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Restaino S, Graziano A, Ronsini C, Paparcura F, Bagolin M, Cinti MC, Castenetto A, Titone F, Rensi M, Driul L, Vizzielli G. A case report of uterine leiomyosarcoma: unusual clinical presentation with unilateral hydronephrosis and importance of an appropriate diagnosis. Minerva Obstet Gynecol 2024; 76:200-204. [PMID: 38624194 DOI: 10.23736/s2724-606x.22.05131-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Uterine leiomyosarcoma is a rare malignant gynecologic tumor that arises from the myometrial or endometrial stromal precursor cells. This tumor has the highest prevalence in the pre- and post-is more frequent between 40 and 60 years old. It has a very unfavorable prognosis: only early-stage tumors have an acceptable prognosis; unfortunately, it is often diagnosed accidentally, typically on an advanced stage, when hematological metastases have already spread. Surgery is the main treatment strategy, while systemic treatment and radiotherapy are not recommended due to the lack of results. Since metastatization is mainly hematological, lymphadenectomy is not recommended. Recent progresses have been achieved in advanced and recurrent disease, often inoperable, thanks to new chemotherapies, target therapies and immunotherapies. We reported the case of a 51-year-old woman evaluated for lumbar pain in the right region compatible with renal colic. The ultrasound evaluation revealed right hydronephrosis and the presence of a paraovarian or intraligamentary mass compatible with fibroma. The abdominal CT confirmed the presence of a mass with heterogeneous vascularization. Therefore, the patient underwent laparoscopic surgery to remove the lesion which resulted to be a leiomyosarcoma G2. During the following week the patient underwent a laparoscopic hysterectomy. The first step for differential diagnosis consists in the evaluation of clinicopathological features, followed by the analysis of preoperative imaging. Pelvic MRI represents the gold standard, while CT is used to detect metastases. The main issue is that imaging shows limited ability in differential diagnosis between benign and malign smooth muscle tumor. The definitive diagnosis is confirmed by histological analysis; this implies the necessity of improved attentions on the surgical procedure, which is often performed by steps with prolongation of the treatment pathway. To distinguish which fibroids presents a major risk to be misdiagnosed, some risk scores were developed (rPRESS in 2014 and pLMS in 2019), though actually they are not applied in clinical practice. Uterine leiomyosarcoma (uLMS) is rare but causes several deaths in perimenopausal women due to lack of effective treatments, although target therapies represent a future hope. Furthermore, clinical practice needs support through the development and improvement of diagnostic risk scores and their integration into guidelines.
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Affiliation(s)
- Stefano Restaino
- Department of Obstetrics and Gynecology, S.M. della Misericordia University Hospital, University of Udine, Udine, Italy
| | - Annalisa Graziano
- Department of Obstetrics and Gynecology, S.M. della Misericordia University Hospital, University of Udine, Udine, Italy
| | - Carlo Ronsini
- Department of Women, Children and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Federico Paparcura
- Department of Obstetrics and Gynecology, S.M. della Misericordia University Hospital, University of Udine, Udine, Italy
| | | | - Marianna C Cinti
- Faculty of Medicine and Surgery, University of Udine, Udine, Italy
| | | | - Francesca Titone
- Department of Oncological Radiotherapy, S.M. della Misericordia University Hospital, University of Udine, Udine, Italy
| | - Marco Rensi
- Department of Nuclear Medicine, S.M. della Misericordia University Hospital, University of Udine, Udine, Italy
| | - Lorenza Driul
- Department of Obstetrics and Gynecology, S.M. della Misericordia University Hospital, University of Udine, Udine, Italy -
| | - Giuseppe Vizzielli
- Department of Obstetrics and Gynecology, S.M. della Misericordia University Hospital, University of Udine, Udine, Italy
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Roslly MZ, Omar N, Naim MS. Primary Axillary Vein Leiomyosarcoma in Li-Fraumeni Syndrome. Radiol Imaging Cancer 2024; 6:e230184. [PMID: 38276907 PMCID: PMC10825712 DOI: 10.1148/rycan.230184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Mohd Zulkimi Roslly
- From the Department of Radiology, Faculty of Medicine and Health
Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai, 71800 Nilai,
Negeri Sembilan, Malaysia (M.Z.R.); Department of Pathology, Hospital Serdang,
Kajang, Selangor, Malaysia (N.O.); and Department of Radiology, Hospital Ampang,
Ampang, Selangor, Malaysia (M.S.N.)
| | - Noorjehan Omar
- From the Department of Radiology, Faculty of Medicine and Health
Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai, 71800 Nilai,
Negeri Sembilan, Malaysia (M.Z.R.); Department of Pathology, Hospital Serdang,
Kajang, Selangor, Malaysia (N.O.); and Department of Radiology, Hospital Ampang,
Ampang, Selangor, Malaysia (M.S.N.)
| | - Mohd Syafiq Naim
- From the Department of Radiology, Faculty of Medicine and Health
Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai, 71800 Nilai,
Negeri Sembilan, Malaysia (M.Z.R.); Department of Pathology, Hospital Serdang,
Kajang, Selangor, Malaysia (N.O.); and Department of Radiology, Hospital Ampang,
Ampang, Selangor, Malaysia (M.S.N.)
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3
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Kawakita H, Ono Y, Watanabe T, Sugiyama Y, Kato F, Katsumata K, Nagakawa Y. [A Patient with Small Intestinal Leiomyosarcoma and Intussusception Who Underwent Single Port Surgery]. Gan To Kagaku Ryoho 2023; 50:1638-1640. [PMID: 38303367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The patient was a 33-year-old female. She was referred to our hospital from a previous clinic with abdominal pain and vomiting. Contrast-enhanced abdominal CT revealed intussusception, leading to a diagnosis of intussusception with a small intestinal tumor as an advanced part. Intestinal obstruction symptoms were observed, and emergency surgery was performed on the same day. As a technique, single port surgery was selected, and laparoscopic reduction was attempted. However, it was ineffective. The site of intussusception was induced outside the body through a small laparotomy wound, and reduction was performed using Hutchinson's procedure. As an adjacent lymph node was markedly swollen, the mesentery involving this lymph node was dissected in a fan shape, and the tumor was extirpated. The tumor measured 40 mm in long diameter, being a hemicircular, protruding lesion. Histologically, disarray of short spindle tumor cells was observed. Immunostaining showed Kit- and DOG1-negtive reactions and partially α-SMA and desmin-positive reactions, suggesting leiomyosarcoma. With the establishment of an immunostaining-test-based classification, leiomyosarcoma is currently rare. In this study, we report a patient in whom single port surgery for intussusception related to small intestinal leiomyosarcoma was successful.
