Benign Leiomyoma Research Articles

Concurrent Esophageal Leiomyoma and Helicobacter pylori Infection

Esophageal leiomyomas are rare benign tumors arising from smooth muscle cells in the esophagus. Despite their rarity, they present unique diagnostic and management challenges due to varied symptomatology and anatomical locations. Here, we present a case of a 40-year-old male with unresolved dysphagia and epigastric pain referred for esophagogastroduodenoscopy (EGD). EGD revealed a medium-sized submucosal mass at the gastroesophageal junction, partially obstructing the lumen. Concurrently, severe chronic active gastritis with Helicobacter pylori (H. pylori) infection was confirmed upon gastric biopsy. Subsequent evaluation included endoscopic ultrasound (EUS), which identified a likely benign esophageal leiomyoma. Although a surgical referral was recommended, the patient was deferred. This case highlights the importance of EGD in diagnosing esophageal leiomyomas and uncovering incidental findings that can significantly influence patient management. The rare presentation of this leiomyoma at the gastroesophageal junction, combined with the co-occurrence of severe H. pylori-induced gastritis and chronic GERD, introduces new considerations for understanding the pathophysiology of esophageal tumors. The rare combination of these factors highlights the need for further research into their interactions, providing novel insights that could influence future diagnostic strategies and therapeutic approaches for similar cases.

Molecular genetics and research progress of uterine leiomyosarcoma.

Uterine leiomyosarcoma (uLMS) is a type of malignant soft-tissue tumor, which is developed from myometrium in the female reproductive system. This disease is difficult to be distinguished from benign uterine leiomyoma in the early stages, but it progresses aggressively and relentlessly. Hence, uLMS has a dismal prognosis and high rates of both misdiagnosis and missed diagnosis. Unfortunately, current studies of uLMS pathogenesis and disease biology are inadequate. uLMS disease models are also very limited, hindering the development of effective therapeutics. In this review, we focus on the pathological molecular biology of uLMS, and systematically review the molecular genetic features, epigenetic variants, experimental models, and clinical research progress of uLMS. We further discuss the development direction and potential needs of uLMS in the fields of tumor evolution, tumor microenvironment, and tumor therapy, with the aim of providing a better understanding of the pathobiological mechanism of uLMS and providing a reference for the development of potential diagnostic and therapeutic strategies.

Can EBP50 and Merlin be used as diagnostic and prognostic markers for uterine smooth muscle tumors?

Uterine smooth muscle tumors are common neoplasms of smooth muscle in the uterus. They range from benign leiomyomas and their variants to malignant leiomyosarcomas. Although there are many subtypes of leiomyoma, mitotically active leiomyoma and leiomyoma with bizarre nuclei are sometimes difficult to differentiate from leiomyosarcoma. Our aim in this study was to investigate whether EBP50 and Merlin expression can be used in the differential diagnosis of uterine smooth muscle tumors and to determine their prognostic significance. Our study analyzed 80 cases diagnosed with uterine smooth muscle tumors from the Pathology Department archive of Dicle University Faculty of Medicine between 2012 and 2023. Primary antibodies EBP50 and Merlin were used in the immunohistochemical study. Information regarding patient age, treatment, and clinical follow-up was obtained from Dicle University Department of Obstetrics and Gynecology and Dicle University Department of Medical Oncology. Our study revealed that EBP50 expression was significantly higher in the leiomyosarcoma and STUMP groups, while Merlin expression was significantly higher in only the leiomyosarcoma group. Prognostic parameters were not found to be associated with EBP50 and Merlin expression levels. EBP50 and Merlin expression levels have not been previously studied in uterine smooth muscle tumors. Our study suggests that high expression of EBP50 in STUMP and leiomyosarcoma, as well as Merlin in leiomyosarcoma, may be helpful in the differential diagnosis of uterine smooth muscle tumors.

Validating the diagnostic accuracy of an MRI-based scoring system for differentiating benign uterine leiomyomas from leiomyosarcomas

ObjectiveUterine leiomyomas are the most common benign uterine tumors. They are difficult to distinguish from their malignant counterparts—smooth muscle tumors of unknown malignant potential (STUMP) and leiomyosarcoma. The purpose of...

Roles of Matrix Metalloproteinases 2 and 9 in Uterine Leiomyosarcoma.

