BACKGROUND Retroperitoneal leiomyomas(RLs)are rare benign tumours that can occur in the pelvic and/or abdominal parietal retroperitoneum.Once torsion occurs,it causes acute abdominal pain and can even lead to serious ...BACKGROUND Retroperitoneal leiomyomas(RLs)are rare benign tumours that can occur in the pelvic and/or abdominal parietal retroperitoneum.Once torsion occurs,it causes acute abdominal pain and can even lead to serious consequences such as gangrene,peritonitis,haemoperitoneum and shock if not identified and treated promptly.Therefore,a better understanding of the characteristics of RL torsion is needed.Here,we present a case of acute pedicle torsion of an RL in the posterior peritoneum followed by a literature review.CASE SUMMARY Herein,we report the case of a 42-year-old woman with RL torsion.The patient visited our hospital complaining of lower abdominal pain for 6 d.Pelvic examination revealed a tender mass superior to the uterus.Pelvic magnetic resonance imaging(MRI)revealed an anterior uterine mass,multiple uterine fibroids and slight pelvic effusion.MRI suggested the possibility of a subserosal myoma of the anterior uterine wall with degeneration.Intraoperative exploration revealed a 10 cm pedunculated mass arising from the posterior peritoneum,with the pedicle torsed two times.Pathological examination confirmed a torsed RL.CONCLUSION In the case of a pelvic mass complicated with acute abdomen,the possibility of torsion should be considered.展开更多
Leiomyomas are the most common benign tumors of the esophagus. They usually occur as a single lesion or as two or three nodules. Only two cases of esophageal multiple leiomyomas comprising more than 10 nodules have be...Leiomyomas are the most common benign tumors of the esophagus. They usually occur as a single lesion or as two or three nodules. Only two cases of esophageal multiple leiomyomas comprising more than 10 nodules have been reported previously. Moreover, there have been few reports of esophageal squamous cell carcinoma overlying submucosal tumors. We describe a 71-yearold man who was diagnosed as having a superficial esophageal cancer coexisting with two or three leiomyoma nodules. During surgery, 10 or more nodules that had not been evident preoperatively were palpable in the submucosal and muscular layers throughout the esophagus. As intramural metastasis of the esophageal cancer was suspected, we considered additional lymphadenectomy, but had to rule out this option because of the patient＇s severe anoxemia. Microscopic examination revealed that all the nodules were leiomyomas （20 lesions, up to 3 cm in diameter）, and that invasion of the carcinoma cells was limited to the submucosal layer overlying a relatively large leiomyoma. This is the first report of superficial esophageal cancer coexisting with numerous solitary leiomyomas. Multiple minute leiomyomas are often misdiagnosed as intramural metastasis, and a leiomyoma at the base of a carcinoma lesion can also be rnisdiagnosed as tumor invasion. The present case shows that accurate diagnosis is required for the management of patients with coexisting superficial esophageal cancer and multiple leiomyomas.展开更多
Background and aims: Adhesions can cause important morbidity including abdominal and pelvic pain, intestinal obstructions, and infertility. When adhesions are formed, there is no efficient method, nowadays, to resolve...Background and aims: Adhesions can cause important morbidity including abdominal and pelvic pain, intestinal obstructions, and infertility. When adhesions are formed, there is no efficient method, nowadays, to resolve them, thus the reduction of their prevalence relies on the prevention. Profiling high risk patients for abdominal and pelvic adhesions (APA) is an important step to this prevention. The risk factors of adhesions in our institution, the association between APA, leiomyomas and skin scar anomaly (SSA) were investigated. Methods: A cross-sectional study was conducted from March 1st to June 30th 2013 including patients who underwent laparotomy or laparoscopy. Patients’ characteristics, presence of a SSA and leiomyomas, as related to adhesions, were analyzed. Student’s t, Pearson’s Khi-square, Fisher’s Exact, Mann-Whitney tests and logistic regression were used. P values < 0.05 were considered statistically significant. Results: The frequency of adhesions was 41.74%. Patients had a mean age of 32.69 ± 8.94 years. Those with a previous abdominal surgery (PAS), SSA and leiomyomas had respectively 12 times [OR: 11.98, CI95 (4.63 - 30.97)], 3 times [OR: 2.79, CI95 (1.16 - 6.71) and 2.5 times [(OR: 2.49, CI95 (1.07 - 5.78)] more adhesions. In logistic regression, a PAS and leiomyomas remained associated significantly to adhesions with p = 0.000 and p = 0.037 respectively. Conclusion: In peritoneal adhesions, leiomyomas and SSA are other factors that may allow a cautious selection of high risk patients who must benefit from particular attention during surgery. Further well designed studies are necessary to investigate the accurate clinical relation among those three conditions.展开更多
Uterine leiomyomas (myomas) are the most common benign tumors of the female genital tract. They affect 20<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span s...Uterine leiomyomas (myomas) are the most common benign tumors of the female genital tract. They affect 20<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">%</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> to 25% of women of childbearing age and are 3 to 9 times more common in black women. We initiated this study in order to report the socio-demographic aspects and the indications for leiomyomas surgery at</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">H<span style="color:#4F4F4F;font-family:Simsun;font-size:14px;white-space:normal;background-color:#FFFFFF;">ô</span>pital du Mali. This was a retro-prospective descriptive study, conducted in the gynecology department of H<span style="color:#4F4F4F;font-family:Simsun;font-size:14px;white-space:normal;background-color:#FFFFFF;">ô</span>pital du Mali from January 1, 2015 to December 31, 2019. Any</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">patients, regardless of their age, in whom a leiomyomas had been detected and surgically treated were included. We had collected 180 cases of surgery for leiomyomas out of 950 surgical procedures, with a frequency of 18.94%. The 36</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">45 age group represented 45% of our patients with an average age of 35 years. Nulligravida</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">accounted for 48.9% and nulliparous (60%). The main reason for consultation was the desire to become pregnant (53.33%). A history of myomectomy was found out in 15.55% of patients. Pelvic ultrasound figured out 64.44% interstitial myomas. Myomectomy was performed in 88.88% of cases and hysterectomy in 11.12% of cases. Among our patients 39.37% had become pregnant. Operative complications were dominated by anemia 14.44%. Leiomyoma was the histological tissue found in all cases of myomectomy. The average duration of </span><span><span style="font-family:Verdana;">hospitalization was 3 days. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Leiomyomas surgery is the first</span></span><span style="font-family:Verdana;"> scheduled gynecological surgical activity. Laparotomy remains the primary route of entry. The indications are dominated by the desire for pregnancy.</span></span></span></span>展开更多
AIM： To investigate the role of vascular endothelial growth factor （VEGF/and its receptors VEGFR-1 and 2 in the growth and differentiation of gastrointestinal strornal tumors （GISTs）. METHODS： Thirty-three GISTs,...AIM： To investigate the role of vascular endothelial growth factor （VEGF/and its receptors VEGFR-1 and 2 in the growth and differentiation of gastrointestinal strornal tumors （GISTs）. METHODS： Thirty-three GISTs, 15 leiomyomas and 6 schwannomas were examined by immunohistochemistry in this study. RESULTS： VEGF protein was expressed in the cytoplasm of tumor cells, and VEGFRol and 2 were expressed both in the cytoplasm and on the membrane of all tumors. Irnrnunohistochernical staining revealed that 26 GISTs （78.8%）, 9 leiornyornas （60.0%） and 3 schwannornas （50.0%/were positive for VEGF; 24 GISTs （72.7%/, 12 leiornyornas （80.0%） and 4 schwannornas （66.7%） were positive for VEGFR-1; 30 GISTs （90.9%/, 5 leiornyornas （33.3%/and 4 schwannornas （66.7%） were positive for VEGFR-2. VEGFR-2 expression was statistically different between GISTs and leiomyomas （P 〈 0.0001）. However, there was no correlation between the expression of VEGF pathway componenets and the clinical risk categories. CONCLUSION： Our results suggest that the VEGF pathway may play an important role in the differentiation of GISTs, leiomyomas and schwannomas.展开更多