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Affiliation(s)
- Hideaki Kawakita
- Dept. of Gastrointestinal and General Surgery, Kohsei Chuo General Hospital
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Kojima T, Shuto T, Hongo N, Miyamoto S. Leiomyosarcoma Presenting as Rupture With a Type II Endoleak After Thoracic Endovascular Aortic Repair. Vasc Endovascular Surg 2023; 57:937-940. [PMID: 37306014 DOI: 10.1177/15385744231174058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Endovascular stent-graft therapy is a commonly performed procedure for aortic lesions worldwide and complications unique to stent grafts, such as postoperative endoleaks, are well known. However, as this treatment modality becomes more popular, physicians should carefully monitor for other unexpected complications, which may not always be related to the graft. This study presents a case of leiomyosarcoma of the aorta that developed during follow-up for a type II endoleak (T2EL) after thoracic endovascular aortic repair. The presence of the T2EL hindered the diagnosis of the sarcoma at an early stage. These findings suggest that an apparent aneurysm that grows suddenly during follow-up after stent grafting should raise the index of suspicion for a neoplasm as well as an endoleak.
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Affiliation(s)
- Takenori Kojima
- Department of Cardiovascular Surgery, Oita University Hospital, Japan
| | - Takashi Shuto
- Department of Cardiovascular Surgery, Oita University Hospital, Japan
| | - Norio Hongo
- Department of Radiology, Oita University Hospital, Japan
| | - Shinji Miyamoto
- Department of Cardiovascular Surgery, Oita University Hospital, Japan
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Akbaş ZŞ, Oto BB, Gönen B, Ülgen ÖA, Sarıcı AM. Conjunctival leiomyosarcoma in a patient with xeroderma pigmentosum: 5-year follow-up without recurrence. Arq Bras Oftalmol 2022; 87:0301. [PMID: 35857981 DOI: 10.5935/0004-2749.2021-0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/13/2021] [Indexed: 12/18/2023] Open
Abstract
Conjunctival leiomyosarcoma is a very rare soft tissue malignancy. Herein, we describe a conjunctival leiomyosarcoma case in a patient with another rare disease, xeroderma pigmentosum. The 27-year-old single-eyed xeroderma pigmentosum patient complained of exophytic mass covering the ocular surface in her left eye. A vascular, hemorrhagic mass covering the entire ocular surface of the left eye was identified on the examination. Thus, total mass excision surgery was performed. The pathological diagnosis was compatible with conjunctival leiomyosarcoma. Additional chemotherapy, radiotherapy, or surgery were not accepted by the patient. No recurrence or metastasis was observed during the 5-year follow-up. Both primary conjunctival leiomyosarcoma and xeroderma pigmentosum are very rare diseases. Conjunctival masses in xeroderma pigmentosum patients should be approached carefully, and histopathological examination is warranted. For conjunctival leiomyosarcoma, early diagnosis, localized, unspread disease, and complete resection provide the best prognosis.
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Affiliation(s)
- Zeynep Şerikoğlu Akbaş
- Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpaşa, Istanbul, Turkey
| | - Bilge Batu Oto
- Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpaşa, Istanbul, Turkey
| | - Busenur Gönen
- Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpaşa, Istanbul, Turkey
| | - Övgü Aydın Ülgen
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Murat Sarıcı
- Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpaşa, Istanbul, Turkey
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Mantas D, Garmpis N, Polychroni D, Garmpi A, Damaskos C, Liakea A, Sypsa G, Kouskos E. Retroperitoneal sarcomas: from diagnosis to treatment. Case series and review of the literature. G Chir 2020; 41:18-33. [PMID: 32038009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Retroperitoneal sarcoma is a rare malignancy arising from mesenchymal cells, most commonly presented as an abdominal mass and is associated with poor prognosis. The most effective treatment modality for retroperitoneal sarcomas is complete surgical resection, including sometimes adjacent organs infiltrated by the tumor. Radiotherapy is frequently applied and has shown some benefit, while the role of chemotherapy and molecular-targeted agents is still not clear. Local recurrence is common for retroperitoneal sarcomas and still remains the main cause of death. The major factors associated with the overall survival are tumor grade, histological subtype, complete macroscopic excision and multifocality. AIM To report our experience via the presentation of patients with retroperitoneal sarcomas managed in our department during the period 2014-18; and to review the current literature. PATIENTS AND METHODS Eight patients appeared with chronic non-specific complaints including abdominal distension and changes in bowel or bladder habit, while one patient presented with acute abdominal pain due to mass rupture. All of the patients underwent surgical resection of the tumor. RESULTS Among the patients, seven were operated for primary disease and one only for recurrent. The most common histologic type was liposarcoma (well-differentiated, dedifferentiated), found in five patients; followed by leiomyosarcoma found in two cases. Fibrous histiocytoma was found in only one case. The masses were removed with macroscopically clear margins (R0 and R1 resections) in four cases. In five patient cases adjuvant therapy was required. Three patients are still alive and free of disease. CONCLUSIONS Retroperitoneal sarcomas present to be a therapeutic challenge based on their location, their extent at the time of diagnosis and the high risk of local recurrence or distant metastasis. Their management requires a multidisciplinary approach, with the surgical resection remaining the mainstay of curative treatment, combined with surveillance for early detection of recurrence or metastases.
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Sakaguchi K, Wakamatsu N. Pathology in Practice. J Am Vet Med Assoc 2018; 253:567-569. [PMID: 30110209 DOI: 10.2460/javma.253.5.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Pulmonary embolism (PE) is usually caused by thrombosis or tumor. We report the long-term survival of a patient with PE due to a leiomyosarcoma in the deep vein. A 71-year-old woman complained of dyspnea and swelling of the left lower limb. Computed tomography revealed filling defects in the pulmonary arteries and deep vein. She was diagnosed with PE caused by venous thrombosis and treated with anticoagulant therapy. Her symptoms were prolonged, and D-dimer tests remained negative. Biopsy of the substance in the deep vein revealed leiomyosarcoma. The possibility of PE caused by extravascular or intravascular tumors should be considered when a patient is negative for D-dimer.
