Deficiencia de vitamina D y patologías ginecológicas de la mujer en edad reproductiva / Vitamin D deficiency and gynecological pathologies in women of reproductive age

RESUMEN La vitamina D está actualmente en el ámbito de la investigación en muchos campos de la medicina. Es conocido que tiene funciones fundamentales en el metabolismo del calcio y modelado óseo. La deficiencia de vitamina definida como la concentración de 25-hidroxicalciferol < 20 ng/mL es observada con frecuencia en pacientes con patologías ginecológicas. En las últimas dos décadas existe evidencia sobre la asociación de concentraciones séricas bajas de vitamina D con trastornos como diabetes mellitus y síndrome metabólico. Cada vez hay más informes que plantean el impacto del metabolismo de esta vitamina en el desarrollo de trastornos del sistema reproductor femenino. El receptor de vitamina D y la 1α-hidroxilasa están presentes en los órganos reproductivos, lo que sugiere que la vitamina D puede tener algún efecto en la modulación de las funciones celulares. Se ha comunicado los efectos perjudiciales de la deficiencia en pacientes con diagnóstico de síndrome de ovarios poliquísticos, endometriosis y leiomiomatosis. La suplementación de vitamina D debería agregarse a los esquemas de tratamiento de la mayoría de las patologías ginecológicas en pacientes con deficiencia, tanto por la mejora de la insulinorresistencia (como en las pacientes con síndrome de ovarios poliquísticos) como por los resultados del tratamiento de la infertilidad. El objetivo de esta revisión fue establecer los efectos de la deficiencia de vitamina D en patologías de la mujer en edad reproductiva.

ABSTRACT Vitamin D is currently under investigation in many fields of medicine. It is known to have fundamental functions in calcium metabolism and bone modeling. Vitamin D deficiency defined as 25-hydroxychalciferol concentration < 20 ng/mL and is frequently observed in patients with gynecological pathologies. In the last two decades there is evidence on the association of low serum vitamin D concentrations with disorders such as diabetes mellitus and metabolic syndrome. There are increasing reports of the impact of vitamin D metabolism on the development of disorders of the female reproductive system. Vitamin D receptor and 1α-hydroxylase are present in the reproductive organs, suggesting that vitamin D may have some effect in modulating cellular functions. The detrimental effects of deficiency have been shown in patients diagnosed with polycystic ovarian syndrome, endometriosis, and leiomyomatosis. Vitamin D supplementation should be added to the treatment schemes of most gynecologic pathologies in patients with deficiency, both for the improvement of insulin resistance (as in patients with polycystic ovarian syndrome) and for the outcomes of infertility treatment. The aim of this review was to establish effects of vitamin D deficiency on pathologies in women of reproductive age.

Clinical analysis of 81 cases of intravenous leiomyomatosis confined to pelvic cavity / 中华妇产科杂志