Uterine leiomyosarcoma (uLMS) is a rare, highly malignant, and invasive cancer, with early metastasis. Mismatch repair (MMR) proteins and matrix metalloproteinases (MMPs) are associated with the occurrence, proliferation, and invasion of most malignant cancers; however, their abnormal expression in uLMS remains poorly clarified. Immunohistochemistry was performed to assess MMR protein and MMP2/9 expression as well as Ki67 marker proliferation in benign and malignant uterine smooth muscle tumors. Data from 28 cases of uterine leiomyoma and 31 cases of uLMS were analyzed. Tumor tissues from patients with uLMS had higher expression levels of MMP2 (p<0.001), MMP9 (p<0.05), and Ki67 (p<0.001) than those from patients with uterine leiomyoma; MMR protein expression showed the opposite trend (p<0.05). uLMS proliferation and metastasis correlated positively with MMP2 (p=0.012 and 0.015, respectively) but negatively with MMP9 (p=0.021 and 0.04, respectively). MMR protein expression did not correlate with uLMS proliferation or metastasis (p>0.05). Expression levels of MMP2 and MMP9 were upregulated in malignant uLMS tumors when compared with those in benign uterine leiomyoma tumors. Increased MMP2 expression might promote uLMS invasion and migration. MMP9 overexpression might be related to uLMS occurrence; however, it protects against uLMS invasion and metastasis. MMP2 and MMP9 may be potential predictors of uLMS cell proliferation, metastasis, and prognosis. These findings could be helpful in developing new strategies for diagnosing and treating uLMS.

Spectrum of endoscopic gastric subepithelial lesions encountered on EUS-FNA: A single center experience.

Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is a minimally invasive and reliable non-surgical technique for the diagnosis of gastrointestinal lesions. The present study aimed to evaluate the spectrum of lesions encountered in the gastric subepithelium on EUS-FNA at a tertiary care center. Archival data of all patients undergoing EUS-FNA for gastric submucosal lesions over a period of 5 years was retrieved. Patient demographics, clinical presentation, and EUS findings were recorded along with the FNA results. A total of 78 EUS-FNA samples were analyzed. Material was adequate in 62 cases (79.48%) and inadequate in 16 cases (12.82%) patients due to scant cellularity. Of the adequate samples, 34 (43.5%) were reported as neoplastic while 20 (25.64%) were non-neoplastic, and 8 (10.25%) were reported as suspicious of a neoplasm. In the neoplastic category, the predominant diagnosis was of spindle cell neoplasm comprising gastrointestinal stromal tumor (13), benign neural tumor (03), leiomyoma (02), and spindle cell tumors (03). The latter could not be categorized further due to a lack of IHC material. The next common diagnosis was adenocarcinoma (06) followed by neuroendocrine tumor (02) and poorly differentiated carcinoma (01). The non-neoplastic lesions included non-specific pathology (15), inflammatory lesions (08), and one case each of tuberculosis, pancreatic rest, and Brunner gland hamartoma. Cell blocks for ancillary testing were available in 54 cases (65.23%) and follow-up was available in 42 cases (53.84%). EUS-FNA is a good modality for the diagnosis of gastric submucosal lesions with a high diagnostic yield.

Survivin-Sodium Iodide Symporter Reporter as a Non-Invasive Diagnostic Marker to Differentiate Uterine Leiomyosarcoma from Leiomyoma.

Leiomyosarcoma (LMS) has been challenging to diagnose because of limitations in clinical and radiographic predictors, as well as the lack of reliable serum or urinary biomarkers. Most uterine masses consist of benign leiomyoma (LM). However, it is currently a significant challenge in gynecology practice to differentiate LMS from LM. This inability poses grave consequences for patients, leading to a high number of unnecessary hysterectomies, infertility, and other major morbidities and possible mortalities. This study aimed to evaluate the use of Survivin-Sodium iodide symporter (Ad-Sur-NIS) as a reporter gene biomarker to differentiate malignant LMS from benign LM by using an F18-NaBF4 PET/CT scan. The PET/CT scan images showed a significantly increased radiotracer uptake and a decreased radiotracer decay attributable to the higher abundance of Ad-Sur-NIS in the LMS tumors compared to LM (p < 0.05). An excellent safety profile was observed, with no pathological or metabolic differences detected in Ad-Sur-NIS-treated animal versus the vehicle control. Ad-Sur-NIS as a PET scan reporter is a promising imaging biomarker that can differentiate uterine LMS from LM using F18-NaBF4 as a radiotracer. As a new diagnostic method, the F18 NaBF4 PET/CT scan can provide a much-needed tool in clinical practices to effectively triage women with suspicious uterine masses and avoid unnecessary invasive interventions.