Objective:To investigate the role of epidermal growth factor(EGF) in the pathogenesis of uterine leiomyomas.Methods:Human myometrial smooth muscle cells(HM-SMCs) and smooth muscle cells of human uterine leiomyomas(HL-...Objective:To investigate the role of epidermal growth factor(EGF) in the pathogenesis of uterine leiomyomas.Methods:Human myometrial smooth muscle cells(HM-SMCs) and smooth muscle cells of human uterine leiomyomas(HL-SMCs) were separated from patients' specimens and cultured.After processed by EGF or PD98059(inhibitor of MKK/MEK) +EGF,the proliferation rate of both SMCs was detected by BrdU method and the phosphorylation level of p44/42 mitogen-activated protein kinase(MAPK) was determined by Western-blot.After different processing time by EGF,the phosphorylation levels of p44/42 MAPK and AKT and p27 expression level in both SMCs were detected by Western-blot.Results:EGF could significantly promote HL-SMCs proliferation and PD98059 could inhibit this effect(P<0.05);besides,PD98059 could inhibit the increase of the phosphorylation level of p44/42 MAPK in both SMCs induced by EGF.When the processing time by EGF was over 15 min,the phosphorylation levels of p44/42 MAPK and AKT in both SMCs decreased sharply and were close to zero:p27 expression in HM-SMCs raised significantly while the upregulation in HL-SMCs was little.Conclusions:EGF could not cause activation of EGFR because of the dephosphorylation of p44/42 MAPK and AKT in HL-SMCs,which caused p27 expression insufficiently and cell cycle dysregulation.展开更多
BACKGROUND Gastric leiomyomas and gastric stromal tumors are the most common types of gastric tumors encountered.In recent years,the incidence of the two types of tumors has been increasing,but the differential diagno...BACKGROUND Gastric leiomyomas and gastric stromal tumors are the most common types of gastric tumors encountered.In recent years,the incidence of the two types of tumors has been increasing,but the differential diagnosis is still a challenge in clinical work.However,as there are many reports on stromal tumors and inflammation-related indicators are gradually being paid attention to as important factors in predicting tumor prognosis,the two main purposes of this study were to explore the inflammation-related differences between the two types of tumors and to develop a nomogram as a predictive model.AIM To explore the differences in platelet-lymphocyte ratio(PLR),neutrophillymphocyte ratio(NLR),lymphocyte mononuclear cell ratio(LMR),and SII between the two types of tumors,and simultaneously create the nomogram model.METHODS This study enrolled 88 patients in the gastric stromal tumor group and 56 patients in the gastric leiomyoma group,and the relevant data of the two groups were entered into the system for an integrated analysis.The primary objective of this study was to identify the differences in the inflammation index between the two types of tumors.RESULTS There were statistically significant differences between the two groups in sex,age,and tumor location.In comparison,gastric leiomyomas seem to be more common in women,young patients,and gastric cardia,which is in line with our previous research;the groups showed the following statistical differences:PLR(158.2%vs 134.3%,P=0.028),NLR(2.35 vs 1.68,P=0.000),LMR(5.75 vs 10.8,P=0.004),and SII(546.2 vs 384.3,P=0.003).The results of the multivariate logistic regression analysis showed that sex,age,tumor location,and LMR were independent risk factors for the identification of the two types of tumors.After considering the risk factors selected by the above analysis into the predictive model,a predictive model for distinguishing gastrointestinal stromal tumors from gastric leiomyomas was established as the nomogram.CONCLUSION Gastric leiomyomas and gastric stromal tumors are not only different in factors such as age of the patient,but also in inflammatory indicators such as LMR and PLR.We have established a predictive model related to the laboratory indicators and are looking forward to further research conducted in this clinical area.展开更多
AIM： Gastrointestinal stromal tumors （GISTs） are rare. GISTs differ from other mesenchymal tumors of the gastrointestinal tract （e.g. leiornyomas and schwannomas）. The purpose of this study was to investigate the...AIM： Gastrointestinal stromal tumors （GISTs） are rare. GISTs differ from other mesenchymal tumors of the gastrointestinal tract （e.g. leiornyomas and schwannomas）. The purpose of this study was to investigate the role of Ets-1 in the growth and differentiation of GISTs. METHODS： Twenty-eight GISTs, nine leiomyomas and six schwannomas were examined by immunohistochemical staining method for Ets-1 in this study. Specimens were selected from surgical pathology archival tissues at Nagasaki University Hospital. RESULTS： Ets-1 protein was expressed in the cytoplasm of cells in all of these tumors. Immunohistochemical staining revealed that 27 GISTs （96.4%）, six leiomyomas （66.7%）, and five schwannomas （83.3%） were positive for Ets-1. Ets-1 expression was statistically different between GISTs and leiomyomas （P〈0.005）. However, there was no correlation between Ets-1 expression and clinical risk categories. CONCLUSION： Ets-1 plays an important role in the growth and differentiation of GISTs, leiomyomas and schwannomas.展开更多
In searching of differentially expressed genes in human uterine leiomyomas, differential display was used with twelve pairs of primers to compare human uterine leiomyomas with matched myometrium. False positives were ...In searching of differentially expressed genes in human uterine leiomyomas, differential display was used with twelve pairs of primers to compare human uterine leiomyomas with matched myometrium. False positives were eliminated by reverse Northern analysis. Positives were confirmed by Northern blot analysis. RESULTS: Four of 69 cDNA fragments (3 up-regulated named L1, L2 and L3 and 1 down-regulated named M1 in leiomyoma) were confirmed by Northern analysis. Sequence comparison and Northern analysis proved that L1 is exactly the human ribosomal protein S19. It was present ubiquitously in 13 tissues tested but in various levels and even in different size. L1 was highly expressed in parotidean cystadenocarcinoma, pancreatic cancer and breast cancer examined. No mutations have been found in human uterine leiomyomas (n=6). CONCLUSIONS: hRPS19 overexpression might be a universal signal in rapid cell growth tissues.展开更多
Objective: To investigate the clinicopathology and DNA ploidy of gastric mucosa associated lymphoid tissue (MALT) lymphoma infiltraving the leiomyomas of the uterus of a patient. Methods: The routine paraffin slides w...Objective: To investigate the clinicopathology and DNA ploidy of gastric mucosa associated lymphoid tissue (MALT) lymphoma infiltraving the leiomyomas of the uterus of a patient. Methods: The routine paraffin slides were cut, stained with HE, immunochemically by ABC methodusing the and stained by Feulgen method. Then the DNA ploidy of tumor cells was measured with an image cytometer. Results: In the mucosa, submucosa and the smooth muscle layer of the stomach and in the leiomyomas of the uterus there was diffusive and dense infiltration of centrocyte-like cells. The DNA measurement results were that the distribution of DNA mass of lymphoma cells in stomach and in lymph nodes had a single main aneuploidy peak each, and the distribution of DNA mass of lymphoma cells in leiomyomas of uterus had two peaks; one of them was the diploid, the other aneuploid. Conclusion: The MALT lymphoma cell invasion in uterus must be differentiated with a primary lymphoma in the uterus, the chronic lymphocyte leukemia in uterus and an endometrial stromal sarcoma. The present prognosis of the patient under discussion was poor. The follow-up results indicated the DNA index seemed to be important for predicting the malignancy degree and prognosis.展开更多
Background Ultrasound （US） is a popular method in the diagnosis and treatment of uterine leiomyomas, but the lack of accuracy greatly limits its application. Recently, microbubble enhancement technique affords direc...Background Ultrasound （US） is a popular method in the diagnosis and treatment of uterine leiomyomas, but the lack of accuracy greatly limits its application. Recently, microbubble enhancement technique affords direct depiction of tumor neovascularity and establishes a more precise vascular map of the tumor. This study was undertaken to describe the distribution patterns of SonoVue, a second-generation contrast agent, in the micrecirculation of uterine leiomyomas, and to investigate the potential use of contrast-enhanced ultrasound （CEUS） in the characterization and treatment of uterine leiomyomas.Methods Ninety-six patients with uterine leiomyomas were enrolled in this study. The CEUS was performed using cadence pulse sequencing technique （CPS） and SonoVue. Enhancement patterns of different lesions were observed.The diagnostic accuracy of CEUS was compared with that of conventional ultrasound.Results After contrast injection, vessels of macro- and micro-circulation of the myoma first appeared, followed by the normal myometrium and finally the endometrium. During the washout phase, the myoma exhibited homogeneous enhancement followed by apparent hypoenhancement. The margin of the tumor was depicted clearly. There was no agent perfusion in the benign degenerative or necrotic area. However in sarcomas degeneration, the feeding vessels appeared markedly earlier than those in myometrium. In addition, the tumor exhibited heterogeneous hyperenhancment with no agent perfusion in the center and no membraniform sign was observed in the late phase. In subserous andsubmucous leiomyomas, the feeding arteries in the pedicle arising from the uterine could be seen. In this study, the diagnostic accuracy of CEUS and conventional US for uterine leiomyomas was 96.7% （160/165） and 82.4% （136/165）respectively.Conclusions CEUS can provide a precise description of the leiomyomas vascularization. The specific enhancement pattern may be helpful for the characterization, treatment choice and therapeutic monitoring of leiomyomas.展开更多