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Affiliation(s)
- Soichiro Kado
- Department of Internal Medicine, Kitaibaraki City Hospital, Japan
| | - Masahide Goto
- Department of Internal Medicine, Kitaibaraki City Hospital, Japan
- Department of Pediatrics, Jichi Medical University, Japan
| | - Hidetsugu Yamao
- Department of Cardiovascular Medicine, Kitaibaraki City Hospital, Japan
| | - Toru Tsukada
- Department of Cardiovascular Surgery, Hitachi General Hospital, Japan
| | - Masataka Sato
- Department of Cardiovascular Surgery, Hitachi General Hospital, Japan
| | - Yoshifumi Uekusa
- Department of Internal Medicine, Kitaibaraki City Hospital, Japan
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Garcia-Prats MD, Lopez-Carreira M, Mayordomo JI, Ballestin C, Rivera F, Diaz-Puente MT, Muñoz M, Cortes-Funes H, Martinez-Tello F. Leiomyosarcoma of the Soft Tissues in a Patient with Nevoid Basal-Cell Carcinoma Syndrome. Tumori 2018; 80:401-4. [PMID: 7839473 DOI: 10.1177/030089169408000516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 57-year-old man was admitted with complaints of progressive anorexia, weight loss and right flank pain. He had been treated for basal-cell carcinoma of the skin 19 years before. On physical examination, eight moles in the face, back and left thigh were found along with palmar pits. In addition, a painful induration in his right thigh was evident. Biopsy proved that six moles were basal-cell carcinomas and the thigh mass a high-grade leiomyosarcoma. Computed tomographs revealed multiple metastases in the lungs and the liver. The patient was treated with epirubicin, with partial response, and subsequently with ifosfamide. He died 17 months after diagnosis. Whereas the world literature records several cases of soft tissue tumors in patients with nevoid basal-cell carcinoma syndrome, this is the first report of a simultaneous occurrence of leiomyosarcoma and nevoid basal-cell carcinoma syndrome.
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Affiliation(s)
- M D Garcia-Prats
- Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain
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11
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Abstract
A case of renal leiomyosarcoma is presented and the difficulty of differential diagnosis from other tumors evidenced. The concomitance of a probable paraproteinemia, which disappeared after surgery, is interesting.
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12
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Abstract
RATIONALE Primary leiomyosarcoma (LMS) of the fallopian tube is extremely uncommon. To the best of our knowledge, so far only 21 cases of primary fallopian tube LMS have been reported in English-language literature. No new case has been reported in the past 7 years. PATIENT CONCERNS A 44-year-old premenopausal patient presented with a 5-day history of lower abdominal pain. DIAGNOSES Pelvic ultrasonography detected an 8.8 × 7.8 × 6.5 cm solid and cystic mass in the left side of the pelvic cavity. The tumor was diagnosed as a primary fallopian tube LMS on paraffin section. INTERVENTIONS The patient treated surgically followed by 4 cycles of postoperative chemotherapy with dacarbazine and DDP. OUTCOMES The patient succumbed to the disease 27 months after the initial therapy. LESSONS Tube LMS is a rare malignant tumor with unknown etiology, difficult early diagnosis, highly invasiveness, high local recurrence and distant metastasis rate, rapid progress, and poor prognosis. It is extremely rare so we can only summarize limited experience from limited data. Every case of tubal LMS is worth being reported.
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Affiliation(s)
- Di You
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Qilin Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Wei Jiang
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Lin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Tianjin Yi
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Lingjun Zhao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Maomao Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Ping Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
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Bladen JC, Moosajee M, Bassett JHD. A Tense Case—Carney's Triad. J R Soc Med 2017; 97:540-1. [PMID: 15520151 PMCID: PMC1079650 DOI: 10.1177/014107680409701109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- John C Bladen
- Department of Medicine, East Surrey Hospital, Redhill, Surrey RH1 5RH, UK.
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Affiliation(s)
- C Wong
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales, UK
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Tsuchiya T, Tanaka N, Nagao M, Watanabe K, Imoto H, Ohnuma S, Musha H, Watanabe M, Murakami K, Fujishima F, Motoi F, Naitoh T, Unno M. [A Case of Leiomyosarcoma of the Small Intestine with Intestinal Hemorrhage Due to Intraluminal Penetration]. Gan To Kagaku Ryoho 2017; 44:1068-1070. [PMID: 29394536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 40-year-old man was referred to our hospital because of severe anemia and small intestinal tumor revealed by computed tomography. The enteroscopy exam showed the intraluminal penetration of the tumor, which was considered as a cause of anemia. Although emergency operation was performed laparoscopically, intraoperative findings indicated tumor invasion into peritoneum, and we converted from laparoscopic surgery to open surgery that included concomitant peritoneum resection. Histopathological findings showed spindle-shaped tumor cells with severe atypia. Immunohistochemical study showed tumor cells to be positive for aSMA, but negative for c-kit and CD34, then we diagnosed the tumor as leiomyosarcoma of the ileum. Since leiomyosarcoma of the small intestine is a rare entity, we have reported with literature consideration.
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Affiliation(s)
- Keijiro Katayama
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan.
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Taijiro Sueda
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Wright JD, Schorge JO, Kilcoyne A, Tambouret RH. Case 16-2017 - A 69-Year-Old Woman with Urinary Incontinence. N Engl J Med 2017; 376:2066-2073. [PMID: 28538116 DOI: 10.1056/nejmcpc1616398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason D Wright
- From the Department of Obstetrics and Gynecology, New York Presbyterian Hospital, and the Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons - both in New York (J.D.W.); and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Harvard Medical School - both in Boston
| | - John O Schorge
- From the Department of Obstetrics and Gynecology, New York Presbyterian Hospital, and the Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons - both in New York (J.D.W.); and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Harvard Medical School - both in Boston
| | - Aoife Kilcoyne
- From the Department of Obstetrics and Gynecology, New York Presbyterian Hospital, and the Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons - both in New York (J.D.W.); and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Harvard Medical School - both in Boston
| | - Rosemary H Tambouret
- From the Department of Obstetrics and Gynecology, New York Presbyterian Hospital, and the Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons - both in New York (J.D.W.); and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Harvard Medical School - both in Boston
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Abstract
RATIONALE Primary leiomyosarcoma of the bone was firstly reported by Evans and Sanerkin in 1965, whereas primary leiomyosarcoma of the vertebra is extremely rare. Because of the rarity of primary vertebral leiomyosarcoma, the diagnosis, treatment, and clinical outcome still remain controversial. Here we report a special case of primary leiomyosarcoma in the thoracic vertebra. PATIENT CONCERNS A 47-year-old female patient was admitted to our institution with the chief complaint of persistent back pain for 4 weeks. She had no symptoms of numbness, weakness, pain, and abnormal sensation in her extremities. DIAGNOSES Neurological examination on admission revealed no obvious abnormality. Magnetic resonance imaging showed a bone destruction of the T11 vertebral body and the right pedicle. Therefore, primary vertebral leiomyosarcoma was suspected. Pathological hematoxylin and eosin staining of the resected tumor revealed a diagnosis of polymorphic undifferentiated sarcoma. Furthermore, to identify the subtype of this sarcoma, the immunohistochemical staining of the tumor was performed with each of the various antibodies and the results are epithelial membrane antigen (-), H-caldesmon (-), desmin (+), smooth muscle actin (+), S-100 (-), myogenin (-), pan-keratin (-), and Ki-67 (positive rate: 20%). Finally, the patient was diagnosed as primary vertebral leiomyosarcoma. INTERVENTIONS the anterior corpectomy and autogenous iliac bone graft with instrumentation combined with the posterior spinal canal decompression and fusion with the pedicle screw system were performed through an anterior-posterior union approach. OUTCOMES Neither clinical symptoms nor signs of tumor recurrence were detected within the follow-up of 6 months. In addition, 11 cases of the primary vertebral leiomyosarcoma reported in the literature were reviewed and summarized. LESSONS Exclusion of metastatic leiomyosarcoma by various imaging modalities and histopathological examinations, especially the immunohistochemical staining with various antibodies against the epithelial and mesenchymal cell markers, are critical for establishing the correct diagnosis of the primary vertebral leiomyosarcoma. Surgical resection, especially the total en bloc spondylectomy, is the main treatment option with a good outcome, albeit with a limited follow-up duration.
