Rectal Leiomyoma Research Articles

ENDOSCOPIC RESECTION OF RECTAL POLYP REVEALING A LEIOMYOMA

Background: Rectal leiomyoma is a rare histological entity withnonspecific appearance on endoscopy and scarce literature regarding its management.The paucity of available literature is likely due to its benign behavior, and treatment is only indicated for symptomcontrol. As such, there are manyunknowns regarding polypectomyeffectiveness as a treatment and whether it is necessary to monitor after excision.Here, we review published cases of rectal leiomyoma and itsproposed endoscopic treatments and outcomes. Case Summary: We report a case of a rectal leiomyoma diagnosed after endoscopic resection of a rectal sessile polyp. A 70-year-old woman with longstanding diabetes was referred for further investigation of chronic constipation and recurrent anal abscess. Colonoscopy revealed a 7-mm sessile polyp in the rectum. Polypectomy was performed using a cold snare, and histology confirmed a rectal leiomyoma and an R0 resection. No bleeding and no residual local lesions were found on control endoscopy. Conclusion: R0 endoscopic resection is an effective, low-risk treatment for rectal leiomyoma, and no follow up is required.

Difficult Defecation Caused by a Huge Rectal Leiomyoma.

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S1752 A Rare Case of Rectal Leiomyoma

S1752 A Rare Case of Rectal Leiomyoma

Rectal leiomyoma, a rare entity.

Rectal tumors are often encountered as an incidental finding on screening colonoscopy. As per the World Health Organization, they are categorized according to their histologic appearance. These include epithelial tumors, mesenchymal tumors and lymphomas. Of interest, in our case, are mesenchymal tumors. These are sub-classified into leiomyomas and gastrointestinal stromal tumors. Our case is a 33-year old male who was diagnosed with a rectal leiomyoma. The uncommon incidence and subsequent management of a rectal leiomyoma in a male, make this case worthy for literature review.

Transvaginal resection of a rectal leiomyoma: A case report

The present study reports the case of a patient with a rectal submucosal tumor (leiomyoma) that was resected transvaginally. A 51-year-old female presented with a rectal submucosal tumor on the anterior wall of the lower rectum, located within 3 cm of the anal verge. This location would normally require intersphincteric or abdominal perineal resection. However, in order to minimize the invasiveness of the treatment and reduce post-operative morbidity, transvaginal resection and laparoscopic diverting ileostomy were performed instead. With the patient under general anesthesia, the posterior vaginal mucosa was incised vertically. The tumor was then excised en bloc with the overlying rectovaginal septum and rectal submucosal tumor. A primary repair of the defect and a diverting stoma were performed. The procedure did not present any complications, and the patient was discharged on day 10 post-surgery. The diverting stoma was closed 3 months later, and the sphincter function of the patient following surgery was monitored by manometry. The results of the manometric tests indicated that the patient did not suffer from fecal incontinence. In addition, the patient did not experience anal dysfunction or discomfort following the surgical procedure.

Colorectal cancer prevention.