This is a case report of a rare myoma of the anterior vaginal wall that mimicked a paraurethral diverticulum in a postmenopausal woman. Surgical treatment of the lesion was performed via a transvaginal approach withou...This is a case report of a rare myoma of the anterior vaginal wall that mimicked a paraurethral diverticulum in a postmenopausal woman. Surgical treatment of the lesion was performed via a transvaginal approach without complications, and the material was sent for anatomopathological examination, which confirmed the diagnosis of leiomyoma. Vaginal leiomyomas are a rare lineage of tumors at this gynecological site, with just over 300 reports worldwide. Symptoms can range from totally asymptomatic to genitourinary complaints, such as urinary incontinence to dyspareunia. The diagnosis is based on a physical examination and preoperative imaging tests (MRI, transvaginal ultrasound, cystoscopy, computed tomography), but the definitive diagnosis is histopathological analysis of the specimen. The treatment of choice is surgery with complete excision of the lesion, and in 90% of cases, the transvaginal approach is chosen.展开更多
BACKGROUND Early esophageal neuroendocrine carcinoma(E-NEC)is a rare but aggressive malignancy with poorly understood endoscopic features.Despite advancements in multi-model endoscopy,including white light endoscopy,m...BACKGROUND Early esophageal neuroendocrine carcinoma(E-NEC)is a rare but aggressive malignancy with poorly understood endoscopic features.Despite advancements in multi-model endoscopy,including white light endoscopy,magnifying end-oscopy narrow-band imaging(NBI),and endoscopic ultrasonography(EUS),the diagnostic characteristics of early E-NEC remain unclear.Comprehensive evalu-ation using these techniques can improve early detection and guide clinical management.This study aimed to investigate the endoscopic features of early E-NEC using multiple imaging modalities.We hypothesized that specific endos-copic patterns,such as irregular microvascular morphology or signs of submu-cosal invasion,could reliably distinguish early E-NEC from other esophageal lesions.AIM To characterize early E-NEC using multi-model endoscopy and identify diag-nostic endoscopic features.METHODS Clinical data of four patients with esophageal submucosal lesions identified by gastroscopy and pathologically diagnosed as E-NEC in the Department of Gastroenterology,The First Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and August 2024 were retrospectively analyzed,and their manifestations under multi-model endoscopy were observed.Grayscale values of ultrasound images in three patients with E-NEC and eight with esophageal leiomyoma were calculated using Image J software and compared using the Mann-Whitney U test.Neuroendocrine neoplasms(NENs)are a rare heterogeneous group of epithelial tumors that originate from peptidergic neurons and neuroendocrine cells,and are characterized by neuroendocrine differentiation.NENs include well-differen-tiated neuroendocrine tumors(NETs),poorly differentiated neuroendocrine carcinomas(NECs),and mixed neuroen-docrine-non-NENs[1],which exhibit a wide range of biological behaviors,from indolent,slow-growing lesions to highly aggressive and metastatic malignancies[2].NENs have the capacity for whole-body distribution,with gastroenteropan-creatic NENs comprising approximately 60%-75%of cases,followed by those in the lungs and mediastinum[3].Eso-phageal NENs(E-NENs)are extremely rare,accounting for only approximately 1.6%of all NENs and occurring far less frequently than other gastrointestinal NENs[4].However,with advancements in early cancer screening and diagnostic techniques,the incidence of E-NENs has gradually increased in recent decades[5].Among E-NENs,<1%are well-differ-entiated NETs,with the vast majority being poorly differentiated small cell NECs[6,7].Nevertheless,esophageal NEC(E-NEC)accounts for only 0.05%-7.6%of all esophageal malignant tumors[8,9],and is characterized by aggressive behavior,rapid progression,and early metastasis.E-NEC primarily affects middle-aged and older individuals,with a higher prevalence in males[10].The tumor-node-metastasis staging system of E-NEC mirrors that of esophageal squamous cell carcinoma(ESCC)[11,12].Early E-NEC is defined as lesions limited to the mucosal or submucosal layer(stages T1a and T1b),with or without nodal metastasis.Clinically,we found that early E-NEC often presents with absent or non-specific symptoms,such as mild dysphagia or retrosternal discomfort,which are easily overlooked or mistaken for benign esophageal conditions such as leiomyoma.Conventional imaging and tumor markers frequently fail to detect early lesions,and endoscopic biopsy results may be inconclusive due to submucosal tumor growth and the overlying normal epithelium[13].As a result,E-NEC is frequently diagnosed at an advanced stage(31%-90%of cases)when regional lymph node or distant metastases have already occurred,contributing to its poor prognosis[2,13,14].Studies have reported a median survival of approximately 11 months and 5-year survival rate of<10%[14].Given these challenges,early detection using endoscopy is essential for improving patient outcomes.展开更多
BACKGROUND Leiomyomas or fibroids commonly originate from the uterus;extrauterine leiomyomas are rare and most often arise from the broad ligament.Diagnosing broad ligament leiomyomas becomes particularly challenging ...BACKGROUND Leiomyomas or fibroids commonly originate from the uterus;extrauterine leiomyomas are rare and most often arise from the broad ligament.Diagnosing broad ligament leiomyomas becomes particularly challenging when they undergo degenerative changes because their clinical and radiological features often mimic those of ovarian tumors.We report a rare case of a giant broad ligament fibroid with cystic degeneration,which was initially mistaken for an ovarian mass.CASE SUMMARY A 49-year-old woman presented with mild abdominal distension and pain as the only symptoms.Upon abdominal examination,a large mass measuring approximately 30 cm and extending from the pelvic cavity to just below the xiphoid process was identified.Both transvaginal ultrasound and contrast-enhanced computed tomography suggested an ovarian origin of the mass.However,laparotomy confirmed that the mass originated from the right broad ligament.The mass was separated from the uterus and bilateral ovaries,with no involvement of the uterus or ovaries.The mass was completely resected with respecting the patient’s desire to retain her uterus and adnexa.Postoperative histopathological examination confirmed leiomyoma with cystic degeneration.CONCLUSION Broad ligament myomas mimic ovarian tumors;accurate diagnosis and careful operation are critical to avoid complications and ensure safety.展开更多
AIM:To investigate the ultrasonographic features of ciliary body mesectodermal leiomyomas(CBL).METHODS:Ultrasonographic data of 18 eyes from 18 patients with histopathologically confirmed CBL were analyzed,covering th...AIM:To investigate the ultrasonographic features of ciliary body mesectodermal leiomyomas(CBL).METHODS:Ultrasonographic data of 18 eyes from 18 patients with histopathologically confirmed CBL were analyzed,covering the period from March 2018 to February 2024.The study included 5 male and 13 female patients,aged 14-64y,with a mean age of 40.11±13.54y.The following ultrasonographic features were evaluated:tumor base diameter,thickness,maximum base diameterto-thickness ratio,shape,internal echogenicity,margin echogenicity,internal echo homogeneity,secondary changes,color Doppler flow imaging(CDFI)findings,and contrast-enhanced ultrasound(CEUS)characteristics.RESULTS:Conventional ultrasound findings of the 18 CBL cases were as follows:1)Tumor size:base diameter of(13.48±4.74)×(11.57±4.00)mm^(2),thickness of 7.70±2.60 mm,and maximum base diameter-to-thickness ratio of 1.77±0.36.2)Shape:14 cases(77.8%)were hemispherical,and 4 cases(22.2%)were irregular.3)Internal echogenicity:the solid component of the tumor was hypoechoic in 16 cases(88.9%)and low-to-medium echogenic in 2 cases(11.1%).4)Margin echogenicity:relatively hyperechoic with a“ring-shaped”margin in 15 cases(83.3%)and isoechoic in 3 cases(16.7%;compared with internal echogenicity).5)Internal echo homogeneity:homogeneous in 11 cases(61.1%)and heterogeneous in 7 cases(38.9%),with 6 cases(33.3%)among the 7 heterogeneous cases exhibiting cystic anechoic areas.6)Secondary retinal detachment was observed in 4 cases(22.2%).CDFI revealed heterogeneous vascularity within the tumors,with blood flow signals ranging from minimal to marked.CEUS was performed in 14 patients:complete contrast agent perfusion was observed in 10 cases(71.4%),and partial perfusion was noted in 4 cases(28.6%).Additionally,8 cases(57.1%)showed a rapid wash-in and slow wash-out pattern,while 6 cases(42.9%)demonstrated a rapid wash-in and rapid wash-out pattern.CONCLUSION:CBL exhibit relatively typical ultrasonographic features,which can provide valuable evidence for the clinical diagnosis and differential diagnosis of intraocular tumors.展开更多
