Análise de custo-utilidade da gosserrelina no tratamento de pacientes com leiomioma: uma perspectiva do Sistema Único de Saúde / Cost-utility analysis of goserelin in the treatment of patients with leiomyoma: a perspective from the Unified Health System

Objetivos: Gosserrelina é indicada para mulheres com leiomioma, por reduzir o risco associado às complicações clínicas. Este trabalho realizou uma análise de custo-utilidade comparando o uso e o não uso de gosserrelina em pacientes com leiomioma sob a perspectiva do Sistema Único de Saúde. Métodos: Um modelo de árvore de decisão foi estruturado para reproduzir o impacto clínico e econômico do uso de gosserrelina antes da miomectomia, cujo comparador seria o não uso de gosserrelina em pacientes elegíveis. Foram considerados: custos médicos diretos e eventos clínicos como complicações intra-hospitalares e tempo de internação. A razão de custo-utilidade incremental é representada pelo custo incremental da gosserrelina por anos de vida ajustado pela qualidade (QALY). Resultados: Em um cenário em que o acesso à gosserrelina é de 51% das pacientes, o custo incremental foi de R$ 629,08. Pacientes no grupo gosserrelina apresentaram um incremento de 0,0261 no QALY. A razão de custo-utilidade incremental foi de R$ 24.019,26 por QALY, ficando abaixo do limiar adotado pelo Ministério da Saúde. Ao variar o percentual de pacientes que recebem gosserrelina para 80% antes de um procedimento cirúrgico, houve um aumento de QALY para 0,5013, reduzindo custos de complicações e a razão de custo-utilidade incremental para R$ 10.581,07 por QALY. No cenário em que 100% das pacientes utilizam gosserrelina, há um aumento de QALY para 0,8290, reduzindo custos de complicações e a razão de custo-utilidade incremental para R$ 10.288,28 por QALY. Conclusão: O uso de gosserrelina possui custo-utilidade favorável, considerando os parâmetros utilizados nesta modelagem econômica. Quando o acesso à gosserrelina é maior, há um decremento expressivo no custo por QALY.

Objectives: Goserelin is indicated for women with leiomyoma to reduce the risk associated with clinical complications. This study conducted a cost-utility analysis comparing the use and non-use of goserelin in patients with leiomyoma from the perspective of the Brazilian Unified Health System. Methods: A decision tree model was structured to reproduce the clinical and economic impact of using goserelin before myomectomy, compared to not using it in eligible patients. Direct medical costs and clinical events such as in-hospital complications and length of stay were considered. The incremental cost-utility ratio is represented by the incremental cost of goserelin per quality-adjusted life year (QALY). Results: In a scenario where access to goserelin is 51% of patients, the incremental cost was R$ 629.08. Patients in the goserelin group showed an increase of 0.0261 in QALY. The incremental cost-utility ratio was R$ 24,019.26 per QALY, below the threshold adopted by the Ministry of Health. When the percentage of patients receiving goserelin was increased to 80% before surgery, there was an increase in QALY to 0.5013, reducing complication costs and the incremental cost-utility ratio to R$ 10,581.07 per QALY. In the scenario where 100% of patients use goserelin, QALY increased to 0.8290, reducing complication costs and the incremental cost-utility ratio to R$ 10,288.28 per QALY. Conclusions: The use of goserelin has a favorable cost utility, considering the parameters used in this economic modeling. When access to goserelin is higher, there is a significant decrease in the cost per QALY.

Leiomioma simplástico del espacio de Retzius en una mujer joven

Se presenta el caso clínico de una fémina de 39 años de edad, quien fue asistida en el Hospital General Docente Guillermo Domínguez López de Puerto Padre, provincia de Las Tunas, por presentar una masa tumoral de aproximadamente 10 cm en el hipogastrio. Luego de realizados el examen clínico y los estudios complementarios pertinentes, se decidió practicar la resección completa del tumor. Durante el procedimiento quirúrgico, se tomó muestra para biopsia cuyo resultado indicó la existencia de un leiomioma simplástico en el espacio de Retzius. La paciente evolucionó satisfactoriamente y egresó de la institución a los 5 días, pero se continuó su seguimiento por consulta externa.