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Puie N, Trică LP, Nagy GA, Rusu I, Şovrea AS, Georgiu C. Hemorrhagic polypoid gastric and colonic metastases nine years after uterine leiomyosarcoma - case report. Rom J Morphol Embryol 2017; 58:1017-1022. [PMID: 29250683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Uterine leiomyosarcoma (ULMS) is a rare tumor, representing 1-2% of all uterine malignancies. It is highly aggressive, with high metastatic rate, especially in lungs, peritoneal cavity, retroperitoneum, bones and liver, usually during the first years after diagnosis. CASE PRESENTATION A 58-year-old woman, with subtotal hysterectomy and bilateral adnexectomy, followed by radiochemotherapy for spindle-type ULMS nine years ago, presented with gastrointestinal bleeding and severe anemia. Three polyps ranging from 2 cm to 5 cm in diameter were found at gastroscopy, the largest being ulcerated, which required a total gastrectomy three months later. Colonoscopy identified two pedunculated polyps on the descending colon, 2 cm and 3.5 cm in diameter. Histologically, both sites revealed proliferations of spindle cells with whorled pattern, moderate to severe nuclear atypia, 5 to 8 mitotic figures (MFs)÷10 high-power fields (HPFs) and additional necrosis in the gastric tumors. Immunohistochemistry was negative for CD117, DOG1, S100 and CD34 and positive for smooth muscle actin (SMA), estrogen receptor (ER) and progesterone receptor (PR). Twenty percent of nuclei stained positive for Ki67. The diagnosis was synchronous hemorrhagic gastric and colonic polypoid metastases of ULMS. Thoracic computed tomography (CT) and abdominal ultrasonography were negative for other metastatic lesions, while abdominal CT revealed abdominal and pelvic lymphadenopathy. CONCLUSIONS This case illustrates a distinct pattern of metastasis that is an extremely rare gastric and colonic location and an expanded disease-free period of nine years since the initial treatment. A long-term clinical and imaging follow-up of this patient is essential.
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Affiliation(s)
- Nicoleta Puie
- Discipline of Histology, Department of Morphological Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania;
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Wang Z, Shi N, Naing A, Janku F, Subbiah V, Araujo DM, Patel SR, Ludwig JA, Ramondetta LM, Levenback CF, Ramirez PT, Piha‐Paul SA, Hong D, Karp DD, Tsimberidou AM, Meric‐Bernstam F, Fu S. Survival of patients with metastatic leiomyosarcoma: the MD Anderson Clinical Center for targeted therapy experience. Cancer Med 2016; 5:3437-3444. [PMID: 27882721 PMCID: PMC5224847 DOI: 10.1002/cam4.956] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 12/13/2022] Open
Abstract
Advanced stage leiomyosarcoma (LMS) is incurable with current systemic antitumor therapies. Therefore, there is clinical interest in exploring novel therapeutic regimens to treat LMS. We reviewed the medical records of 75 consecutive patients with histologically confirmed metastatic LMS, who had been referred to the Clinical Center for Targeted Therapy at MD Anderson Cancer Center. To lay the foundation for potential phase I trials for the treatment of advanced LMS, we analyzed tumor response and survival outcome data. The frequent hotspot gene aberrations that we observed were the TP53 mutation (65%) and RB1 loss/mutation (45%) detected by Sequenom or next-generation sequencing. Among patients treated with gene aberration-related phase I trial therapy, the median progression-free survival was 5.8 months and the median overall survival was 15.9 months, significantly better than in patients without therapy (1.9 months, P = 0.001; and 8.7 months, P = 0.013, respectively). Independent risk factors that predicted shorter overall survival included hemoglobin <10 g/dL, body mass index <30 kg/m2 , serum albumin <3.5 g/dL, and neutrophil above upper limit of normal. The median survivals were 19.9, 7.6, and 0.9 months for patients with 0, 1 or 2, and ≥3 of the above risk factors, respectively (P < 0.001). A prognostic scoring system that included four independent risk factors might predict survival in patients with metastatic LMS who were treated in a phase I trial. Gene aberration-related therapies led to significantly better clinical benefits, supporting that further exploration with novel mechanism-driven therapeutic regimens is warranted.
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Affiliation(s)
- Zhijie Wang
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
- Department of Medical OncologyCancer HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Naiyi Shi
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Aung Naing
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Filip Janku
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Vivek Subbiah
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Dejka M. Araujo
- Department of Sarcoma Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Shreyaskumar R. Patel
- Department of Sarcoma Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Joseph A. Ludwig
- Department of Sarcoma Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Lois M. Ramondetta
- Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Charles F. Levenback
- Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Pedro T. Ramirez
- Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Sarina A. Piha‐Paul
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - David Hong
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Daniel D. Karp
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Apostolia M. Tsimberidou
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Funda Meric‐Bernstam
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Siqing Fu
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
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Massarotti EM, Sax PE, Compton L, Levy BD, Loscalzo J. Testing Limits. N Engl J Med 2016; 375:1383-1388. [PMID: 27705260 DOI: 10.1056/nejmcps1414259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Elena M Massarotti
- From the Departments of Medicine (E.M.M., P.E.S., B.D.L., J.L.) and Pathology (L.C.), Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Paul E Sax
- From the Departments of Medicine (E.M.M., P.E.S., B.D.L., J.L.) and Pathology (L.C.), Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Leigh Compton
- From the Departments of Medicine (E.M.M., P.E.S., B.D.L., J.L.) and Pathology (L.C.), Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Bruce D Levy
- From the Departments of Medicine (E.M.M., P.E.S., B.D.L., J.L.) and Pathology (L.C.), Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Joseph Loscalzo
- From the Departments of Medicine (E.M.M., P.E.S., B.D.L., J.L.) and Pathology (L.C.), Brigham and Women's Hospital and Harvard Medical School, Boston
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Gowda RM, Gowda MR, Mehta NJ, Osborne R, Bixon R, Vasavada BC, Sacchi TJ. Right Atrial Extension of Primary Venous Leiomyosarcoma: Pulmonary Embolism and Budd-Chiari Syndrome at Presentation. Angiology 2016; 55:213-6. [PMID: 15026878 DOI: 10.1177/000331970405500215] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Venous leiomyosarcomas are rare and arise predominantly in the inferior vena cava (IVC). The clinical findings are nonspecific and may precede the diagnosis by several years. IVC leiomyosarcoma is predominantly seen in women. Intracavitary extension of vascular tumors tends to result from embolization or propagation along great veins, and this is a serious risk factor for pulmonary embolism and sudden death when it reaches the right heart. Modern imaging modalities using computed tomography, magnetic resonance imaging, individually or in combination with cavography, ultrasound, and echocardiography, allow an early and accurate preoperative diagnosis, resulting in a higher rate of surgical resection and improved survival. The authors present a 72-year-old woman who presented with pulmonary embolism and Budd-Chiari syndrome. Pathological examination revealed a leiomyosarcoma. The tumor, involving the IVC, was diagnosed with imaging techniques that showed intracardiac extension of a primary venous leiomyosarcoma. The literature discussing leiomyosarcoma of the IVC is briefly reviewed.