Introduction: To develop a regression model that can reliably predict the recommended time interval for surveillance colonoscopy, possibly eliminating the need for pathology. Methods: We retrospectively analyzed 625 patients who had colonoscopy with polyps in the year 2013 at a university hospital. Exclusion criteria included patients with prior colon cancer or colorectal surgery, IBD, colon cancer syndrome, polyps not retrieved, or a lesion only biopsied. Binary logistic regression was performed using Statistical Package for the Social Sciences v.21. The binary dependent variable was the surveillance interval recommendation of 3 years or other than 3 years. The reference value was the 2012 AGA guidelines. In this study, we treated screening and surveillance together and hyperplastic polyps beyond the splenic flexure as adenomas, as there is evidence that pathologist may misclassify SSA as hyperplastic. Independent variables were defined as follows: number of polyps (1, 2, 3, or > 4), size of the polyps (any polyp >10mm or not), and location of the polyps (0, 1, 2, or >3 polyps proximally). Results: Two thousand two hundred three colonoscopies were reviewed. Six hundred twenty-five exams met the study criteria. Of those, 429 were for screening and 196 for surveillance. Polyp size, number, and location were all significant factors in determining the interval. The nagelkerke R square is 0.803, and the omnibus tests of the coefficients were all <0.000 (Table 1). Sensitivity and specificity for the model is 92.2% and 94.9%, respectively. Area under the ROC curve was 0.93. For the 3-year interval, 3.5% of patients got a false positive result, and 2.4% got a false negative result. Two patients with pathology of rectal carcinoid and a rectal leiomyoma were assigned “not 3 years.” False positives occurred mainly in patients with multiple hyperplastic polyps (15 patients) or large benign polyps (5 patients). False negatives occurred in 3 patients with tubulovillous adenoma less than 10 mm and in 15 patients with between 3-5 small polyps.Table 1: Coefficients of RegressionConclusion: This regression model may allow gastroenterologists to reliably determine surveillance interval at the time of procedure, saving time, cost, and possibly improving adherence and decreasing anxiety. Furthermore, the consistency of pathology has been challenged for diagnosis of sessile serrated adenomas in the proximal colon, thus putting the utility of pathology in question. Though validation is needed, this model may be used to discard resected polyps without pathology evaluation when the results are unlikely to change clinical behavior.

内肛門括約筋からの発生が考えられた直腸平滑筋腫に経腟的局所切除術を施行した1例

症例は，65歳女性．肛門部違和感を主訴に他院を受診し，内・外痔核の診断で手術目的に当科紹介された．直腸指診で下部直腸前壁に5cm大の粘膜下腫瘍を認め，針生検にて平滑筋腫と診断した．直腸腫瘍の摘除にあたっては，経肛門的超音波検査で経腟的アプローチが有効と考えられ，経腟的直腸腫瘍局所切除術を施行した．術中所見では，腫瘍は被膜を有し，一部内肛門括約筋との連続性が認められたことから内肛門括約筋由来と考えられた．組織学的には，紡錘形細胞が錯走配列を呈しており，核異型や核分裂像は認めなかった．免疫組織学的には，α-SMA陽性，desmin陽性，c-kit陰性，CD34陰性で，平滑筋腫と診断した．内肛門括約筋由来の平滑筋腫は非常に稀で，直腸前壁の平滑筋腫に対し経腟的局所切除術が有効と考えられた1例を報告した．

Treatment of rectal leiomyoma by endoscopic resection

Leiomyomas of the rectum are rare, with low reported incidence in literature. In most cases, patients are asymptomatic, and are often incidental endoscopic findings. The difficult distinction from leiomyosarcomas, associated with the possibility of recurrence, implies the absence of a standard treatment. Endoscopic resection, if well indicated, may be a therapeutic option. In this study, we report two cases of asymptomatic leiomyoma of the rectum in two patients, discovered incidentally during a routine colonoscopy, removed by conventional polypectomy and discuss its diagnostic and therapeutic aspects based on a literature review.

F-18 FDG-PET Imaging in Rectal Leiomyoma

F-18 FDG-PET Imaging in Rectal Leiomyoma

A case of rectal leiomyoma successfully treated by endoscopic mucosal resection with a detachable snare

A case of rectal leiomyoma successfully treated by endoscopic mucosal resection with a detachable snare

Lower gastrointestinal bleeding secondary to a rectal leiomyoma

The occurrence of leiomyoma of the rectum is uncommon. Most of these lesions are clinically silent and are found incidentally during laparotomy or endoscopic procedures for unrelated conditions. Symptomatic leiomyomas of the rectum are encountered less frequently, with only sporadic reports in the literature. We describe a case of a leiomyoma of the rectum presenting as recurrent lower gastrointestinal hemorrhage and secondary anemia.