Objective:To investigate the clinical features, treatment and recurrence factors of intravenous leiomyomatosis (IVL) confined to the pelvic cavity after the operation.Methods:The clinical data of 81 patients who underwent surgery and were pathologically diagnosed with IVL at Women′s Hospital, School of Medicine, Zhejiang University from January 2014 to March 2021, were analyzed retrospectively to explore the influencing factors of postoperative recurrence of IVL, including age, gravidity and parity, surgical methods, intraoperative conditions and so on.Results:(1) Clinical features: the age of 81 IVL patients was (43.9±8.1) years old; increased menstrual volume in 26 cases (32%, 26/81), prolonged menstrual period in 31 cases (38%, 31/81), frequency and urgency to urinate in 4 cases (5%, 4/81), abdominal pain and abdominal distension in 8 cases (10%, 8/81), and pelvic masses in 34 cases (42%, 34/81). IVL was diagnosed right in 4 of 72 patients (6%, 4/72) underwent preoperative ultrasound, right in 11 of 51 patients (22%, 11/51) underwent magnetic resonance imaging (MRI), and right in 4 of 19 patients (4/19) underwent CT. (2) Treatment: all patients with IVL underwent surgical treatment. Surgical procedure: myomectomy in 37 cases, total hysterectomy and bilateral salpingectomy in 19 cases, total hysterectomy and bilateral salpingo-ophorectomy in 25 cases. Surgical approach: hysteroscopic operation in 6 cases, transabdominal operation in 52 cases, laparoscopic operation in 23 cases. Fifty-three cases underwent rapid intraoperative pathological examination, 17 cases (32%, 17/53) of them were diagnosed right as IVL. (3) Influencing factors of IVL postoperative recurrence: among 81 patients with IVL, 3 cases were lost to follow-up, and 8 cases (10%, 8/78) had recurrence during follow-up. Age<35 years, number of pregnancies<2, number of births<2, number of fibroids ≥10, abnormal appearance of fibroids (long, vermicular, beadlike, cystic, etc.) and IVL invasion into adjacent vessels were all the risk factors influencing postoperative recurrence of IVL (all P<0.05). Methods of operation, ovariectomy or not, IVL invasion or not, maximum diameter of IVL, abundant blood vessels near uterine fibroids were not associated with postoperative recurrence of IVL (all P>0.05). Conclusions:The clinical manifestations and preoperative auxiliary examination of IVL are lack of specificity. Doctors need to pay attention to young patients with uterine fibroids, and choose the appropriate surgical scope when the characteristic manifestations of IVL be found during the operation, or the right diagnoses of IVL in the surgery′s rapid intraoperative pathology be examined, and should remove the IVL lesions to reduce the recurrence as far as possible.

Inversión uterina no puerperal: primer caso reportado en el Perú / Non-puerperal uterine inversion: first case reported in Peru

RESUMEN La inversión uterina no puerperal es muy rara. Se comunica un caso asociado con leiomiomatosis. Se trató de una multípara de 45 años que manifestó sangrado vaginal grave, dolor pélvico y sensación de cuerpo extraño vaginal. Se diagnosticó mioma uterino en fase abortiva. Se programó para miomectomía con probable histerectomía abdominal y se encontró inversión uterina completa. Este reporte constituye un caso anecdótico de inversión uterina no puerperal, cuyo tratamiento quirúrgico fue exitoso.

ABSTRACT Non-puerperal uterine inversion is very rare. A case associated with leiomyomatosis is reported. The case of a 45-year-old multiparous woman with severe vaginal bleeding, pelvic pain and vaginal foreign body sensation is presented. Uterine leiomyoma in abortive phase was diagnosed. She was scheduled for myomectomy with probable abdominal hysterectomy and complete uterine inversion was found. This report is an anecdotal case of non-puerperal uterine inversion, whose surgical treatment was successful.

Leiomyomatosis peritonealis disseminata during pregnancy: a case report and literature review / 中华围产医学杂志

Objective:To review the clinical and pathological features, pathogenesis, and differential diagnosis of leiomyomatosis peritonealis disseminata (LPD) during pregnancy.Methods:We report the diagnosis and treatment of LPD in a pregnant woman admitted to Jiaozhou Central Hospital of Qingdao. We retrieved relevant literature from China and abroad to review the clinical characteristics and outcomes.Results:(1) Case report: The 33-year-old pregnant woman who had had previous cesarean sections was admitted at 37 +2 weeks gestation due to premature rupture of membranes 30 minutes before arriving at the hospital with a pelvic mass which was first diagnosed seven months earlier, in the first trimester. A lower segment cesarean section was performed, and the pelvic mass was removed on admission. No relapse was reported during the postoperative follow-up for 26 months. (2) Literature review: thirteen papers involving 15 cases, including the present case, were retrieved. The age at onset was 32 years old (19-47 years old); five of them had a history of myomectomy. Twelve cases had no significant symptoms, and the diagnosis was made at delivery or postpartum; the other three had noticeable features, mainly with abdominal pain. Six had obstetrical complications, including hypertensive disorders of pregnancy, premature rupture of membrane, abnormal fetal position, and oligohydramnios. Two cases had a history of assisted reproductive technology. Eleven cases delivered after 32 gestational weeks, three before 28 weeks, one aborted at ten gestational weeks due to severe complications. Twelve had cesarean section and myomectomy and the uterus and appendages were preserved. Three cases had a cesarean hysterectomy and two of them also had bilateral salpingo-oophorectomy. The pathological manifestations of seven cases were extensive and massively distributed small fibroids, similar to malignant tumor infiltration, with the diameter of 0.5 to 1.0 cm; five cases had multiple large fibroids, accompanied by scattered small fibroids. Conclusion:LPD during pregnancy is rare, and usually benign, with no obvious clinical symptoms. LPD is more likely to be misdiagnosed as a malignant tumor before the operation, and the diagnosis is usually confirmed by postoperative histopathology. A common surgical strategy is a cesarean section combined with pelvic mass resection.