Rate of Leiomyosarcomas during Surgery for Uterine Fibroids: 8-Year Experience of a Single Center.

The aim of this study is to investigate the prevalence of occult malignant mesenchymal tumors in patients operated on for uterine fibroids in relation to the surgical approach and type of operation. A retrospective review of all patients that underwent surgery for uterine fibroids (January 2011-December 2018) at the 1st Department of Obstetrics & Gynecology at "Papageorgiou" Hospital. The surgical approach and clinicopathological characteristics were analyzed. A total of 803 patients were operated on: 603 (75.1%) with laparotomy, 187 (23.3%) laparoscopically, and 13 (1.6%) vaginally. Furthermore, 423 (52.7%) patients underwent hysterectomy and 380 (47.3%) myomectomies. Laparoscopy and myomectomy were offered to younger patients with fewer smaller uterine fibroids and were associated with statistically significant shorter hospitalization. The pathological reports revealed: 690 (86%) benign leiomyomas, 32 (4%) cellular leiomyomas, 29 (3.6%) degenerated leiomyomas, 22 (2.7%) adenomyomas, 18 (2.2%) atypical-bizarre leiomyomas, 1 (0.1%) STUMP, 5 (0.65%) endometrial stromal sarcomas, and 6 (0.75%) cases of leiomyosarcomas (LMS). All LMS were preoperatively characterized as suspicious and underwent abdominal hysterectomy. Morcellation was offered in two cases of atypical leiomyomas, with no morcellation-associated complication. Laparoscopy as a valuable surgical approach for young patients with fewer in number and smaller in size fibroids is associated with shorter hospitalization. The risk of unintended morcellation of LMS seems to be very low and can be reduced with careful preoperative work-up but not eliminated.

К вопросу о дифференциальной диагностике первичной лейомиосаркомы влагалища, доброкачественной метастазирующей лейомиомы с трансформацией одного узла в лейомиосаркому и первичной лейомиосаркомы брюшины

Differential diagnosis of primary leiomyosarcoma of the vagina/omentum, “benign metastatic leiomyoma” with transformation of one node into leiomyosarcoma, primary peritoneal leiomyosarcoma can present certain difficulties. Due to the rarity of peritoneal leiomyomatosis with malig-nant transformation in postmenopausal women, as well as the rarity of vaginal leiomyosarcomas, we present a clinical case of this kind of differ-ential diagnosis based on a pathohistological examination of material obtained during surgery in a woman with a giant pelvic mass.

Robotic assisted transvesical excision of recurrent bladder leiomyoma with intraoperative ultrasound guidance

Leiomyoma of the urinary bladder is uncommon benign tumor with a wide range of clinical presentations. Surgical excision remains the definitive treatment of leiomyoma with excellent outcomes. Seldom literatures reported the use of robotic-assisted surgical techniques for its excision. A 51-year-old woman presented with frequent episodes of visible hematuria in consistence with lower urinary tract symptoms. The initial diagnosis was a urinary tract infection. However, symptoms did not resolve even with the proper antibiotics. After further investigations a soft tissue density mass measuring 20 × 23 × 20 mm within the left posterior wall of the urinary bladder extending towards the bladder neck was found. The histological finding of the transurethral resected biopsy of the mass revealed a benign submucosal leiomyoma of the bladder with no evidence of any malignancy. Using the Intuitive Da Vinci X system the tumor was excised using the ultrasound guidance to define the tumour margins, sparing the left ureteric orifice and ureter. The patient was discharged home on the day of surgery, with a urethral catheter in place. The catheter was successfully removed after 10 days, with cystogram prior confirming no leakage. The ureteric stent was removed by flexible cystoscopy two weeks later. The final histology was reported as a bladder leiomyoma with no evidence of malignant features and negative circumferential resection margins. Herein, in the current case we present a safe and effective technique for the excision of recurrent bladder leiomyoma using the robotic-assisted transvesical approach with intraoperative ultrasound guidance.

