Leiomyoma Research Articles

Comparison of the effectiveness between radiofrequency ablation and microwave ablation in treating uterine leiomyoma

Objective To investigate the efficiency of radiofrequency ablation (RFA) and microwave ablation (MWA) in treating uterine leiomyoma.Methods The clinical data of thermal ablation with RFA and MWA were retrospectively analyzed in 42 patients.All patients were followed up at least 12 months to observe the therapeutic effects after the treatment.The changes of vital signs and the size of uterine leiomyoma,the score of uterine leiomyoma symptom and quality of Iife(UFS-QOL) were compared after RFA or MWA,the two thermal ablations techniques of clinic efficiency and influence on complications were analyzed.Results 23 patients received treatment of RFA and 19 patients received MWA,the visual analogue scale(VAS)during operation and postoperation were statistically significant differences between the two groups(P ＜0.05).The sizes of uterine leiomyoma were significantly reduced after the thermal ablation,the differences of volume within two groups in different time were statistics significance(P ＜0.05),but there were no statistics significance differences between two groups (P ＞0.05).The symptoms in two groups were improved significantly after treatment and the scores of UFS-QOL were no statistics significance differences between two groups (P ＞0.05).Conclusions Both of RFA and MWA have significant clinic efficiency in treating uterine leiomyoma.Compared with MWA,RFA with lower adverse reactions during operation and postoperation. Key words: Ultrasonography; Microwave/therapeutic use; Catheter ablation; Uterine neoplasms; Leiomyoma

High resolution esophageal manometry of patients with lower esophageal leiomyoma

Objective To explore the effects of lower esophageal leiomyoma on esophageal dynamics.Methods A total of 25 patients with lower esophageal leiomyoma,31 patients with gastroesophageal reflux disease (GERD) and 16 healthy controls were selected.The differences of high resolution esophageal manometry results were compared among the groups.The t-test or one way analysis of variance was performed for normally distributed measurement data comparison.Rank sum test was used for non-normally distributed measurement data comparison.Results Among 25 patients with lower esophageal leiomyoma,14 patients accompanied with acid reflux,heartburn,chest pain or other GERD symptoms.In the group of patients with lower esophageal leiomyoma,the lower esophageal sphincter pressure (LESP),the lower esophageal sphincter relaxation rate (LESRR),low esophageal body pressure and peristaltic contraction percentage were (9.00 ± 6.30) mmHg (1 mmHg =0.133 kPa),53.0 ％ (0,334.0％),(34.66±18.33) mmHg and 55.6％ (0,100.0％),respectively,which were lower than those of the healthy control group ((16.25 ± 3.71) mmHg,86.5％ (49.0％,103.0％),(57.75 ± 22.49) mmHg,100.0％ (80.0％,100.0％)),and the differences were statistically significant (t=-4.150,Z=-2.353,t=-3.601,Z=-3.798; all P＜0.05).However there were no significant differences in esophageal dynamics indexes between patients with lower esophageal leiomyoma accompanied GERD symptoms and without GERD symptoms (all P＞0.05).There were no significant differences in esophageal dynamics indexes between the GERD patients and patients with lower esophageal leiomyoma accompanied GERD symptoms (all P＞0.05).LESRR level of patients with lower esophageal leiomyoma (71.4％(45.5％,150.0％)) increased after endoscopic submcosal dissection (Z=-2.194,P=0.028).Conclusions Lower esophageal leiomyoma may affect esophageal motor function,which contributed to anti-reflux esophageal function decline.Lower esophageal leiomyoma combined with gastroesophageal reflux symptoms are not uncommon. Key words: Esophageal neoplasms; Leiomyoma; Manometry; Gastroesophageal reflux

Expression of nerve growth factor produced by ectopic endometrium from patients with adenomyosis and its relationship with pain scales and innervation