A case report of HLRCC syndrome combined Ⅳ inferior vena cava tumor thrombus / 中华泌尿外科杂志

Hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome is a rare hereditary disease and characterized by cutaneous leiomyoma, uterine leiomyoma and/or renal cell carcinoma, but rarely associated with vena cava embolism. We treated 1 case of HLRCC syndrome patients with inferior vena cava tumor emboli (Mayo grade Ⅳ), confirmed after genetic testing, the patient and her family refused further treatment. The patient died after two months of follow-up after discharge.

Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cell carcinoma: Morphological appraisal with a comprehensive review of differential diagnoses

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an autosomal dominant syndrome wherein affected individuals are at risk for the development of cutaneous leiomyomas, early-onset multiple uterine leiomyomas, and an aggressive subtype of renal cell cancer. HLRCC is caused by germline mutations in the fumarate hydratase (FH) gene, which inactivates the enzyme and alters the function of the tricarboxylic acid/Krebs cycle. This article reviews the hitherto described morphologic features of HLRCC-associated renal cell carcinoma (RCC) and outlines the differential diagnosis and ancillary use of immunohistochemistry and molecular diagnostics for these tumors. The morphologic spectrum of HLRCC-associated RCC is wide and histologic features, including tumor cells with prominent nucleoli, perinucleolar halos, and multiple architectural patterns within the same tumor, which are suggestive of this diagnosis. FH immunohistochemistry in conjunction with genetic counseling and germline FH testing are the important parameters for detection of this entity. These kidney tumors warrant prompt treatment as even smaller sized lesions can demonstrate aggressive behavior and systemic oncologic treatment in metastatic disease should, if possible, be part of a clinical trial. Screening procedures in HLRCC families should preferably be evaluated in large cohorts.

Cordeiro em pele de lobo: um caso clínico / Sheep in wolf's clothing: a case report / Cordero con piel de lobo: un caso clínico

Introdução: Quando um utente recorre a uma consulta médica, este já tem uma ideia pré-definida do seu problema de saúde. Esta advém da sua experiência anterior, da cultura local e da sua estrutura de apoio. Apresentação do Caso: Mulher de 48 anos, ex-fumadora. Antecedentes pessoais de excisão de leiomioma uterino há 18 anos. Recorreu à médica de família por tosse há quatro meses. Fez uma tomografia computadorizada tórax, onde se individualizavam formações nodulares dispersas, sugestivas de metastização. Referenciou-se de urgência para consulta de pneumologia, onde lhe foi pedida biópsia, a qual a doente recusou. Após breve avaliação familiar, a própria utente compreendeu que o seu medo era gerado pela sua experiência prévia de vida. A utente acabou por realizar biópsia que revelou padrão de leiomioma. Admitiu-se leiomiomatose benigna metastizante secundária à excisão de miomas uterinos. Conclusão: A "dolência" compreendida pelos utentes vai influenciar o modo como vão gerir a sua doença e a sua dolência. Na consulta existe a gestão entre os medos do doente e as incertezas diagnósticas por parte do médico. Nestes casos, o médico de família não deve assumir uma posição paternalista de decisão, mas sim capacitar os utentes para uma escolha consciente e informada.

