Metastasizing leiomyoma during pregnancy

Uterine leiomyoma is a benign tumor of myometrial tissue which affects women of reproductive age. Its prevalence increases with age and has a peak incidence at the age of forty. The term "metastasizing leiomyoma" refers to a tumor of dense connective tissue and smooth myometrial muscle cells located outside the uterus. This group of tumors can metastasize to different organs, the lung being its main focus. We present the case report of a 33-year-old female gravida 3, para 1, abortus 1, at 11 weeks of pregnancy, with pelvic masses. The diagnosis was metastasizing leiomyoma during pregnancy.

Leiomioma vesical. A propósito de un caso / Bladder leiomyoma. A case report

RESUMEN Fundamento: El leiomioma vesical es un tumor de origen mesenquimal, benigno, derivado de las fibras del músculo liso, su diagnóstico definitivo es por estudio histológico; su tratamiento es quirúrgico con pronóstico excelente. Son pocos los casos que se presentan en la bibliografía consultada por la escasa incidencia de este tipo de tumor. Objetivo: Reportar un caso diagnosticado con un leiomioma vesical. Presentación del caso: Se presenta el caso de una paciente femenina de 48 años de edad, atendida en el Hospital General Provincial Camilo Cienfuegos de Sancti Spíritus, que fue diagnosticada con ureterocele izquierdo. La paciente a los 7 años acudió con síntomas de polaquiuria, goteo posmiccional y sensación de repleción después de la micción. A la exploración física sin alteraciones en general. Ecografía renovesical con imagen quística en uréter distal izquierdo, de gran tamaño, con paredes gruesas, que ocupa casi la totalidad de la vejiga, con ureterohidronefrosis severa izquierda. Se le realizó cirugía definitiva, cistectomía parcial con reimplante ureteral izquierdo, con buena evolución. El resultado del diagnóstico anatomopatológico fue un leiomioma vesical. Conclusiones: El leiomioma vesical es una neoplasia poco frecuente en vejiga; en el caso reportado al realizarle el tratamiento quirúrgico se observó un excelente pronóstico.

ABSTRACT Background: Bladder leiomyoma is a benign tumor of mesenchymal origin, derived from smooth muscle fibers, its definitive diagnosis is by histological study; its treatment is surgical with excellent prognosis. Few cases are presented in the literature due to the low incidence of this nature. Objective: To report a case diagnosed with a bladder leiomyoma. Case report: A 48-year-old female patient, assisted at Camilo Cienfuegos General Provincial Hospital in Sancti Spíritus, diagnosed with left ureterocele. The patient came to consulting 7 years after have presented symptoms of pollakiuria, post-mictional drip and repletion sense afterwards urination. Physical examination showed no general alterations. Renovesical ultrasound showed a cystic image in the left distal ureter, large, thick-walled, occupying almost the entire bladder, with severe left ureterohydronephrosis. Definitive and partially cystectomy surgery was performed with left ureteral reimplantation, presenting good evolution. The result of the anatomopathological diagnosis was a bladder leiomyoma. Conclusions: Bladder leiomyoma is a rare neoplasm in the bladder; in the reported case, after surgical treatment, an excellent prognosis was observed.

Does big mean evil? Giant, but benign uterine leiomyoma: case report and review of the literature / Será que grande significa maligno? Leiomioma gigante, porém benigno: Relato de caso e revisão de literatura

Abstract Uterine leiomyoma is themost prevalent benign type of gynecological tumor. It affects more than 80% of women worldwide and, within this group, more than 50% may be asymptomatic. However, large fibroid volumes may be associated with symptoms of extrinsic compression, and most of the cases do not present atypical cells. We present the case of a 49-year-old woman who underwent a total abdominal hysterectomy of a 13.5-kg uterine leiomyoma with no malignancies at histopathology and review the literature about giant uterine leiomyomas and their clinical repercussion. We concluded that large volumes do not always pose a threat regarding malignancy; however, future molecular studies are needed to investigate giant uterine fibroids.