To investigate the expression of nerve growth factor (NGF) in the ectopic endometrium in adenomyosis patients, and explore the relationship between NGF expression and innervation or pain scales. From Mar. 2009 to Oct. 2009, 45 adenomyosis patients undergoing hysterectomy in Obstetrics and Gynecology Hospital of Fudan University were enrolled in this study, which were classified into 33 cases in pain group and 12 cases in non-pain group based on symptom. The degree of dysmenoreal, chronic pelvic pain and dyspareunia was evaluated by visual analogue scale, including no pain, mild to moderate pain and severe pain group. In the mean time, 26 patients with leiomyoma or cervical intraepithelial neoplasia III (CIN III) undergoing hysterectomy were defined as control group. Ectopic endometrium from experimental group and eutopic endometrium from control group were collected in the surgery. The expression of NGF was examined by immunohistochemistry. The density of protein gene product (PGP) 9.5 positive nerve fibers was detected by immuno-fluorescence. The NGF level and the density of PGP 9.5 positive nerve fibers in adenomyosis pain group (0.25 ± 0.08, 16 ± 8 )were higher than adenomyosis painless (0.19 ± 0.05, P = 0.007;11 ± 5, P = 0.018) and control group (0.18 ± 0.05, P = 0.000; 9 ± 4, P = 0.000) . The NGF level and the density of PGP9.5 positive nerve fibers in severe dysmenorrheal group (0.29 ± 0.07, 19 ± 10) were higher than mild to moderate dysmenorrheal (0.22 ± 0.07, P = 0.018;13 ± 4, P = 0.035) and painless group (0.18 ± 0.05, P = 0.000;11 ± 5, P = 0.006) of adenomyosis patients. There was no difference of NGF level and the density of PGP 9.5 positive nerve fibers in chronic pelvic pain group and no chronic pelvic pain group of adenomyosis patients, so was dyspareunia group and no dyspareunia group. The increased NGF level of adenomyosis nodules and improving innervation might be involved in the mechanism of adenomyosis related pain.

Proteasome LMP2/β1i subunit as biomarker for human uterine leiomyosarcoma

Uterine leiomyosarcoma (Ut-LMS) develops more frequently in the myometrium of the uterine body than in the uterine cervix. Although the development of gynecological tumors is often correlated with the secretion of female hormones that of Ut-LMS does not, and its risk factor(s) remain unknown. Importantly, a diagnostic biomarker that can distinguish malignant tumor Ut-LMS from benign tumor leiomyoma (LMA), has yet to be established. Therefore, the risk factor(s) associated with Ut-LMS need to be examined in order to establish a diagnosis and clinical treatment method. Mice with a homozygous deficiency for the proteasome b-ring subunit, low-molecular mass polypeptide (LMP)2/b1i spontaneously develop Ut-LMS, with a disease prevalence of ~40% by 14 months of age. In recent studies, we showed that LMP2/b1i expression was absent in human Ut-LMS, but present in other human uterine mesenchymal tumors including uterine LMA. Moreover, LMP2/b1i is also known to negatively regulate human Ut-LMS tumorigenesis. Additional experiments furthermore revealed the differential expression of cyclin E and calponin h1 in human uterine mesenchymal tumors. Therefore, LMP2/b1i is a potential diagnostic biomarker when combined with the candidate molecules, cyclin E and calponin h1 for human Ut-LMS, and may be a targeted molecule for a new therapeutic approach. --------------------------------------------- Cite this article as : Hayashi T, Horiuchi A Aburatani H, Ishiko O, Yaegashi N, Kanai Y, Zharhary D, Tonegawa S, Konishi I. Proteasome LMP2/s1i subunit as biomarker for human uterine leiomyosarcoma. Int J Cancer Ther Oncol 2014; 2 (1):02018. DOI: http://dx.doi.org/10.14319/ijcto.0201.8

Resection of Degenerated Leiomyoma by Laparotomy during Second Trimester of Pregnancy with Favorable Outcome: A Case Report and Review of Literature Regarding Leiomyomas during Pregnancy