Pulmonary benign metastasizing uterine leiomyoma (PBML): a case report and review of the literature.

The authors report the case of a 47-year-old female who presented with a 6-month history of irregular vaginal bleeding and severe hot flushes. The patient had no previous history of gynaecological surgery. Ultrasonography and subsequent MRI identified a suspicious 105×65mm mass involving the right uterine cornu and broad ligament. Computed tomography identified bilateral lung nodules, suspicious for metastases. Histological assessment of the final uterine surgical specimen identified a benign dissecting leiomyoma involving the broad ligament and cervix. BML was diagnosed after thoracoscopic resection of a lung lesion which revealed a histologically identical tumour with entrapped normal lung alveoli. This case shows that there is a minority of patients without previous uterine surgery who still go on to develop pulmonary BML. In our case, a combined treatment approach was adopted, involving substitution of hormone replacement therapy to a non-hormonal alternative, thoracoscopic resection of lung lesions and interval surveillance imaging of the chest. BML is a rare condition but should be considered as a differential in women with pulmonary nodules and a history of uterine leiomyomata. Its diagnosis and subsequent counselling can be challenging; therefore cases should be treated by multidisciplinary teams in tertiary specialized centres.

A Case of Large Cervical Leiomyoma

Uterine Leiomyoma or Myoma or commonly favorite named Fibroid is a most common entity of genital organ tumor. It isalmost benign tumor of smooth muscle origin where smooth muscle fiber and fibrous connective tissue intermingled togetheroften found in uterus. Although it is a disease of nulliparous but in perspective of our country it diagnosed in patient's havingone or two child because of early marrital status. Tumor varies in number 1-200 and also varies different clinical features andseverity depending site of presentation. Leiomyoma is generally slowly progressive disease but sometimes it grows veryrapidly. With the advent of Ultrasonography it is incidentally diagnosed often with asymptomatic cases. UsuallyUltrasonography is the single most predictor of investigation1 from very early cases although MRI is helpful. Asymptomatic large Fibroid present with various unusual symptoms like pressure symptom of surrounding structure or feelingof heaviness of lower abdomen or fullness of abdomen. Large cervical Fibroid is a uncommon presentation with mainly urinarydifficulties where patients chief complaints is frequent micturation and incomplete voiding of urine without significantmenstrual abnormalities. The described cases for urinary complain patient consulted with urologist and referred as a largecervical Fibroid diagnosed by sonography. This article illustrates a case of 34 years old lady present with frequent micturationand incomplete voiding of urine that developed last 5-6 months duration. Total abdominal hysterectomy performed,histologically the specimen showed benign uterine leiomyoma. Post operative circumstance uneventful evaluation occur andpatient back to home with normal duration hospital stay.

A case report of bilateral benign Ovarian Fibrothecoma coincidental with ascites: an unconventional co-occurrence.

We present the case of a 54-year-old female who presented complaining only of a slow progressive increase in the abdominal contour associated with vague abdominal pain. Our preoperative radiological imaging revealed multiple ovarian and uterine masses. Surgical intervention in the form of a hysterectomy with bilateral salpingo-oophorectomy was achieved. Histopathological analysis revealed bilateral benign ovarian fibrothecoma with benign uterine leiomyomas. The patient underwent an uneventful postoperative recovery. Ovarian Fibrothecoma is a rare gynecological pathology. The uniqueness of our case stems from the rarity of its bilateral occurrence and in rare occasions, their occurrence is accompanied by ascites. This kind of co-occurrence should be differentiated from other rare presentations, such as Meigs Syndrome. Therefore, documentation is necessary to circumvent misdiagnoses and to abate the resulting patient morbidity. To further highlight the value of our case, it is to the best of our knowledge, the first documented case of this pathology from our country.

