Smooth Muscle Bundles Research Articles

Temporospatial localization of telocytes during esophageal morphogenesis in rabbit

Telocytes (TCs) are CD34 and Vimentin positive (+) immunoreactive stromal cells with a small-sized body and several extremely long telopodes. TCs have been described to provide a mechanical support throughout the tissue by making cellular connections (homo- or hetero) to form a 3D network. Such network can transmit the intercellular signaling. Recently, TCs have been described in the esophageal wall. However, information concerning the role of these cells in esophageal organization and development is rare. Thus, we aimed to record the temporo-spatial localization pattern of TCs during esophageal morphogenesis in rabbit. Embryos and fetuses of New Zealand White rabbits (10th–30th gestational days) were collected. Using CD34 immunostaining, TCs have not been demonstrated in the wall of the developing esophagus till the end of the second third of pregnancy. On 24th gestational day, CD34+ TCs were organized in the adventitia of the esophageal wall specifically in close association with the endothelial cells lining the micro vessels. Later on 26th gestational day, CD34+TCs were additionally expressed in the sub-mucosa and in lamina propria (sub-epithelial). On 28th gestational day, additional CD34+TCs were detected among the smooth muscle bundles of the muscular layer. Reaching the last gestational day, CD34+TCs formed several sheaths in the esophageal wall namely sub epithelial sheath, sub-mucosal, muscular (circular and longitudinal) and inter-muscular sheaths and an outer adventitial one. On the other hand, vimentin immunohistochemistry revealed wider spread TCs positivity in all developmental ages. Presumptively, arrangement of CD34 and vimentin positive TCs in all layers of the developing esophageal wall hypothesizes that TC may play a potential role as a progenitor cell initially in differentiation of the epithelial and muscular precursors and finally in shaping of the various layers of the rabbit esophageal wall during its morphogenesis. TCs are also proposed to be involved in the angiogenesis of the esophageal blood capillaries.

Histogenesis of uterus in human fetuses

IntroductionThe histological changes during the development of the human uterus throughout the fetal period exhibit varying cellular patterns in the lining epithelium. The present study documents these progressive changes during fetal uterine maturation. Methods70 fetal uteri whose age varies from 14th to 40th gestational weeks without any external anomalies were studied. ResultsAt 14 weeks, the uterine lining epithelium is predominantly pseudostratified columnar, the nuclei being arranged at varying levels. However, the lower part of cervix shows epithelium comprising of a mosaic of flat or slightly raised polygonal cells which gradually changes to stratified squamous epithelium with advancing gestation. From 32 weeks onwards, the pseudostratification of uterine epithelium changes to simple columnar epithelium progressively. At 14 weeks, two distinct layers of mesenchymal cells are apparent, elongated cells in abundance at the subserosal layer and sparsely arranged rounded cells towards the lumen. Endometrial glands appear by the 17th week. DiscussionExcept for the lower part of cervix, pseudostratified columnar epithelium lines the fetal uterus. As gestation progresses, pseudostratification gradually changes to simple columnar epithelium. The palmate folds of the epithelium appear by 17 weeks in cervical canal. The smooth muscle bundle appears by 24 weeks of gestation. Undifferentiated mesenchymal cells around paramesonephric duct develop into both smooth muscles and endometrial cells.

Gross and histologic relationships of the retropubic urethra to lateral pelvic sidewall and anterior vaginal wall in female cadavers: clinical applications to retropubic surgery

