Uterine Tumors Research Articles

Radiation-Induced Uterine Stromal Sarcoma: A Case Report and Review of the Literature

The radio-induced stromal sarcoma (RISS) is a rare clinical entity, being the second most common type of uterine mesenchymal neoplasm after leiomyosarcoma. Its incidence increases as survival after radiotherapy improves, and it often poses a therapeutic challenge. We report the case of a 58-year-old patient, followed since 2014 for initially classified stage IIb squamous cell carcinoma of the uterine cervix, treated with external pelvic radiotherapy and brachytherapy. After 6 years of surveillance, the patient presented with persistent pelvic pain. Clinical examination and pelvic MRI revealed the presence of a tumoral process in the uterine cervix with suspicious thickening of the endometrium. Morphological and immunohistochemical pathological study of the lesion confirmed its tumoral nature, indicative of a high-grade stromal sarcoma. Radiotherapy can induce malignant tumors after a latent period of several years. Radio-induced gynecological sarcomas are most often associated with a poor prognosis, emphasizing the need for careful and close monitoring after pelvic irradiation.

Phenotype of Parathyroid-targeted Cdc73 Deletion in Mice Is Strain-dependent.

Hyperparathyroidism jaw-tumor syndrome is an autosomal dominant disorder caused by mutations in the CDC73/HRPT2 tumor suppressor gene, encoding parafibromin, and manifesting benign or malignant parathyroid tumors, ossifying jaw fibromas, uterine tumors, and kidney lesions. Sporadic parathyroid carcinomas also frequently exhibit inactivating CDC73 mutations and loss of parafibromin. To study the role of CDC73 in parathyroid cell proliferation in vivo, we generated mice with a parathyroid-specific deletion of Cdc73. Homozygous knockout mice on a mixed B6/129/CD1 background had decreased serum calcium and PTH and smaller parathyroid glands compared with heterozygous or wild-type littermates, whereas homozygous Cdc73-null mice on other backgrounds exhibited no abnormalities in parathyroid gland function or development. No hypercalcemia or parathyroid hypercellularity was observed in mice of any background examined at any age. Thus, although postnatally acquired complete loss of CDC73 causes parathyroid cell proliferation and hyperparathyroidism, such as seen in human hyperparathyroidism jaw-tumor syndrome, our results suggest that earlier, developmentally imposed complete loss of Cdc73 can cause a primary defect in parathyroid gland structure/function in a strain-dependent manner. This striking disparity in parathyroid phenotype related to genetic background offers a unique opportunity in an in vivo model system to precisely dissect and identify the responsible molecular mechanisms.

O-14 A rare case of hypercalcaemia in pregnancy

Abstract Introduction Hypercalcaemia is infrequent during pregnancy, but it is associated with foetal and maternal morbidity and mortality. Although primary hyperparathyroidism (pHPT) accounts for the majority of the cases, other aetiologies such as genetic causes in a young population should be considered. Clinical Case A 27-year-old female was diagnosed with pHPT during her 16th week of gestation after she presented with vomiting and was found to have raised adjusted calcium of 3.22 mmol/L, low phosphate of 0.6 mmol/L and Parathyroid Hormone of 10.6 pmol/L. The patient's hypercalcaemia dated back 2 years, she had a history of three previous miscarriages, and was not on any hypercalcaemia-inducing medications. Unbeknownst to her, her father was also being evaluated for hypercalcaemia. Her thyroid-stimulating hormone was fully suppressed with raised free thyroid hormones and negative TSH receptor antibodies; this was improved with Carbimazole therapy. Plasma and urine Metanephrines were normal, and neck ultrasound did not reveal any parathyroid lesions. She underwent parathyroidectomy three weeks later after a period of intravenous hydration. A 2 cm left superior parathyroid adenoma was excised, and the plasma calcium level promptly normalised. Genetic testing for familial hyperparathyroidism revealed an autosomal dominant heterozygous CDC73 variant, which is associated with Hyperparathyroidism-Jaw Tumour syndrome. The Clinical Genetics team is arranging genetic testing for her first-degree relatives. She delivered a live baby at 38 + 6 weeks of gestation via emergency caesarean section, performed for foetal hypoxia on cardiotocography, and genetic testing of the newborn child using umbilical cord blood was performed at the time of delivery. She will undergo regular screening for uterine, renal and jaw tumours (every 5 years), and is planned for 6-monthly calcium and parathyroid hormone tests. Conclusion Primary hyperparathyroidism is best treated with parathyroidectomy before pregnancy as the maternal and foetal complications increase according to the hypercalcaemia severity. During pregnancy, mild cases could be treated conservatively while parathyroidectomy is reserved for severe cases and is performed in the second trimester. Germline CDC73 analysis is recommended in young pHPT patients, and in this case revealed a pathological variant associated with Hyperparathyroidism-Jaw Tumour syndrome, familial isolated pHPT and parathyroid carcinoma.

