical presentation, showed cardiovascular symptoms. We emphasize the histopathological features and the differential diagnosis of this rare tumor in the light of the literature.     

Endometrial stromal sarcoma with endometrioid adenocarcinoma of the uterus: a case report

Endometrial stromal sarcoma (ESS) is a rare malignant neoplasm of the uterus. We report the first case of undifferentiated ESS (UES) coexistent with grade 1 endometrioid adenocarcinoma in a 73-year-old female who presented with irregular vaginal bleeding for 4 days after menopause 20 years. Imaging examination including Magnetic Resonance Imaging (MRI) demonstrated multi-node reflection in uterine cavity without metastatic lesions, and the endometrium essentially normal. Grossly, a grey-red breakable polypoid tumor of 4.5 × 3.0 ×2.0 cm was recognized in the posterior uterine wall with surrounding slight rough endometrium. Microscopically, the tumor was composed of a larger component of undifferentiated stromal sarcoma that was distinct from a smaller endometrioid adenocarcinoma. The separate components of the tumor could be supported in immunohistochemical studies. There was no sign of recurrence for postoperative 6 months.     

Primary osteosarcoma of the uterus: report of a case with immunohistochemical study.

A 63-yr-old female presented with uncontrollable uterine bleeding. Pathological evaluation revealed a uterine mesenchymal neoplasm which histologically represented a primary osteosarcoma. Immunohistochemistry was utilized to help support the diagnosis. The English literature regarding this rare uterine neoplasm is briefly reviewed.     

Cotyledonoid dissecting leiomyoma of the uterus: a case report and review of the literature

"Cotyledonoid dissecting leiomyoma" or "Sternberg tumor" is a very rare variant of smooth muscle tumors with a distinctive gross appearance. We describe a similar lesion, probably the sixth reported case, comparing its clinicopathological features with those of previous cases. A 26-yr-old nulliparous woman underwent laparotomy for a large pelvic mass replacing the postero-lateral aspect of the uterus with extension into the left pelvic cavity in the form of numerous exophytic congested small nodules. The tumor was removed by resection without hysterectomy after frozen section examination. Histologically, there were variable sized micronodules of benign smooth muscle fascicles, which were separated by fibrous connective tissue with a marked hydropic change and rich vascularity. Immunohistochemical and ultrastructural studies were helpful for confirmation of the smooth muscle nature, but not useful for the definitive diagnosis. Due to bizarre, sarcoma-like gross appearances, this type of lesion should be subjected to frozen section examination in order to avoid overtreatment and preserve the fertility in young women.     

Myxoid leiomyosarcoma of the uterus: a case report and review of the literature.

A case report of myxoid leiomyosarcoma of the uterus in a 54-year-old woman is presented as a rare variant of uterine sarcoma. Only 14 cases have been described in the literature. These tumors have a striking myxoid appearance and exhibit highly malignant behavior despite their low mitotic index. Although it is difficult to establish the nature of the neoplastic cells in the myxoid areas, both light microscopical and immunohistochemical characteristics showed features of smooth muscle cells in some of the cellular areas. Our patient had a tumor which arose in association with hyalinized benign leiomyomatous lesion. Like other reported cases of myxoid leiomyosarcoma, the tumor behaved aggressively.     

子宫平滑肌肉瘤伴淋巴结及卵巢转移一例

患者女,55岁.绝经3年,主因发现子宫肌瘤11年,腹胀2年,无阴道不规则出血及排液于2009年6月15日以"盆腹腔巨大肿物性质待查"收住院.患者1998年体检B超提示子宫肌瘤,单发0.8 cm.服中药定期复查无增大.2007年无诱因出现腹胀,并进行性加重,无腹痛.复查B超子宫7.6 cm×15.0 cm×11.0 cm,可见多个低回声团.双附件未见异常回声.本次入院妇科彩超:子宫前位,4.3 cm×3.9 cm×3.0 cm,表面不平,回声不均,宫底部外突充满盆、腹腔囊实性肿物,范围30.0 cm×30.0 cm×19.5 cm.     

子宫肌瘤合并升结肠游离及阑尾炎1例

患者,女性,50岁,主因下腹痛1周,检查发现子宫肌瘤于2006-03-31入院。1周前因下腹痛在社区卫生院予输液抗炎治疗稍有好转,来我院复查,做彩超示:子宫切面内径约7.5cm×5.1cm,形态失常,轮廓线不规则,体积稍大,回声不均匀,后壁可见一大小约3.5cm×4cm肿块图像,形态呈圆形,边缘清楚,内部为低回声,分布不均质,后方回声无变化,子宫内膜线居中。宫内可见节育器回声,位置正常。提示:子宫肌瘤,宫内节育器。妇科检查:已婚经产外阴,阴道畅,宫颈光滑,子宫水平位,略大于正常,子宫左前方可触及一大小约3cm×4cm大小包块,质硬,活动欠佳,压痛,与子宫关系密切,…