BACKGROUND Leiomyomas(LMs)are mesenchymal tumors that arise from smooth muscle cells.LMs most commonly arise in organs with an abundance of smooth muscle such as the uterus and gastrointestinal tract.Conversely,LMs ar...BACKGROUND Leiomyomas(LMs)are mesenchymal tumors that arise from smooth muscle cells.LMs most commonly arise in organs with an abundance of smooth muscle such as the uterus and gastrointestinal tract.Conversely,LMs are rarely detected in the head and neck region.In this study,we report a rare case of laryngeal LM(LLM)and summarized the clinical characteristics of reported LLMs to help clinicians better understand this rare disease and improve its diagnosis,treatment,and postoperative course.CASE SUMMARY A 49-year-old man was admitted to our ENT outpatient clinic with a chief complaint of pharynx discomfort for 2 months.Laryngoscopy performed under topical anesthesia revealed a solitary,pink mass at the tubercle of epiglottis.Surgery via laryngeal endoscopy was performed under general anesthesia,and the lesion was excised easily.Positive immunohistochemical staining for desmin and smooth-muscle actin indicated a smooth muscle origin and the diagnosis was laryngeal leiomyoma.After surgery,the patient’s condition was stable,and he was discharged 2 d after surgery.During the 1-year postoperative period,the patient’s condition remained stable without evidence of recurrence.CONCLUSION Surgical resection is the preferred treatment for LLMs,its early diagnosis and differential diagnosis have important clinical significance.展开更多
BACKGROUND Endoscopic resection of giant gastric leiomyomas,particularly in the fundus and cardia regions,is infrequently documented and presents a significant challenge for endoscopic surgery.CASE SUMMARY Herein,a ca...BACKGROUND Endoscopic resection of giant gastric leiomyomas,particularly in the fundus and cardia regions,is infrequently documented and presents a significant challenge for endoscopic surgery.CASE SUMMARY Herein,a case of a 59-year-old woman with a giant gastric leiomyoma was reported.The patient presented to the department of hepatological surgery with a complaint of right upper abdominal pain for one month and worsening for one week.The patient was diagnosed as gastric submucosal tumor(SMT),gallstone,and cholecystitis combined with computed tomography and gastroendoscopy prior to operation.Upon admission,following a multi-disciplinary treatment discussion,it was determined that the patient would undergo a laparoscopic cholecystectomy and endoscopic resection of gastric SMT.It took 3 hours to completely resect the lesion by Endoscopic submucosal excavation and endoscopic fullthickness resection,and about 3 hours to suture the wound and take out the lesion.The lesion,ginger-shaped and measuring 8 cm×5 cm,led to transient peritonitis post-surgery.With no cardiac complications,the patient was discharged one week after surgery.CONCLUSION Endoscopic resection of a giant leiomyoma in the cardiac fundus is feasible and suitable for skilled endoscopists.展开更多
BACKGROUND Gastric mesenchymal tumors(GMT)are identified as soft tissue neoplasms that arise from mesenchymal stem cells within the gastrointestinal tract.GMT pri-marily encompass gastric stromal tumors(GST),gastric l...BACKGROUND Gastric mesenchymal tumors(GMT)are identified as soft tissue neoplasms that arise from mesenchymal stem cells within the gastrointestinal tract.GMT pri-marily encompass gastric stromal tumors(GST),gastric leiomyomas,and gastric schwannomas.Although most GMT are benign,there are still potential malignant changes,especially GST.Thus,early surgical intervention is the primary treat-ment for GMT.We have designed a simple endoscopic“calabash”ligation and resection(ECLR)procedure to treat GMT.Its efficacy and safety need to be com-pared with those of traditional endoscopic techniques,such as endoscopic sub-mucosal excavation(ESE).AIM To assess the safety and effectiveness of ECLR in managing small GMT(sGMT)with a maximum diameter≤20 mm by comparing to ESE.METHODS This retrospective analysis involved patients who were hospitalized in our institution between November 2021 and March 2023,underwent endoscopic resection,and received a pathological diagnosis of GMT.Cases with a tumor diameter≤20 mm were chosen and categorized into two cohorts:Study and control groups.The study group was composed of patients treated with ECLR,whereas the control group was composed of those treated with ESE.Data on general clinical characteristics(gender,age,tumor diameter,tumor growth direction,tumor pathological type,and risk grade),surgery-related information(complete tumor resection rate,operation duration,hospitalization duration,hospitalization cost,and surgical complications),and postoperative follow-up were collected for both groups.The aforementioned data were subsequently analyzed and compared.RESULTS Five hundred and eighty-nine individuals were included,with 297 cases in the control group and 292 in the study group.After propensity score matching,the final analysis incorporated 260 subjects in each cohort.The findings indicated that the study group exhibited shorter operation duration and lowered medical expenses relative to the control group.Furthermore,the study group reported less postoperative abdominal pain and had a lower incidence of intraoperative perforation and postoperative electrocoagulation syndrome than the control group.There were no substantial variations observed in other parameters among the two cohorts.CONCLUSION ECLR is a viable and effective approach for managing sGMT.展开更多
AIM： To study the endoscopic, pathological and immunoo histochemical features of esophageal mesenchymal tumors. METHODS： Twenty-nine patients diagnosed as esophageal rnysenchymal tumors by electronic endoscopy and e...AIM： To study the endoscopic, pathological and immunoo histochemical features of esophageal mesenchymal tumors. METHODS： Twenty-nine patients diagnosed as esophageal rnysenchymal tumors by electronic endoscopy and endoscopic ultrasound （EUS） were observed under light microscopes, and all tissues were stained by the immunohistochemical method. The expression of CD117, CD34, SMA and desmin were measured by staining intensity of cells and positive cell ratios. RESULTS： Endoscopically, esophageal gastrointestinal stromal tumors （GISTs） and leiomyomas （LMs） had similar appearances, showing submucosal protuberant lesions. They all showed low echo images originated from the muscularis propria or muscularis mucosa on EUS. Endoscopy and EUS could not exactly differentiate esophageal GISTs from LMs. Microscopically, there were two kinds of cells： spindle cell type and epitheloid cell type in esophageal GISTs. Leiomyomas and leiomyosarcornas were only of spindle cell type. One malignancy was found in five cases of esophageal GISTs, and one malignancy in 24 cases of leiomyomas and leiomyosarcomas. Using Fisher＇s exact method, the differences of malignant lesion proportion were not significant between esophageal LMs and GISTs, 1/5 vs 1/24 （P 〉 0.05）. All cases of esophageal GISTs were positive for CD117, and 3 cases were also positive for CD34. The 24 cases of leiomyomas and leiomyosarcomas were all negative for CD117 and CD34. The differences of positive rates of CD117 and CD34 were significant between esophageal GISTs and LMs, 5/5 vs 0/24, 3/5 vs 0/24 （P 〈 0.005）. All leiomyomas and leiomyosarcomas were positive for SMA, and desmin. Among 5 cases of esophageal GISTs, 2 cases were SMA positive, and 1 case was desmin positive. The differences in positive rates and expression intensity of SMA and desmin were significant between esophageal LMs and GISTs, 24/24 vs 2/5, 24/24 vs 115 （P 〈 0.005）. CONCLUSION： The most common esophageal mesenchymal tumors are leiomyomas, and esophageal GISTs are less common. Most of esophageal LMs and GISTs are benign. Endoscopy and EUS are the effective methods to diagnose esophageal mesenchymal tumors and they can provide useful information for the treatment of these tumors. However, they cannot exactly differentiate esophageal GISTs from LMs. Pathological, especially immunohistochemical features are useful to differentiate GISTs from leiomyomas.展开更多
AIM: To investigate the role of angiopoietin (Ang) -1, -2 and -4 and its receptors, Tie-1 and -2, in the growth and differentiation of gastrointestinal stromal tumors (GISTs).METHODS: Thirty GISTs, seventeen leiomyoma...AIM: To investigate the role of angiopoietin (Ang) -1, -2 and -4 and its receptors, Tie-1 and -2, in the growth and differentiation of gastrointestinal stromal tumors (GISTs).METHODS: Thirty GISTs, seventeen leiomyomas and six schwannomas were examined by immunohistochemistry in this study.RESULTS: Ang-1, -2 and -4 proteins were expressed in the cytoplasm of tumor cells, and Tie-1 and -2 were expressed both in the cytoplasm and on the membrane of all tumors. Immunohistochemical staining revealed that 66.7% of GISTs (20 of 30), 76.5% of leiomyomas (13 of 17) and 83.3% of schwannomas (5 of 6) were positive for Ang-1. 83.3% of GISTs (25 of 30), 82.4% of leiomyomas (14 of 17) and 100% of schwannomas (6 of 6) were positive for Ang-2. 36.7% of GISTs (11 of 30), 58.8% of leiomyomas (10 of 17) and 83.3% of schwannomas (5 of 6) were positive for Ang-4. 60.0% of GISTs (18 of 30), 82.4% of leiomyomas and 100% of schwannomas (6 of 6) were positive for Tie-1. 10.0% of GISTs (3 of 30), 94.1% of leiomyomas (16 of 17) and 33.3% of schwannomas (2 of 6) were positive for Tie-2. Tie-2 expression was statistically different between GISTs and leiomyomas (P < 0.001). However, there was no correlation between expression of angiopoietin pathway components and clinical risk categories.CONCLUSION: Our results suggest that the angiopoietin pathway plays an important role in the differentiation of GISTs, leiomyomas and schwannomas.展开更多
基金Medical and Health Science and Technology Project of Zhejiang Province of China,No.2022KY274.
