Leiomioma vulvar de localización en la glándula de Bartolino: un dilema diagnóstico / Vulvar leiomyoma located in Bartholin's gland: a challenging clinical case

Resumen ANTECEDENTES: Los leiomiomas son tumores benignos que se originan en las fibras musculares lisas. La mayor parte de los leiomiomas del aparato genital femenino se localizan en el útero. La localización extrauterina es excepcional, la incidencia del leiomioma vulvar es del 0.07%. Estos tumores del músculo liso suelen ser indoloros, de crecimiento lento y pueden aparecer en mujeres de cualquier edad. OBJETIVO: Reportar un caso de leiomioma vulvar que, por su baja incidencia y similitud clínica con otras lesiones, como el quiste de la glándula de Bartolino, pueden conducir a un diagnóstico erróneo inicial. Además, efectuar una revisión bibliográfica que aporte conocimiento a su diagnóstico y tratamiento. CASO CLÍNICO: Paciente de 52 años, con una masa vulvar de años de evolución y un diagnóstico equívoco inicial de quiste de la glándula de Bartolino. La paciente fue intervenida mediante escisión quirúrgica y estudio histopatológico posterior. El diagnóstico definitivo fue de leiomioma vulvar con diferenciación simplástica. CONCLUSIONES: En contraposición con sus homólogos uterinos, la localización vaginal del leiomioma es excepcional. Si bien hasta ahora no ha podido demostrarse la efectividad de la biopsia preoperatoria se aconseja su toma porque podría tratarse de una masa de características malignas, lo que modificaría el tratamiento y su urgencia. La actitud quirúrgica es, quizá, la más acertada porque permite, además de un diagnóstico anatomopatológico definitivo, un tratamiento curativo. Se propone la escisión completa, mediante una incisión elipsoidal en la piel y asegurar la extirpación completa de la pseudocápsula.

Abstract BACKGROUND: Leiomyomas are benign tumors that originate in smooth muscle fibers. Most leiomyomas of the female genital tract are located in the uterus. Extrauterine localization is exceptional; the incidence of vulvar leiomyoma is 0.07%. These smooth muscle tumors are usually painless, slow growing and can occur in women of any age. OBJECTIVE: To report a case of vulvar leiomyoma that because of its low incidence and clinical similarity to other lesions, such as Bartholin's gland cyst, may lead to an initial misdiagnosis. In addition, a review of the literature should be carried out in order to contribute to its diagnosis and treatment. CLINICAL CASE: A 52-year-old patient with a vulvar mass of years of evolution and an initial misdiagnosis of Bartholin's gland cyst. The patient was operated by surgical excision and subsequent histopathological study. The definitive diagnosis was vulvar leiomyoma with symplastic differentiation. CONCLUSIONS: In contrast to its uterine counterparts, the vaginal location of leiomyoma is exceptional. Although the effectiveness of a preoperative biopsy has not been demonstrated so far, it is advisable to take a biopsy because it could be a mass with malignant characteristics, which would change the treatment and its urgency. The surgical approach is perhaps the most appropriate because it allows, in addition to a definitive anatomopathological diagnosis, a curative treatment. Complete excision is proposed, by means of an ellipsoidal incision in the skin and ensuring complete excision of the pseudocapsule.

Multifocal Epstein–Barr virus-associated miliary post-transplant smooth muscle tumors

Epstein–Barr virus (EBV) promotes the development of undifferentiated carcinomas of the upper aerodigestive tract and different types of lymphomas. This ability of tumorigenesis is heightened in many immunocompromised patients who have an increased incidence of lymphoproliferative disorders. The virus also induces smooth muscle proliferation, and those occurring following transplantation are designated as EBV-associated post-transplant smooth muscle tumors. We report multifocal miliary-sized leiomyomas in the lungs in a renal transplant recipient as an incidental finding.