Dedifferentiated Leiomyosarcoma of the Uterine Corpus with Heterologous Component: Clinicopathological Analysis of Five Consecutive Cases from a Single Institution and Comprehensive Literature Review.

Dedifferentiation is a very rare phenomenon in uterine leiomyosarcoma (LMS). The aim of this study was to comprehensively analyze the clinicopathological characteristics of uterine dedifferentiated LMS (DDLMS). We reviewed electronic medical records and pathology slides from five patients with uterine DDLMS and performed immunostaining. The mean age of the patients was 56 years. Two patients presented with abdominal discomfort, while in three cases the uterine tumors were detected on routine medical examination. The mean size of the tumors was 17.0 cm. Four patients underwent hysterectomy. The initial stages were distributed as IB (2/5), IIIC (2/5), and IVC (1/5). Post-operative concurrent chemoradiation therapy, radiation therapy, and chemotherapy were administered in one, one, and two patients, respectively. Despite post-operative treatment, three patients developed metastatic recurrences in the abdominal and pelvic organs. Recurrence-free survival time ranged between 4 and 30 months. Histologically, the differentiated areas demonstrated the classic morphology of malignant smooth muscle differentiation, whereas the dedifferentiated areas resembled undifferentiated pleomorphic sarcoma and were characterized by large pleomorphic tumor cells admixed with haphazardly arranged atypical cells with marked nuclear pleomorphism. All cases also exhibited heterologous components, including chondrosarcoma (CSA; 3/5) and rhabdomyosarcoma (2/5). In two cases, the heterologous components were initially detected in primary tumors. In three cases, the primary tumors did not exhibit any dedifferentiated or heterologous components. Instead, more than half of the recurrent tumors consisted of heterologous components. Three cases showed a sharp demarcation between the LMS and CSA components, while in two cases the dedifferentiated area imperceptibly merged with the differentiated component. Immunostaining revealed that the dedifferentiated components exhibited a lack of desmin immunoreactivity in three of the four examined cases. A subset of uterine LMS represents various amounts and types of dedifferentiation and heterologous components in both primary and recurrent tumors. Routine recognition of DDLMS and distinction from its mimickers are required for accurate diagnosis and further characterization of these rare tumors.

MR Imaging Findings of Uterine Adenomatoid Tumors.

Adenomatoid tumor is a rare benign genital tract neoplasm of mesothelial origin. Uterine adenomatoid tumors occur in the outer myometrium and may mimic leiomyomas. Because hormonal treatment is not applicable to adenomatoid tumors and laparoscopic enucleation is not easy as myomectomy, it is important to differentiate adenomatoid tumors from leiomyomas for the adequate treatment. The purpose of this study is to evaluate the MRI findings of adenomatoid tumor for the differentiation from leiomyoma. MRI findings of surgically proven 10 uterine adenomatoid tumors in 9 women were retrospectively evaluated with correlation to histopathological findings. All 10 tumors appeared as solid myometrial masses and showed heterogeneous signal intensity with admixture of partially ill-defined slight high-intensity areas containing abundant tubular tumor cells and well-defined myoma-like low-intensity areas reflecting smooth muscle hypertrophy on T2WI including 4 lesions with peripheral ring-like high intensity. High-intensity areas on T2WI tended to show high intensity on diffusion-weighted imaging (DWI) with relatively high apparent diffusion coefficient (ADC), suggesting T2 shine-through effect due to abundant tubules. Intra-tumoral hemorrhage revealed on MRI was rare. Early intense contrast-enhanced areas on dynamic contrast-enhanced study were observed dominantly within the high-intensity areas but rarely within the low-intensity areas on T2WI. The outer myometrial mass with the admixture of well-defined low- and ill-defined high-intensity areas on T2WI may be suggestive of adenomatoid tumor. Peripheral ring-like high intensity on T2WI and DWI may also be suggestive. Dynamic contrast-enhanced MR study may be helpful for the differentiation from leiomyoma.