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Affiliation(s)
- Ramesh M Gowda
- Division of Cardiology, Long Island College Hospital, Brooklyn, NY, USA
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Affiliation(s)
- Frederik L Giesel
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
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Pulcinelli FM, Catalano A, Malle G, Mossa B, Caserta D. A uterus soaked in blood with low haemoglobin in a case of unrecognized uterine sarcoma. EUR J GYNAECOL ONCOL 2016; 37:122-125. [PMID: 27048123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Uterine sarcomas are rare and aggressive tumors. In some cases they can cause rupture of the uterus with or without clinical and radiological symptoms. Therefore, it is important to observe patients with clinical and/or radiological suspicion of sarcoma, even when there are no clinical manifestations. CASE REPORT A 71-year old woman, who was under the authors' observation for pain in the right iliac fossa. The US and the CT scan showed an abdominal-pelvic mass.Laboratory tests showed a slight but progressive reduction of haemoglobin, which could not be explained by the clinical symptoms and by the results of the imaging tests. During the surgical intervention, a small amount of peritoneal fluid, an increased uterine volume, and a subverted anatomy were observed A haematoma was found in the uterus and this could explain the progressive reduction of haemoglobin and the very low presence of peritoneal effusion. CONCLUSION The rupture of the uterus could not have been suspected as the patient did not have any type of symptoms, except for the slow and progressive reduction in the haemoglobin value. Therefore, it is important to observe patients with clinical and/or radiological suspicion of sarcoma, even when there are no clinical manifestations.
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Abstract
Ulcerative colitis (UC) is known to be associated with an increased risk of colorectal cancer. However, the occurrence of non-epithelial malignancies is uncommon. An elevated lesion in the descending colon was found in a 51-year-old woman with a 30-year history of UC. Despite tumor progression, repeated biopsies showed no cancerous findings. Because the lesion was highly suspected to be a malignant tumor, a partial colectomy was performed. The pathological diagnosis was leiomyosarcoma. Leiomyosarcoma of the gastrointestinal tract is rare, and this is only the third known case reported in patients with UC.
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Affiliation(s)
- Daisuke Akutsu
- Department of Gastroenterology and Hepatology, University of Tsukuba, Japan
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Wincewicz A, Kowalik A, Zięba S, Góźdź S, Woltanowska M. Leiomyosarcoma FNCLCC G3 pT2B of broad ligament adherent to right oviduct - case report with molecular profiling. Rom J Morphol Embryol 2016; 57:1409-1414. [PMID: 28174812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Here we present a report of 61-year-old female patient. Uterus with left appendages was removed together with clinically tagged "tumor of right ovary" and then extensively sampled and routinely processed with Hematoxylin-Eosin (HE) and some additional staining. There was discernible oviduct adherent to grayish, solid, polycyclic 22 cm in diameter focally necrotic tumor to be diagnosed high-grade conventional leiomyosarcoma FNCLCC (Fédération Nationale des Centres de Lutte Contre le Cancer) G3 pT2b, according to 7th edition pTNM, according to World Health Organization (WHO) 2013 International Classification of Diseases for Oncology (ICD-O): 8890÷3, in nearby of right oviduct. Grade of differentiation was given according to FNCLCC classification: grade 3 {point score: 6 = 1 [microscopically necrosis comprised 10% of the tumor] + 3 [high mitotic index eight mitoses÷one high-power field (HPF) in hot spots in HE slides; Ki67 labeled approximately 60% of tumor cells] + 2 [histopathological type: conventional leiomyosarcoma]}. The staging was more appropriate for pT2b (7th edition pTNM) for deeply seated sarcoma of soft tissues, in examined samples, there was no trace of microscopically evident ovarian texture) rather than pT1a for ovarian tumors. The tumor was alpha-smooth muscle actin (α-SMA)-positive. Detected epithelial membrane antigen (EMA) immuno-reactivity indicates a possible change in mesenchymal origin. Next generation sequencing revealed tumor protein p53 (TP53) mutation C275Y (7577114 C>T). Each soft tissue malignancy should be carefully reported with appropriate choice of staging and precisely graded with internationally acknowledged classification.
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Affiliation(s)
- Andrzej Wincewicz
- Non Public Health Care Unit, Department of Pathology (NZOZ Zaklad Patologii Spólka z o.o.), Kielce, Poland; ,
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Affiliation(s)
- Ahmed Abdel Samie
- Department of Gastroenterology, Pforzheim Hospital, Kanzlerstr. 2-6, 75175, Pforzheim, Germany,
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Kerimoglu OS, Pekin A, Yilmaz SA, Bakbak BBG, Celik C. Pyometra in elderly post-menopausal women: a sign of malignity. EUR J GYNAECOL ONCOL 2015; 36:59-61. [PMID: 25872336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To describe the clinical and histopathological characteristics of 12 patients with pyometra and highlight the increased incidence of gynecological malignancy in these patients. MATERIALS AND METHODS The authors examined the medical records of 12 patients with pyometra, who were treated between 2009 and 2013. RESULTS All patients were post-menopausal, and their mean age was 70.83 ± 6.978 years (min = 61, max = 82). To remove purulent fluid via dilation and because of the probability of malignancy, three patients (25%) underwent cervical biopsy and endometrial curettage; the other nine patients (75%) underwent curettage alone, with suitable antibiotic therapy. Of the 12 patients, nine (75%) had gynecologic malignancy [(endometrial cancer, n = 5, 41.6%), (cervical cancer, n = 3, 25%), (uterine leiomyosarcoma, n = 1, 8.3%)]. In three (25%) patients, the cause of pyometra was benign pathologies, among which the most common were leiomyomas (n = 2, 66.6%). CONCLUSION Pyometra diagnosed during the post-menopausal period should be considered a complication caused by gynecological malignancy until proven otherwise.