Uterine smooth muscle tumor of uncertain malignant potential: fertility and clinical outcomes / 부인종양

OBJECTIVE: In this study, we aimed to evaluate the clinicopathological features, obstetric, and oncological outcomes of patients diagnosed with a uterine smooth muscle tumors of uncertain malignant potential (STUMP). METHODS: A dual-institutional, database review was carried out to screen patients with STUMP who were treated with upfront surgery between January 2006 and December 2017. Data including age at the time of diagnosis, recurrence rate, disease-free survival, overall survival, and fertility outcomes were retrospectively analyzed. RESULTS: Fifty-seven patients with STUMPs were included in the study. The median age at the time of diagnosis was 42 (range, 16 to 75) years. The median follow-up was 57 (range, 16 to 125) months. Eight patients (14%) had recurrence during follow-up. Recurrent STUMPs were seen in seven patients and leiomyosarcoma after 14 months in one patient. Seven patients with a recurrent STUMP survived, while the remaining patient died. Recurrence rates were similar for women who underwent myomectomy and those who underwent hysterectomy. The presence of uterine localization of tumor (subserosal vs intramural-submucosal) statistically significantly affected recurrence rates (odds ratio=5.72; 95% confidence interval=1.349–24.290; p=0.018). Ten of 27 patients who underwent myomectomy for uterine myoma had fertility desire. Seven pregnancies were recorded. CONCLUSIONS: Our study results suggest that fertility-sparing approaches are feasible in patients with STUMP, although recurrence may be seen.

Differential expression, diagnostic and prognostic significance of stathmin-1 and CD147 in various uterine smooth muscle tumors / Expresión diferencial, diagnóstico y significado de pronóstico de stathmin-1 y CD147 en diferentes tumores del músculo liso uterino

SUMMARY: Uterine smooth muscle tumors (USMT) are common, behavior-distinct gynecological tumors; including: leiomyoma (ULM), leiomyosarcoma (ULMS), and smooth muscle tumors of undetermined malignant potential (STUMP). Pre-operative distinction is difficult, thus diagnosis relies on histopathology. Immunohistochemistry (IHC) had been used to help in distinction. We studied two markers (stathmin-1 and CD147) to demonstrate whether they have diagnostic/ prognostic assist. Sixty seven USMT are studied. Age, follow up, and recurrence/metastasis data were collected. Representative slides were stained and Histologic score (HS) calculated as stain intensity (SI) X percentage of positive tumor cells (PP). Results were grouped as low expression (LE) and high expression (HE); then correlated to tumor types, and risk of recurrence/ metastasis. Statistical analysis (P < 0.05); Sensitivity, specificity, positive and negative predictive values and confidence intervals in diagnosing ULMS were calculated. Stathmin-1 HS (p= 0.000) and HE (p=0.002) were different among groups. Same as for CD147 HS and HE (both p=0.000), with a gradient increase from LM to STUMP to ULMS. Sensitivity, specificity, positive and negative predictive values and confidence intervals in diagnosing ULMS were as following: For stathmin-1 HS: 92 %; 20 %; 42 %; and 80 % (CI= 44-96 %). For Stathmin-1 HE: 80 %; 66 %; 60 %; and 84 % (CI=66-94 %). For CD147 HS: 85 %; 22 %; 41 %; and 69 %. For CD147 HE: 58 %; 49 %; 42 %; and 65 % (CI= 45-80 %), respectively. Recurrence / metastasis were documented in 6 cases (4 ULMS; 2 STUMP) with follow up ranging from 6 months to 102 months. 5 tumors had stathmin-1 HE (p=0.099); 2 had CD147 HE (p=0.393) in the primary tumors. STMN1 and CD147 are helpful diagnostic tests for USMT sub-typing, especially for ULMS. Gradient increase of expression from LM, to STUMP, to ULMS may indicate a role in malignant transformation in USMT, and in increased risk of recurrences/metastasis.