FOXO3a deregulation in uterine smooth muscle tumors

ObjectiveThe present study aimed to investigate FOXO3a deregulation in Uterine Smooth Muscle Tumors (USMT) and its potential association with cancer development and prognosis. MethodsThe authors analyzed gene and protein expression profiles of FOXO3a in 56 uterine Leiomyosarcomas (LMS), 119 leiomyomas (comprising conventional and unusual leiomyomas), and 20 Myometrium (MM) samples. The authors used techniques such as Immunohistochemistry (IHC), FISH/CISH, and qRT-PCR for the present analyses. Additionally, the authors conducted an in-silico analysis to understand the interaction network involving FOXO3a and its correlated genes. ResultsThis investigation revealed distinct expression patterns of the FOXO3a gene and protein, including both normal and phosphorylated forms. Expression levels were notably elevated in LMS, and Unusual Leiomyomas (ULM) compared to conventional Leiomyomas (LM) and Myometrium (MM) samples. This upregulation was significantly associated with metastasis and Overall Survival (OS) in LMS patients. Intriguingly, FOXO3a deregulation did not seem to be influenced by EGF/HER-2 signaling, as there were minimal levels of EGF and VEGF expression detected, and HER-2 and EGFR were negative in the analyzed samples. In the examination of miRNAs, the authors observed upregulation of miR-96-5p and miR-155-5p, which are known negative regulators of FOXO3a, in LMS samples. Conversely, the tumor suppressor miR-let7c-5p was downregulated. ConclusionsIn summary, the outcomes of the present study suggest that the imbalance in FOXO3a within Uterine Smooth Muscle Tumors might arise from both protein phosphorylation and miRNA activity. FOXO3a could emerge as a promising therapeutic target for individuals with Unusual Leiomyomas and Leiomyosarcomas (ULM and LMS), offering novel directions for treatment strategies.

Uterine inflammatory myofibroblastic tumor: a retrospective analysis.

Uterine inflammatory myofibroblastic tumor (UIMT) is a rare tumor of the female reproductive tract with uncertain malignant potential. Previous case series reports have limited our understanding of its diagnosis and treatment. Therefore, we conducted a retrospective analysis of patient files at West China Second University Hospital, Sichuan University to contribute valuable clinical insights to future treatment strategies for this disease. We comprehensively reviewed patient files of individuals diagnosed with UIMT from January 1st, 2013 to May 1st, 2023. We included twenty-seven cases of uterine inflammatory myofibroblastic tumor in our study. Of these, 51.85% (14 cases) were diagnosed with abnormal uterine bleeding, 2 cases had dysmenorrhea, and 12 were unexpectedly diagnosed with suspected uterine fibroids. Ten cases performed total hysterectomy, and 17 cases underwent lesion resection. The positive rate of anaplastic lymphoma kinase (ALK) immunohistochemistry reached 96.3%. After a median of 8 months follow-up time, all patients were disease-free and had survived. Uterine inflammatory myofibroblastic tumor is easily misdiagnosed, making its diagnosis challenging. Histological features, immunohistochemical results, and molecular confirmation using fluorescence in situ hybridization (FISH) or Next-generation sequencing should be used to confirm the diagnosis. Positive ALK immunohistochemistry, ALK rearrangement, ALK fusion are helpful in diagnosis and ALK inhibitor therapy. Total hysterectomy is often performed for women who do not require fertility, while lesion resection and close follow-up may be considered for those who require fertility preservation.

Uterine smooth muscle tumors of uncertain malignant potential: a 13-year retrospective study.