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Gavrilov EK, Khubulava GG, Tarasov VA, Larin IA. [REMOVAL OF FLOATING THROMBUS FROM INFERIOR VENA CAVA IN A PATIENT WITH GIANT RECURRENT UTERINE LEIOMYOSARCOMA]. Klin Med (Mosk) 2015; 93:58-60. [PMID: 27008745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper reports successful combined cytoreductive surgical intervention on a patient with giant recurrent uterine leiomyosarcoma complicated by tumour thrombosis of left ovarian and left renal veins and inferior vena cava. After the comprehensive examination confirmed good prospects for conservative therapy, surgery was performed on 07.02.12 including laparotomic resection of the giant tumour from the abdominal cavity and small pelvis, sigmoid and rectal resection, formation of end-to-end descendorecto-anastomosis, left-hand nephrectomy, removal of tumour thrombus from the suprarenal part of inferior vena cava. The postoperative period was uneventful. No signs of pulmonary thromboembolism were recorded intra- and postoperatively. Wound healing occurred by primary intention, the sutures were removed on day 12 after surgery. The patient was discharged to be further treated on an outpatient basis. Pathological changes in the lower limbs were absent. The patient recovered and leads an active lifestyle. The follow-up examination (July 2012, March 2014) confirmed her healthy status and the absence of signs suggesting the risk of relapse and progress of the neoplastic process.
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Arcana R, Frisancho O, Yábar A. [Colonic intussusception by leiomyosarcoma]. Rev Gastroenterol Peru 2013; 33:251-254. [PMID: 24108379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED We report the case of female patient, 34 years old, occupation Secretary. BACKGROUND Polycystic ovary and chronic anemia. No family history of cancer. The patient reported three weeks abdominal pain, fever, bloody loose stools, nausea and vomiting. Abdominal pain is located in flank and right lower quadrant, is colicky, intensity 5 / 10, associated with abdominal distension. On physical examination, vital functions indicated T 38.6 ° FC 98 x min, FR 18 x min, BP 120/80, was awake, she looked pale, in generally fair condition, lucid and oriented. The abdomen was distended, the increased bowel sounds, tympanic to percussion, with tenderness in the right abdomen (more intense in the right iliac fossa), palpable mass is not defined edges lower right quadrant of about 6cm. CLINICAL DIAGNOSIS abdominal pain syndrome (appendicular mass, intestinal obstruction, intussusceptions). In examinations auxiliars highlighted in 9.1 g of hemoglobin with decreased corpuscular constants. Reviewed by history "rectal bleeding", DRE: yellow stool, no trace of blood, so that colonoscopy was deferred. Reassessed at 24 hours, we decide surgery with a presumptive diagnosis of intestinal obstruction, intussusception. In surgery, we identified a transverse colon tumor (with colo-colonic intussusception) and 10cm of colon was resected and meso tumor: TT anastomosis was performed in transverse colon. The lesion was a tumor of the middle region of the transverse colon, proliferative fibroid appearance, which almost completely obstructed the intestinal lumen, measuring about 7x5cm. The study of pathology with immunohistochemistry indicated that the tumor corresponded to leiomyosarcoma of the colon. Was discharged in good condition. The rarity of this type of malignancy and this type of presentation led us to make this report.
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Affiliation(s)
- Ronald Arcana
- Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú
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Andersen RE, Kristensen BW, Gill S. Cardiac leiomyosarcoma, a case report. Int J Clin Exp Pathol 2013; 6:1197-1199. [PMID: 23696944 PMCID: PMC3657379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/16/2013] [Indexed: 06/02/2023]
Abstract
In this case report we present the history of a patient admitted with recurrent pulmonary edema. Transesophageal echocardiography showed a tumour in the left atrium, occluding the ostium of the mitral valve and mimicking intermittent mitral stenosis. Cardiac surgery followed by pathological examination revealed that the tumour was a leiomyosarcoma. Images from the echocardiography as well as the pathological findings are shown and discussed. The present case report illustrates that atrial tumors comprise also sarcomas, suggesting the use of careful, rapid diagnostic procedures and treatment to prevent dissemination of malignancy.
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Affiliation(s)
- Rikke E Andersen
- Department of Cardiology, Odense University HospitalOdense, Denmark
| | | | - Sabine Gill
- Department of Cardiology, Odense University HospitalOdense, Denmark
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Perisano C, Maffulli N, Colelli P, Marzetti E, Panni AS, Maccauro G. Misdiagnosis of soft tissue sarcomas of the lower limb associated with deep venous thrombosis: report of two cases and review of the literature. BMC Musculoskelet Disord 2013; 14:64. [PMID: 23421389 PMCID: PMC3599198 DOI: 10.1186/1471-2474-14-64] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/28/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Deep venous thrombosis (DVT) or pulmonary embolism (PE) is a rare, but not exceptional presentation of soft tissue sarcomas (STSs). Due to the remarkable difference in the incidence between DVT or PE and STSs, this type of STS presentation is usually associated with a considerable delay in tumor diagnosis and treatment. CASE PRESENTATION We describe two cases of STS who presented with DVT and PE. Physical and radiographic examination only showed the presence of DVT. Both patients were treated for DVT or PE for several months. Due to the persistence of symptoms and the inefficacy of anticoagulant therapy, magnetic resonance imaging (MRI) was performed, which revealed the presence of a lower limb mass in both cases. The definite diagnosis was reached via excisional biopsy and histological examination.In one case, MRI showed a large tumor in the anterior muscle compartment of the right thigh, with thrombosis of the right common femoral vein and involvement of the ipsilateral common iliac vein and inferior vena cava until the confluence of the renal veins. In the other case, MRI showed a large tumor in the middle third of the right thigh. The lesion was in close proximity to the superficial femoral vein that appeared compressed and showed signs of thrombosis. In both cases, histological examination revealed a high-grade leiomyosarcoma. CONCLUSION STSs of the lower extremities can rarely present with DVT or PE. This possibility should be considered in the differential diagnosis of painful leg swelling, especially in patients with recurrent or refractory venous thrombosis. When a STS is suspected, MRI should be obtained followed by excisional biopsy of the eventual mass. A delay in diagnosis and treatment of STSs often results in very poor prognosis.Level of evidence. IV.
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Affiliation(s)
- Carlo Perisano
- Department of Geriatrics, Neurosciences and Orthopedics, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Queen Mary, University of London Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Rd, London, E1 4DG, UK
| | - Pamela Colelli
- Department of Radiology, Hospital ”A.Perrino”, S.S.7 – 72100, Brindisi, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopedics, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy
| | | | - Giulio Maccauro
- Department of Geriatrics, Neurosciences and Orthopedics, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy
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Affiliation(s)
- Sanae Abakka
- Department of Obstetrics and Gynaecology, Oncology and high risk pregnancies, Maternity Hospital Souissi, University teaching hospital Ibn Sina of Rabat, Rabat, Morocco.