Knowledge of the retropubic space anatomy is essential for safe entry and surgical applications within this space. The objectives of this study were to examine the gross and histologic anatomy of the retropubic urethra, paraurethral tissue, and urethrovaginal space and to correlate findings to retropubic procedures. Anatomic relationships of the retropubic urethra were examined grossly in unembalmed female cadavers. Measured distances included: lateral urethral wall to arcus tendineus fascia pelvis at the level of urethrovesical junction and at 1 cm distal. Other measurements included retropubic urethral length and distances from internal urethral opening to each ureteric orifice. Microscopic examination was performed at the same levels examined grossly in separate nulliparous specimens. Descriptive statistics were used for data analyses. In all, 25 cadavers were examined grossly. Median distance from lateral urethral wall to arcus tendineus fascia pelvis at the level of urethrovesical junction was 25 mm (range, 13-38 mm). At 1 cm distal, the median distance from aforementioned structures was 14 mm (10-26 mm). Median length of the retropubic urethra was 23 mm (range 15-30 mm). Four nulliparous specimens, ages 12 weeks, and 34, 47, and 52 years, were examined histologically. No histologic evidence of a discrete fascial layer between bladder/urethra and anterior vagina was noted at any level examined. Tissue between the urethra and the pelvic sidewall skeletal muscle was composed of dense fibrous tissue, smooth muscle bundles, scant adipose tissue, blood vessels, and nerves. The smooth muscle fibers of the vaginal muscularis interdigitated with skeletal muscle fibers in the pelvic sidewall at both levels examined. No histologic evidence of "pubourethral ligaments" within the paraurethral tissue was noticed. A 2-cm "zone of safety" exists between the urethra and arcus tendineus fascia pelvis at the urethrovesical junction level. Suture or graft placement within this region should minimize injury to the urethra, pelvic sidewall muscles, and bladder. Knowledge that the shortest length of retropubic urethra was 1.5 cm and shortest urethra to arcus tendineus fascia pelvis distance was 1 cm highlights the importance of maintaining dissection and trocar entry site close to pubic bone to avoid bladder and/or urethral injury. Histologic analysis of paraurethral tissue supports the nonexistence of pubourethral ligaments.

Formation and transformation of glands and muscle tissue in the prostate of human fetuses.

Background. At the present time in the literature there is conflicting information about the course of the processes of human prostate morphogenesis. A more thorough study of the processes of morphogenesis in the pathologically unchanged prostate can facilitate understanding of the occurrence of atypical forms of glands and muscle bundles. Objective. To study in the human prostate the formation and transformation of glands and muscle tissue. Materials and methods. A morphometric study was performed on 19 prostate fetuses from 14 to 40 weeks of intrauterine development. Results. It was established that the transformation of epithelial buds into glandular tubules is not accompanied by an increase in their area, since the formation of ta lumen occurs by apoptosis. The main stages of the transformation of epithelial strands into typical alveolar-tubular glands are traced. At this insignificant increase in the specific area of the glandular parenchyma in the organ, the transformation of the developing glands occurs mainly due to their canalization (the specific area of the gland enlarges increases 3.8 times - p <0.05). Conclusions. Transformation of prostate glands in the prenatal period occurs in a certain sequence: the formation of epithelial buds, their canalization by apoptosis with the formation of epithelial ducts and prostatic ducts and the formation of end pieces of prostate glands from these ducts. In prenatal periods, the structure and orientation of smooth muscle bundles around the glands can not provide evacuation of the contents of the prostate glands.

Presacral tumors of the Currarino triad: teratomas or hamartomas?

Purpose: The aim was to elucidate the nature of the presacral tumors in the Currarino triad through studying their preoperative radiological anatomy and histopathology of excised specimens.Patients and methods: The study group included three operated cases of Currarino triad. All were women who presented with constipation and demonstrated the typical three components of the disease: anorectal anomaly, sacral bony defect, and presacral tumor. The histopathological slides of excised specimens (presacral tumors) were available for re-examination. For comparison, we included another ‘control’ group representing the standard sacrococcygeal teratomas (without vertebral or anorectal anomalies).Results: Histopathological examination of presacral tumors in the Currarino triad showed multicystic spaces lined by different types of epithelia mainly keratinized stratified squamous epithelium with focal areas of transitional epithelium. The underlying stroma showed fibrovascular connective tissue admixed with randomly arranged smooth muscle bundles. In contrast to the standard sacrococcygeal teratomas, neither skin adnexal structures nor heterologous mesenchymal tissues were observed; no immature elements could be detected.Conclusion: In the Currarino triad, several clinical and histopathological observations would suggest the excised presacral tumors to be developmental cysts (retrorectal hamartomas) rather than neoplastic teratomas.Keywords: Currarino triad, hamartoma, sacrococcygeal, tailgut, teratoma