The case report of a 39 years woman is presented, who was assisted in Guillermo Domínguez López Teaching General Hospital from Puerto Padre, Las Tunas province, due to a tumoral mass of around 10 cm in the hypogastrium. After the clinical exam and the pertinent complementary studies, it was decided to practice the complete resection of the tumor. During the surgical procedure, a sample for biopsy was taken which result indicated the existence of a symplastic leiomyoma in the Retzius space. The patient had a favorable clinical course and she was discharged from the institution 5 days later, but continued with follow up in outpatient department.

Inversión uterina no puerperal en paciente con leiomioma uterino: caso clínico

La inversión uterina es una patología de presentación rara e infrecuente. Se presenta el caso de una paciente con inversión uterina no puerperal con requerimiento de histerectomía abdominal total. Sin antecedentes de importancia asistió al servicio de urgencias por un cuadro clínico de dolor abdominal de 10 días de evolución asociado a sangrado vaginal abundante con inestabilidad hemodinámica y sensación de masa vaginal. Al examen físico se evidenció una masa sobresaliente del canal vaginal de aspecto necrótico, por lo que se sospechó mioma nascens. Durante la estancia hospitalaria presentó inestabilidad hemodinámica, por lo que fue llevada a histerectomía abdominal de urgencia con hallazgo de inversión uterina. La inversión uterina no puerperal es infrecuente. Es importante realizar un buen diagnóstico clínico apoyado de las imágenes si se encuentran disponibles, la intervención quirúrgica es necesaria y proporciona un buen pronóstico. La histerectomía vaginal no es sencilla en estos casos, por lo que se recomienda la histerectomía abdominal total.

Uterine inversion is a rare and infrequent disease. The case of a patient with a non-puerperal uterine inversion that had to be treated with a total abdominal hysterectomy is presented in this study. With no important history of disease, she attended the emergency department presenting abdominal pain in the last 10 days associated with vaginal bleeding and mass sensation. The physical examination revealed a protruding necrotic-like mass through the vagina, hence the suspicion of a myoma nascens. During her hospital ward stay, she presented hemodynamic instability, urgent abdominal hysterectomy had to be done which revealed uterine inversion. Non-puerperal uterine inversion is infrequent. Precise clinical diagnosis is important supported by diagnostic imaging if available. The surgical intervention is necessary, giving a good prognosis. Vaginal hysterectomy is not easy in this type of cases, therefore total abdominal hysterectomy is recommended.

Angioleiomyoma of the Sinonasal Tract: A Systematic Review of an Uncommon Clinicopathological Entity

Abstract Introduction Angioleiomyoma is a rare neoplasm that represents ∼ 0.2 % of all head and neck benign tumors and ∼ 2% of total cases of tumors of the sinonasal tract. It was once considered a possible subtype of leiomyoma, but, in the 2020 World Health Organization (WHO) classification of soft tissue tumors, it is accepted as a singular entity. Objective To systematically review the existing literature on angioleiomyoma in the light of the new classification of soft tissue tumors. Data Synthesis The present study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive search in the PubMed, Cochrane, Scopus, and Google Scholar databases was performed in January 2022. The search items included the following keywords: nasal angioleiomyoma OR sinonasal angioleiomyoma OR nasal vascular leiomyoma OR sinonasal vascular leiomyoma. A total of 87 patients were evaluated. He age of the patients in the studies ranged from 15 to 88 years (mean age at diagnosis: 55.6 years). The most common site of involvement was the nasal septum (28.4 %), followed by the inferior turbinate (22.5%). The most common symptom was nasal obstruction (66.7%), followed by epistaxis (47.1%). Surgical excision represented the main treatment, and there was recurrence of pathology in only 1 case (0.9%). Conclusion To our knowledge, only 87 cases of sinonasal-tract angioleiomyoma have been previously described. The results of the present review seem to confirm the rarity and the benign nature of this neoplasm, and they seem to confirm the necessity to improve the available data about sinonasal-tract angioleiomyoma.