文摘BACKGROUND Retroperitoneal leiomyomas(RLs)are rare benign tumours that can occur in the pelvic and/or abdominal parietal retroperitoneum.Once torsion occurs,it causes acute abdominal pain and can even lead to serious consequences such as gangrene,peritonitis,haemoperitoneum and shock if not identified and treated promptly.Therefore,a better understanding of the characteristics of RL torsion is needed.Here,we present a case of acute pedicle torsion of an RL in the posterior peritoneum followed by a literature review.CASE SUMMARY Herein,we report the case of a 42-year-old woman with RL torsion.The patient visited our hospital complaining of lower abdominal pain for 6 d.Pelvic examination revealed a tender mass superior to the uterus.Pelvic magnetic resonance imaging(MRI)revealed an anterior uterine mass,multiple uterine fibroids and slight pelvic effusion.MRI suggested the possibility of a subserosal myoma of the anterior uterine wall with degeneration.Intraoperative exploration revealed a 10 cm pedunculated mass arising from the posterior peritoneum,with the pedicle torsed two times.Pathological examination confirmed a torsed RL.CONCLUSION In the case of a pelvic mass complicated with acute abdomen,the possibility of torsion should be considered.
文摘Leiomyomas are the most common benign tumors of the esophagus. They usually occur as a single lesion or as two or three nodules. Only two cases of esophageal multiple leiomyomas comprising more than 10 nodules have been reported previously. Moreover, there have been few reports of esophageal squamous cell carcinoma overlying submucosal tumors. We describe a 71-yearold man who was diagnosed as having a superficial esophageal cancer coexisting with two or three leiomyoma nodules. During surgery, 10 or more nodules that had not been evident preoperatively were palpable in the submucosal and muscular layers throughout the esophagus. As intramural metastasis of the esophageal cancer was suspected, we considered additional lymphadenectomy, but had to rule out this option because of the patient＇s severe anoxemia. Microscopic examination revealed that all the nodules were leiomyomas （20 lesions, up to 3 cm in diameter）, and that invasion of the carcinoma cells was limited to the submucosal layer overlying a relatively large leiomyoma. This is the first report of superficial esophageal cancer coexisting with numerous solitary leiomyomas. Multiple minute leiomyomas are often misdiagnosed as intramural metastasis, and a leiomyoma at the base of a carcinoma lesion can also be rnisdiagnosed as tumor invasion. The present case shows that accurate diagnosis is required for the management of patients with coexisting superficial esophageal cancer and multiple leiomyomas.
文摘Background and aims: Adhesions can cause important morbidity including abdominal and pelvic pain, intestinal obstructions, and infertility. When adhesions are formed, there is no efficient method, nowadays, to resolve them, thus the reduction of their prevalence relies on the prevention. Profiling high risk patients for abdominal and pelvic adhesions (APA) is an important step to this prevention. The risk factors of adhesions in our institution, the association between APA, leiomyomas and skin scar anomaly (SSA) were investigated. Methods: A cross-sectional study was conducted from March 1st to June 30th 2013 including patients who underwent laparotomy or laparoscopy. Patients’ characteristics, presence of a SSA and leiomyomas, as related to adhesions, were analyzed. Student’s t, Pearson’s Khi-square, Fisher’s Exact, Mann-Whitney tests and logistic regression were used. P values < 0.05 were considered statistically significant. Results: The frequency of adhesions was 41.74%. Patients had a mean age of 32.69 ± 8.94 years. Those with a previous abdominal surgery (PAS), SSA and leiomyomas had respectively 12 times [OR: 11.98, CI95 (4.63 - 30.97)], 3 times [OR: 2.79, CI95 (1.16 - 6.71) and 2.5 times [(OR: 2.49, CI95 (1.07 - 5.78)] more adhesions. In logistic regression, a PAS and leiomyomas remained associated significantly to adhesions with p = 0.000 and p = 0.037 respectively. Conclusion: In peritoneal adhesions, leiomyomas and SSA are other factors that may allow a cautious selection of high risk patients who must benefit from particular attention during surgery. Further well designed studies are necessary to investigate the accurate clinical relation among those three conditions.
文摘Uterine leiomyomas (myomas) are the most common benign tumors of the female genital tract. They affect 20<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">%</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> to 25% of women of childbearing age and are 3 to 9 times more common in black women. We initiated this study in order to report the socio-demographic aspects and the indications for leiomyomas surgery at</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">H<span style="color:#4F4F4F;font-family:Simsun;font-size:14px;white-space:normal;background-color:#FFFFFF;">ô</span>pital du Mali. This was a retro-prospective descriptive study, conducted in the gynecology department of H<span style="color:#4F4F4F;font-family:Simsun;font-size:14px;white-space:normal;background-color:#FFFFFF;">ô</span>pital du Mali from January 1, 2015 to December 31, 2019. Any</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">patients, regardless of their age, in whom a leiomyomas had been detected and surgically treated were included. We had collected 180 cases of surgery for leiomyomas out of 950 surgical procedures, with a frequency of 18.94%. The 36</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">45 age group represented 45% of our patients with an average age of 35 years. Nulligravida</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">accounted for 48.9% and nulliparous (60%). The main reason for consultation was the desire to become pregnant (53.33%). A history of myomectomy was found out in 15.55% of patients. Pelvic ultrasound figured out 64.44% interstitial myomas. Myomectomy was performed in 88.88% of cases and hysterectomy in 11.12% of cases. Among our patients 39.37% had become pregnant. Operative complications were dominated by anemia 14.44%. Leiomyoma was the histological tissue found in all cases of myomectomy. The average duration of </span><span><span style="font-family:Verdana;">hospitalization was 3 days. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Leiomyomas surgery is the first</span></span><span style="font-family:Verdana;"> scheduled gynecological surgical activity. Laparotomy remains the primary route of entry. The indications are dominated by the desire for pregnancy.</span></span></span></span>
文摘AIM： To investigate the role of vascular endothelial growth factor （VEGF/and its receptors VEGFR-1 and 2 in the growth and differentiation of gastrointestinal strornal tumors （GISTs）. METHODS： Thirty-three GISTs, 15 leiomyomas and 6 schwannomas were examined by immunohistochemistry in this study. RESULTS： VEGF protein was expressed in the cytoplasm of tumor cells, and VEGFRol and 2 were expressed both in the cytoplasm and on the membrane of all tumors. Irnrnunohistochernical staining revealed that 26 GISTs （78.8%）, 9 leiornyornas （60.0%） and 3 schwannornas （50.0%/were positive for VEGF; 24 GISTs （72.7%/, 12 leiornyornas （80.0%） and 4 schwannornas （66.7%） were positive for VEGFR-1; 30 GISTs （90.9%/, 5 leiornyornas （33.3%/and 4 schwannornas （66.7%） were positive for VEGFR-2. VEGFR-2 expression was statistically different between GISTs and leiomyomas （P 〈 0.0001）. However, there was no correlation between the expression of VEGF pathway componenets and the clinical risk categories. CONCLUSION： Our results suggest that the VEGF pathway may play an important role in the differentiation of GISTs, leiomyomas and schwannomas.