The KAT6B::KANSL1 Fusion Defines a New Uterine Sarcoma With Hybrid Endometrial Stromal Tumor and Smooth Muscle Tumor Features

Neoplasms harboring a KAT6B/A::KANSL1 fusion were initially reported as benign (leiomyomas) and malignant (leiomyosarcomas, low-grade endometrial stromal sarcomas [LG-ESSs]) uterine neoplasms. However, they may represent an emerging entity characterized by clinical aggressiveness contrasting with a rather reassuring microscopic appearance. Here, we aimed to confirm that this neoplasm is a distinct clinicopathologic and molecular sarcoma and identify criteria that should alert pathologists and lead to KAT6B/A::KANSL1 fusion testing in routine practice. Therefore, we conducted a comprehensive clinical, histopathologic, immunohistochemical, and molecular study, including array comparative genomic hybridization, whole RNA-sequencing, unsupervised clustering, and cDNA mutational profile analyses of 16 tumors with KAT6B::KANSL1 fusion from 12 patients. At presentation, patients were peri-menopausal (median, 47.5 years), and the primary tumors were located in the uterine corpus (12/12, 100%), with an additional prevesical location in 1 (8.3%) of 12 cases. The relapse rate was 33.3% (3/9). All tumors (16/16, 100%) showed morphologic and immunohistochemical features overlapping between leiomyoma and endometrial stromal tumors. A whirling recurrent architecture (resembling fibromyxoid-ESS/fibrosarcoma) was found in 13 (81.3%) of 16 tumors. All tumors (16/16, 100%) exhibited numerous arterioliform vessels, and 13 (81.3%) of 18 had large hyalinized central vessels and collagen deposits. Estrogen and progesterone receptors were expressed in 16 (100%) of 16 and 14 (87.5%) of 16 tumors, respectively. Array comparative genomic hybridization performed on 10 tumors classified these neoplasms as simple genomic sarcomas. Whole RNA-sequencing on 16 samples and clustering analysis on primary tumors found that the KAT6B::KANSL1 fusion always occurred between exons 3 of KAT6B and 11 of KANSL1; no pathogenic variant was identified on cDNA, all neoplasms clustered together, close to LG-ESS, and pathway enrichment analysis showed cell proliferation and immune infiltrate recruitment pathway involvement. These results confirm that the sarcomas harboring a KAT6B/A::KANSL1 fusion represent a distinct clinicopathologic entity, close to LG-ESS but different, with clinical aggressiveness despite a reassuring morphology, for which the KAT6B/A::KANSL1 fusion is the molecular driver alteration.

A-39 year old, nulligravida woman with giant leiomyomas: a case report

Introduction: The most common neoplasm of the uterus, uterine leiomyomas, or fibroids, are benign growths that affect 20–30% of women between the ages of 30 and 50. The smooth muscle of the uterus gives rise to leiomyomas. In this case report, we sought to highlight the case of a 39-year-old nulligravida lady with a fast expanding abdominal mass and abdominal pain. Case Presentation: The gynecologist department at Dr. Kariadi General Hospital Semarang received a visit from a 39-year-old nulligravida lady complaining of a fast-expanding lump in her belly and extreme weight loss over the past year. During the abdominal exam, an immovable mass that could have been an 8-month pregnancy was felt in the midline of the abdominal area, extending from the lower abdomen to the epigastric area. Ascites were also discovered. The multislice computerized tomography (MSCT) results showed a solid lobulated inhomogeneous mass with internal calcification which extended from the abdominal cavity to the pelvic cavity and visualized the size of (anteroposterior 21.7 cm x laterolateral 24.1 cm x craniocaudal 36.8 cm), compressing the surrounding bowel structures, liver, spleen, and bladder. Several lymphadenopathies were also discovered. A frozen section, a bilateral salpingo-oophorectomy, and a total abdominal hysterectomy were performed. The results of the histology suggested a benign leiomyoma. Her vital signs were steady after surgery, and she fully recovered. The patient was called for a follow-up one week after being released for surgical suture removal and evaluation. The patient was discharged on the sixth postoperative day in good condition. Conclusion: In determining if uterine smooth muscle tumors are benign or malignant, clinical characteristics, physical examination, imaging, and pathological findings are still considered very useful. The histopathology examination is still the most reliable diagnostic tool. The decision to perform a hysterectomy on this patient was determined accordingly to the tumor's size, probability of malignancy, and increasing morbidity.