Gastric Hamartomatous Inverted Polyp Causing Ball Valve Syndrome

A 75-year-old woman with no significant past medical history presented for worsening fatigue and postprandial nausea. Laboratory data showed a hemoglobin level of 2.4 g/dL. Esophagogastroduodenoscopy showed that a pedunculated polyp arising from the lesser curvature of the upper gastric body was intussuscepted into a pylorus ring (Figure A). The polyp was pulled back into the stomach with grasping forceps. A mucinous fluid was secreting from the polyp, and dilated vessels were observed on its surface (Figure B). Endoscopic ultrasonography showed a heterogeneous lesion in the third layer of the gastric wall with variable cystic components (Figure C). For a definitive diagnosis and treatment of this polyp, the patient underwent endoscopic submucosal dissection (ESD). Histopathology showed submucosal proliferation of pseudo-pylorus glands, cystic glands, and smooth muscle bundles with no atypia (Figure D), thus confirming a diagnosis of a gastric hamartomatous inverted polyp (GHIP). Her symptoms disappeared and anemia improved after ESD. GHIP is rare, and most GHIPs are detected incidentally. Interestingly, in the present case, GHIP caused ball valve syndrome. Considering her clinical improvement after ESD, the main reason for her anemia could have been related to a mechanical disruption of the dilated veins on the polyp surface by ball valve syndrome. The authors would like to thank Editage (www.editage.jp) for English language editing.

The proliferation process features inside intestinal anastomosis created by live tissues electric welding technology

The aim — to study the proliferation processes inside the intestinal anastomose created with live tissues electric welding technology during the early postoperative period.Materials and methods. The study was performed on 58 pigs of the breed «Ukrainian Big White» weighing 45 — 75 kg. Changes in intestinal anastomoses were examined on the 4, 7 and 21 day after its creation. The circular welded ileo‑ileal intestinal anastomose (n = 83), ileo‑colonic (n = 15) and colo‑colonic (n = 68) anastomoses were created in operating room for 54 animals (main group), and 4 stapled intestinal anastomoses — at control group. The electric welding devices EK‑300M1 and Patonmed‑300 were utilized, as well as prototypes of surgical equipment to create circular intestinal anastomoses. For the morphological study reason anastomoses were taken after clinical testing by stretching with a fluid inflating up to 29 — 33 mm Hg pressure, the IA line defect by fluid was not detected.Results and discussion. After 4 days, the welded intestinal anastomoses line did not have any exudative edema or deformation, and were thickened. There was a mucosa defect with great hyperplastic activity of epithelial cells at the edges. The defect bottom was covered by a layer of coagulated structures of the intestinal wall and a newly formed granulation tissue. In the mucosa, the submucosal layer and the muscular membrane the coagulation conglomerates, without any encapsulation or bacterial either macrophages activity or rejection were observed. Powerful fibers neogenesis, the spread of fibers along the structural shells, and a large number of already functioning newly formed blood vessels were found. In the control group, unlike the welded anastomoses, oncoming of the destructive period phase was observed. After 7 days during water probe achieved intraluminal pressure of 220 mm Hg wall led to intestine rupture far from welded anastomoses. To that period, we discovered the wide network of young fibrous connective tissue yet was formed, oriented mainly tangentially according the mesentery. After 21 days, the colon mucosa over welded anastomoses was healed; inside this scar the regeneration of the glands was revealed. The fibrous connective tissue was disseminated as bands, from submucous membrane to the muscular, tightly interwoven with bundles of oriented collagen fibers with bundles of smooth muscles. In addition to significant vascularization of the coarse‑fibrous connective tissue, restoration of large blood vessels functionality was observed. In animals from the control group, after 21 days, IA was seen as an uneven scar covered with epithelium, poor by blood vessels.Conclusions. The functioning up to 4th postoperative day newly formed vessels, which uniformly passed from one connected intestine edge to the other and were developing simultaneously with the network of young collagen fibers, leaving no sites of poor blood supply — indicated the course of the proliferation phase inside welded intestinal anastomoses without any complications, which started at the welding moment. The mesh character of the connective tissue growth from the zone of the electric welding connection along the natural membranes of the intestinal wall was a consequence of the productive type of inflammation in this zone — in contrast to the coarse‑fibrous organization of the staple anastomose line. The presence of the yet formed mucous glands in welded anastomose zone was the consequence of regeneration processes activation in the intestinal epithelium, maybe also of more subtle processes of tissues restoration.

