Proliferation Of Smooth Muscle Bundles Research Articles

Clinicopathologic and endoscopic characteristics of ten patients with gastric hamartomatous inverted polyp: a single center case series

BackgroundGastric hamartomatous inverted polyps (GHIPs) are not well characterized and remain diagnostically challenging due to rarity. Therefore, this study aims to investigate the clinicopathologic and endoscopic characteristics of patients with GHIP.MethodsWe retrospectively reviewed clinicopathologic and endoscopic features of ten patients with GHIP who were admitted to Beijing Friendship Hospital from March 2013 to July 2022. All patients were treated successfully by endoscopic resection.ResultsGHIPs were usually asymptomatic and found incidentally during gastroscopic examination. They may be sessile or pedunculated, with diffuse or local surface redness or erosion. On endoscopic ultrasonography, the sessile submucosal tumor-type GHIP demonstrated a heterogeneous lesion with cystic areas in the third layer of the gastric wall. Histologically, GHIPs were characterized by a submucosal inverted proliferation of cystically dilated hyperplastic gastric glands accompanied by a branching proliferation of smooth muscle bundles. Inflammatory cells infiltration was observed in the stroma, whereas only one patient was complicated with glandular low-grade dysplasia. Assessment of the surrounding mucosa demonstrated that six patients (60%) had atrophic gastritis or Helicobacter pylori–associated gastritis, and four patients (40%) had non-specific gastritis. Endoscopic resection was safe and effective.ConclusionsGHIPs often arise from the background of abnormal mucosa, such as atrophic or H.pylori-associated gastritis. We make the hypothesis that acquired inflammation might lead to the development of GHIPs. We recommend to make a full assessment of the background mucosa and H. pylori infection status for evaluation of underlying gastric mucosal abnormalities, which may be the preneoplastic condition of the stomach.

Successful treatment of multiple cutaneous leiomyomas with carbon dioxide laser ablation.

Successful treatment of multiple cutaneous leiomyomas with carbon dioxide laser ablation.

A Rare Cause of Intussusception in an Adult

Case: A 60-year-old female with no significant past medical history was evaluated in our clinic for persistent mid-abdominal pain, microcytic anemia and abnormal imaging. She reported a year of intermittent post-prandial abdominal discomfort. These episodes were of variable duration and often associated with nausea, vomiting and a sensation of bloat. Her previous work up included an initial CT scan which revealed an approximately 12 cm segment of ileum containing elongated “fat” in its central portion with an associated ileo-ileal intussusception, but without obstruction. Subsequent colonoscopy was notable for a prolapsed ileocecal valve, but a normal appearing ileum up to 15 to 20 cm. A small bowel follow through revealed a long, serpiginous, fixed low density lesion extending through several mid-ileal loops in the right lower quadrant. After evaluation in our clinic, she underwent a retrograde double-balloon enteroscopy. Approximately 50 to 60 cm proximal to the ileocecal valve she was found to have a polypoidal lesion with a very long, thick stalk and overlying ulceration. An endoloop was applied close to the base of the stalk and the lesion was then partially resected with snare cautery. The gross description of the resected specimen revealed a red-tan irregularly shaped polypoid mass measuring 5 x 1.8 x 1.6 cm. Microscopically, there was a mixed proliferation of smooth muscle bundles, nerves and ganglion cells, mature adipose tissue, and numerous thin and some thick walled blood vessels involving the mucosa, submucosa and smooth muscle consistent with a small bowel neuromuscular and vascular hamartoma (NVMH). Discussion: NMVH is a rare benign neoplasm occurring in the small intestine that was first described by Fernando and McGovern in 1982. From our review, there have only been 15 cases reported in the literature since its introduction. NMVH typically occurs in adults and often presents as intermittent intestinal obstruction or as occult gastrointestinal bleeding. In each of the previous cases, surgical resection has led to resolution of the patient's symptoms. From our review, this is the first case in the English literature of attempted endoscopic resection of a NMVH via double-balloon enteroscopy. Other types of small intestinal hamartomas have been reported in the literature as rare causes of intussusception, typically in children. In addition, cecal hamartomas have been reported as a rare cause of colonic intussusception. To our knowledge, there has been no previous report of image-documented intussusception caused by small intestinal NMVH in an adult or child. We would like to support its inclusion in the differential diagnosis of causes of intussusception in adults.

A congenital smooth muscle hamartoma masquerading as a reticulate vascular naevus

Smooth muscle hamartoma (SMH) is a benign congenital or acquired hamartomatous lesion comprising a dermal proliferation of smooth muscle bundles. We report a case of congenital SMH with an unusual clinical appearance. A 3-year-old girl presented with an asymptomatic atrophic linear lesion on the posterior surface of her right thigh, which had been present since birth. The striking resemblance to a vascular lesion initially led to the erroneous clinical diagnosis of atrophic reticulate vascular naevus. However, a skin biopsy showed typical features of SMH. To our knowledge, SMH with linear configuration has only been described in two previous cases, and there are no previous reports of SMH with such a marked resemblance to a vascular lesion.