The primary objective of this study was to provide valuable evidence for the management of patients diagnosed with uterine smooth muscle tumors of uncertain malignant potential (STUMP), with a focus on those with reproductive aspirations. We conducted a retrospective analysis of clinical and pathological data from the medical records and slides of STUMP patients treated at Drum Tower Hospital, affiliated with Nanjing University Medical School, from January 2009 to December 2021. Thirty-four patients were included in the study, with a median follow-up duration of 76 months (range: 13-157 months). After slide review, the diagnosis agreement rate was 77.3% (34/44 among initially considered cases). The consistency rate between our hospital's diagnosis and those of other institutions was 75% (15/20). The accuracy rate of intraoperative frozen section diagnosis was low, at 21.4% (3/14). Half of the patients (17) underwent myomectomy, while the other half (17) received hysterectomy, including one subtotal hysterectomy. Two recurrences were observed (5.9%), one as STUMP and the other as leiomyosarcoma, with one recurrence in each surgical group. Notably, 4 of 9 patients with reproductive aspirations successfully underwent cesarean deliveries. Patients with single lesions appeared to exhibit potentially favorable fertility outcomes compared to those with multiple lesions. The diagnosis of STUMP was difficult. Myomectomy potentially could serve as an alternative for patients with reproductive needs. In selected cases with single lesions, it may indicate potentially favorable fertility outcomes.

The utility of MRI for the preoperative differential diagnosis of uterine sarcoma and leiomyoma: a single-center study.

Although uterine sarcoma is a rare disease, its prognosis is extremely poor;thus, it is important to differentiate it from uterine leiomyoma. In this retrospective study, we examined the association between preoperative MRI findings and postoperative pathology results in 170 patients with uterine tumors who underwent preoperative MRI examination at Fukushima Red Cross Hospital. In 4 cases of sarcoma / smooth muscle tumor of unknown malignant potential (STUMP), abnormal findings were found at a high frequency with T1-weighted imaging (T1WI) (75%), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and contrast enhancement (CE) (100%). In cases of ordinary leiomyoma, on the other hand, abnormal findings were less frequent. The rates of high DWI signal intensity for degenerated and cellular leiomyoma were 31% and 64%, respectively, and the CE-positive rates were 31% and 57%, respectively. Apparent Diffusion Coefficient (ADC) values appeared to be useful in differentiating degenerated leiomyoma from sarcoma. The relatively characteristic findings of uterine sarcoma on MRI images may overlap with those of degenerated leiomyoma and cellular leiomyoma, making it difficult to diagnose sarcoma on imaging alone. However, findings that distinguish sarcoma from ordinary, degenerated, and cellular leiomyoma cases are worthy of attention, to avoid overlooking sarcoma.

Visual diagnosis of internal tumors of dogs and cats in Samarkand

In this article, is provided the importance and effectivity using visual diagnostic methods in the practice of veterinary oncology for the purpose of early diagnosis and treatment of tumors as ultrasound and X-ray and also blood morphological biochemical parameters in 15 dogs with oncological diseases of internal organs in the of canine service dogs and 2 cats belonging to the population of Samarkand region. During the research, 55 service dogs, 110 dogs under the care of the population in the regions of Samarkand and Tashkent and 123 street dogs a total of 288 dogs, as well as the clinic of the “Veterinary Surgery and Obstetrics” Department of the SamSUVM and Specialization of veterinary clinic of the National Cynology Center of Custom service in Tashkent. As a result of clinical and visual diagnosis of 56 heads of population brought to the veterinary clinic, 15 (5.3%) dogs and 2 (3.6%) cats had problems related to tumors located in various internal organs. Tumors identified were uterine and ovarian tumors in 6 (40%) dogs and 2 cats (100%), vaginal tumors in 3 (20%), liver tumors in 2 (13.3%), 1 (6.69%) tumor in stomach, 1 (6.69 %) esophagus, 2 (13.3 %) intestinal tumors were determinated.