STUDY ON POSTNATAL GROWTH AND DEVELOPMENT OF CROP AND PROVENTRICULUS OF DIGESTIVE TRACT OF BROILER

The experiment was carried out to investigate postnatal growth and development of crop and proventriculus of digestive tract of broiler. Total 45 (“Cobb-500”) chickens of three age groups like day 1(D1), day14 (D14), day 28 (D28) were used each group containing fifteen chickens. All birds were slaughtered after respective days then crop and proventriculus were collected. Total length, diameter and weight were determined by “slide calipers” and electronic balance. Then the samples were processed and stained with H and E stain for histological study. The length (cm), diameter (cm) and weight (gm) of crop and proventriculus were increased gradually with the age where highest at 28 and lowest at day 1. Number of mucosal folds of crop was highest at 1 and lowest at day 28. The keratinized stratified squamous epithelium of crop was thickest at day 28. Submucosa contains thin loose connective tissue. Tunica muscularis contains thick inner circular and thinner outer longitudinal smooth muscle and externally covered by adventitia. The mucosa of the proventriculus has macroscopic papillae with numerous folds and lined by simple columnar epithelium. Submucosal glands are lined by simple cuboidal to low columnar epithelium. Lamina propria contains loose connective tissue and muscularis contains scattered bundles of smooth muscle. Tunica muscularis consists of smooth muscle and externally covered by serosa.

Presacral tumors of the Currarino triad

Purpose: The aim was to elucidate the nature of the presacral tumors in the Currarino triad through studying their preoperative radiological anatomy and histopathology of excised specimens. Patients and methods: The study group included three operated cases of Currarino triad. All were women who presented with constipation and demonstrated the typical three components of the disease: anorectal anomaly, sacral bony defect, and presacral tumor. The histopathological slides of excised specimens (presacral tumors) were available for re-examination. For comparison, we included another ‘control’ group representing the standard sacrococcygeal teratomas (without vertebral or anorectal anomalies). Results: Histopathological examination of presacral tumors in the Currarino triad showed multicystic spaces lined by different types of epithelia mainly keratinized stratified squamous epithelium with focal areas of transitional epithelium. The underlying stroma showed fibrovascular connective tissue admixed with randomly arranged smooth muscle bundles. In contrast to the standard sacrococcygeal teratomas, neither skin adnexal structures nor heterologous mesenchymal tissues were observed; no immature elements could be detected. Conclusion: In the Currarino triad, several clinical and histopathological observations would suggest the excised presacral tumors to be developmental cysts (retrorectal hamartomas) rather than neoplastic teratomas. Keywords: Currarino triad, hamartoma, sacrococcygeal, tailgut, teratoma

Identification of uterine pacemaker regions at the myometrial-placental interface in the rat.