基金supported by Program for New Century Excellent Talents in University(NCET-11-0949)
文摘Objective:To investigate the role of epidermal growth factor(EGF) in the pathogenesis of uterine leiomyomas.Methods:Human myometrial smooth muscle cells(HM-SMCs) and smooth muscle cells of human uterine leiomyomas(HL-SMCs) were separated from patients' specimens and cultured.After processed by EGF or PD98059(inhibitor of MKK/MEK) +EGF,the proliferation rate of both SMCs was detected by BrdU method and the phosphorylation level of p44/42 mitogen-activated protein kinase(MAPK) was determined by Western-blot.After different processing time by EGF,the phosphorylation levels of p44/42 MAPK and AKT and p27 expression level in both SMCs were detected by Western-blot.Results:EGF could significantly promote HL-SMCs proliferation and PD98059 could inhibit this effect(P<0.05);besides,PD98059 could inhibit the increase of the phosphorylation level of p44/42 MAPK in both SMCs induced by EGF.When the processing time by EGF was over 15 min,the phosphorylation levels of p44/42 MAPK and AKT in both SMCs decreased sharply and were close to zero:p27 expression in HM-SMCs raised significantly while the upregulation in HL-SMCs was little.Conclusions:EGF could not cause activation of EGFR because of the dephosphorylation of p44/42 MAPK and AKT in HL-SMCs,which caused p27 expression insufficiently and cell cycle dysregulation.
基金Supported by Beijing Municipal Science&Technology Commission,No.D17100006517003and Beijing Municipal Administration of Hospitals Incubating Program,No.PX2020001.
文摘BACKGROUND Gastric leiomyomas and gastric stromal tumors are the most common types of gastric tumors encountered.In recent years,the incidence of the two types of tumors has been increasing,but the differential diagnosis is still a challenge in clinical work.However,as there are many reports on stromal tumors and inflammation-related indicators are gradually being paid attention to as important factors in predicting tumor prognosis,the two main purposes of this study were to explore the inflammation-related differences between the two types of tumors and to develop a nomogram as a predictive model.AIM To explore the differences in platelet-lymphocyte ratio(PLR),neutrophillymphocyte ratio(NLR),lymphocyte mononuclear cell ratio(LMR),and SII between the two types of tumors,and simultaneously create the nomogram model.METHODS This study enrolled 88 patients in the gastric stromal tumor group and 56 patients in the gastric leiomyoma group,and the relevant data of the two groups were entered into the system for an integrated analysis.The primary objective of this study was to identify the differences in the inflammation index between the two types of tumors.RESULTS There were statistically significant differences between the two groups in sex,age,and tumor location.In comparison,gastric leiomyomas seem to be more common in women,young patients,and gastric cardia,which is in line with our previous research;the groups showed the following statistical differences:PLR(158.2%vs 134.3%,P=0.028),NLR(2.35 vs 1.68,P=0.000),LMR(5.75 vs 10.8,P=0.004),and SII(546.2 vs 384.3,P=0.003).The results of the multivariate logistic regression analysis showed that sex,age,tumor location,and LMR were independent risk factors for the identification of the two types of tumors.After considering the risk factors selected by the above analysis into the predictive model,a predictive model for distinguishing gastrointestinal stromal tumors from gastric leiomyomas was established as the nomogram.CONCLUSION Gastric leiomyomas and gastric stromal tumors are not only different in factors such as age of the patient,but also in inflammatory indicators such as LMR and PLR.We have established a predictive model related to the laboratory indicators and are looking forward to further research conducted in this clinical area.
文摘AIM： Gastrointestinal stromal tumors （GISTs） are rare. GISTs differ from other mesenchymal tumors of the gastrointestinal tract （e.g. leiornyomas and schwannomas）. The purpose of this study was to investigate the role of Ets-1 in the growth and differentiation of GISTs. METHODS： Twenty-eight GISTs, nine leiomyomas and six schwannomas were examined by immunohistochemical staining method for Ets-1 in this study. Specimens were selected from surgical pathology archival tissues at Nagasaki University Hospital. RESULTS： Ets-1 protein was expressed in the cytoplasm of cells in all of these tumors. Immunohistochemical staining revealed that 27 GISTs （96.4%）, six leiomyomas （66.7%）, and five schwannomas （83.3%） were positive for Ets-1. Ets-1 expression was statistically different between GISTs and leiomyomas （P〈0.005）. However, there was no correlation between Ets-1 expression and clinical risk categories. CONCLUSION： Ets-1 plays an important role in the growth and differentiation of GISTs, leiomyomas and schwannomas.
文摘In searching of differentially expressed genes in human uterine leiomyomas, differential display was used with twelve pairs of primers to compare human uterine leiomyomas with matched myometrium. False positives were eliminated by reverse Northern analysis. Positives were confirmed by Northern blot analysis. RESULTS: Four of 69 cDNA fragments (3 up-regulated named L1, L2 and L3 and 1 down-regulated named M1 in leiomyoma) were confirmed by Northern analysis. Sequence comparison and Northern analysis proved that L1 is exactly the human ribosomal protein S19. It was present ubiquitously in 13 tissues tested but in various levels and even in different size. L1 was highly expressed in parotidean cystadenocarcinoma, pancreatic cancer and breast cancer examined. No mutations have been found in human uterine leiomyomas (n=6). CONCLUSIONS: hRPS19 overexpression might be a universal signal in rapid cell growth tissues.
文摘Objective: To investigate the clinicopathology and DNA ploidy of gastric mucosa associated lymphoid tissue (MALT) lymphoma infiltraving the leiomyomas of the uterus of a patient. Methods: The routine paraffin slides were cut, stained with HE, immunochemically by ABC methodusing the and stained by Feulgen method. Then the DNA ploidy of tumor cells was measured with an image cytometer. Results: In the mucosa, submucosa and the smooth muscle layer of the stomach and in the leiomyomas of the uterus there was diffusive and dense infiltration of centrocyte-like cells. The DNA measurement results were that the distribution of DNA mass of lymphoma cells in stomach and in lymph nodes had a single main aneuploidy peak each, and the distribution of DNA mass of lymphoma cells in leiomyomas of uterus had two peaks; one of them was the diploid, the other aneuploid. Conclusion: The MALT lymphoma cell invasion in uterus must be differentiated with a primary lymphoma in the uterus, the chronic lymphocyte leukemia in uterus and an endometrial stromal sarcoma. The present prognosis of the patient under discussion was poor. The follow-up results indicated the DNA index seemed to be important for predicting the malignancy degree and prognosis.
文摘Background Ultrasound （US） is a popular method in the diagnosis and treatment of uterine leiomyomas, but the lack of accuracy greatly limits its application. Recently, microbubble enhancement technique affords direct depiction of tumor neovascularity and establishes a more precise vascular map of the tumor. This study was undertaken to describe the distribution patterns of SonoVue, a second-generation contrast agent, in the micrecirculation of uterine leiomyomas, and to investigate the potential use of contrast-enhanced ultrasound （CEUS） in the characterization and treatment of uterine leiomyomas.Methods Ninety-six patients with uterine leiomyomas were enrolled in this study. The CEUS was performed using cadence pulse sequencing technique （CPS） and SonoVue. Enhancement patterns of different lesions were observed.The diagnostic accuracy of CEUS was compared with that of conventional ultrasound.Results After contrast injection, vessels of macro- and micro-circulation of the myoma first appeared, followed by the normal myometrium and finally the endometrium. During the washout phase, the myoma exhibited homogeneous enhancement followed by apparent hypoenhancement. The margin of the tumor was depicted clearly. There was no agent perfusion in the benign degenerative or necrotic area. However in sarcomas degeneration, the feeding vessels appeared markedly earlier than those in myometrium. In addition, the tumor exhibited heterogeneous hyperenhancment with no agent perfusion in the center and no membraniform sign was observed in the late phase. In subserous andsubmucous leiomyomas, the feeding arteries in the pedicle arising from the uterine could be seen. In this study, the diagnostic accuracy of CEUS and conventional US for uterine leiomyomas was 96.7% （160/165） and 82.4% （136/165）respectively.Conclusions CEUS can provide a precise description of the leiomyomas vascularization. The specific enhancement pattern may be helpful for the characterization, treatment choice and therapeutic monitoring of leiomyomas.