Association between uterine leiomyoma and fragmented QRS waves: a prospective case-control study

SUMMARY OBJECTIVE: The aim of this study was to evaluate the relationship between uterine leiomyoma and fragmented QRS, a non-invasive indicator of cardiovascular risk and myocardial ischemia, in women with uterine leiomyoma. METHODS: In this prospective case-control study, a total of 47 patients diagnosed with uterine leiomyoma (case group) and 47 healthy individuals without uterine leiomyoma (control group) who had undergone bilateral tubal ligation surgery were included. Various demographic, clinical, and laboratory parameters and the presence of fragmented QRS were recorded. RESULTS: The leiomyoma group showed significantly higher body mass index (27.46±2.18 vs. 25.9±2.87 kg/m2, p=0.005) and waist circumference (91.34±9.30 vs. 84.97±9.3 cm, p=0.001) compared with the control group. Uterine volumes were also significantly higher in the leiomyoma group (235.75±323.48 vs. 53.24±12.81 mm3, p<0.001). The presence of fragmented QRS was detected in 18.1% of the patients. Multiple regression analysis identified age, fasting blood glucose value, and the presence of fragmented QRS as independent risk factors for the presence of leiomyoma. CONCLUSION: This study provides valuable insights into the relationship between uterine leiomyoma and fragmented QRS. The presence of fragmented QRS was identified as an independent risk factor for the presence of leiomyoma. Further research is needed to better understand the underlying mechanisms connecting uterine leiomyoma and cardiovascular health.

Síndrome de leiomiomatose cutânea e uterina múltipla: relato de três casos clínicos / Multiple cutaneous and uterine leiomyomatosis syndrome: report of three clinical cases

A síndrome de Reed ocorre em mulheres com múltiplos leiomiomas cutâneos e leiomiomatose uterina. Relatam-se três casos de pacientes do sexo feminino, acompanhadas em hospital universitário, com pápulas e nódulos eritêmato-acas- tanhados dolorosos em membros superiores e tórax, agravados por frio, pressão e estresse, e associados a miomatose uterina. Foram realizados diversos tratamentos prévios, sem sucesso, tais como: aplicação de corticoterapia e toxina botulínica intralesional, bloqueadores de canais de cálcio, neuromoduladores e analgésicos orais. Foi, então, realizado tratamento cirúrgico, com melhora dos sintomas. O co- nhecimento e o esclarecimento dessa síndrome é fundamental para estabelecer a relação com miomatose uterina e câncer de células renais, para que, então, a partir da lesão de pele, se faça o rastreio das demais neoplasias, diagnóstico precoce e a educação em saúde.

Reed syndrome occurs in women with multiple cutaneous leiomyomas and uterine leiomyomatosis. We report the case of three female patients followed at a university hospital with painful erythematous-brown papules and nodules on the upper limbs and chest, aggravated by cold, pressure, stress, and associated with uterine myoma- tosis. Several previous unsuccessful treatments were performed, such as the applica- tion of corticotherapy and intralesional botulinum toxin, calcium channel blockers, neuromodulators, and analgesics. Surgical treatment was performed with the im- provement of symptoms. Knowledge and clarification of this syndrome are essential to establish a relationship between uterine myomatosis and renal cell neoplasm, so that, after the skin lesion, screening for other neoplasms, early diagnosis, and health education can be carried out.

Leiomyoma of the palatine tonsil - report of a rare and unusual tumor at this site

A leiomyoma is a remarkably rare cause of a benign, one-side tonsillar enlargement. The diagnosis is essentially histologic and will not normally be suspected clinically. Immunohistochemistry is needed for substantiation of the morphology and confirmation. We submit this illustrative case report.

Importância do diagnóstico por imagem em pacientes com sangramento uterino anormal / Importance of diagnostic imaging in patients with abnormal uterine bleeding

O sangramento uterino anormal é diagnóstico sindrômico comum no consultório do ginecologista e pode comprometer substancialmente a qualidade de vida. O objetivo no diagnóstico de sangramento uterino anormal é distinguir pacientes com causas estruturais (anatômicas), como pólipo, adenomiose, leiomioma, malignidade e hiperplasia, de pacientes que apresentam anatomia normal, nas quais o sangramento pode ser devido a alteração dos mecanismos de coagulação, distúrbios ovulatórios, distúrbios primários do endométrio, iatrogenia, ou ter outra causa não classificada. O diagnóstico se inicia a partir de anamnese detalhada e exame físico geral e ginecológico completos, seguidos da solicitação de exames complementares (laboratoriais e de imagem), conforme indicado. O exame de imagem de primeira linha para identificação das causas estruturais inclui a ultrassonografia pélvica. Histerossonografia, histeroscopia, ressonância magnética e amostragem endometrial para exame de anatomia patológica são opções que podem ser incluídas no diagnóstico a depender da necessidade. O objetivo deste artigo é apresentar a relevância dos exames de imagem na investigação das causas de sangramento uterino anormal.

Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office and may substantially affect quality of life. The aim in the diagnosis of abnormal uterine bleeding is to distinguish women with anatomic causes such as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia from women with normal anatomy where the cause may be coagulopathy, ovulatory disorders, endometrial, iatrogenic and not otherwise classified. Diagnosis begins with a thorough history and physical examination followed by appropriate laboratory and imaging tests as indicated. The primary imaging test for the identification of anatomic causes include ultrasonography. Saline infusion sonohysterography, magnetic resonance, hysteroscopy, endometrial sampling are options that can be included in the diagnosis depending on the need. The aim of this article is to present the relevance of imaging exams in the investigation of the causes of abnormal uterine bleeding.

Expression and sensitivity of immunohistochemical markers SMA, Desmin, CD10 for uterine leiomyomas - A tertiary care centre experience

Introduction: Leiomyoma is the most common benign tumor of the uterus which usually presents with menorrhagia, pain in abdomen or both. In extremely rare cases where uterine leiomyoma can be difficult to distinguish from other uterine smooth muscle tumors, immunohistochemistry is used. This study was aimed to study the expression and sensitivity of immunohistochemical markers SMA, Desmin, CD 10 for uterine leiomyomas and to find average number of mitosis in uterine leiomyomas using Ki 67. Materials and methods: The present study was carried out in the Department of Pathology, Dhiraj General Hospital and Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia. A total 50 cases of uterine leiomyomas after its histological diagnosis were evaluated with immunohistochemical markers SMA, Desmin, CD 10 and Ki 67. Results: SMA expression was seen in all 50 cases of uterine leiomyomas with strong expression in 44 cases (88%). Strong SMA expression was seen more in usual leiomyomas as compared to leiomyomas with secondary changes. Desmin expression was also seen in all the 50 cases of uterine leiomyomas with moderate expression in 26 cases (52%). Weak CD 10 expression was seen in 15 cases of uterine leiomyomas (30%). Ki 67 was expressed very focally in only 3 cases of leiomyomas with mean value of only 0.3% tumor cells. Conclusions: Leimyomas was most frequently seen in the women in 4th decade. The most common clinical presentation was menorrhagia. SMA and Desmin expression was seen in all the cases with strong and moderate immunoreactivity respectively. SMA expression was found to be more specific than Desmin in uterine leiomyoma. Weak CD 10 and focal Ki 67 were expressed only in few cases and were found to be insignificant.

Leiomioma ovárico primario

El leiomioma es un tumor mesenquimal benigno común que puede desarrollarse allí donde haya músculo liso; raro como tumor ovárico primario, su origen aún es controversial. El leiomioma ovárico primario es uno de los tumores benignos más raros del ovario, representa 0,5% a 1% de los tumores benignos y suele observase en mujeres entre 20 y 65 años. Generalmente, son asintomáticos y se les encuentra de forma incidental durante el examen pélvico o la cirugía por otra causa, pero en ocasiones puede manifestarse por dolor abdominal y masa palpable. El diagnóstico definitivo es difícil antes de la extirpación quirúrgica. Debido a que no existen síntomas patognomónicos ni tiene imágenes características, los principales diagnósticos diferenciales incluyen fibroma, tecoma, tumor estromal esclerosante y leiomiosarcoma. La tinción inmunohistoquímica es fundamental para el diagnóstico preciso y debe considerarse en el diagnóstico diferencial de los tumores ováricos de células fusiformes. Se presenta un caso de leiomioma ovárico primario.