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van der Pluijm RW, Lamers MJ, de Boer M, van der Graaf WTA, van Laarhoven HWM. A female with a leiomyosarcoma presenting with acute thoracic pain and dyspnoea. Neth J Med 2012; 70:377-380. [PMID: 23065989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- R W van der Pluijm
- Department of Internal Medicine, Radboud University Nijmegen Medical Centre and Academic Medical Centre, University of Amsterdam, The Netherlands
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Al-Riyami AZ, Tsang PWK, Hudoba M. Extreme eosinophilia in a setting of metastatic leiomyosarcoma: an unusual case report. Ann Hematol 2011; 91:1323-4. [PMID: 22194143 DOI: 10.1007/s00277-011-1391-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 12/12/2011] [Indexed: 12/01/2022]
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36
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Bellver M, Rodríguez Lago I, Queipo F, Pastor C, Arredondo J, Hernández-Lizoaín JL. Colocolonic intussusception secondary to high grade colonic leiomysarcoma. Rev Esp Enferm Dig 2011; 103:601-603. [PMID: 22149568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Gulati A, Khelemsky Y, Loh J, Puttanniah V, Malhotra V, Cubert K. The use of lumbar sympathetic blockade at L4 for management of malignancy-related bladder spasms. Pain Physician 2011; 14:305-310. [PMID: 21587335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Cancer-related bladder spasms may be a rare but severe symptom of bladder or metastatic cancer or its related treatments. Various treatments described in the literature include systemic medications, intravesical or epidural medications, or even sacral neurolectomies. OBJECTIVE We present 3 patients who have suffered from bladder spasm either from invasion of the bladder wall by tumor (2 patients) or from intravesical chemotherapeutic treatment. DESIGN Case Report. SETTING Cancer pain management hospital. METHODS For each patient, we describe the use of lumbar sympathetic block to successfully treat the bladder spasms. Sympathetic blockade was performed at the left anterolateral border of lumbar vertebra L4. We used 10 mL of local anesthetic (0.25% bupivacaine) delivered in 2 mL aliquots, each given after negative aspiration for heme. Each procedure was performed with fluoroscopic guidance (both AP and lateral views) with the use of iodine contrast (Omnipaque-180) to confirm the location of the medication and its resulting spread. RESULTS All 3 patients had a reduction in the frequency and intensity of spasms, with 2 out of 3 patients not having a recurrence of the spasms for up to 2 months post procedure and follow up. LIMITATIONS Case Report. CONCLUSION Lumbar sympathetic blockade could be a useful treatment for recurrent bladder spasm in the oncologic population. Based on these findings, we feel that the branches of the sympathetic nerve set at L4 may be a good target for neurolytic procedures, such as radiofrequency ablation, for long term treatment of bladder spasms. Further research is necessary to determine the efficacy of this technique for the treatment of bladder spasms in the oncologic population.
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Affiliation(s)
- Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Resch T, Oberhuber R, Zitt M, Laimer E, Gehwolf P, Pratschke J, Klaus A. Leiomyosarcoma of the colon: unresolved issues of a rare but highly aggressive malignancy. Am Surg 2011; 77:E62-E64. [PMID: 21679535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Thomas Resch
- Department of Visceral, Transplant, and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichtstrasse 35, A-6020 Innsbruck, Austria.
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Singla K, Preet Malhotra K, Rathore R, Arora D, Sharma S. Scrotal leiomyosarcoma associated with bilateral epididymo-orchitis. Urology 2011; 78:1069-70. [PMID: 21439614 DOI: 10.1016/j.urology.2011.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 11/17/2022]
Abstract
Leiomyosarcoma of the scrotum is a rare tumor. We report the case of a 60-year-old man who presented with bilateral testicular enlargement that was clinically misdiagnosed as a testicular tumor. The tumor was excised by bilateral inguinal orchiectomy. Histopathologic examination revealed a scrotal wall leiomyosarcoma with bilateral epididymo-orchitis.
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Affiliation(s)
- Komal Singla
- Department of Pathology, University of Delhi College of Medical Sciences, Delhi, India
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Yang SH, Chien JCW, Chen CL, Chan WP. Leiomyosarcoma of ovarian vein compression as a cause of hydronephrosis. EUR J GYNAECOL ONCOL 2011; 32:336-338. [PMID: 21797130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present a case of leiomyosarcoma of the right ovarian vein with MRI findings. The patient was a 52-year-old woman who had suffered from right flank pain for one week. Abdominal ultrasound and excretory urography revealed hydronephrosis of the right kidney. Ureteroscopy showed external compression at the right upper third of the ureter. CT and MRI of the abdomen revealed a retroperitoneal mass with compression of the right ureter. The retroperitoneal mass proved on histology to be a leiomyosarcoma arising from the right ovarian vein.
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Affiliation(s)
- S H Yang
- Department of Radiology, Taipei Medical University-Wan Fang Hospital, Taiwan, Republic of China
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Hardefeldt LY, Poulsen KP, McGuirk SM, Livesey MA, Koch C, Perrier MP, Pinkerton ME. Urogenital leiomyosarcoma in an alpaca. Can Vet J 2010; 51:1387-1390. [PMID: 21358933 PMCID: PMC2978993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A mass in the pelvic canal of a 4-year-old pregnant alpaca hembra diagnosed as leiomyosarcoma of the urogenital tract was confirmed by biopsy. Following a tube cystotomy, the alpaca was presented 33 d later, 2 d after the tube cystotomy had been dislodged. A dead cria was delivered by caesarean section.
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Affiliation(s)
- Laura Y Hardefeldt
- School of Veterinary Science, University of Wisconsin, Madison, Wisconsin 53706, USA.
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Parmeggiani D, Avenia N, De Falco M, Bilancio G, Ruggero R, Docimo G, Gubitosi A, Fiore A, Atelli P, Misso C, Mordente S, Parmeggiani U. [Retroperitoneal dedifferentiated liposarcoma (DDLS) with hyperglycemic activity: case report and literature review]. MINERVA CHIR 2010; 65:479-484. [PMID: 20802435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The authors describe a Retroperitoneal De Differentiated LipoSarcomas (DDLs), that for its clinical behavior shows peculiar characteristics and original aspects: typical is the recurrence due to local invasiveness, but absolutely original seems to be the surviving time, maybe correlated to its histological evolution (dedifferentiation from leiomyosarcoma to liposarcoma) and an interesting correlation from the tumor recurrence and the glycemic curve first and after the surgical treatments. A 66-year-old woman, presenting typically with very big abdominal masses, treated three times in almost three years, every time with aggressive surgical treatments. Histological response was leiomyo-sarcoma in the first two operations and liposarcoma in the last treatment and in every preoperative phase the patient, normally prediabetic, started to have problem of glycemia balancing, needing an insulin support until the postoperative phases when its glycemia was coming back in normal value without insulin needs, of course until a new tumor recurrence. This last aspect, not depending on pancreas involvement or hormonal activity (immune-histo-chemistry was never conforming a neuro-endocrine activity), seems probably due directly to a mass and metabolic effect of the tumor. Beginning from the description of this case and its interesting biology and reviewing most of the literature on the argument, authors hope to give our support to still debated and partially unknown aspects of these kinds of tumors.