Key Points Coordinated contraction of the uterine smooth muscle is essential to parturition.Histologically and physiologically defined pacemaker structures have not been identified in uterine smooth muscle.Here we report combined electrophysiological and histological evidence of zones associated with pacemaker activity in the rat myometrium.Our method relies crucially on the integration of histological and electrophysiological data in an in silico three‐dimensional reconstruction of the rat myometrium at 10 μm resolution.We find that myometrial/placental pacemaking zones are closely related with placental sites and the area of disruptive myometrial remodelling surrounding such sites.If analogues of the myometrial/placental pacemaking zone are present in the human, defining their histology and physiology will be important steps towards treatment of pre‐term birth, pre‐eclampsia, and postpartum haemorrhage. Coordinated uterine contractions are essential for delivering viable offspring in mammals. In contrast to other visceral smooth muscles, it is not known where excitation within the uterus is initiated, and no defined pacemaking region has hitherto been identified. Using multi‐electrode array recordings and high‐resolution computational reconstruction of the three‐dimensional micro‐structure of late pregnant rat uterus, we demonstrate that electrical potentials are initiated in distinct structures within the placental bed of individual implantation sites. These previously unidentified structures represent modified smooth muscle bundles that are derived from bridges between the longitudinal and circular layers. Coordinated implantation and encapsulation by invading trophoblast give rise to isolated placental/myometrial interface bundles that directly connect to the overlying longitudinal smooth muscle layer. Taken together, these observations imply that the anatomical structure of the uterus, combined with site‐specific implantation, gives rise to emergent patterns of electrical activity that drive effective contractility during parturition.

Repair of injured urethras with silk fibroin scaffolds in a rabbit model of onlay urethroplasty

BackgroundPreclinical validation of scaffold-based technologies in animal models of urethral disease is desired to assess wound healing efficacy in scenarios that mimic the target patient population. This study investigates the feasibility of bilayer silk fibroin (BLSF) scaffolds for the repair of previously damaged urethras in a rabbit model of onlay urethroplasty. Materials and methodsA focal, partial thickness urethral injury was created in adult male rabbits (n = 12) via electrocoagulation and then onlay urethroplasty with 50 mm2 BLSF grafts was carried out 2 wk after injury. Animals were randomly divided into three experimental groups and harvested at 2 wk after electrocoagulation (n = 3), and 1 (n = 3) or 3 (n = 6) months after scaffold implantation. Outcome analyses were performed preoperatively and at 2 wk after injury in all groups as well as at 1 or 3 mo after scaffold grafting and included urethroscopy, retrograde urethrography (RUG), and histological and immunohistochemical analyses. ResultsAt 2 wk after electrocoagulation, urethroscopic and RUG evaluations confirmed urethral stricture formation in 92% (n = 11/12) of rabbits. Gross tissue assessments at 1 (n = 3) and 3 (n = 6) mo after onlay urethroplasty revealed host tissue ingrowth covering the entire implant site. At 3 mo post-op, RUG analyses of repaired urethral segments demonstrated a 39% reduction in urethral stenosis detected following electrocoagulation injury. Histological and immunohistochemical analyses revealed the formation of innervated, vascularized neotissues with α-smooth muscle actin+ and SM22α+ smooth muscle bundles and pan-cytokeratin + epithelium at graft sites. ConclusionsThese results demonstrate the feasibility of BLSF matrices to support the repair of previously damaged urethral tissues.

Tiotropium inhibits methacholine-induced extracellular matrix production via β-catenin signaling in human airway smooth muscle cells.

BackgroundAirway remodeling is an important feature of chronic obstructive pulmonary disease (COPD) that is associated with disease severity and irreversible airflow limitation. An extensive alteration of the extracellular matrix (ECM) surrounding the airway smooth muscle (ASM) bundle is one of the pathological manifestations of airway remodeling, which contributes to the decline in lung function. Tiotropium, a long-acting inhaled muscarinic receptor antagonist, has been confirmed to play a role in preventing airway remodeling including ECM deposition beyond bronchodilation in vivo, but the relationship between ASM cell (ASMC) relaxation and ECM production remains unclear.PurposeIn this study, we attempted to investigate the influence of tiotropium on ECM production by ASMCs and the underlying mechanism.MethodsTiotropium was added 30 minutes before the addition of methacholine to primary cultured human ASMCs. Protein expression was analylized by Western Blot and mRNA abundance was determined by real-time PCR.ResultsWe found that tiotropium reduced collagen I protein expression, and the mRNA abundance of collagen I, fibronectin, and versican. β-catenin signaling was inactivated by inhibiting glycogen synthase kinase 3β (GSK3β) phosphorylation in this process. Tiotropum inhibited the amount of active β-catenin and its transcription activity. Furthermore, overexpression of active β-catenin by adenoviruses carrying the S33Y mutant resisted the suppressive effect of tiotropium on collagen I protein expression. However, silencing β-catenin by specific small interfering RNA enhanced the negative effect of tiotropium.ConclusionThese findings suggest that relaxation of ASMCs by tiotropium can prevent ECM production through β-catenin signaling.