Leiomyoma is a common benign mesenchymal tumor that can develop wherever smooth muscle is present; rare as a primary ovarian tumor, its origin is still controversial. Primary ovarian leiomyoma is one of the rarest benign ovarian tumors, accounting for 0.5% 1% of benign tumors and is usually seen in women between 20 and 65 years of age. They are usually asymptomatic and appear incidentally during a pelvic examination or surgery for another cause but can occasionally manifest by abdominal pain and palpable mass. Definitive diagnosis is difficult before surgical removal. Because there are no pathognomonic symptoms and no characteristic imaging, the main differential diagnoses include fibroma, thecoma, sclerosing stromal tumor and leiomyosarcoma. Immunohistochemical staining is essential for accurate diagnosis and should be considered in the differential diagnosis of ovarian spindle cell tumors. A case of primary ovarian leiomyoma is presented.

Reporting of uterine fibroids on ultrasound examinations: an illustrated report template focused on surgical planning / Relato de miomas uterinos em exames de ultrassonografia: um modelo de relatório ilustrado com foco no planejamento cirúrgico

Abstract Uterine fibroids are the most common benign gynecologic tumors in women of reproductive age, and ultrasound is the first-line imaging modality for their diagnosis and characterization. The International Federation of Gynecology and Obstetrics developed a system for describing and classifying uterine fibroids uniformly and consistently. An accurate description of fibroids in the ultrasound report is essential for planning surgical treatment and preventing complications. In this article, we review the ultrasound findings of fibroids, detailing the main points to be reported for preoperative evaluation. In addition, we propose a structured, illustrated report template to describe fibroids, based on the critical points for surgical planning.

Resumo Os miomas uterinos são os tumores ginecológicos benignos mais comuns em mulheres em idade reprodutiva, sendo a ultrassonografia a modalidade de imagem de primeira linha para seu diagnóstico e caracterização. A Federação Internacional de Ginecologia e Obstetrícia desenvolveu um sistema para descrever e classificar os miomas uterinos de forma uniforme e consistente. Uma descrição precisa dos miomas no laudo ultrassonográfico é essencial para o planejamento do tratamento cirúrgico e prevenção de complicações. Neste artigo, revisamos os achados ultrassonográficos de miomas, detalhando os principais pontos a serem relatados para avaliação pré-operatória. Além disso, propomos um modelo de relatório estruturado e ilustrado para descrição de miomas, com base nos pontos críticos para o planejamento cirúrgico.

A case report of epididymal leiomyoma / 中华泌尿外科杂志

Leiomyomas are benign tumors that arise from smooth muscle cells and rarely involve the male genitourinary system. We reported a case of a patient who underwent radical orchiectomy for epididymal tumor. The postoperative pathological diagnosis was epididymal leiomyoma, and there was no recurrence after 9 months of follow-up.

Safety and effectiveness of superselective embolization of the uterine arteries in the treatment of uterine fibroids / 中国基层医药

Objective:To analyze the safety and effectiveness of superselective embolization of the uterine arteries in the treatment of uterine fibroids.Methods:The clinical data of 60 patients with uterine fibroids who were admitted to Zhejiang Veteran Hospital from February 2020 to February 2022 were retrospectively analyzed. These patients were divided into a control group and an observation group ( n = 30/group) according to different surgical methods. The control group underwent conventional surgery. The observation group underwent superselective embolization of the uterine arteries. Uterine size, uterine fibroid size, postoperative hormone level, and complications were compared between the two groups. Results:There was no significant difference in total response rate between the observation and control groups [93.33 (28/30) vs. 83.33 (25/30), χ2 = 1.46, P > 0.05]. After surgery, serum estradiol, luteinizing hormone, follicle-stimulating hormone, and progesterone levels in the observation group were (164.14 ± 19.97) ng/L, (2.43 ± 1.47) IU/L, (2.51 ± 1.14) IU/L, and (5.05 ± 0.43) μg/L, respectively, which were significantly lower than (190.23 ± 21.62) ng/L, (3.78 ± 1.63) IU/L, (3.94 ± 1.23) IU/L, (8.22 ± 1.35) μg/L in the control group ( t = 4.86, 3.37, 4.67, 12.25, all P < 0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group [3.33% (1/30) vs. 20.00% (6/30), χ2 = 4.04, P < 0.05). Conclusion:Compared with conventional surgery, superselective embolization of the uterine arteries is more effective on uterine fibroids, better keep postoperative hormone level stable, and reduce or avoid short- and long-term complications. Therefore, superselective embolization of the uterine arteries for the treatment of uterine fibroids deserves the clinical promotion.