An Unusual Presentation of Rectal Leiomyoma

An Unusual Presentation of Rectal Leiomyoma

Heavy rectal bleeding secondary to the passage of a rectal leiomyoma per anus

Leiomyoma of the rectum is rare and this is the first case reported where such a tumour has passed per rectum, resulting in heavy bleeding. The management of the acute surgical problem as well as rectal leiomyoma per se is discussed.

経こう門的マイクロサージェリー（ＴＥＭ）で切除し得た直腸平滑筋腫の１例

症例は72歳男性,現病歴では2mm年4日5日に腹腔鏡下胆嚢摘出術が施行されていた.その際,入院時の直腸診で下部直腸の前壁側に拇指頭大の硬い腫瘤を触知し,大腸内視鏡検査で下部直腸の前壁側に黄色調で半球状の粘膜下腫瘤を認めた.筋原性の粘膜下腫瘍の診断で経肛門的マイクロサージェリー(tran-sanal endoscopic microsurgery:以下TEM)を行った.摘出標本は22×15mm,黄白色の充実性腫瘍で病理学的には平滑筋腫であった.

Endoscopic removal of rectal leiomyoma: case report

Although leiomyomas of the stomach or small intestine are relatively common, those of the colon or rectum are rare.1-4 Several cases of endoscopic resection of colorectal leiomyomas have been described.5-7 However, conventional polypectomy of leiomyomas can result in perforation.8 To reduce the risk of perforation, submucosal injection can be performed before removal. We report a case of rectal leiomyoma in which complete enucleation was performed endoscopically using this method.

Postoperative anal pain and rectal leiomyoma: Report of a difficult case

Ein 35jahriger Mann litt nach zwei anorektalen Operationen an schweren chronischen Analschmerzen, Blutungen und einer obstruierten Defakation. An der posterioren distalen Rektumwand konnte ein schmerzhafter raumfordernder Prozes getastet werden, der mittels Endoskopie, anorektalem Ultraschall und tomographisch bewertet wurde. Die gestreifte Sphinktermuskulatur relaxierte beim Pressen wahrend der Manometrie und der Defakographie nicht. Wir fuhrten eine rektale Exzision mit koloanaler Anastomose durch. Histologisch ergab sich ein fibromatoses Leiomyom des Rektums. Trotz vollstandiger Entfernung des Neoplasmas persistieren ein Jahr nach der Operation noch geringfugige Schmerzen und Obstipationserscheinungen.

でん部腫りゅうが初発症状であった管外型直腸平滑筋腫の１例

初発症状としての左臀部腫瘤を臀部膿瘍と診断され,長期間経過観察されていた管外型直腸平滑筋腫の1例を経験した.症例は47歳,男性.5年前に左臀部腫瘤に気づき他医を受診,臀部膿瘍と診断され切開排膿を繰り返し受けていたが,排便困難が出現し当院を受診した.注腸造影・大腸内視鏡検査で,肛門縁より5cmの後壁に内腔をほぼ占拠する潰瘍形成のない粘膜下腫瘤が認められ,内視鏡の挿入は不可能であった.骨盤部CT検査では,小骨盤腔内に一部石灰化を伴う内部均一,境界明瞭な7cm径の腫瘤が認められ,骨盤部MRI検査でも同様の所見であった.大きさから平滑筋肉腫を完全に否定できず,腹会陰式直腸切断術を施行した.摘出標本では,腫瘤は7×8×7cm大の一部壊死を伴う弾性のある黄色調の粘膜下腫瘍であり,病理組織学的には細胞異型や核分裂像は認あられず,良性の平滑筋腫と診断された.

Six Cases of Small Leiomyoma of the Rectum

Abstract:Six cases of rectal leiomyoma, measuring less than 10 mm in diameter, are reported. The color of the overlying mucosa was similar to that of the surrounding mucosa. No central depression or ulceration was observed endoscopically in any of the six cases. In five cases, the tumors were sessile or semipedunculated and mobile, and were thus snare polypectomised. In the remaining case, the tumor was flat‐elevated and immobile, and removed surgically by transanal wedge‐resection. All six cases were benign leiomyoinas without malignant changes such as cellular atypia or mitosis.