Introduction: When a patient has a medical appointment, they already have a pre-defined idea of their health problem. This idea is influenced by their previous experience, local culture and family support. Case Description: 48-year-old female, former smoker. She reveals a personal history of uterine leiomyoma excision 18 years ago. She turns to her doctor complaining of cough for the last four months. A chest computed tomography was ordered, in which nodular formations were identified, suggestive of metastasis. An urgent referral was made to a pulmonology consultation, where a biopsy was requested, which the patient refused to perform. After a family assessment, the patient realized that her previous life experience generated her fear. The patient ended up performing the biopsy that revealed a leiomyoma pattern. The diagnosis of benign metastatic leiomyomatosis secondary to uterine fibroid excision was made. Conclusion: The "illness" understood by patients will influence how they will manage their disease and their malaise. In the consultation there is a confrontation between the patient's fears and the diagnostic uncertainties of the physician. In such cases, the family doctor should not assume a paternalistic position of decision, but should empower patients to make a conscious and informed choice

Introducción: Cuando un paciente tiene una cita médica, ya tiene una idea predefinida de su problema de salud. Esta idea está influenciada por su experiencia previa, cultura local y apoyo familiar. Presentación del caso: Mujer de 48 años, exfumadora. Ella revela una historia personal de escisión de leiomioma uterino hace 18 años. Ella recurre a su médico quejándose de tos durante los últimos cuatro meses. Se ordenó una Tomografía computarizada de tórax, en la que se identificaron formaciones nodulares, sugestivas de metástasis. Se hizo una referencia urgente a una consulta de neumología, donde se solicitó una biopsia, que el paciente se negó a realizar. Después de una evaluación familiar, la paciente se dio cuenta de que su experiencia de vida anterior generaba miedo. Se realizó el diagnóstico de leiomiomatosis benigna metastatizante secundaria a escisión de fibromas uterinos. Conclusión: La "enfermedad" entendida por los pacientes influirá en cómo manejarán su enfermedad y su malestar. En la consulta existe una confrontación entre los temores del paciente y las incertidumbres diagnósticas del médico. En tales casos, el médico de familia no debe asumir una posición paternalista de decisión, sino que debe capacitar a los pacientes para que tomen una decisión consciente e informada.

Leiomiomatosis peritoneal diseminada en paciente histerectomizada / Disseminated Peritoneal Leiomyomatosis in a Hysterectomized Patient

La leiomiomatosis peritoneal diseminada es una entidad rara de etiología incierta, caracterizada por la proliferación de múltiples nódulos benignos en la cavidad peritoneal, formados por células musculares lisas, que pueden simular una carcinomatosis peritoneal. Es más frecuente en mujeres en edad fértil, durante el embarazo o por el uso de anticonceptivos orales. Se presenta el caso de una mujer de 40 años diagnosticada de leiomiomatosis peritoneal diseminada, sometida a una histerectomía simple por miomatosis uterina. Después de dos años del diagnóstico presenta una exacerbación de la enfermedad y se sospecha de malignización, por lo que se realiza una laparotomía exploratoria donde se observan múltiples nódulos miomatosos extendidos por epiplón, peritoneo y apéndice. Se le practica la exéresis de todos los nódulos (omentectomía, apendicectomía y anexectomía bilateral(. La biopsia confirma el diagnóstico de leiomiomatosis peritoneal diseminada. Actualmente, la paciente permanece asintomática tras 6 años de seguimiento(AU)

