Cases Of Smooth Muscle Tumors Research Articles

Application of transvaginal morcellation within disposable extraction bag with traction wire in laparoscopic myomectomy

To investigate the effect and clinical value of morcellation within disposable extraction bag with traction wire through posterior vaginal fornix in laparoscopic myomectomy. A total of 42 patients who underwent laparoscopic myomectomy and morcellation through posterior vaginal fornix in the Second Affiliated Hospital of Soochow University from June 2019 to June 2021 were retrospectively analyzed. After the uterine fibroids were removed, the fibroids were placed into the extraction bag, tightening the mouth of the bag with a traction wire to make it airtight. After the uterine incisions were sutured, the extraction bag was taken out through the posterior fornix of the vagina, and the fibroids were broken up with a scalpel in the bag and taken out. The fibroids were successfully removed from the 42 patients through the posterior fornix of the vagina. There were no fibroids fragments found in the peritoneal cavity and vagina. There were no malignant cells or spindle cells found in the peritoneal lavage cytology before and after the operation. After filling the extraction bags with water, there was no leakage. There were 39 cases of uterine leiomyoma, 2 cases of cell-rich uterine leiomyoma, and 1 case of smooth muscle tumor of uncertain malignant potential in postoperative pathological diagnosis. Forty-two cases were followed up for 6 to 30 months. The posterior vaginal fornix incision healed well and there was no recurrence or metastasis. Morcellation within disposable extraction bag with traction wire through posterior vaginal fornix in laparoscopic myomectomy is a safe and feasible method for fibroids removal, which may help to reduce the dissemination of iatrogenic tumors.

恶性潜能未定的平滑肌肿瘤1例并文献复习

恶性潜能未定的平滑肌肿瘤1例并文献复习

Risk of incidental genital tract malignancies at the time of myomectomy and hysterectomy for benign conditions.

ObjectiveTo determine the incidence of accidentally diagnosed genital malignancies in women undergoing gynecological surgeries for pathologies presumed to be benign.MethodsData of all women who underwent hysterectomy for benign indications were retrieved from hospital records. A total of 628 cases of hysterectomy and 35 cases of myomectomy were included. The final histopathology was accessed through the computer records, and the total number of genital tract malignancies was included.ResultsThe incidence of occult uterine, ovarian, and cervical malignancies in women undergoing hysterectomy was 0.47%, 0.31%, and 0.15%, respectively. The incidence of uterine corpus malignancies in women undergoing myomectomy was 2.8%, and 3 cases of smooth muscle tumor of uncertain malignant potential (STUMP) were also identified. Endometrial stromal sarcomas were the most common pathology among uterine malignancies, followed by leiomyosarcoma and endometrial adenocarcinoma.ConclusionPostoperative diagnosis of malignancies in women undergoing surgery for benign indications poses great challenges to the treating surgeon. Occult malignancies must be ruled out by thorough preoperative assessment, especially in some subsets of women. Morcellation is an inevitable technique and complement to laparoscopic surgeries, although little chances of malignancy spread is related to its use. Nevertheless, thorough preoperative investigations and always ensuring contained morcellation can minimize these chances.

Immunohistochemical profile of uterine leiomyomas; a comparison between different subtypes.

Background:Of all Smooth muscle tumours originating from uterus are leiomyomas are the most common ones. Benign nature and smooth muscle origination of leiomyomas can be easily documented via histological examination. In present study it was tried to examine immunohistochemical profile of leiomyomas with different subtypes.Material and Methods:In this cross-sectional study 64 cases of smooth muscle tumors originating from uterus were included in study. As a control group 12 cases of conventional leiomyomas were selected. Then estrogen receptor, progesterone receptor, p53 and ki-67 were assessed. Statistical analysis was conducted using SPSS 16.0.Results:P 53 and ki-67 antibody status was diffusely positive in 12 out of 24 cases (50%) of leiomyosarcomas. Leiomyomas with bizzare nuclei were stained with Ki67 proliferative marker less than those in obviously malignant cases (P < 0.001). Estrogen and progesterone receptors had a reverse correlation with tumours malignancy potential.Conclusion:Since p53 is known as an important inhibitory trigger for proliferative cycle of cells, in current study it was concluded that p53 inhibitory role decreases as malignancy potential increases, also tumors dependence on steroids via steroid receptors decreases as malignancy potential increases.