Aims: We present a case of degenerated leiomyoma in pregnancy causing pain that deteriorated with conservative management and was successfully treated with myomectomy. Presentation ofCase: A 37-year-old woman with a known asymptomatic subserosal leiomyoma was admitted to the obstetrics clinic of our hospital at the gestational age of 18+3 weeks due to gradually worsening constant right quadrant lower abdomi nal pain of acute onset. Clinical examination, laboratory investigation and abdominal ultrasonography led to the conclusion that the pain was due to the degeneration of the leiomyoma. The initial conservative approach was not effective so the subserous lei omyoma was resected by laparotomy. The pregnancy progressed normally until the delivery of a healthy neonate at 37+5 weeks gestational age by cesarean section due to the prior myomectomy. The

Leiomyoma of the Gastrointestinal Tract With Interstitial Cells of Cajal

Leiomyomas (LMs) of the gastrointestinal tract arise within the muscularis mucosae (superficial) and muscularis propria (deep). There are isolated reports of KIT-positive cells, presumed interstitial cells of Cajal (ICCs), within gastrointestinal LMs. We have encountered esophageal LMs with a high proportion of KIT-positive and DOG1-positive spindle-shaped cells, an appearance that mimicked gastrointestinal stromal tumor. Our aim was to explore the prevalence of ICCs in LMs of the gastrointestinal tract and the etiopathogenic significance of these cells in this benign neoplasm. We identified 34 esophageal LMs (28 deep, 6 superficial), 8 gastric LMs, and 5 small-bowel LMs (all lesions in muscularis propria). We performed immunohistochemical staining studies for desmin, DOG1, and KIT on these neoplasms. We also evaluated 12 superficial colonic LMs. ICCs were distinguished from mast cells on the basis of morphology (elongated and occasionally branching spindle-shaped cells) and the presence of DOG1 reactivity. Four cases were screened for mutations in PDGFRA exons 12, 14, and 18 and KIT exons 9, 11, 13, and 17. ICCs were identified in all deep esophageal LMs and constituted an average of 20% of the lesional cells; focally, these cells comprised >50% of cells. The density of these cells was significantly higher than the background muscularis propria, and hyperplasia of ICCs was not identified in the adjacent muscle. ICCs were identified in 6 of 8 gastric LMs and 1 of 5 small-bowel LMs and were entirely absent in all superficial esophageal and colonic/rectal LMs. There were no mutations in KIT or PDGFRA. ICCs are universally present in deep esophageal LMs, and thus these neoplasms could be mistaken for gastrointestinal stromal tumors, particularly on biopsy samples, an error associated with adverse clinical consequences. ICCs are also identified in gastric and intestinal LMs, albeit in a smaller proportion of cases. Colonization and hyperplasia by non-neoplastic ICCs likely account for this phenomenon.

Down-Regulation of miR-29b Is Essential for Pathogenesis of Uterine Leiomyoma

Uterine leiomyomata (LMs) are the most common tumor affecting the female reproductive organs. The most notable pathophysiologic feature of this tumor is the excessive accumulation of rigid extracellular matrix (ECM) composed mainly of collagen types I and III. It is believed that the rigidity of the collagen-rich ECM causes symptoms such as abnormal bleeding and pelvic pain/pressure. However, the molecular pathogenesis for this ECM-rich tumor has yet to be elucidated. We have established that miR-29b was consistently down-regulated in LM compared with myometrium (MM). Hence, the function of miR-29b in LM was examined in vivo using adult female ovariectomized NOD-scid IL2Rγ(null) mice for subrenal xenograft models. In LM xenografts, restoring miR-29b inhibited the accumulation of ECM and the development of solid tumors. Although the miR-29b knockdown in MM cells increased the expression of collagens, it did not transform MM cells into tumorigenic, indicating that the down-regulation of miR-29b is essential but not sufficient for LM tumorigenesis. In addition, 17β-estradiol and progesterone down-regulated miR-29b and up-regulated mRNAs for multiple collagens in LM xenografts. Thus, we conclude that ECM production in LMs is regulated by steroid hormones via down-regulation of miR-29b, which is one of the mechanisms underlying the excessive accumulation of ECM.