Inducible Loss Of Integrin β1 From Bladder Smooth Muscle Causes Increased Voiding Frequency And Impaired Muscarinic Contractility

Integrins are integral membrane proteins which, in dynamic ways, physically link, the actin cytoskeleton to the extracellular matrix. They exhibit broad functional diversity and are involved in cellular differentiation, adhesion, proliferation and mechanotransduction. Diabetic bladder dysfunction (DBD) is a very common progressive complication of diabetes mellitus resulting in overactivity during the early compensatory phase and ultimately in an atonic bladder which is unable to empty properly. Both genomic and proteomic approaches focused on bladder smooth muscle (BSM) have demonstrated altered expression of cell adhesion proteins and extracellular matrix as well as compromised contractility, as molecular markers of DBD. To begin to understand the role of cell adhesion and mechanosensitive signaling in BSM we created a mouse with tamoxifen (TMX) inducible, smooth muscle‐conditional deletion of β1‐integrin using Cre‐lox (Txβ1‐cKO). Loss of β1‐integrin mRNA and protein following TMX induction by i.p. injection (5 × 2 mg on consecutive days) were confirmed by PCR and Western blotting. Void‐spotting assays on filter paper revealed a progressive increase in number of voids from 2.5/4 h to 8.3/4 h over a period of 60 days following Cre‐induction (n=5 mice/group, P<0.05). Littermate controls injected with vehicle (no TMX) showed no change. The mean volume/void decreased from 264 μl to 158 μl over 60 days in the integrin knockouts. An increase in the number of voids with reduced volume/void is often taken to indicate some form of overactivity. Urodynamic measurements using cystometry under anesthesia, revealed significantly reduced peak bladder pressures during voiding (20 cmH2O vs. 26 cmH2O, P<0.05), reduced intercontraction interval (44 s vs. 249 s, P<0.01), and reduced compliance (17 s/cmH2O vs. 68 s/cmH2O, N.S.) in TMX injected vs. control mice. Thus, in vivo voiding frequency was dramatically increased at the same time as the bladders showed increased resistance to filling and lower expulsive pressures. Urothelium dissected muscle‐strip force measurements by myography revealed a significant loss of contractile force in integrin‐deficient bladders in response to electrical field stimulation (45% and 62% mean reductions at 25 and 60 days post Cre‐induction respectively, for stimulation frequencies of 1 – 50 Hz). Selective inhibition of the muscarinic force component by incubation of strips with 0.5 μM atropine, indicated that muscarinic contractility was severely inhibited in integrin‐deficient BSM (17.2% of force generation was due to muscarinic receptors compared to 50% in controls) while purinergic contractility was largely intact. Masson trichrome staining of paraffin embedded bladder sections revealed a substantial expansion of collagenous connective tissue in BSM and disruption to close packing of smooth muscle bundles. We conclude that β1‐integrin is necessary for BSM structural integrity and for muscarinic signaling during force generation. These findings begin to offer insights into the physiological role of integrin mechanical signaling in BSM and may be relevant to certain bladder pathologies in which integrin expression levels have been shown to be dysregulated.Support or Funding InformationSupport for this work was provided by NIH grants DK‐083299 and DK‐095922.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Epibulbar complex cartilaginous choristoma: A distinctive clinicopathological case series and literature review.