The value of CT for differentiating gastric leiomyoma from gastric schwannoma / 中国医师进修杂志

Objective:To evaluate the value of CT for differentiating gastric leiomyoma (GLM) from gastric schwannoma (GS).Methods:The clinical and imaging data of 42 patients with GLM (GLM group) and 41 patients with GS (GS group) were analyzed retrospectively. The general information and CT features were compared between two groups. The independent factors for differentiating GLM from GS were obtained by multivariate Logistic regression analysis. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficiency of the model.Results:The proportion of female and age in GLM group were significantly lower than those in GS group: 59.52% (25/42) vs. 85.37% (35/41), (51.83 ± 10.52) years old vs. (58.80 ± 10.63) years old, and there were statistical differences ( P<0.01). The upper part of the stomach rate, irregular shape rate, intraluminal growth rate, ratio of long diameter to short diameter and mild to moderate enhancement rate in GLM group were significantly higher than those in GS group: 71.43% (30/42) vs. 14.63% (6/41), 52.38% (22/42) vs. 21.95% (9/41), 92.86% (39/42) vs. 19.51% (8/41), 1.90 ± 0.55 vs. 1.34 ± 0.28 and 92.86% (39/42) vs. 51.22% (21/41), the cystic degeneration rate, ulcer rate, incidence of tumor-associated lymph node, CT values of venous phase and delayed phase in GLM group were significantly lower than those in GS group: 2.38% (1/42) vs. 26.83% (11/41), 7.14% (3/42) vs. 24.39% (10/41), 2.38% (1/42) vs. 60.98% (25/41), (59.21 ± 9.75) HU vs. (66.22 ± 10.33) HU and (65.02 ± 8.62) HU vs. (76.85 ± 11.89) HU, and there were statistical differences ( P<0.01 or <0.05); there were no statistical difference in the rate of calcification and the CT values of plain scan and arterial phase between the two groups ( P>0.05). Multivariate Logistic regression analysis result showed that the tumor location, growth mode, tumor-associated lymph node and ratio of long diameter to short diameter were the independent factors for differentiating GLM from GS ( OR = 34.385, 25.314, 0.023 and 97.700; 95% CI 2.848 to 415.171, 2.674 to 239.670, 0.001 to 0.637 and 3.113 to 3 066.549; P<0.01 or <0.05); when the model threshold was >0.647, the area under the curve was 0.988 (95% CI 0.934 to 1.000), with a sensitivity of 92.9% and specificity of 97.6%. Conclusions:When the tumor is prone to the upper part of the stomach, intraluminal growth, ratio of long diameter to short diameter >1.28, and the absence of the tumor-associated lymph node, GLM tends to be considered, on the contrary, it tends to be GS. Therefore, CT imaging features have certain value in differentiating GLM from GS before surgery.

Diagnosis and treatment of 12 cases of fumarate hydratase-deficient renal cell carcinoma / 现代泌尿外科杂志

【Objective】 To summarize and analyze the clinical data of fumarate hydrase-deficient renal cell carcinoma (FH-RCC), so as to improve the understanding of the disease. 【Methods】 General clinical data of 12 FH-RCC patients treated during Mar.2019 and Dec.2021 were retrospectively analyzed, including the imaging, pathological, genetic testing, surgical and adjuvant therapy, and follow-up results. 【Results】 All cases were confirmed with pathology or genetic tests, including 1 case complicated with uterine fibroids, 3 cases with renal cysts, 4 with family history of uterine fibroids and 2 with family history of renal carcinoma. Cysticular irregular density shadows with an enhancement of 25.8 Hu were detected in 4 cases. Of the 7 cases undergoing genetic testing, 2 had embryo and system mutation, 1 had germ line mutation, 1 had system mutation, and 3 had no germ line or system mutation. Radical nephrotomy was performed in 9 cases. The average operation time was 3.8 h, and the average amount of blood loss was 625 mL. Immunotherapy with targeted therapy was conducted in 10 cases, surgery with postoperative adjuvant therapy in 7 cases, and tyrosine kinase inhibitor with immune checkpoint inhibitor (TKI/ICI) in 1 case. All 12 cases were followed up, 3 died of tumor, 1 had no recurrence, 8 showed progress on imaging. 【Conclusion】 FH-RCC is a rare and highly malignancy prone to metastasis. Imaging shows cystic solid space occupying lesions. FH immunohistochemical staining is negative. Genetic testing is needed to confirm the diagnosis. TKI/ICI combination therapy has a good survival benefit.