Disseminated peritoneal leiomyomatosis is a rare entity of uncertain etiology, characterized by the proliferation of multiple benign nodules in the peritoneal cavity. These nodules are formed by smooth muscle cells, which can simulate peritoneal carcinomatosis. It manifests predominantly in women of childbearing age, especially during pregnancy or with the use of oral contraceptives. We report here the case of a 40-year-old woman diagnosed with disseminated peritoneal leiomyomatosis, who underwent simple hysterectomy due to uterine myomatosis. Two years after the diagnosis, she presented with an exacerbation of the disease and malignancy was suspected. So exploratory laparotomy was performed. Multiple myomatous nodules were observed, extended by omentum, peritoneum and appendix. All nodules were removed -omentectomy, appendectomy and bilateral adnexectomy. Biopsy confirms the diagnosis of disseminated peritoneal leiomyomatosis. As of today, the patient remains asymptomatic after 6 years of follow-up(AU)

Bevacizumab Plus Erlotinib Combination Therapy for Advanced Hereditary Leiomyomatosis and Renal Cell Carcinoma-Associated Renal Cell Carcinoma: A Multicenter Retrospective Analysis in Korean Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is a rare genetic syndrome resulting from germline mutations in fumarate hydratase. The combination of bevacizumab plus erlotinib showed promising interim results for HLRCC-associated RCC. Based on these results, we analyzed the outcome of bevacizumab plus erlotinib in Korean patients with HLRCC-associated RCC. MATERIALS AND METHODS: We retrospectively reviewed the efficacy and safety of bevacizumab plus erlotinib in patients with HLRCC-associated RCC who were confirmed to have germline mutations in fumarate hydratase. The primary endpoint was the objective response rate (ORR), while the secondary endpoints were progression-free survival (PFS) and overall survival (OS). RESULT: We identified 10 patients with advanced HLRCC-associated RCC who received bevacizumab plus erlotinib. Median age at diagnosis was 41 years, and five of the patients had received the combination as first- or second-line treatments. The ORR was 50% and the median PFS and OS were 13.3 and 14.1 months, respectively. Most adverse events were predictable and manageable by conventional measures, except for one instance where a patient died of gastrointestinal bleeding. CONCLUSION: This is the first real-world outcome of the treatment of advanced HLRCC-associated RCC. Bevacizumab plus erlotinib therapy showed promising activity with moderate toxicity. We should be increasingly aware of HLRCC-associated RCC and bevacizumab plus erlotinib should be a first-line treatment for this condition, unless other promising data are published.

The treatment and nursing of diffuse uterine leiomyomatosis / 中国实用护理杂志

Objective@#To summarize and analyze the treatment and nursing of diffuse uterine leiomyomatosis.@*Methods@#The clinical data of 16 patients with diffuse uterine leiomyomatosis admitted to Department of Obstetrics and Gynecology in Shengjing Hospital Affiliated to China Medical University from January 2009 to December 2016 were retrospectively analyzed, aiming at analyzing their treatment methods, perioperative indicators, nursing measures, etc., and analyzing the importance of nursing methods.@*Results@#Sixteen patients were treated with gonadotropin-releasing hormone agonist (GnRH-a) after abdominal myomectomy. The surgical procedures of 16 patients were smooth. The average operative time was 123.56 (45-190) min, the average intraoperative blood loss was 225.00(100-600) ml, the average number of fibroids resected during the operation was 61.63(16-135), the average extraction time was 4.06(3-6)days, the average postoperative time of indwelling catheter was 1.94(1-4)days, the average postoperative time of leaving the bed was 1.94(1-4) days, the average postoperative exhaust time was 1.81(1-3) days, and the average postoperative hospital stay was 5.25(4-7) days. Among them, 1 patient had postoperative intestinal fistula, which was cured after conservative treatment. Blood transfusion was performed for 8 patients with hemoglobin lower than 70 g/L. All patients received preoperative psychological nursing and postoperative comprehensive nursing, and were discharged successfully.@*Conclusions@#Transabdominal myomectomy plus GnRH-a treatment is an option for patients with diffuse uterine leiomyomatosis who want to preserve fertility. Do perioperative nursing seriously, can shorten the length of hospital stay, improve the cure rate.