Expression of L1 protein correlates with cluster of differentiation 24 and integrin β1 expression in gastrointestinal stromal tumors

The present study examined 66 cases of gastrointestinal stromal tumors (GISTs), 20 cases of smooth muscle tumors, 20 cases of schwannomas and 20 cases of normal gastric tissues in order to analyze the expression of L1, cluster of differentiation (CD)24 and integrin β1 by immunohistochemical staining. Patients were subjected to follow-up, and survival data were evaluated. L1 expression was detected in 57.6% of GIST cases; this was a significantly higher percentage compared with that found in the smooth muscle tumor cases or the normal control group. CD24 and integrin β1 were also expressed at significantly higher levels in the GIST cases than in the normal control group, although no significant difference was found in the expression levels of these proteins in smooth muscle tumor or schwannoma cases. These higher levels of L1 and integrin β1 expression were associated with an increased risk of invasive GIST, and were significantly positively correlated with Ki-67 expression. CD24 expression was not associated with the risk of GIST invasion or Ki-67 expression. There were positive correlations between L1, CD24 and integrin β1 expression; however, these had no significant association with patient survival. Therefore, L1 alone or in conjunction with CD24 (L1 + CD24), or integrin β1 (L1 + integrin β1) can be considered a valuable indicator for the differential diagnosis of GIST. Furthermore, L1 and integrin β1 can be used alone or in combination to evaluate the biological behavior of GISTs. Future studies are required to evaluate the prognostic value of these markers.

Completely infarcted smooth muscle tumor of the placental membrane

Non-trophoblastic tumor of the placenta is rare, and so is placental smooth muscle tumor. We report leiomyoma of the placental membrane, which was discovered on cesarean section. Histologically, the tumor was a benign leiomyoma with complete necrosis, and this finding was confirmed immunohistochemically. Only six cases of smooth muscle tumors of the placenta have been reported to date. This is the third report of leiomyoma involving the placental membrane.

AIDS-Related EBV-Associated Smooth Muscle Tumors: A Review of 64 Published Cases

The number of reported cases of smooth muscle tumor (SMT) arising in patients with AIDS has been increasing since the mid-1990s. The aim of this study is to characterize the epidemiology, clinical manifestations, pathologic features, prognosis and, management of Epstein-Barr virus-related SMT (EBV-SMT) in patients with AIDS. An English language literature search identified 53 articles including 64 reported cases of EBV-SMT. The majority of these reports involved patients who were young, severely immunosuppressed, and had multifocal tumors. The central nervous system was the most common site to be involved. Histologically, tumors had smooth muscle features and were immunoreactive for muscle markers and all but two tumors demonstrated the presence of EBV by either immunohistochemistry, in situ hybridization, and/or PCR. While mitoses and/or necrosis were used to separate leiomyoma from leiomyosarcoma, these features did not correlate with clinical outcome. Treatment included primarily resection, and less often radiotherapy, chemotherapy and highly active antiretroviral therapy (HAART). Overall, EBV-SMTs appear to have variable aggressiveness and clinical outcome and may exhibit a more favorable prognosis compared to conventional leiomyosarcoma. Tumor-related death from EBV-SMT occurred in only 4 of 51 patients.