To newly describe the clinical and histopathological characteristics of epibulbar complex cartilaginous choristoma incidentally observed in a series of pterygium excision patients.Noncomparative case series with chart review of 8 patients.During a 4-year period, we identified 8 cases of conventional unilateral nasal subpterygial cartilaginous choristoma in 1799 pterygium patients and analyzed their clinicopathological features. The incidence rate of this entity is 0.44% in pterygium patients. All of the cartilaginous choristomas were buried deep in the caruncle, covered by the pterygium, and embedded in tenon facia tissue. Its clinicopathological characteristics include hyaline cartilaginous tissue that is surrounded by fibrous connective tissue and smooth muscle bundles. S-100 protein-staining specifically revealed chondrocytes embedded within chondroid matrix.Epibulbar complex cartilaginous choristoma covered by pterygia and predominantly observed in the older population is rare. The lesions were buried deep in the caruncle, covered by the pterygium and embedded in tenon fascia tissue. These findings are inconsistent with those in previous reports.

Mesenteric cystic lymphangioma: a case report

In adult, cystic lymphangioma of mesentery is an extremely rare manifestation of an intraperitoneal tumor. The clinical presentations of it are variable and occasionally area incidental finding. Herein, we describe a mesenteric cystic lymphangioma in a 39-year-old Iranian woman. The patient was presented with abdominal pain in the periumbilical area from 6 h earlier in the morning. Histopathological review of the excised mass revealed large numbers of cystic lymphatic channels lined by flattened endothelial cells and had smooth muscle bundles in their walls. The patient had an uneventful postoperative period. Although mesenteric cystic lymphangiomas are very rare, the clinical presentations of them are not specific. Therefore, surgeons and pathologist sensitization and awareness about these diagnostic challenges are necessary.

48 Gastric Adenomyoma: A Rare Subepithelial Distal Stomach Tumor

Gastric adenomyoma is a benign, rare subepithelial tumor composed of mucosal elements and a prominent smooth muscle stroma commonly found in the stomach or duodenum occurring from the ages of 1 week to 81 years. Many cases are incidental findings on endoscopic examination or computed tomography (CT) scans; however, gastric adenomyoma can produce peptic-type ulcers and gastrointestinal (GI) tract bleeding. It is very difficult to diagnose this entity radiographically with non-specific CT findings; thus it is noteworthy for radiologists to recall this benign tumor. Whenever there is a gastric cystic subepithelial mass involving the distal portion of the stomach, it is important to remember gastric cystic adenomyoma. A 30-year-old woman presented to a teaching hospital in south Texas with abdominal pain. A CT scan showed narrowing of the distal stomach and antrum and a cystic lesion suggestive of a stromal tumor. A gastroduodenectomy specimen was obtained and processed at the surgical anatomic pathology laboratory. H&E and immunohistochemistry (IHC) studies were performed on formalin-fixed paraffin-embedded (FFPE) tissue. Microscopic examination demonstrates a segment of stomach with gastric antral type mucosa and an underlying mass forming lesion consisting of scattered gastric type glands with focal metaplastic changes admixed with bundles of smooth muscle. Focally active duodenitis is present overlying the lesional tissue. Helicobacter pylori-like organisms are not identified. An immunohistochemical stain for CD117 is negative in the stromal cells. CD10 is positive in scattered inflammatory cells and negative in the stroma cells surrounding the entrapped glands. PAX-8 is negative in the entrapped glands, and CD34 highlights scatter vascular channels. There is no dysplasia or malignancy. This is a rare case of gastric adenomyoma, a benign hamartomatous tumor involving the antrum that must be considered when evaluating gastric subepithelial masses involving the distal portion of the stomach.

Congenital Linear Smooth Muscle Hamartoma with Hypertrichosis: Hair Density on Dermoscopy in Parallel with the Number of Smooth Muscle Bundles.

Congenital Linear Smooth Muscle Hamartoma with Hypertrichosis: Hair Density on Dermoscopy in Parallel with the Number of Smooth Muscle Bundles.