Feasibility study of one-stage surgery of intracardiac leiomyomatosis through an abdominal approach / 中国实用外科杂志

OBJECTIVE: To investigate the feasibility of abdominal surgical resection of intracardiac leiomyomatosis.METHODS: The clinical data of 4 cases of intracardiac leiomyomatosis performed in zhongshan Hospital,Fudan University from December 2015 to August 2017 were analyzed retrospectively. RESULTS: Four patients underwent onestage surgery through an abdominal approach,without death. The operative time was 185-420(315.3 ± 86.4) min.Extracorporeal circulation time was 22-175(71.8±60.4)min and blood loss was 600-3000(1475.0±941.7)mL. Acute renal failure occurred in one of the patients after operation,the rest had no surgical complications. After 8-26 months of follow-up,there was no sign of recurrence and metastasis. CONCLUSION: One-stage surgery of intracardiac leiomyomatosis through an abdominal approach is feasible. But,how to determine the indications of surgery remains to be further explored and studied.

Clinical analysis of intravenous leiomyomatosis:report of 9 cases / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the clinical characteristics,diagnosis and treatment of intravenous leiomyomatosis(IVL).METHODS: The clinical data of 9 IVL treated at Women's Hospital,Zhejiang University School of Medicine from January 2013 to December 2017 were analyzed retrospectively. All the cases were followed up.RESULTS: Out of 8702 patients with uterine leiomyoma,9 patients were diagnosed with IVL. Most patients complained of pelvic mass,and 6 patients had enlarged uterus. Preoperative imaging examination demonstrated parametrial mass in 5 cases. All nine cases were confined to the pelvic cavity except for one who had lung metastasis. Two cases had myomectomy,and seven underwent hysterectomy. The lesions were dendritic,dumbbell-shaped,elliptical or elongate in four cases. Nine cases had a mean follow-up of 28.2 months,and recurrence occurred in two cases.CONCLUSION: The obvious enlargement of uterus and parametrial mass are important features of IVL. It is difficult to diagnose preoperatively. Identifying the morphological features of lesions during operation can improve the diagnostic accuracy. Total hysterectomy is the first choice of treatment and long-term follow-up is also needed.

The treatment and nursing of diffuse uterine leiomyomatosis / 中国实用护理杂志

Objective To summarize and analyze the treatment and nursing of diffuse uterine leiomyomatosis. Methods The clinical data of 16 patients with diffuse uterine leiomyomatosis admitted to Department of Obstetrics and Gynecology in Shengjing Hospital Affiliated to China Medical University from January 2009 to December 2016 were retrospectively analyzed, aiming at analyzing their treatment methods, perioperative indicators, nursing measures, etc., and analyzing the importance of nursing methods. Results Sixteen patients were treated with gonadotropin-releasing hormone agonist (GnRH-a) after abdominal myomectomy. The surgical procedures of 16 patients were smooth. The average operative time was 123.56 (45-190) min, the average intraoperative blood loss was 225.00(100-600) ml, the average number of fibroids resected during the operation was 61.63(16-135), the average extraction time was 4.06 (3- 6)days, the average postoperative time of indwelling catheter was 1.94(1- 4)days, the average postoperative time of leaving the bed was 1.94(1-4) days, the average postoperative exhaust time was 1.81 (1-3) days, and the average postoperative hospital stay was 5.25(4-7) days. Among them, 1 patient had postoperative intestinal fistula, which was cured after conservative treatment. Blood transfusion was performed for 8 patients with hemoglobin lower than 70 g/L. All patients received preoperative psychological nursing and postoperative comprehensive nursing, and were discharged successfully. Conclusions Transabdominal myomectomy plus GnRH-a treatment is an option for patients with diffuse uterine leiomyomatosis who want to preserve fertility. Do perioperative nursing seriously, can shorten the length of hospital stay, improve the cure rate.