First series of 18 pregnancies after ulipristal acetate treatment for uterine fibroids

Design : Retrospective analysis of a series of 52 patients prospectively included in the PGL4001 (ulipristal acetate) Effi cacy Assessment in Reduction of Symptoms Due to Uterine Leiomyomata (PEARL) II and III trials. Setting : Academic hospital. Patient(s) : Among the 52 patients, 21 wished to conceive upon treatment completion. Intervention(s) : None. Main Outcome Measure(s) : Pregnancy rate and live birth rate. Result(s) : Twenty-one patients attempted to get pregnant, amongwhom15 (71%) succeeded, totaling 18 pregnancies. Among these 18 pregnancies, 12 resulted in the birth of 13 healthy babies and 6 ended in early miscarriage. No regrowth of fi broids was observed during pregnancy. Conclusion(s) : We report the fi rst series of pregnancies achieved after UPA treatment. Our data confi rm a sustained long-term eff ect after UPA therapy. (Fertil Steril®, 2014. by American Society for Reproductive Medicine).

LMP2/b1i as a potential biomarker of human uterine mesenchymal tumors under the combination of candidate molecules, cyclin E and calponin h1

Uterine leiomyosarcoma (Ut-LMS) develops more often in myometrium of the uterine body than in the uterine cervix. The development of gynecologic tumors is often correlated with female hormone secretion; however, the development of Ut-LMS is not substantially correlated with hormonal conditions, and the risk factor(s) are not yet known. Importantly, a diagnostic-biomarker, which distinguishes malignant tumor Ut-LMS from benign tumor leiomyoma (LMA), is yet to be established. Accordingly, it is necessary to examine risk factor(s) associated with Ut-LMS, to establish a diagnosis and a clinical treatment method. The mice with a homozygous deficiency for proteasome b-ring subunit, low-molecular mass polypeptide (LMP)2/b1i spontaneously develop Ut-LMS, with a disease prevalence of ~40% by 14 months of age. In the recent study, we found LMP2/b1i expression to be absent in human Ut-LMS, but present in other human uterine mesenchymal tumors including uterine LMA. Moreover, LMP2/b1i is reported to negatively regulate human Ut-LMS tumorigenesis. Additional experiments furthermore indicate the differential expressions of cyclin E and calponin h1 during human uterine mesenchymal tumors. Therefore, LMP2/b1i is a potential diagnostic biomarker under the combination of candidate molecules, cyclin E and calponin h1 for human Ut-LMS, and may be a targeted-molecule for a new therapeutic approach.

A diagnostic biomarker: differential expression of LMP2/β1i in human uterine neoplasms

Uterine leiomyosarcoma (Ut-LMS) more frequently develops in the muscle tissue layer of the uterine body than in the uterine cervix. The development of gynecological tumors is often correlated with the secretion of female hormones; however, the development of Ut-LMS has not been correlated with hormonal conditions, and risk factors remain unknown. A diagnostic biomarker that can distinguish malignant Ut-LMS from benign tumor leiomyoma (LMA) has not yet been established. Therefore, an analysis of the risk factors associated with human Ut-LMS is needed in order to establish a treatment method. Proteasome LMP2/β1i-deficient mice spontaneously develop Ut-LMS, with a disease prevalence of ~40% by 14 months of age. We found that the expression of LMP2/β1i was absent in human Ut-LMS, but present in human LMA. Therefore, the defective expression of LMP2/β1i may be one of the risk factors for Ut-LMS. LMP2/β1i is may be a potential diagnostic biomarker for human Ut-LMS, and may be a targeted molecule for a new therapeutic approach.

Submucosal tunneling endoscopic resection in the treatment of rectal submucosal tumors originating from muscularis propria

To evaluate the clinical value of submucosal tunneling endoscopic resection (STER) for rectal submucosal tumors (SMT) originating from muscularis propria. Clinicopathological data of 8 cases with rectal SMT originating from muscularis propria undergoing STER in our center from March 2011 to March 2013 were analyzed retrospectively. En bloc STER was performed successfully in all the 8 cases. The tumors location was 5-15 cm from the edge of anus. The resected specimen size ranged from 1.0 to 3.5 cm (average 1.8 cm). The mean procedure time was 51 min (range, 40-70 min). One patient developed mucosa perforation and was repaired with metal clips. One patient developed subcutaneous emphysema in one leg, which was disappeared after two weeks. Postoperative pathological examination revealed schwannoma in 3 cases, leiomyoma in 2 cases, stromal tumor in 1 case, and proliferation of collagen fibers nodular degeneration in 2 cases. Postoperative follow-up ranged from 6 to 30 months and no residual lesion or recurrence was found. STER is a safe and effective method for rectal SMT originating from muscularis propria in our initial experience.