文摘This is a case report of a rare myoma of the anterior vaginal wall that mimicked a paraurethral diverticulum in a postmenopausal woman. Surgical treatment of the lesion was performed via a transvaginal approach without complications, and the material was sent for anatomopathological examination, which confirmed the diagnosis of leiomyoma. Vaginal leiomyomas are a rare lineage of tumors at this gynecological site, with just over 300 reports worldwide. Symptoms can range from totally asymptomatic to genitourinary complaints, such as urinary incontinence to dyspareunia. The diagnosis is based on a physical examination and preoperative imaging tests (MRI, transvaginal ultrasound, cystoscopy, computed tomography), but the definitive diagnosis is histopathological analysis of the specimen. The treatment of choice is surgery with complete excision of the lesion, and in 90% of cases, the transvaginal approach is chosen.
基金Supported by National Natural Science Foundation of China,No.82370570.
文摘BACKGROUND Early esophageal neuroendocrine carcinoma(E-NEC)is a rare but aggressive malignancy with poorly understood endoscopic features.Despite advancements in multi-model endoscopy,including white light endoscopy,magnifying end-oscopy narrow-band imaging(NBI),and endoscopic ultrasonography(EUS),the diagnostic characteristics of early E-NEC remain unclear.Comprehensive evalu-ation using these techniques can improve early detection and guide clinical management.This study aimed to investigate the endoscopic features of early E-NEC using multiple imaging modalities.We hypothesized that specific endos-copic patterns,such as irregular microvascular morphology or signs of submu-cosal invasion,could reliably distinguish early E-NEC from other esophageal lesions.AIM To characterize early E-NEC using multi-model endoscopy and identify diag-nostic endoscopic features.METHODS Clinical data of four patients with esophageal submucosal lesions identified by gastroscopy and pathologically diagnosed as E-NEC in the Department of Gastroenterology,The First Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and August 2024 were retrospectively analyzed,and their manifestations under multi-model endoscopy were observed.Grayscale values of ultrasound images in three patients with E-NEC and eight with esophageal leiomyoma were calculated using Image J software and compared using the Mann-Whitney U test.Neuroendocrine neoplasms(NENs)are a rare heterogeneous group of epithelial tumors that originate from peptidergic neurons and neuroendocrine cells,and are characterized by neuroendocrine differentiation.NENs include well-differen-tiated neuroendocrine tumors(NETs),poorly differentiated neuroendocrine carcinomas(NECs),and mixed neuroen-docrine-non-NENs[1],which exhibit a wide range of biological behaviors,from indolent,slow-growing lesions to highly aggressive and metastatic malignancies[2].NENs have the capacity for whole-body distribution,with gastroenteropan-creatic NENs comprising approximately 60%-75%of cases,followed by those in the lungs and mediastinum[3].Eso-phageal NENs(E-NENs)are extremely rare,accounting for only approximately 1.6%of all NENs and occurring far less frequently than other gastrointestinal NENs[4].However,with advancements in early cancer screening and diagnostic techniques,the incidence of E-NENs has gradually increased in recent decades[5].Among E-NENs,<1%are well-differ-entiated NETs,with the vast majority being poorly differentiated small cell NECs[6,7].Nevertheless,esophageal NEC(E-NEC)accounts for only 0.05%-7.6%of all esophageal malignant tumors[8,9],and is characterized by aggressive behavior,rapid progression,and early metastasis.E-NEC primarily affects middle-aged and older individuals,with a higher prevalence in males[10].The tumor-node-metastasis staging system of E-NEC mirrors that of esophageal squamous cell carcinoma(ESCC)[11,12].Early E-NEC is defined as lesions limited to the mucosal or submucosal layer(stages T1a and T1b),with or without nodal metastasis.Clinically,we found that early E-NEC often presents with absent or non-specific symptoms,such as mild dysphagia or retrosternal discomfort,which are easily overlooked or mistaken for benign esophageal conditions such as leiomyoma.Conventional imaging and tumor markers frequently fail to detect early lesions,and endoscopic biopsy results may be inconclusive due to submucosal tumor growth and the overlying normal epithelium[13].As a result,E-NEC is frequently diagnosed at an advanced stage(31%-90%of cases)when regional lymph node or distant metastases have already occurred,contributing to its poor prognosis[2,13,14].Studies have reported a median survival of approximately 11 months and 5-year survival rate of<10%[14].Given these challenges,early detection using endoscopy is essential for improving patient outcomes.
文摘BACKGROUND Leiomyomas or fibroids commonly originate from the uterus;extrauterine leiomyomas are rare and most often arise from the broad ligament.Diagnosing broad ligament leiomyomas becomes particularly challenging when they undergo degenerative changes because their clinical and radiological features often mimic those of ovarian tumors.We report a rare case of a giant broad ligament fibroid with cystic degeneration,which was initially mistaken for an ovarian mass.CASE SUMMARY A 49-year-old woman presented with mild abdominal distension and pain as the only symptoms.Upon abdominal examination,a large mass measuring approximately 30 cm and extending from the pelvic cavity to just below the xiphoid process was identified.Both transvaginal ultrasound and contrast-enhanced computed tomography suggested an ovarian origin of the mass.However,laparotomy confirmed that the mass originated from the right broad ligament.The mass was separated from the uterus and bilateral ovaries,with no involvement of the uterus or ovaries.The mass was completely resected with respecting the patient’s desire to retain her uterus and adnexa.Postoperative histopathological examination confirmed leiomyoma with cystic degeneration.CONCLUSION Broad ligament myomas mimic ovarian tumors;accurate diagnosis and careful operation are critical to avoid complications and ensure safety.
基金Supported by National Key R&D Program of China(No.2018YFC0116000).
文摘AIM:To investigate the ultrasonographic features of ciliary body mesectodermal leiomyomas(CBL).METHODS:Ultrasonographic data of 18 eyes from 18 patients with histopathologically confirmed CBL were analyzed,covering the period from March 2018 to February 2024.The study included 5 male and 13 female patients,aged 14-64y,with a mean age of 40.11±13.54y.The following ultrasonographic features were evaluated:tumor base diameter,thickness,maximum base diameterto-thickness ratio,shape,internal echogenicity,margin echogenicity,internal echo homogeneity,secondary changes,color Doppler flow imaging(CDFI)findings,and contrast-enhanced ultrasound(CEUS)characteristics.RESULTS:Conventional ultrasound findings of the 18 CBL cases were as follows:1)Tumor size:base diameter of(13.48±4.74)×(11.57±4.00)mm^(2),thickness of 7.70±2.60 mm,and maximum base diameter-to-thickness ratio of 1.77±0.36.2)Shape:14 cases(77.8%)were hemispherical,and 4 cases(22.2%)were irregular.3)Internal echogenicity:the solid component of the tumor was hypoechoic in 16 cases(88.9%)and low-to-medium echogenic in 2 cases(11.1%).4)Margin echogenicity:relatively hyperechoic with a“ring-shaped”margin in 15 cases(83.3%)and isoechoic in 3 cases(16.7%;compared with internal echogenicity).5)Internal echo homogeneity:homogeneous in 11 cases(61.1%)and heterogeneous in 7 cases(38.9%),with 6 cases(33.3%)among the 7 heterogeneous cases exhibiting cystic anechoic areas.6)Secondary retinal detachment was observed in 4 cases(22.2%).CDFI revealed heterogeneous vascularity within the tumors,with blood flow signals ranging from minimal to marked.CEUS was performed in 14 patients:complete contrast agent perfusion was observed in 10 cases(71.4%),and partial perfusion was noted in 4 cases(28.6%).Additionally,8 cases(57.1%)showed a rapid wash-in and slow wash-out pattern,while 6 cases(42.9%)demonstrated a rapid wash-in and rapid wash-out pattern.CONCLUSION:CBL exhibit relatively typical ultrasonographic features,which can provide valuable evidence for the clinical diagnosis and differential diagnosis of intraocular tumors.