Testicular angioleiomyoma presenting with haematospermia

Testicular angioleiomyoma presenting with haematospermia

Congenital Smooth Muscle Hamartoma on the Face Treated Using Vascular Laser

A congenital smooth muscle hamartoma is a rare, benign proliferation of smooth muscle bundles in the dermis that is usually diagnosed in the neonatal period or infancy. Surgical excision is the first-line therapeutic option, but in certain areas such as the face, surgery may be too aggressive, and different treatments should be considered. We present the case of a congenital smooth muscle hamartoma on the face treated using pulsed dye laser with good response.

Solitary gastric Peutz-Jeghers type stomach polyp mimicking a malignant gastric tumor

Most cases of Peutz-Jeghers type polyps of the stomach are associated with mucocutaneous pigmentation and multiple intestinal polyposis. A solitary Peutz-Jeghers type polyp of the stomach is rare. We here report a case of a 71-year-old woman with a solitary Peutz-Jeghers type polyp of the stomach who presented with intolerable epigastric pain and weight loss of 5 kg over the prior two months. During the hospital treatment course for this patient, endoscopic examination revealed a bulging lesion with a central hole, mucosal ulceration, an asymmetrical wall thickness and a narrowing of the gastric lumen. A gastric biopsy further revealed ulceration with moderate dysplasia. The patient received endoscopic ultrasonography which showed a second subepithelial lesion that measured 4 cm × 3 cm. Computed tomography of the abdomen subsequently showed a thickened gastric wall with three visibly enlarged lymph nodes, all greater than 1 cm. The suspected diagnosis was malignant gastric cancer with lymph node metastases. The other lesion, which measured 2 cm × 2 cm × 1 cm was noted in the submucosa of the jejunum during surgery. The patient was treated using a subtotal gastrectomy and partial resection of the jejunal tumor. The final pathological report indicated a gastric Peutz-Jeghers type polyp with proliferation of smooth muscle bundles in the submucosal layer, and hyperplastic glands in the mucosal layer and ectopic pancreas of the jejunum. This is the first reported clinical case of a solitary Peutz-Jeghers type polyp of the stomach accompanying a lymph node enlargement and ectopic pancreas in the jejunum that simulates stomach cancer with lymph node metastases.

A Case of Acquired Smooth Muscle Hamartoma on the Sole

A smooth muscle hamartoma is a benign proliferation of smooth muscle bundles within the dermis. It arises from smooth muscle cells that are located in arrector pili muscles, dartos muscles, vascular smooth muscles, muscularis mammillae and the areolae. Acquired smooth muscle hamartoma (ASMH) is rare, with only 10 such cases having been reported in the English medical literature to date. Most of these cases of ASMH were shown to have originated from arrector pili and dartos muscles. Only one case was reported to have originated from vascular smooth muscle cells. A 21 year-old woman presented with a tender pigmented nodule, with numbness, on the sole of her foot, and this lesion had developed over the previous 18 months. The lesion showed no hyperpigmentation or hypertrichosis, and the biopsies demonstrated increased smooth muscle bundles in the dermis, and especially around the blood vessels. Moreover, the specimens stained positive with Masson trichrome stain and alpha-smooth-muscle actin antibodies, thus supporting our diagnosis of ASMH of the foot sole. Herein, we report on a rare case of ASMH on the foot sole, and this lesion originated from vascular smooth muscle cells. This type of case has not been previously described in the English medical literature.

Acquired Penoscrotal Smooth Muscle Hamartoma

Smooth muscle hamartoma is an uncommon, usually congenital benign proliferation of smooth muscle bundles within the dermis.’ Unlike previously reported cases of acquired smooth muscle hamartomas, our case did not occur in association with Becker’s nevus. To our knowledge we report the first case of acquired smooth muscle hamartoma in the penoscrotal region. CASE REPORT A 65-year-old man presented with penoscrotal swelling that he had noticed approximately 8 months previously (fig. 1, A). No evidence of trauma, allergic reaction or insect bite was found. Physical examination revealed thickening and swelling flesh in the scrotum and the entire penile shaft circumferentially, which was not tender when palpated. Excisional biopsy of the scrotal wall and penile skin was interpreted as a smooth muscle hamartoma (fig. 2). Exploration revealed normal cord structures and testes. The entire scrotal wall was excised with only a small amount remaining. Perineal skin flaps were mobilized to cover the testes. Penile shaft skin was incised at the ventral midline and circumscribed distally. Hamartomatous subcutaneous tissue was excised extensively, avoiding perforation of the underlying skin, and the penis was covered with this skin (fig. 1, B). At followup 15 months postoperatively there was no sign of recurrence.

Accessory Scrotum or Perineal Collision-Hamartoma: A Case Report to Illustrate a Misnomer

A case of a congenital perineal tumor in a male infant is described, which consisted of separated fat and smooth muscle tissue in nodular arrangement. According to its clinical presentation, this lesion would be grouped into the category of so called "accessory scrotum," as part of the entity of ectopic scrotum. Based on our case and on a review of the literature, the possibility is raised that this labelling may be inappropriate on grounds of etiology and pathomorphology. It is suggested to consider similar lesions as the result of a perineal hamartomatous fat tissue overgrowth with transposed scrotal skin, which may or may not show additional hamartomatous proliferation of smooth muscle bundles, and to label them "perineal lipoma/lipoblastoma with ectopic scrotal skin" or "perineal collision-hamartoma" in the case of a prominent isolated smooth muscle component.