Disseminated peritoneal leiomyomatosis: a devastating sequelae of unconfined laparoscopic morcellation

There has been growing concern surrounding the use of unconfined power morcellation in laparoscopic surgeries for uterine leiomyoma due to its associated risks and long-term clinical sequelae, including parasitic leiomyomas and disseminated peritoneal leiomyomatosis (DPL). We present a case of DPL resulting from previous laparoscopic morcellation and a review of the existing literature. DPL is a potentially devastating consequence of unconfined laparoscopic morcellation in the surgical management of uterine fibroids. A multidisciplinary approach is recommended in the management of DPL, especially in cases of multivisceral involvement. Clinical caution ought to be exercised when using power morcellators; when unavoidable, confined laparoscopic morcellation offers a promising mitigation and should be adopted if practicable.

Aberrant uterine leiomyomas with extrauterine manifestation: intravenous leiomyomatosis and benign metastasizing leiomyomas

OBJECTIVE: Intravenous leiomyomatosis (IVL) and benign metastasizing leiomyoma (BML) are uncommon variants of benign uterine leiomyomas with extrauterine manifestations. Categorizing the extent of disease allows clinicians to delineate the clinical spectrum and the level of sophistication for complete surgical resection. METHODS: Twelve patients with IVL and BML were reviewed. They were divided into early versus late stage disease groups, and initial manifestation, clinical characteristics, laboratory values, surgical pathology, and follow up data were summarized. RESULTS: Patients were mostly pre- or peri-menopausal and parous. Patients with late stage disease were more likely to present with cardiac symptoms or abnormal findings on chest X-ray, whereas those with early stage disease presented with classical leiomyoma symptoms including heavy menstrual bleeding, increased myoma size, or lower abdominal discomfort. Tumor marker levels were within normal ranges. A trend of higher neutrophil to leukocyte ratio was observed in the late versus the early stage group (10.4 vs. 1.51, P=0.07); the platelet leukocyte ratio was statistically higher in patients with late stage IVL (0.23 vs. 0.13, P=0.04). The overall recurrence rate was 25%. No recurrence was observed in stage I or stage III IVL groups, while 50% of the stage II IVL group showed recurrence in the pelvic cavity. CONCLUSION: IVL and BML are benign myoma variants with paradoxically metastatic clinical presentation. Careful inquiry of systemic symptoms, the presence of underlying systemic inflammation, and a high index of suspicion are required for preoperative diagnosis. Furthermore, a multidisciplinary approach is necessary to improve outcomes of surgical resection.

Leiomiomatosis benigna metastásica: reporte de caso clínico / Benign intraperitoneal metastatic leiomyomatosis: a case report

Benign intraperitoneal metastatic leiomyomatosis is a rare benign disease that is observed when a leiomyoma is present in the peritoneal surface. Women who have undergone hysterectomy for leiomyomas are most commonly affected. Patients are usually asymptomatic at presentation, being frequently an incidental finding in imaging studies. Ultrasound and CT play an important role in the diagnosis. The lesions are histologically identical to their uterine counterparts. There are different theories about the pathogenesis of the disease, including peritoneal seeding after laparoscopic hysterectomy. Others support the hypothesis of multiple independent foci of smooth muscle proliferation. Treatment, as in uterine leiomyomatosis, is generally conservative. We report a 53-year-old hysterectomized woman with intraperitoneal leiomyomas detected in a routine physical examination as mobile abdominal masses who underwent successful laparoscopic resection.

Diagnosis and differential diagnosis of uterine intravenous leiomyomatosis on sonography / 中华医学超声杂志（电子版）