基金Supported by National Natural Science Foundation of China,No.82071031。
文摘BACKGROUND Leiomyomas(LMs)are mesenchymal tumors that arise from smooth muscle cells.LMs most commonly arise in organs with an abundance of smooth muscle such as the uterus and gastrointestinal tract.Conversely,LMs are rarely detected in the head and neck region.In this study,we report a rare case of laryngeal LM(LLM)and summarized the clinical characteristics of reported LLMs to help clinicians better understand this rare disease and improve its diagnosis,treatment,and postoperative course.CASE SUMMARY A 49-year-old man was admitted to our ENT outpatient clinic with a chief complaint of pharynx discomfort for 2 months.Laryngoscopy performed under topical anesthesia revealed a solitary,pink mass at the tubercle of epiglottis.Surgery via laryngeal endoscopy was performed under general anesthesia,and the lesion was excised easily.Positive immunohistochemical staining for desmin and smooth-muscle actin indicated a smooth muscle origin and the diagnosis was laryngeal leiomyoma.After surgery,the patient’s condition was stable,and he was discharged 2 d after surgery.During the 1-year postoperative period,the patient’s condition remained stable without evidence of recurrence.CONCLUSION Surgical resection is the preferred treatment for LLMs,its early diagnosis and differential diagnosis have important clinical significance.
文摘BACKGROUND Endoscopic resection of giant gastric leiomyomas,particularly in the fundus and cardia regions,is infrequently documented and presents a significant challenge for endoscopic surgery.CASE SUMMARY Herein,a case of a 59-year-old woman with a giant gastric leiomyoma was reported.The patient presented to the department of hepatological surgery with a complaint of right upper abdominal pain for one month and worsening for one week.The patient was diagnosed as gastric submucosal tumor(SMT),gallstone,and cholecystitis combined with computed tomography and gastroendoscopy prior to operation.Upon admission,following a multi-disciplinary treatment discussion,it was determined that the patient would undergo a laparoscopic cholecystectomy and endoscopic resection of gastric SMT.It took 3 hours to completely resect the lesion by Endoscopic submucosal excavation and endoscopic fullthickness resection,and about 3 hours to suture the wound and take out the lesion.The lesion,ginger-shaped and measuring 8 cm×5 cm,led to transient peritonitis post-surgery.With no cardiac complications,the patient was discharged one week after surgery.CONCLUSION Endoscopic resection of a giant leiomyoma in the cardiac fundus is feasible and suitable for skilled endoscopists.
文摘BACKGROUND Gastric mesenchymal tumors(GMT)are identified as soft tissue neoplasms that arise from mesenchymal stem cells within the gastrointestinal tract.GMT pri-marily encompass gastric stromal tumors(GST),gastric leiomyomas,and gastric schwannomas.Although most GMT are benign,there are still potential malignant changes,especially GST.Thus,early surgical intervention is the primary treat-ment for GMT.We have designed a simple endoscopic“calabash”ligation and resection(ECLR)procedure to treat GMT.Its efficacy and safety need to be com-pared with those of traditional endoscopic techniques,such as endoscopic sub-mucosal excavation(ESE).AIM To assess the safety and effectiveness of ECLR in managing small GMT(sGMT)with a maximum diameter≤20 mm by comparing to ESE.METHODS This retrospective analysis involved patients who were hospitalized in our institution between November 2021 and March 2023,underwent endoscopic resection,and received a pathological diagnosis of GMT.Cases with a tumor diameter≤20 mm were chosen and categorized into two cohorts:Study and control groups.The study group was composed of patients treated with ECLR,whereas the control group was composed of those treated with ESE.Data on general clinical characteristics(gender,age,tumor diameter,tumor growth direction,tumor pathological type,and risk grade),surgery-related information(complete tumor resection rate,operation duration,hospitalization duration,hospitalization cost,and surgical complications),and postoperative follow-up were collected for both groups.The aforementioned data were subsequently analyzed and compared.RESULTS Five hundred and eighty-nine individuals were included,with 297 cases in the control group and 292 in the study group.After propensity score matching,the final analysis incorporated 260 subjects in each cohort.The findings indicated that the study group exhibited shorter operation duration and lowered medical expenses relative to the control group.Furthermore,the study group reported less postoperative abdominal pain and had a lower incidence of intraoperative perforation and postoperative electrocoagulation syndrome than the control group.There were no substantial variations observed in other parameters among the two cohorts.CONCLUSION ECLR is a viable and effective approach for managing sGMT.
基金Supported by the Scientific and Technological Foundation of the Jiangxi Provincial Department of Science and Technology
文摘AIM： To study the endoscopic, pathological and immunoo histochemical features of esophageal mesenchymal tumors. METHODS： Twenty-nine patients diagnosed as esophageal rnysenchymal tumors by electronic endoscopy and endoscopic ultrasound （EUS） were observed under light microscopes, and all tissues were stained by the immunohistochemical method. The expression of CD117, CD34, SMA and desmin were measured by staining intensity of cells and positive cell ratios. RESULTS： Endoscopically, esophageal gastrointestinal stromal tumors （GISTs） and leiomyomas （LMs） had similar appearances, showing submucosal protuberant lesions. They all showed low echo images originated from the muscularis propria or muscularis mucosa on EUS. Endoscopy and EUS could not exactly differentiate esophageal GISTs from LMs. Microscopically, there were two kinds of cells： spindle cell type and epitheloid cell type in esophageal GISTs. Leiomyomas and leiomyosarcornas were only of spindle cell type. One malignancy was found in five cases of esophageal GISTs, and one malignancy in 24 cases of leiomyomas and leiomyosarcomas. Using Fisher＇s exact method, the differences of malignant lesion proportion were not significant between esophageal LMs and GISTs, 1/5 vs 1/24 （P 〉 0.05）. All cases of esophageal GISTs were positive for CD117, and 3 cases were also positive for CD34. The 24 cases of leiomyomas and leiomyosarcomas were all negative for CD117 and CD34. The differences of positive rates of CD117 and CD34 were significant between esophageal GISTs and LMs, 5/5 vs 0/24, 3/5 vs 0/24 （P 〈 0.005）. All leiomyomas and leiomyosarcomas were positive for SMA, and desmin. Among 5 cases of esophageal GISTs, 2 cases were SMA positive, and 1 case was desmin positive. The differences in positive rates and expression intensity of SMA and desmin were significant between esophageal LMs and GISTs, 24/24 vs 2/5, 24/24 vs 115 （P 〈 0.005）. CONCLUSION： The most common esophageal mesenchymal tumors are leiomyomas, and esophageal GISTs are less common. Most of esophageal LMs and GISTs are benign. Endoscopy and EUS are the effective methods to diagnose esophageal mesenchymal tumors and they can provide useful information for the treatment of these tumors. However, they cannot exactly differentiate esophageal GISTs from LMs. Pathological, especially immunohistochemical features are useful to differentiate GISTs from leiomyomas.
文摘AIM: To investigate the role of angiopoietin (Ang) -1, -2 and -4 and its receptors, Tie-1 and -2, in the growth and differentiation of gastrointestinal stromal tumors (GISTs).METHODS: Thirty GISTs, seventeen leiomyomas and six schwannomas were examined by immunohistochemistry in this study.RESULTS: Ang-1, -2 and -4 proteins were expressed in the cytoplasm of tumor cells, and Tie-1 and -2 were expressed both in the cytoplasm and on the membrane of all tumors. Immunohistochemical staining revealed that 66.7% of GISTs (20 of 30), 76.5% of leiomyomas (13 of 17) and 83.3% of schwannomas (5 of 6) were positive for Ang-1. 83.3% of GISTs (25 of 30), 82.4% of leiomyomas (14 of 17) and 100% of schwannomas (6 of 6) were positive for Ang-2. 36.7% of GISTs (11 of 30), 58.8% of leiomyomas (10 of 17) and 83.3% of schwannomas (5 of 6) were positive for Ang-4. 60.0% of GISTs (18 of 30), 82.4% of leiomyomas and 100% of schwannomas (6 of 6) were positive for Tie-1. 10.0% of GISTs (3 of 30), 94.1% of leiomyomas (16 of 17) and 33.3% of schwannomas (2 of 6) were positive for Tie-2. Tie-2 expression was statistically different between GISTs and leiomyomas (P < 0.001). However, there was no correlation between expression of angiopoietin pathway components and clinical risk categories.CONCLUSION: Our results suggest that the angiopoietin pathway plays an important role in the differentiation of GISTs, leiomyomas and schwannomas.