Differential expression of P16 and P21 in benign and malignant uterine smooth muscle tumors

The diagnosis of benign and malignant uterine smooth muscle tumors depends on morphologic criteria such as nuclear atypia, coagulative tumor cell necrosis and mitotic activity. Most of these tumors are readily classifiable into benign or malignant categories using these criteria. However, the distinction between leiomyomas and leiomyosarcomas may at times be problematic. Hence, it would be useful to have additional markers which could help to distinguish these tumors. The aim of the study was to evaluate p16 and p21 expressions in uterine smooth muscle tumors and determine whether p16 and p21 have a potential value in the differential diagnosis of problematic cases. In addition, we evaluated whether the differential expression of p16 and p21 in uterine leiomyosarcomas correlated with tumor recurrence and patient survival. p16 and p21 expressions were investigated by immunohistochemistry from paraffin-embedded tissues in 53 cases of uterine smooth muscle tumors consisting of 15 cases of leiomyoma, 14 cases of atypical leiomyoma (leiomyoma with bizarre nuclei), 3 cases of smooth muscle tumor of uncertain malignant potential (STUMP) and 21 cases of leiomyosarcoma. Cases were evaluated with respect to both staining percentage and intensity. There was a statistically significant difference in p16 and p21 staining percentage and intensity between leiomyosarcomas and the other groups. There was no difference in p16 and p21 expressions between leiomyomas, atypical leiomyomas (leiomyoma with bizarre nuclei) and STUMPs. Multivariate analysis showed that the tumor stage was the only independent significant prognostic factor for overall survival in leiomyosarcomas. Neither p16 nor p21 was correlated with disease-free or overall survival. Our findings suggested that p16 and p21 may be of value as an adjunct to conventional morphologic criteria in the assessment of problematic uterine smooth muscle tumors.

Immunohistochemical Analysis of P16, P53, and Ki-67 Expression in Uterine Smooth Muscle Tumors

Despite well-established criteria, the distinction of uterine leiomyosarcoma from certain variants of benign leiomyoma, particularly bizarre leiomyoma, can be challenging morphologically. Recent studies reported the overexpression of p16 protein in uterine leiomyosarcoma. However, the potential role of immunohistochemistry of p16, p53, and Ki-67 in the differential diagnosis of leiomyosarcoma and bizarre leiomyoma has not been well assessed. We had immunohistochemically studied the expression of p16, p53, and Ki-67 proteins in 100 cases of uterine smooth muscle tumors, including 35 usual leiomyomas (LM), 13 cellular leiomyomas (CLM), 15 bizarre leiomyomas (BLM), 2 cases of smooth muscle tumor of uncertain malignant potential (STUMP), and 35 leiomyosarcoma (LMS). For p16 immunostain, strong and mediate-to-diffuse staining pattern (>25% cells positive) was seen in 100% of LMS and STUMP. There were 86.5% of BLM that showed positive for p16, which includes 60% of them showing mediate-to-diffuse p16 positivity. Although 38.5% of CLM and 14% of usual LM showed p16 positivity, the majority of those (70%) are focal with weak p16 staining pattern. The strong, mediate-to-diffuse p53 immunostain was seen in 91% of LMS, 60% of BLM, and 50% of STUMP, but none of usual LM and CLM. More than 10% of cells positive for Ki-67 were observed in 83% of LMS, 100% of STUMP, and 48% of BLM, but none of usual LM and CLM. Our study indicates that distinct expression patterns for p16, p53, and Ki-67 exist between leiomyosarcoma and usual LM and CLM (P<0.0001). Immunohistochemical study with a panel of antibodies to p16, p53, and Ki-67 is helpful in distinguishing LMS from CLM and usual LM. However, due to significant overlapping staining patterns between LSM and BLM (P=0.09), immunostains for p16, p53, and Ki-67 have limited role in differentiating LMS from BLM.

Primary duodenal neoplasms: A retrospective clinico-pathological analysis

To analyze the clinico-pathological spectrum of primary duodenal neoplasms. A total of 55 primary duodenal neoplasms reported in the last 10 years after excluding ampullary and periampullary tumors were included in the study. Clinical details were noted and routine hematoxylin and eosin stained paraffin sections were studied for histological subtyping of the tumors. On histopathological examination primary duodenal neoplasms were categorized as: epithelial tumor in 27 cases (49.0%) including 10 cases of adenoma, 15 cases of adenocarcinoma, and 2 cases of Brunner gland adenoma; mesenchymal tumor in 9 cases (16.3%) consisting of 4 cases of gastrointestinal stromal tumor, 4 cases of smooth muscle tumor and I case of neurofibroma; lymphoproliferative tumor in 12 cases (21.8%), and neuroendocrine tumor in 7 cases (12.7%). Although non-ampullary/periampullary duodenal adenocarcinomas are rare, they constitute the largest group. Histopathological examination of primary duodenal tumors is important for correct histological subtyping.