RESUMEN: Los tumores del músculo liso uterino (USMT, por sus siglas en inglés) son tumores ginecológicos comunes y de comportamiento distinto; incluyendo: leiomioma (ULM), leiomiosarcoma (ULMS) y tumores de músculo liso de potencial maligno indeterminado (STUMP). La distinción preoperatoria es difícil, por lo que el diagnóstico se basa en la histopatología. La inmunohistoquímica (IHQ) se había utilizado para ayudar en la distinción. Estudiamos dos marcadores (stathmin-1 y CD147) para demostrar si había efecto diagnóstico / pronóstico. Se estudiaron 67 USMT. Se recopilaron los datos de edad, seguimiento y recurrencia / metástasis. Las muestras representativas se tiñeron y la puntuación histológica (HS) se calculó como la intensidad de la tinción (IS) x porcentaje de células tumorales positivas (PP). Los resultados se agruparon como expresión baja (EB) y expresión alta (EA); luego se correlacionaeon con los tipos de tumores y el riesgo de recurrencia / metástasis. Análisis estadístico (P <0,05); se calcularon la sensibilidad, la especificidad, los valores predictivos positivos y negativos y los intervalos de confianza en el diagnóstico de ULMS. Stathmin-1 HS (p = 0,000) y HE (p = 0,002) fueron diferentes entre los grupos. Igual que para CD147 HS y HE (ambos p = 0,000), con un aumento de gradiente de LM a STUMP a ULMS. La sensibilidad, la especificidad, los valores predictivos positivos y negativos y los intervalos de confianza en el diagnóstico de ULMS fueron los siguientes: Para stathmin-1 HS: 92 %; 20 %; 42 %; y 80 % (IC = 44-96 %). Para Stathmin-1 HE: 80 %; 66 %; 60 %; y 84 % (IC = 66-94 %). Para CD147 HS: 85 %; 22 %; 41 %; y el 69 %. Para CD147 HE: 58 %; 49 %; 42 %; y 65 % (IC = 45-80 %), respectivamente. La recurrencia / metástasis se documentaron en 6 casos (4 ULMS; 2 STUMP) con un seguimiento que osciló entre 6 meses y 102 meses. Cinco tumores tenían stathmin-1 HE (p = 0,099); dos tenían CD147 HE (p = 0,393) en los tumores primarios. STMN1 y CD147 son pruebas de diagnóstico útiles para la subclasificación de USMT, especialmente para ULMS. El aumento en el gradiente de la expresión de LM, a STUMP, a ULMS puede indicar un papel en la transformación maligna en USMT y en un mayor riesgo de recurrencias / metástasis.

Leiomioma primario de ovario / Primary ovarian leiomyoma

Objetivo: presentar el reporte de un caso correspondiente a leiomioma primario de ovario. Este corresponde a un tipo de lesión poco común del ovario. Descripción del caso: mujer de 46 años de edad, a la cual se le realizó un control por historia de masa anexial derecha, con hallazgo ultrasonográfico de masa ovárica derecha de 45x36 mm de aspecto homogéneo, sólida y encapsulada. Se realizó histerectomía total y ooforectomía bilateral. El estudio hispatológico demostró que se trataba de un leiomioma primario de ovario. En el estudio inmunohistoquímico se demostró negatividad en las tinciones de alfa inhibina y S-100, mientras que la tinción de actina de músculo liso y la vimentina fueron positivos, consistente con un leiomioma primario de ovario. Discusión:los leiomiomas primarios de ovario son tumores poco frecuentes y muchas veces subdiagnosticados. Son de evolución benigno, con una sobrevida de 100 por ciento a los 5 años...

Expression of KI-67,P53,BCL-2 in uterine smooth muscle tumors and clinical significance / 基础医学与临床

ObjectiveTo investigate the relationship and clinical significance of P53,KI-67,BCL-2 and uterine smooth muscle tumors.Methods Thirty samples of leomyoma,23 smooth muscle tumors with uncertain malignant potential(STUMP) and 27 leomyosarcomas(LMS) were stained immunohistochemically.The?~2 test was used for the statistical analysis of the data. Results The malignant side of the spectrum was strongly stained for KI-67 and P53 while uniformly decreasing toward the benign tumors.The results were statistically significant(P