Uterine Epithelioid Leiomyosarcoma Arising Within Leiomyoma in A Postmenopausal Woman: A Case Report

@#Uterine leiomyosarcoma is a malignant smooth muscle tumour of the uterus. It is rare and accounting for less than 2% of cases in malignant gynaepathology. To date, only a few reported cases of leiomyosarcoma arising from leiomyoma documented in the literature. We shared an uncommon occurrence of leiomyosarcoma arising from leiomyoma. Presented herein is a case of a ‘rare epithelioid subtype’ of leiomyosarcoma arising from a leiomyoma in a postmenopausal woman. We highlighted the importance of recognizing the possibilities of this event to allow for a timely diagnosis of leiomyosarcoma and to provide insights on management of patients presented with clinically presumed fibroid.

Torsión uterina causada por miomatosis: reporte de un caso / Uterine torsion caused by myomatosis: A case report

Resumen ANTECEDENTES: La torsión uterina es una rotación del útero sobre su eje mayor de más de 45°; por lo general sucede en torno del istmo uterino. Los leiomiomas son el factor predisponente más frecuente en úteros no grávidos. OBJETIVO: Reportar el caso de una paciente con torsión uterina cervical y miomatosis de grandes elementos. CASO CLÍNICO: Paciente de 42 años, nuligesta, con antecedente de miomatosis uterina de grandes elementos de 27 x 27 cm. Los síntomas se iniciaron con síndrome doloroso abdominal intenso, tipo cólico, localizado en el hipogastrio y la fosa iliaca. En la exploración física el abdomen se percibió doloroso a la palpación superficial y profunda, con una tumoración cercana a la cicatriz umbilical (25 cm), móvil y dolorosa. En la laparotomía exploradora se encontró líquido peritoneal hemorrágico y se observó una torsión uterina (una vuelta) cerca del cuello del útero, además de un mioma subseroso en la cara posterior, de 27 x 27 cm. El útero, los anexos y las salpinges se advirtieron con datos francos de daño vascular, con áreas de isquemia. Por lo anterior se decidieron la histerectomía total abdominal y la salpingooforectomia bilateral. El informe histopatológico reportó: útero con cambio isquémico extenso panmural, sin evidencia de neoplasia maligna. CONCLUSIONES: El dolor abdominal es el síntoma más común de la torsión uterina que puede variar de leve a agudo. El diagnóstico preoperatorio rápido y preciso de torsión uterina es decisivo y se justifica la intervención quirúrgica de urgencia.

Abstract BACKGROUND: Uterine torsion is a rare entity that is defined as a rotation of the uterus on its major axis of more than 45°, generally occurring at the level of the uterine isthmus. Leiomyomas are the most frequent predisposing factor in non-gravid uterus. OBJECTIVE: Report of a case of a gynecological patient with uterine torsion at the cervical level in a uterus with uterine myomatosis of large elements. CLINICAL CASE: A 42-year-old patient, nulliparous, with a history of uterine myomatosis with large elements of 27 x 27 cm. The symptoms began with intense abdominal pain syndrome, colic type, located in the hypogastrium and the iliac fossa. On physical examination, the abdomen was perceived as painful on superficial and deep palpation, with a mobile and painful tumor close to the umbilical scar (25 cm). In the exploratory laparotomy, hemorrhagic peritoneal fluid was found and a uterine torsion (one turn) was observed near the cervix, as well as a subserous myoma on the posterior face, measuring 27 x 27 cm. The uterus, the annexes and the salpinges were noted with frank data of vascular damage, with areas of ischemia. Therefore, total abdominal hysterectomy and bilateral salpingo-oophorectomy were decided. The histopathological report reported: uterus with extensive panmural ischemic change, without evidence of malignancy. CONCLUSIONS: In uterine torsion, abdominal pain is the most common symptom and can range from mild to severe abdominal symptoms. Therefore, a prompt and accurate preoperative diagnosis of uterine torsion is crucial and urgent surgical intervention is warranted.