A Case Report of a Patient with Uterine Smooth Muscle Tumor of Uncertain Malignant Potential

A Case Report of a Patient with Uterine Smooth Muscle Tumor of Uncertain Malignant Potential

Robot-assisted surgeries in the treatment of malignant uterine tumors

Robot-assisted surgeries in the treatment of malignant uterine tumors

The Importance of Uterine Tumors in the Day-to-Day Practice of the General Surgery Department of Ignace Deen National Hospital

The Importance of Uterine Tumors in the Day-to-Day Practice of the General Surgery Department of Ignace Deen National Hospital

A pedunculated uterine tumor

A pedunculated uterine tumor

Dietary Patterns and Common Diseases in Chinese Elderly: Exploring Associations and Providing Guidance for Personalized Interventions

The current state of geriatric disease prevention and treatment in China has not yet been able to meet the urgent needs brought about by an aging population, and specific dietary patterns can significantly improve or exacerbate the risk of certain diseases. However, the relationship between geriatric diseases and the dietary patterns of the Chinese elderly population has not been fully explored. CLHLS 2018 were analyzed in the present study. Principal component analysis was employed to identify the main dietary patterns of the Chinese elderly, and binary logistic regression models were used to analyze the associations between these dietary patterns and the 16 common diseases. Four main dietary patterns were identified in the Chinese elderly population: Egg-Milk Pattern, Salt-preserved vegetable-Nut Pattern, Vegetable-Fruit Pattern, and Fish-Meat Pattern. Higher scores for the Egg-Milk Pattern were associated with a greater risk of heart disease, stroke or cardiovascular disease, respiratory disease, glaucoma, prostate tumor, and Parkinson's disease in older adults (p<0.05). Higher scores for Salt-preserved vegetable-Nut Pattern correlated with a greater risk of hypertension, heart disease, and uterine tumors and a lower risk of rheumatism or rheumatoid disease in older adults (P<0.05). The higher scores of the Vegetable-Fruit Pattern were associated with a lower risk of heart disease in older adults (p<0.05). Finally, higher scores of the Fish-Meat Pattern correlated with a lower risk of heart disease, stroke, and cardiovascular disease and a greater risk of rheumatic or rheumatoid disease in older adults (p<0.05). The same dietary pattern may have contrasting effects on different diseases. The correlations between dietary patterns and diseases derived from this study may provide a basis for the prevention and individualized management of diseases in the elderly.

Uterine tumor resembling ovarian sex-cord tumor - a rare gynecological neoplasm.

Uterine tumor resembling ovarian sex-cord tumor is a rare group of uterine neoplasms with unknown histogenesis and differentiation towards ovarian sex-cord elements. They are benign in nature with low malignancy potential. Diagnosis is based on immunohistochemistry and morphological features, and the distinction from other more malignant differentials is paramount to correctly individualizing treatment.

A rare case of uterine lipo-leiomyoma in a 63-year-old Nigerian woman; a case report

Background: Lipo-leiomyoma accounts for about 0.03%-0.2% of uterine tumours. The aetiology of lipo-leiomyoma is unclear, with some suggesting fatty metamorphogenesis and others involving growth factors and oestrogens. Radiological evaluation and histology are necessary for definitive diagnosis. If asymptomatic, no treatment is needed, but surgical resection is performed in symptomatic patients. Case Presentation: This was a case of a 63-year-old Nigerian woman who experienced pelvic pain and heaviness for a year, worsening pelvic pain and distension, and post-menopausal bleeding. Abdominal examinations revealed a pelvic mass, vaginal examination showed no vaginal and cervical lesions, while abdominopelvic ultrasonography (USS) unveiled a hyperechoic mass in the posterior uterus. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathological assessment of the samples showed a confirmatory diagnosis of uterine lipo-leiomyoma. Conclusion: Lipo-leiomyoma is a rare, distinct uterine pathology that should be considered a differential diagnosis in post-menopausal women with vaginal bleeding. Total abdominal hysterectomy and bilateral salpingo-oophorectomy are recommended for menopausal women with symptomatic disease to prevent recurrent anaemia and also remove possible sites of the tumour even as the patient is unlikely to conceive again. Histopathological evaluation is crucial for post-menopausal women with coexisting bleeding per vagina.