The sheath of Waldeyer is not a specific anatomical trait of the ureterovesical junction

The function of the ureterovesical junction depends upon a peculiar structure, the adventitial fibromuscular sheath of Waldeyer, which coats the distal end of the ureter. The origin of the smooth muscle of Waldeyer's sheath (WS) is disputed. Evidence points more likely to an ureteral one. In this regard we hypothesized the WS is not specific to the distal ureter but is rather a common trait. We therefore aimed at exploring whether or not the proximal ureter is provided with a similar adventitial fibromuscular coat. We performed an immunohistochemical study on human samples of proximal ureter resulted after nephrectomies in ten patients. We applied myoid immunohistochemical markers: α-smooth muscle actin (α-SMA), desmin, and heavy chain of smooth muscle myosin (SMM) which labeled additional adventitial smooth muscle bundles, a discontinuous inner circular one applied on the muscular coat, and outer longitudinal cords specifically located on one side of the ureter, as is the case for WS. Moreover, the lamina propria myoid deep layer showed isolated smooth muscle fibers and spindle-shaped stromal cells with telocyte morphology. Our results support the idea that WS may not be a specific structure of the distal ureter, instead being just a common anatomical characteristic of the ureter.

A Case of Esophageal Gastrointestinal Stromal Tumor Managed With Endoscopic Ultrasound Surveillance

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. They are classified based on their immunohistochemical studies with the expression of c-kit and typically present between 40-50-year-olds. GIST predominantly occur in the stomach (50%) and intestine (25%), followed by the colon and rectum (10%) and rarely in the esophagus (< 5%). Due to the rarity of esophageal GIST (ESOGIST), they are poorly understood and there is a paucity of research evaluating tumor characteristics and management. Our patient is an 83-year-old Hispanic male with a history of prior esophageal impactions due to known Schatzki's rings, presenting with postprandial vomiting. He denies any constitutional symptoms, dysphagia or odynophagia. His initial physical exam and labs are unremarkable. Endoscopy on admission shows a Schatzki's ring at the gastroesophageal junction and new 5mm nodule in the distal esophagus with three ulcers in the esophagus, stomach and duodenum respectively. Pathology of the nodule demonstrates squamous cell mucosa with smooth muscle bundles positive for desmin and negative for S100. Stomach biopsy is positive for H. pylori, which is treated with triple therapy. Endoscopic ultrasound (EUS) guided fine needle aspiration shows a spindle cell neoplasm that is C-kit, DOG-1, and SMA positive and desmin negative. Management of lesions < 2cm are controversial. Thus, given the tumor size and no high risk features on EUS, shared-decision-making was utilized to pursue management with EUS surveillance and planned resection if progressive. ESOGIST is uncommon and comprises less than 1% of all GIST. For lesions < 2cm with suspicious features on EUS, resection is indicated. Surgical resection is also directed for localized ESOGIST ≥2cm or which are symptomatic, with increased overall survival and disease-free survival with adjuvant Imatinib therapy. Enucleation is recommended for management of small tumors (2-5cm) with esophagectomy recommended for tumors >90mm. More research on the management of tumors between 60-90mm needs to be conducted. For larger tumors preoperative Imatinib therapy should be considered. This can improve resectability and is also the standard of therapy when surgery is contraindicated. This case is unique given the rarity of EOSGIST, and highlights the importance of further research on the management of these tumors to establish continued guidelines for care.

Angiomyolipoma of the Glabellar Region.

Angiomyolipomas are hamartomatous lesions consisting of smooth muscle bundles, thick-walled blood vessels, and mature adipocytes. They are usually found in the kidneys of tuberous sclerosis patients and more rarely in other organs, such as the liver, the oral cavity, the sinonasal tract, the heart, the large intestines, the lungs, and the skin. Cutaneous angiomyolipoma has shown to be very rare and generally occurs at the ends of the digits, the elbows, the ears, and the nose. Herein, we report the first documented case of angiomyolipoma of the glabellar region.