Objective Uterine intravenous leiomyomatosiswas a rare type of uterus tumors.Because of the lack of knowledge about the ultrasonic patterns of this kind of disease,misdiagnosis frequently happens.Reviewing the cases and relevant researcheswas helpful to understand the disease and figure it out inultrasonic images.Methods Six cases of patients with uterine intravenous leiomyomatosis were reviewed which werehospitalized in Beijing Obstetrics and Gynecology Hospital during 2014 to 2016.All of the patients underwentultrasound examinations before surgery.The ultrasound findings,clinical presentations and pathological features of the 6 patients were evaluated.Results In 6 patients with uterine intravenous leiomyomatosis,3 cases were solid tumors,located in the cervix region and para uterine region,withirregular veinvascular inside;3 cases performance as multiple tumorlocated in dilated uterine vein,active tumor embolus were found in inferior vena cavain one of the 3 cases.Conclusions Uterine intravenous leiomyomatosisis found to be a solid mass located in the cervix region and para uterine region.The internal fissure of solid tumor is an important feature.Tumor extending to the iliac vein and inferior vena cava in some cases.Thusit is hard to be diagnosed before surgery by ultrasonography.Moreover,transvaginal ultrasound combined with inferior vena cava ultrasonography and echocardiography has a more obvious advantage in the diagnosis of the uterine intravenous leiomyomatosis.

Clinical analysis of leiomyomatosis peritonealis disseminate after laparoscopic uterine myomectomy in ten cases / 中华妇产科杂志

Objective To investigate the clinicopathological features,treatment and prognosis of leiomyomatosis peritonealis disseminata (LPD).Methods A total of 10 patients suffered from LPD after laparoscopic uterine myomectomy were collected in the First Affiliated Hospital of Zhengzhou University from September 2012 to September 2016,and all clinical database were retrospectively analyzed.Results (1)Clinical features:the age of 10 cases was 25-50 years old,and 8 cases of them were in child-bearing age,while 2 cases were in perimenopausal period.Of 10 cases,2 cases manifested as discontinuous lower abdominal pain,and the other cases were seen the doctor for the examinations found tumors of pelvis or abdomen.All 10 cases had a history of laparoscopic uterine myomectomy under went power morcellation with an average of (4.0±2.2) years (range 1.3 to 8.1 years),2 cases of them had a history of oral hormone treatment after the first myoma morcellation.(2) Treatment methods and postoperative pathologic diagnosis:during intraoperative exploration,LPD nodules were most distributed in Douglas pouch (10 cases),and next in mesentery (7 cases),abdominal peritoneum (6 cases) and omentum majus (4 cases),etc.Seven of the 8 cases of child-bearing age were performed laparoscopic LPD nodules removal,1 case gone combined with laparotomy and resecting LPD nodules;2 cases in perimenopausal period done laparotomy oophorotomy and resected all LPD nodules and omentum.(3) Postoperative relapse and reproductive outcomes:the follow-up time of all cases was 2.8 years,and no recurrence was found during the follow-up period;2 cases had natural conception and term vaginal birth during the follow-up period.Conclusions LPD is mainly related to iatrogenic planting and spreading,which is a benign disease and characterized by multiple smooth muscle nodules throughout abdominopelvic cavity,and the nodules of LPD is commonly located in Douglas pouch,mesenteric and omentaum majus,etc.The preferred method of LPD should be individual operative treatment according to different situations,and in which patients may be have better prognosis.

Nursing of one patient under went thoracoabdominal surgery for recurrent pelvic intravenous leiomyoma involving right atrium / 中华护理杂志

To summarize the nursing experience on recurrent intravenous leiomyomatosis with right atrial invasion in one case undergoing thoracoabdominal joint surgery.The key points were muhidisciplinary consultation and collaboration,detailed personalized surgical program and reasonable arrangements.A comprehensive preoperative assessment and psychological counseling was carried out.In the process of operation nosocomial infection was strictly controlled.The patient underwent an 8-hour procedure with 1 000ml intraoperative blood loss and was in good recovery right now.

Nursing of one patient under went thoracoabdominal surgery for recurrent pelvic intravenous leiomyoma involving right atrium / 中华护理杂志

To summarize the nursing experience on recurrent intravenous leiomyomatosis with right atrial invasion in one case undergoing thoracoabdominal joint surgery.The key points were muhidisciplinary consultation and collaboration,detailed personalized surgical program and reasonable arrangements.A comprehensive preoperative assessment and psychological counseling was carried out.In the process of operation nosocomial infection was strictly controlled.The patient underwent an 8-hour procedure with 1 000ml intraoperative blood loss and was in good recovery right now.