Abstract 996: Identification of molecular biomarkers differentiating malignant uterine leiomyosarcoma from benign leiomyoma

Abstract Uterine leiomyosarcomas are rare, aggressive cancers that represent the most common type of uterine sarcomas. They frequently harbor genetic alterations in TP53, RB1, PTEN, and ATRX. Their benign counterpart, uterine leiomyomas (or fibroids) are very common tumors that may significantly affect women’s quality of life. The majority of leiomyomas harbor genetic alterations affecting either MED12, HMGA2, or FH. A third of leiomyosarcomas have been reported to harbor leiomyoma-associated driver mutations, suggesting that some leiomyomas may have undergone malignant transformation. The leiomyoma/leiomyosarcoma diagnosis is largely based on histopathology. This can be specifically challenging in differentiating leiomyosarcomas from a subset of leiomyomas that display histopathological features resembling malignancy. The aim of this study was to identify molecular biomarkers that can accurately differentiate benign and malignant uterine smooth muscle tumors. 3’RNA sequencing of 48 leiomyosarcomas and 44 leiomyomas revealed that leiomyosarcomas are uniquely characterized by dysregulation of the retinoblastoma pathway. We confirmed upregulation of several members of this pathway, including TOP2A and CDK1, in a publicly available transcriptomic dataset of 49 uterine leiomyosarcomas. The second objective of this study was to explore the gene expression profile of leiomyosarcomas carrying leiomyoma-associated driver mutations. This revealed that unlike leiomyomas, leiomyosarcomas do not form distinct gene expression profiles based on the presence of leiomyoma-associated driver mutations such as MED12. However, leiomyosarcomas with a MED12 mutation showed upregulation of RAD51B and ADAM12, which we have previously highlighted as biomarkers of leiomyomas harboring a MED12 mutation. We identified upregulation of IRS4 and characteristic deletions affecting COL4A5 and COL4A6 in four in-house and three additional uterine leiomyosarcomas from The Cancer Genome Atlas (TCGA) collection. Similar driver alterations have previously been reported in a small subset of leiomyomas but not in leiomyosarcomas. In conclusion, leiomyosarcomas display a gene expression profile characterized by dysregulation of genes related to the retinoblastoma pathway. These include potential biomarkers that could be used in a clinical setting to differentiate leiomyosarcomas from leiomyomas. Citation Format: Sara Khamaiseh, Riitta Koivisto-Korander, Terhi Ahvenainen, Ralf Bützow, Miika Mehine, Pia Vahteristo. Identification of molecular biomarkers differentiating malignant uterine leiomyosarcoma from benign leiomyoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 996.

Benign metastasizing uterine leiomyoma with lymphatic and pulmonary metastases: a case report and literature review

BackgroundBenign metastasizing leiomyoma (BML) is a rare disease usually observed in women of reproductive or premenopausal age with a history of uterine myomectomy or hysterectomy. The most common sites of metastases are the pulmonary, and other sites include heart, bones, liver, lymph nodes, bladder, skeletal muscles, and central nervous system. Here, we report a case of a 50 year-old woman with a history of hysterectomy who was initially suspected of uterine sarcoma but was finally confirmed to have BML with lung and lymph node metastases, and discuss the treatment and prognosis of BML.Case presentationA 50 year-old woman with a history of total abdominal hysterectomy presented with mild but persistent abdominal pain for more than 3 months. She was suspected of having uterine sarcoma before surgery and laparoscopic extensive debulking surgery including bilateral oophorectomy, pelvic and para-aortic lymph node dissection to the level of the left renal vein, and transcutaneous dissection of the right inguinal lymph nodes. Pathology confirmed a benign leiomyoma, and the patient was diagnosed with BML. No medication was administered after the surgery, and the follow-up was of no significance.ConclusionBenign metastasizing leiomyoma (BML) is a rare disorder in which histologically benign smooth muscle tumors metastasize to extrauterine sites. Metastases are commonly observed in the lung, liver, lymph nodes, skin, bladder, esophagus, and skeletal muscles. BML is usually misdiagnosed as a malignant tumor before surgery until the pathology confirms its benign nature. However, this treatment remains controversial and undetermined. The prognosis is usually favorable owing to its benign nature.