Leiomioma submucoso de gran tamaño: una presentación inusual. Reporte de Caso / Large submucosal leiomyoma: an unusual presentation

Se ha postulado que más del 70 % de las mujeres antes de la menopausia son diagnosticadas de leiomiomas; de estas un 25 % presentan sintomatología grave. La ecografía es la modalidad de imagen de primera elección para su estudio. Se tiene registros de progresión de leiomiomas a leiomiosarcomas, que conllevan a un mal pronóstico y son responsables de una cuarta parte de las muertes por neoplasias uterinas, con una sobrevida a 5 años que van desde 46-53 %, lo cual incentiva el diagnóstico precoz y eficaz de masas uterinas. El caso reportado es una presentación inusual de un leiomioma de gran tamaño, que por los hallazgos de imagen se reportó como una neoplasia maligna, su aspecto macroscópico totalmente atípico reforzaba la sospecha imagenológica. Solo se pudo determinar el diagnóstico definitivo mediante estudio histopatológico posterior a histerectomía. Las evaluaciones ginecológicas de rutina deben incluir exámenes especializados de imagen pélvica, la ausencia de presentación típica o síntomas característicos de una patología no debe ser motivo para obviar exámenes complementarios que permitan un diagnóstico oportuno y tratamiento eficiente de leiomiomas, incluso en casos de presentaciones inusuales y desafiantes para el diagnóstico, como el que se ha reportado en esta obra.

It has been postulated that more than 70% of premenopausal women are diagnosed with leiomyomas; Of these, 25% have severe symptoms. Ultrasound is the imaging modality of choice for its study. There are reports of progression from leiomyomas to leiomyosarcomas, which leads to a poor prognosis, and is responsible for a quarter of deaths from uterine neoplasms, with a 5-year survival ranging from 46-53%; this should encourage early and effective diagnosis of uterine masses. The reported case is an unusual presentation of a large leiomyoma, which due to its imaging characteristics, was reported as a malignant neoplasm. Its completely atypical macroscopic appearance reinforced the imaging diagnosis suspicion. The definitive diagnosis could only be determined by histopathological study after hysterectomy. Routine gynecological evaluations should include specialized pelvic imaging exams, the absence of a typical presentation or characteristic symptoms of a pathology should not be a reason to obviate ancillary testing that would allow a timely diagnosis and effective treatment of leiomyomas, even in unusual and challenging presentations, such as with the patient in this case report.

Histopathological analysis of hysterectomy specimens

Background: Uterus is prone for various non-neoplastic and neoplastic lesions and also hysterectomy is the most common gynecological surgery indicated as a definitive treatment. Grossly unremarkable many specimens may reveal pathologies on histological examination. Hence, all hysterectomy specimens must undergo proper histopathological examination. In our study, hysterectomy specimens were studied and results compared with their clinical diagnosis. Aim and Objective: The objectives of the present study were to know the frequency and incidence of various lesions of the female genital tract and to compare findings of the present study with other studies. Materials and Methods: The study was a retrospective analysis of 250 hysterectomy specimens. All types of hysterectomies such as vaginal, abdominal, laparoscopic, and total abdominal hysterectomy without or with unilateral/bilateral salpingectomy/salpingo-oophorectomy were included in the study. Histopathological examination was done minimum by two faculty members. The results were noted and statistical analysis was done. Results: Total 250 hysterectomy specimens were studied. Vaginal hysterectomy was the most commonly performed type of hysterectomy which includes 187 cases (74.8%) out of 250 cases. Among the uterine pathologies, the most common lesion was leiomyoma (34.4%) followed by adenomyosis (26%). In our study during histopathological examination of cervix, the most frequent cervical lesion was found chronic cervicitis in 50.4% of cases. Conclusion: The present study highlights the wide spectrum of lesions of female genital tract and conveys that histopathology remains the primary modality for confirmation of diagnosis of lesions. We can conclude from the present study that many lesions had been diagnosed on microscopic examination though normal gross examination. Hysterectomy specimen should undergo proper histopathological examination, because it is the gold standard tool for final diagnosis.