The Burden of Uterine Fibroids

Uterine leiomyomas (fibroids) are the principal cause of hysterectomy in the U.S., and prevalence of this common condition is three times higher among

The comparason of the clinical efficacy of laparoscopic myomectomy surgery and open myomectomy surgery for the patients with uterine fibroids

Objective To investigate the clinical efficacy of laparoscopic myomectomy surgery and open myomectomy surgery for the patients with uterine fibroids.Methods 78 patients with uterine fibroids in our hospital were divided into observation group and control group by random serial number,and each group had 39 cases.The observation group was given laparoscopic myomectomy,while the control group was given open myomectomy surgery.The average time,average blood loss,postoperative exhaust time and average postoperative hospitalization days were compared between the two groups.Results The operative time,blood loss,postoperative exhaust time and hospital stay time of the observation group were (113.3 ± 15.1) min,(50.5 ± 27.5) ml,(19.5 ± 5.1) h and (4.6 ± 0.5) d,while those in the control group were (61.5 ± 12.7) min,(100.9 ± 35.7) ml,(37.6 ± 4.9) h and (7.7 ± 0.6) d,the differences were significant between the two groups (t =11.79,10.35,8.06,7.11,all P ＜ 0.05).Conclusion Compared with open myomectomy surgery,laparoscopic myomectomy can not only shorten the hospital stay,but also reduce the time of discharge,and it is worth to be further promoted in clinical. Key words: Uterine neoplasms ; Leiomyoma; Laparoscopic surgery ; Surgery

Endometriosis, Leiomyoma and Adenomyosis: the Risk of Gynecologic Malignancy

The aim of this review article was to evaluate the relationship and the possible etiological mechanisms between endometriosis, leiomyoma (LM) and adenomyosis and gynecological cancers, such as ovarian and endometrial cancer and leiomyosarcoma (LMS). MEDLINE was searched for all articles written in the English literature from July 1966 to May 2013. Reports were collected systematically and all the references were also reviewed. Malignant transformation of gynecologic benign diseases such as endometriosis, adenomyosis and LM to ovarian and endometrial cancer remains unclear. Hormonal factors, inflammation, familial predisposition, genetic alterations, growth factors, diet, altered immune system, environmental factors and oxidative stress may be causative factors in carcinogenesis. Early menarche, low parity, late menopause and infertility have also been implicated in the pathogenesis of these cancers. Ovarian cancers and endometriosis have been shown to have common genetic alterations such as loss of heterozygosity (LOH), PTEN, p53, ARID1A mutations. MicroRNAs have also been implicated in malignant transformation. Inflammation releases proinflammatory cytokines, and activates tumor associated macrophages (TAMS) and nuclear factor kappa b (NF-KB) signaling pathways that promote genetic mutations and carcinogenesis. MED12 mutations in LM and smooth muscle tumors of undetermined malignant potential (STUMP) may contribute to malignant transformation to LMS. A hyperestrogenic state may be shared in common with pathogenesis of adenomyosis, LM and endometrial cancer. However, the effect of these benign gynecologic diseases on endometrial cancer should be studied in detail. This review study indicates that endometriosis, LM, adenomyosis may be associated with increased risk of gynecological cancers such as endometrial and ovarian cancers. The patients who have these gynecological benign diseases should be counseled about the future risks of developing cancer. Further studies are needed to investigate the relationship between STUMPs, LMS and LM and characteristics and outcome endometrial carcinoma in adenomyotic patients.