An Uncommon Case of Urethral Leiomyoma in a Female

Rare sites of myoma can present with unusual symptoms, which can cause clinical dilemmas in management. Leiomyomas are benign mesenchymal tumours which arise from smooth muscles. They are commonly found in the uterus. Leiomyoma in the vagina and urethra are a rare occurrence. The literature mostly reported cases of urethral leiomyoma arising from the proximal urethra. In our case, we report a distal urethral leiomyoma, which is an unusual location.&#x0D; This young lady was a 32-year-old Filipino (Asian) lady who presented with mass per vagina, recurrent UTI, difficulty in micturition, discharge per vagina, the feeling of fullness in the vagina, difficulty and unpleasantness during sex for 2.5 years. She came with previous medical records &amp; USG which disclosed many differential diagnoses of PID, cystocele, urethrocele, embryological remnant cyst, urethral diverticulitis and caruncle. She was treated for her complaints, nonetheless, her symptoms gradually became more disabling. After a thorough urogynecological investigation, which included an ultrasound, MRI with contrast and biopsy of the mass, the precise diagnosis of a distal urethral benign leiomyoma’ was made. She underwent a complete surgical excision under general anaesthesia, with excellent post-operative recovery, and was well relieved of all her complaints.

High levels of hypusinated eIF5A in leiomyoma and leiomyosarcoma pathologies: a possible novel therapeutic target

Research questionIs the hypusinated form of the eukaryotic translation initiation factor 5A (EIF5A) present in human myometrium, leiomyoma and leiomyosarcoma, and does it regulate cell proliferation and fibrosis? DesignThe hypusination status of eIF5A in myometrial and leiomyoma patient-matched tissues was evaluated by immunohistochemistry and Western blotting as well as in leiomyosarcoma tissues by immunohistochemistry. Myometrial, leiomyoma and leiomyosarcoma cell lines were treated with N1-guanyl-1,7-diaminoheptane (GC-7), responsible for the inhibition of the first step of eIF5A hypunization, and the proliferation rate was determined by MTT assay; fibronectin expression was analysed by Western blotting. Finally, expression of fibronectin in leiomyosarcoma tissues was detected by immunohistochemistry. ResultsThe hypusinated form of eIF5A was present in all tissues examined, with an increasing trend of hypusinated eIF5A levels from normal myometrium to neoplastic benign leiomyoma up to neoplastic malignant leiomyosarcoma. The higher levels in leiomyoma compared with myometrium were confirmed by Western blotting (P = 0.0046). The inhibition of eIF5A hypusination, with GC-7 treatment at 100 nM, reduced the cell proliferation in myometrium (P = 0.0429), leiomyoma (P = 0.0030) and leiomyosarcoma (P = 0.0044) cell lines and reduced the expression of fibronectin in leiomyoma (P = 0.0077) and leiomyosarcoma (P = 0.0280) cells. The immunohistochemical staining of leiomyosarcoma tissue revealed that fibronectin was highly expressed in the malignant aggressive (central) part of the leiomyosarcoma lesion, where hypusinated eIF5A was also highly represented. ConclusionsThese data support the hypothesis that eIF5A may be involved in the pathogenesis of myometrial benign and malignant pathologies.

Rare case of coagulative necrosis of uterine leiomyoma: Case report

Coagulative tumor necrosis or tumor cell necrosis is a very rare type of fibroid degeneration, commonly occurs in 80% of leiomyosarcomas, but it is rare in benign uterine leiomyomas. Women with menorrhagia have increased levels of plasminogen activators in endometrium and use of anti-fibrinolytics can enhance the formation of thrombus in leiomyoma. Degeneration like red and hyaline in uterine leiomyomas may be associated with pregnancy and use of progestogen or OCP’s but degeneration associated with use of anti-fibrinolytics can occur in any part of reproductive life. Materials and Methods: We present the case of 28yr lady with heavy menstrual bleeding and severe dysmenorrhea since 2 years, diagnosed with fibroid uterus and was on anti-fibrinolytics (Tranexamic acid) on and off for 2years. Finally underwent a myomectomy, wherein we found a cheesy degenerative material with final histopathology report revealing as coagulative tumor necrosis without any atypical cells. Conclusion: Coagulative necrosis is usually seen in malignant condition. Infarct type necrosis and thrombus was observed in benign leiomyoma, possibly secondary to prolonged, repetitive use of Tranexamic acid.