An appendiceal leiomyoma in a child with acquired immunodeficiency syndrome

Children with acquired immunodeficiency syndrome (AIDS) are at an increased risk for lymphoproliferative and neoplastic disorders. Included among these are smooth muscle neoplasms such as leiomyomas and leiomyosarcomas. There have been at least 15 reported cases of smooth muscle tumors in the approximately 8,000 children with AIDS, however the incidence in immunocompetent children is only two per ten million. The lesions in children with human immunodeficiency virus infection are usually found in the lung, liver, and gastrointestinal tract. Here, we present an unusual case of a 12-year-old African American girl with vertically acquired AIDS who presented to the pediatric emergency department with severe diffuse abdominal pain. She was ultimately found to have an appendiceal leiomyoma on abdominal exploration, the first reported case. Our report suggests that smooth muscle tumors of the appendix be included in the differential diagnosis of abdominal masses in children with AIDS.

Expression of p16 protein in patients with uterine smooth muscle tumors: an immunohistochemical analysis

Objective The loss of cell cycle control is a critical step in the development of neoplasia. The p16 protein has been identified as a tumor suppressor protein, which binds specifically to the cyclin-dependent kinase CDK-4, inhibiting the catalytic activity of the CDK4-cyclin D complex, and thereby acts as a negative cell cycle regulator. In the present study, we compared the expression of p16 protein in cases with leiomyoma, uterine smooth muscle tumor of uncertain malignant potential (STUMP), and leiomyosarcoma (LMS). Methods P16 expression was investigated by immunohistochemistry from paraffin-embedded tissue in 26 patients with leiomyoma, in 24 patients with STUMP, and in 21 patients with LMS. Results P16 was expressed in 12% of leiomyomas, in 21% of STUMP, and in 57% of LMS. A statistically significant difference regarding the frequency of p16 protein expression was observed between LMS and STUMP ( P < 0.05) as well as between LMS and leiomyoma ( P < 0.05), but not between STUMP and leiomyoma ( P > 0.05). Likewise, the staining intensity did significantly differ between LMS and leiomyoma and between LMS and STUMP ( P < 0.05), but no statistical significant difference was observed between STUMP and leiomyoma ( P > 0.05). No statistically significant correlation between p16 expression and clinical stage, age, vascular space involvement, and recurrence disease could be found in patients with LMS ( P > 0.05). Additionally, the overall survival did not significantly differ between p16-positive and p16-negative cases ( P > 0.05). Conclusions We found that p16 was more frequently and more strongly expressed in LMS compared to STUMP and leiomyoma. We therefore concluded that p16 might play an important role in sarcomagenesis. Furthermore, p16 might be a useful immunohistochemical marker, which could help to distinguish cases of smooth muscle tumors in which histologic features are ambiguous or borderline, but the use of p16 in a diagnostic setting should await further clinical studies and clarification of the mechanisms.

Expression of matrix metalloproteinases in patients with uterine smooth muscle tumors: an immunohistochemical analysis of MMP-1 and MMP-2 protein expression in leiomyoma, uterine smooth muscle tumor of uncertain malignant potential, and leiomyosarcoma.