Clinical efficacy of exclusive right-thoracic approach in esophageal surgery

Objective To investigate the indications and clinical efficacy of an exclusive right-thoracic approach in esophageal surgery. Methods The clinical data of 35 patients with esophageal disease who underwent an exclusive right-thoracic approach operation from June 2008 to June 2010 at the Affiliated Hospital of Qingdao University were retrospectively analyzed. Of the 35 patients, 21 were with esophageal cancer, and their ages were above 70 years, the partial pressure of oxygen of arterial blood （ PaO2 ） , maximal voluntary ventilation and forced vital capacity of the first second were （70±9）mm Hg （1 mm Hg=0.133 kPa）, 51%±9% and 57%±11%, respectively. Fourteen patients were with benign esophageal disease or low grade malignancy, and their PaO2 maximal voluntary ventilation and forced vital capacity of the first second were （96 ± 13 ）mm Hg, 83 %± 11% and 91%± 14%, respectively. Exclusive right-thoracic approach was selected for all the patients, and surgical procedure was selected according to the location of the lesions. Patients were followed up by out-patient examination or phone call till April 2012. Results All the operations were carried out successfully, 21 patients with esophageal cancer underwent partial esophagus resection and stomach-esophagus intrathoracic anastomosis through a right-thoracic approach. Of the 14 patients with benign esophageal disease or low grade malignancy, 2 patients were with esophageal leiomyoma, 3 with esophageal stromal tumor and 1 with esophageal leiomyomatosis underwent partial esophagus resection ± intrathoracic anastomosis ; 7 patients with esophageal leiomyoma and 1 with esophageal stromal tumor underwent tumor extirpation. The operation time and operative blood loss were （3.4 ± 1.8）hours and （160±44） ml, respectively. The number of lymph node dissected of the 21 patients withesophageal tumor was 14 ± 5, including 1. 1 ± 0. 7 lymph nodes dissected near the left gastric artery. No anastomosis fistula and perioperative death were detected, and the duration of hospital stay was （ 10±4） days. The postoperative PaO2 , maximal voluntary ventilation and forced vital capacity of the first second were （66 ± 10） mm Hg, 50% ± 11% and 51% ± 15% for patients with esophageal cancer, and （94 ± 13） mm Hg, 80% ± 13% and 87% ± 16% for patients with benign esophageal disease or low grade malignancy. All the patients were followed up for 1-2 years, no eating obstruction was detected, and the postoperative 1- and 2-year survival rate were 82.9% （29/35） and 77.1% （27/35）, respectively. Of the 8 patients with esophageal cancer who died postoperatively, 1 died of cardiovascular diseases and 7 died of tumor recurrence and metastasis. Conclusion Exclusive rightthoracic appraoch could be used for patients with benign esophageal disease, low-grade malignancy and old esophageal cancer patients with poor oulmonarv function. Key words: Esophageal neoplasms; Surgical approach, exclusive right thoracic incision; Efficacy

The clinical observation of gongliuxiao combined with mifepristone in the treatment of uterine fibroids

Objective To explore the clinical curative effect of treating peptic ulcer by rabeprazole joint clarithromycin and amoxicillin.Methods 80 cases were divided randomly into control group and observation group.Patients in the control group were given mifepristone,patients in the treatment group were given gongliuxiao on the base of the control group,after one course of treatment,the clinical curative effects of the two groups were evaluated.Results The clinical effective rate of the control group and observation group was 72.5 ％ and 92.5 ％,respectively,the curative effect of treatment group was significantly better than that of control group (x2 =5.600,P ＜ 0.01).Conclusion The clinical curative effect of treating uterine fibroids by gongliuxiao combined with mifepristone is distinct,safe and reliable. Key words: Leiomyoma; Gongliuxiao; Mifepristone

Apoptotic and cytotoxicity effects of All Trans Retinoic Acid (ATRA) in cultured human uterine myoma