MASSIVE PRIMARY LEIOMYOSARCOMA ON CAVUM THORAX : A VERY RARE CASE

The cavum thorax primary leiomyosarcoma is extremely rare and unusual case. leiomyosarcoma as smooth muscle carcinoma could be comes from various part of body as primary site, but in the case of cavum thorax leiomyosarcoma its estimated only 1-4 of all soft tissue sarcoma. In this report we present a 69 years old woman came to the outpatient clinic with a big lump in the chest. This lump has been felt for 1 year and was a big and bizarre looking tumor, pain was felt in the right chest with intensity of 4-5 visual analog scale. Difficulty to breath and shortness of breath was not complained by the patient, nausea and vomiting was not complained. The patient has a history of uterine tumor that has been done by surgery. Diagnostic test of Multidetector Computed Tomography (MDCT) scan and ultrasonography has been done in this patient, and show a suggestive malignant soft tissue tumor. The surgery has been done with preoperative internal mammary artery embolization to prevent massive bleeding. A 15 cm length, 9 cm wide and 500 grams of weight tumor was evacuated. The immunohistochemistry examination was performed to the tumor specimen, and the result was a leiomyosarcoma tissue. A good examination, early detection with adequate diagnostic tools and adequate surgery as the only option of treatment is a predicting factor of successful treatment, due to lack of treatment option and ineffectiveness use of adjuvant therapy.

Virtual reality education program for women with uterine tumors treated by high-intensity focused ultrasound

This study aimed to develop and determine the effects of a nursing education program using virtual reality (VR) for women with uterine tumors undergoing treatment with high-intensity focused ultrasound (HIFU). Various nursing education methods need to be developed alongside new treatment methods and their effects should be clinically verified. Nursing intervention using VR has recently been attempted. The study comprises a pre- and post-test design with a non-equivalent control group.We assigned 54 women to experimental (n = 26) and control (n = 28) groups. The patients were diagnosed with benign uterine tumors and were treated with HIFU at two women's hospitals in D city. Data collected from these hospitals were analyzed using descriptive statistics, a pre-test of homogeneity, independent t-tests, and repeated measures analysis of variance. In the experimental group, uncertainty (t = 4.26, p < 0.001) and anxiety (t = 4.09, p < 0.001) were significantly lower compared to the control group. However, nursing satisfaction was significantly higher in the experimental group than in the control group (t = −4.50, p < 0.001). The VR education program is an educational nursing intervention that reduces uncertainty and anxiety and improves nursing satisfaction among women with uterine tumors treated by HIFU. We suggest that future nursing research integrates and converges disciplines according to progressive treatment methods and technological advancements for patients.

SMARCA4 / BRG1 -deficient Uterine Neoplasm With Hybrid Adenosarcoma and Carcinoma Features: Expanding the Molecular-morphologic Spectrum of SMARCA4 -driven Gynecologic Malignancies.

SMARCA4 gene encodes BRG1 , a member of the SWItch/sucrose non-fermentable protein family involved in epigenetic transcriptional regulation of important cellular processes. In the uterine corpus, SMARCA4 / BRG1 deficiency is associated with a novel class of undifferentiated uterine sarcomas, characterized by younger age onset, rhabdoid histology, focal phyllodiform architecture, high-risk pathologic findings, and dismal prognosis. Herein, we report a case of a 34-year-old Asian woman with a SMARCA4 / BRG1 -deficient uterine tumor fulfilling the clinicopathologic features of an undifferentiated uterine sarcoma. However, the tumor exhibited several unique features that have not been previously emphasized, including (1) conspicuous phyllodiform architecture recapitulating conventional adenosarcoma, (2) rhabdoid tumor cells forming cords and keratin-positive cohesive epithelial islands, and (3) cooccurrence with a spatially distinct and discrete endometrial complex atypical hyperplasia from the rest of the proliferation. By immunohistochemistry, the tumor cells were diffusely positive for synaptophysin, whereas BRG1 was lost. Pertinent molecular findings included frameshift mutations in the SMARCA4 gene, mutations in histone modification and chromatin remodeling genes, including KMT2C , ARID1B , KAT6A , and NCOR1 , and mutations in Wnt signaling involving APC and CTNNB1 . Copy number gain in MDM2 and CDK4 were also identified. The tumor mutation burden was intermediate (6.8/MB) and it was microsatellite stable. On balance, our case exhibited morphologic and molecular features that overlap with (1) an undifferentiated uterine sarcoma, (2) an adenosarcoma with sarcomatous overgrowth, and (3) a mixed adenosarcoma and undifferentiated endometrial carcinoma. These hybrid features further expand the molecular-morphologic spectrum of SMARCA4 / BRG1 -deficient uterine neoplasms.