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Affiliation(s)
- D Parmeggiani
- VI Division of General Surgery, Department of Emergency Surgery, Naples, Italy.
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Hashimoto A, Oda Y, Inagaki Y, Iguchi M, Wakita Y, Shimizu A, Murata Y, Tanaka J, Naganuma T, Nakano H. [A case of primary leiomyosarcoma of the small bowel with hepatic portal venous gas]. Nihon Shokakibyo Gakkai Zasshi 2010; 107:1159-1166. [PMID: 20616484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 92-year-old woman was admitted with speech disturbance. She had severe anemia (hemoglobin, 6.3g/dl), and abdominal ultrasonography revealed hepatic portal venous gas and an intra-abdominal tumor. Abdominal computed tomography also revealed an irregularly enhanced intra-abdominal tumor, 32x35mm in diameter, which was surgically resected. The tumor was located in the small intestine. Histopathological examination revealed spindle-shaped atypical cells. Immunological evaluation showed the tumor to be SMA (+), c-kit (-), CD34 (-), S100 (-). The Ki-67/MIB1 labeling index was 2.3%. The tumor was diagnosed as leiomyosarcoma of the small bowel. The patient recovered after surgery and was discharged.
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Affiliation(s)
- Akira Hashimoto
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital.
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Ben-Ishay O, Shmulevsky P, Brauner E, Vladowsy E, Kluger Y. Mucosal small bowel metastasis from uterine leiomyosarcoma. Isr Med Assoc J 2010; 12:309-310. [PMID: 20929089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Offir Ben-Ishay
- Department of General Surgery B, Rambam Health Care Campus, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Ketata W, Msaad S, Kwass H, Bahri Zouari I, Abbes K, Yangui I, Boudawara T, Ayoub A. [Primary pulmonary leiomyosarcoma revealed by spontaneous pneumothorax]. Rev Pneumol Clin 2009; 65:309-312. [PMID: 19878807 DOI: 10.1016/j.pneumo.2009.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 05/25/2009] [Accepted: 05/25/2009] [Indexed: 05/28/2023]
Abstract
We report the case of a 57-year-old patient admitted for dyspnea and dry cough. Thoracic radiograph showed a right pneumothorax and right paracardiac opacity. Thoracic drainage was carried out allowing the return of the lung at the wall. Chest CT-scan revealed right upper mediastinopulmonary mass taking contrast material associated with a nodular thickening of the pleura. CT-guided biopsy of the mass and the pleural nodules concluded to pulmonary leiomyosarcoma. Death occurred one month after diagnosis confirmation. Pneumothorax is a usual mode of revealing sarcoma's pulmonary metastases; however, it is exceptionally associated with primitive pulmonary sarcomas. Our case is the second published case, to our knowledge, of primitive pulmonary leiomyosarcoma presenting with pneumothorax.
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Affiliation(s)
- W Ketata
- Service de Pneumoallergologie, CHU Hédi Chaker, Sfax, Tunisia.
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Boybeyi O, Akçören Z, Oğuz B, Akyüz C, Sanal O, Ergin S, Ersoy-Evans S, Tanyel FC. Multifocal leiomyosarcomatosis in a 6-year-old child with epidermodysplasia verruciformis and immune defect. J Pediatr Surg 2009; 44:e5-8. [PMID: 19573649 DOI: 10.1016/j.jpedsurg.2009.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Revised: 04/02/2009] [Accepted: 04/04/2009] [Indexed: 11/18/2022]
Abstract
Leiomyosarcoma and epidermodysplasia verruciformis are rarely encountered in children. The association of either leiomyosarcoma or epidermodysplasia verruciformis with immune deficiency has previously been documented. A 6-year-old girl, who has had multifocal leiomyosarcomatosis after the previous diagnoses of epidermodysplasia verruciformis and immune defect, represents an interesting association of these features.
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Affiliation(s)
- Ozlem Boybeyi
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
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Hsu HH, Chen YC, Tian YC, Chan YL, Kuo MC, Tang CC, Fang JT, Lee SY, Yang CW. Role of serum sodium in assessing hospital mortality in cancer patients with spontaneous tumour lysis syndrome inducing acute uric acid nephropathy. Int J Clin Pract 2009; 63:751-6. [PMID: 19402210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Spontaneous tumour lysis syndrome (STLS) inducing acute uric acid nephropathy, a rare and neglected disease, presents more insidiously than conventional post-treatment tumour lysis syndrome. Although STLS is a serious and potentially fatal complication in patients with neoplastic disorders, few investigations have addressed the relevance of clinical and laboratory features in assessing prognosis. A retrospective study was conducted, reviewing the records of all patients who developed acute renal failure (ARF) at Chang Gung memorial hospital between 1 July 1999 and 30 June 2003. STLS-induced acute uric acid nephropathy was identified in 12 of 1072 ARF patients (1.1%) during the study period. All patients had advanced stage tumours with large tumour burden, and 66.7% of cases had abdominal organ involvement. All 12 hyperuricemic patients became oliguric despite conservative therapy, and remained hyperuricemic (21.6 +/- 5.2 mg/dl) before dialysis therapy. Diuresis developed in eight patients (66.7%), with associated resolution of hyperuricemia, azotemia and metabolic derangements following dialysis initiation. Overall hospital mortality was 58.3%. Death in most patients was related to hyponatremia and hypoalbuminemia on admission. The serum sodium was found to have the best Youden index (0.86) and highest overall prediction accuracy (93%). Moreover, serum sodium and serum albumin for individual patients were significantly and positively correlated (r = 0.617, p = 0.032). This investigation confirms a grave prognosis for cancer patients with STLS inducing acute uric acid nephropathy. Hyponatremia and hypoalbuminemia on the first day of admission indicate poor prognosis in such patients.
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Affiliation(s)
- H-H Hsu
- Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Alvite Canosa M, Alonso Fernández L, Seoane Vigo M, Berdeal Díaz M, Pérez Grobas J, Carral Freire M, Bouzón Alejandro A, Gómez Dovigo A, Maceira Quintián F, Gómez Freijoso C. [Leiomyosarcoma of the colon with lung metastases as the first manifestation]. Rev Esp Enferm Dig 2009; 101:145-146. [PMID: 19335052 DOI: 10.4321/s1130-01082009000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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50
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Avery JK. Reports in the record. What is your protocol? J Ark Med Soc 2009; 105:174. [PMID: 19248345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- J Kelley Avery
- State Volunteer Mutual Insurance Company, Brentwood, Tenn, USA
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