Background: Uterine leiomyoma is the most common tumor among the female in the reproductive period. The first step to control the tumor is employing medical treatment. Currently GnRH agonists are the most common drugs for medical therapy of uterine myoma. Climacteric-like symptoms and osteoporosis and recurrence of the size of tumor after GnRH agonists consumption are among the most common side effects of employing the medical treatment. In the present study the apoptotic and cytotoxicity effects of All Trans Retinoic Acid (ATRA) on cultured human leiomyoma cells were investigated. Methods: Samples were myoma cells of women with myomatosis uterine admitted in Imam Reza hospital of Kermanshah. After preparation and counting by neobar lam, they were cultured for 24 hours. Then they were divided into exposed and control groups. The experimental group exposed to ascending concentrations of ATRA and the control group did not have any intervention. After exposure, the cells were cultured for 72 hours. Finally the apoptosis and cytotoxicity were measured using TUNEL method and LDH kit respectively and the results were compared. Results: The results indicated that apoptotic effects of ATRA were significantly higher than those of control group (P<0.01). Cytotoxicity rate of ATRA was higher than that of control group. Conclusion: The above findings support the hypothesis that probably retinoic acid pathway is one of the main pathways in myoma pathogenesis. It is possible that this patll way. Would be used to stopping to growth of myoma. Keywords: Myoma, ATRA, apoptosis, cell culture ‌

Thoracoscopic operation in the treatment of esophageal leiomyoma

Objective To explore the feasibility and reliability of thoracoscopic surgery in the treatment of esophageal leiomyoma.Methods According to the tumor site selection of incision,7 patients with esophageal leiomyoma were taken myomectomy by thoracoscopic surgery.Results All cases were cured,and there was no death and serious complication.The patients were followed up for 3 to 24 months.There was no recurrence.Conclusion The myomectomy by thoracoscopic surgery would be an alternative to open surgery for patients with esophageal leiomyomas,which is safe and effective. Key words: Esophageal, leiomyoma; Thoracoscopy ; Surgical procedures, minimally invasive

Rupture of uterine vessel by twisted leiomyoma causing massive intraperitoneal haemorrhage and hypovolemic shock

DOI: http://dx.doi.org/10.4038/sljog.v35i1.6005 Sri Lanka Journal of Obstetrics and Gynaecology 2013; 35 : 34-36

Gastroscopic, endoscopic ultrasonographic, immunohistochemical and clinicopathological features of esophageal mesenchymal tumors

Objective To explore the features of clinicopathology,gastroscopy,endoscopic ultrasonography (EUS) and immunohistochemistry of esophageal mesenchymal tumors (EMT).Methods The clinical data of 98 cases of EMT patients who underwent endoscopic biopsy,endoscopic treatment or surgery and were diagnosed according to pathological and immunohistochemistry examination were collected.The clinicopathologic characteristics,endoscopy,EUS and immunohistochemistry of these cases were retrospectively analyzed,and differentiated from other submucosal tumor.Results Among the 98 cases of EMT,there were 77 leiomyomas (LM),15 gastrointestinal stromal tumors (GIST),four lipomas,one leiomyoblastoma and one schwannoma.The age of GIST group were older than that of LM group,and most were male patients predominated in these two groups.Dysphagia was the most common symptom of EMT.Gastrointestinal bleeding was rare,which was different from other gastrointestinal mesenchymal tumors.Under endoscopy,the appearances of EMT were similar,as submucosal protuberant lesions.One esophageal GIST was extraluminal lesion.Under EUS,LM,GIST and schwannoma showed low echo images originated from the muscularis propria or muscularis mucosa.Lipomas showed high echo images originated from submucosa.Pathological examination indicated that main cell type of LM and schwannoma was spindle cell,part of GIST was epitheloid cell type.The expressions of CD117 and CD34 were high in GIST,the expressions of SMA and Desmin were high in LM.S-100 was expressed in schwannoma.Other submucosal tumors,such as esophageal cyst,esophageal tuberculosis,esophageal carcinosarcoma,and some esophageal squamous carcinoma were easily misdiagnosed as EMT.Conclusions Esophageal LM is the most common EMT,followed by GIST.EUS is helpful in EMT diagnosis,however it can not accurately distinguish GIST,LM or schwannoma. Key words: Esophageal neoplasms; Leiomyoma; Gastrointestinal stromal tumors; Neurilemmoma; Endosonography; Immunohistochemistry; Diagnosis, differential