Matrix metalloproteinases (MMPs) have been suggested to play an important role in tumor invasion and metastasis. We compared the expression of MMP-1 and MMP-2 protein in patients with leiomyoma, uterine smooth muscle tumor of uncertain malignant potential (STUMP), and leiomyosarcoma (LMS). MMP-1 and MMP-2 expression was investigated by immunohistochemistry from paraffin-embedded tissue in 26 patients with leiomyoma, in 24 patients with STUMP, and in 21 patients with LMS. MMP-1 was expressed in 92% of leiomyomas, in 83% of STUMP, and in 86% of LMS, whereas MMP-2 was expressed in 12% of leiomyomas, in 17% of STUMP, and in 48% of LMS. A statistically significant difference regarding the frequency of MMP-2 expression was observed between LMS and STUMP (P =.025) as well as between LMS and leiomyoma (P =.006), but not between STUMP and leiomyoma (P >.05). Likewise, the staining intensity did significantly differ between LMS and leiomyoma (P =.025), but no statistical significant difference was observed between LMS and STUMP (P >.05) and between STUMP and leiomyoma (P >.05). The stronger MMP-2 expression in patients with LMS compared with STUMP and leiomyoma indicates that this protein might be a marker for tumor invasion or metastasis in patients with uterine LMS. Furthermore, MMP-2 seems to be a useful immunohistochemical parameter to distinguish cases of smooth muscle tumors in which histologic features are ambiguous or borderline. Further studies including larger numbers of patients are necessary to establish MMP-2 as a routine marker for tumor invasion and progression.

MIB-1 (Ki-67), p53, estrogen receptor, and progesterone receptor expression in uterine smooth muscle tumors

The diagnosis of benign, uncertain malignant potential, and malignant uterine smooth muscle tumors depends on mitotic counts, nuclear atypia, and other morphologic features. This study was undertaken to evaluate the utility of selected immunohistochemical markers in differentiating these tumors. Fifteen cases of cellular leiomyoma, 7 cases of smooth muscle tumor of uncertain malignant potential (STUMP), and 12 cases of leiomyosarcoma were immunostained for MIB-1 (Ki-67), p53, estrogen receptor and progesterone receptor (PR) using monoclonal antibodies and the avidin-biotin-peroxidase method. The percentage of cells stained was subjectively assessed to the nearest 5%. One percent was used for rare positive cells. MIB-1 expression of ≥15% was seen in 11 and expression of p53 in ≥15% cells was present in 5 of 12 leiomyosarcomas. MIB-1 and/or p53 expression of >15% was seen in all 12 leiomyosarcomas but in none of the 7 STUMP or 15 cellular leiomyomas. PR was absent in 10 of 12 leiomyosarcomas but present in 7 of 7 STUMP and 14 of 15 cellular leiomyomas. MIB-1 of 5% to 10% was seen in 6 of 7 STUMP but in only 1 of 15 cellular leiomyomas. MIB-1, p53, and PR are useful in differentiating leiomyosarcoma from STUMP and cellular leiomyoma. MIB-1 is useful in distinguishing STUMP from cellular leiomyomas. HUM PATHOL 32:984-987. Copyright © 2001 by W.B. Saunders Company

SMOOTH MUSCLE TUMOR OF THE SMALL INTESTINE IN A SHAPE OF CYSTIC TUMOR PRESENTING WITH PERFORATION -A CASE REPORT-

We experienced a case of smooth muscle tumor of the small intestine in a shape of cystic tumor presenting with perforation. A 47-year-old woman was seen at the hospital because of a right lower quadrant pain and fever. There were tenderness and rebound tenderness in the right lower abdomen. Abdominal ultrasonography revealed a 7cm tumor with enheterogenous internal echo in the right side of the uterus. Abdominal CT visualized a cystic tumor with enhanced margin and gas in the tumor. Torsion of the right ovarian cyst was suspected and an emergency operation was performed. At laparotomy, a cystic tumor was found in the upper jejunum with the ruputerd wall and there was accumulation of pus in the vicinity of the tumor. About 10cm of the small intestine including the tumor was excised. The excised specimen revealed a 70×63mm cystic tumor with the wall thickness of 2mm, necrosed tissue in the lumen and a communication with the small intestine. Histopathologically, interlacing spindle cell was confirmed in the cyst wall, and SMA staining was positive. The definite diagnosis of smooth muscle tumor of the small intestine was made.

A transmission electron microscopic study of two cases of oral smooth muscle neoplasm

Two cases of smooth muscle tumors that had appeared in the oral regions were examined by means of histopathology and electron microscopy. One was a case of angiomyoma that appeared in the lip of a 33-year-old man, and the other was a case of leiomyosarcoma in the maxilla of a 63-year-old woman. The results of the examination of both cases were as follows: the benign tumor (angiomyoma) was composed of mainly mature smooth muscle cells having dark cytoplasm, and the malignant tumor (leiomyosarcoma) consisted mainly of two types of cells, undifferentiated mesenchymal cells or fibroblast-like cells (type I) and myofibroblast-like cells (type II). Based upon these results, the relationship between the myogenous differentiation and the component cell types, and biological behavior of these smooth muscle tumors was discussed.

A CASE OF LEIOMYOSARCOMA OF THE JEJUNUM ASSOCIATED WITH VON RECKLINGHAUSEN'S DISEASE

Von Recklinghausen's disease (VRD) is characterized by cafe au lait spots and multiple skin tumors. It may also be accompanied by other systemic lesions. We experienced a case of leiomyosarcoma of the jejunum associated with VRD and report it in this paper with a review of the literature. A 43-year-old man visited our hospital with the chief complaints of epigastraligia and anemia. On physical examination, there were cafe au lait spots over his entire body and skin tumors in the anterior chest and the left upper arm which revealed VRD. The occult blood was strongly positive. There was no abnormality in the stomach, duodenum or colon. Barium meal examination of the small intestine and superior mesenteric angiography showed a myogenic tumor of the jejunum. Partial enterectomy was performed. The histopathological examination showed that it was leiomyosarcoma. There are 23 reported cases of smooth muscle tumors of the gastrointestinal tract with VRD which include the one just reported. In 18 of the 23 cases, the tumors were leiomyoma and in five they were leiomyosarcoma. The possibility of digestive disease should be borne in mind in every patient with VRD and symptoms of digestive dysfunction.

Leiomyosarcoma of Small Vein From Forearm

Although some 120 cases of leiomyosarcomas of large arteries and veins have been reported since the original case cited by Perl in 1981, with an additional 30 cases of smooth muscle tumors from major veins reported in 1960, it is an unusual event to find malignant smooth muscle tumors arising from the walls of smaller vessels. This report concerns a rather rare type of leiomyosarcoma involving the veins of the upper extremity, having its origin in the antecubital vein in the forearm of a 65 year old white male. The tumor was 2 cm in diameter and pearly white, smooth and somewhat lobulated in configuration. The tumor cells are moderately enlarged and flattened occurring in groups. Cells are arranged in various patterns and whorls. Mitotic figures are frequently observed.

Leiomyosarcoma of the breast. A case of long survival and late hepatic metastasis

A case of leiomyosarcoma of the breast that metastasized to the liver 15 years after mastectomy is reported. Leiomyosarcoma appears to have less aggressive biologic behavior than other types of breast sarcomas. Analysis of the reported cases of smooth muscle tumors of the breast revealed some guidelines for the histologic diagnosis of these tumors. Tumors with three or more mitoses per 10 HPF are leiomyosarcomas, and those with no mitotic activity, necrosis, and significant cellular atypia are leiomyomas. The borderline cases are best considered smooth muscle tumors with uncertain malignant potential.

2. 3 Cases of Smooth Muscle Tumor in the Colon and Rectum: Review of Reported Cases in Japan

Leiomyomas and leiomyosarcomas may occur anywhere in the gastrointestinal tract, but those tumors of the colon and rectum are rare.Only 8 cases of leiomyosarcoma in the colon and 30 cases of leiomyoma in the rectum have been reported in the literatures in Japan.Recently, we have observed 2 cases of leiomyoma in the rectum and a case of leiomyosa-rcoma in the ascending colon.These three cases were reported and we reviewed 9 cases of leiomyosarcoma in the colon and 32 cases of leiompoma in the rectum.