Resumo Leiomioma uterino é o tumor benigno ginecológico de maior prevalência. Ele afeta mais de 80% das mulheres no mundo e, deste grupo, mais de 50% podem ser assintomáticas. Contudo, miomas de grande volume podem ser associados com sintomas de compressão extrínseca, e a maioria dos casos não apresentam células atípicas. Nós apresentamos o caso de uma mulher de 49 anos que foi submetida a histerectomia total abdominal de um espécime de 13,5 quilos sem malignidades ao exame histopatológico. Também revisamos a literatura sobre leiomiomas uterinos de grande volume e sua repercussão clínica. Concluímos que grandes volumes nem sempre representam um risco relacionado à malignidade; contudo, estudos moleculares futuros são necessários para investigar leiomiomas uterinos gigantes.

Consideraciones del Leiomioma y su Variante Intraósea en Mandíbula, Algoritmo de Trabajo Según Análisis de Literatura / Considerations of Leiomyoma and its Intraosseous Variant in the Jaw, Working Algorithm According to Literature Analysis

RESUMEN: El Leiomioma es una neoplasia benigna originada en el tejido muscular liso por lo que puede manifestarse en cualquier región del cuerpo humano que contenga músculo liso, siendo el sitio más común el útero, la piel y en el tracto gastrointestinal. La escasa cantidad de tejido muscular liso en boca hace que su manifestación oral sea infrecuente, representando solo 0.06 % del total de este tipo de tumores. Los sitios más afectados suelen ser los labios, las mejillas, el paladar, la lengua y encías. Histológicamente se distinguen tres tipos: el Leiomioma Sólido, Angioleiomioma (Vascular) y Leiomioma Epitelioide (Leiomioblastoma). El origen de esta neoplasia en boca suele ser la túnica media de los vasos sanguíneos. El Leiomioma intraóseo suele ser aún menos frecuente, y con un diagnóstico diferencial complejo, con histopatología que en varias ocasiones no suele ser fácil de clasificar. Si bien es definida como un tumor benigno, su manifestación intraósea puede llegar a ser localmente agresiva y con un diagnóstico controversial, debiendo abordarse muchas veces como una neoplasia maligna. El objetivo de este artículo es presentar una revisión de la literatura de esta variante intraósea de Leiomioma situada en mandíbula, sus consideraciones clínicas y un algoritmo de tratamiento.

ABSTRACT: Leiomyoma is a benign neoplasm, the origin is the smooth muscle tissue that can be found in any area of the human body, which contains smooth muscle tissue. The most common regions it can be located, are the uterus, the skin and the gastrointestinal tract. The low quantity of muscle tissue in the mouth leads to infrequent oral manifestation, representing only 0.06 % of these tumors. The most affected regions are the lips, cheeks, palate, tongue and gums. The Histologic classification is: Solid Leiomyoma, Angioleiomyoma (vascular) and Epithelioid Leiomyoma (Leiomyoblastoma). The origin of this tumor in the mouth is the tunica media of the blood vessels. Nevertheless, and in spite of being defined as a benign tumor, it can be extremely aggressive, be subject to controversial diagnosis, and must often be treated as a malign neoplasm. The Intraosseous Leiomyoma is infrequent and presents a complicated differential diagnosis, with a histopathology that many times cannot be easily classified. The aim of this article is to present a review of intraosseous variant Leiomyoma in the mandible, the clinicians´ considerations and a treatment algorithm.

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.

Dermatomiofibroma lineal: reporte de un caso / Linear dermatomyofibroma: report of a case

El dermatomiofibroma es un tumor benigno infre-cuente de origen mesenquimático. Generalmente, se presenta como un tumor rosado nodular, espe-cialmente en mujeres en la década de los 30, en hombros y axila. Clínica e histológicamente puede simular otros tu-mores mesenquimáticos como el dermatofibroma , leiomioma y el dermatofibrosarcoma protuberans. Se presenta caso de dermatomiofibroma lineal, para describir sus características clínicas e histo-lógicas, necesarias para su correcto diagnóstico y enfrentamiento terapéutico.

Dermatomyofibroma is an uncommon mesen-chymal benign tumor. It usually presents in wo-men at their thirties, as a pink nodular tumor on the shoulder and axilla. Clinically and histologically it may mimic other mesenchymal tumors such as dermatofibroma, leiomyoma and dermatofibrosarcoma protube-rans. We present the case of a linear dermatomyofi-broma and describe its clinical and histological characteristics, which may help the clinician in the correct diagnosis and therapeutic approach of this rare but benign tumor.

Perianal leiomyoma / Leiomioma de localização perianal

Abstract Leiomyomas are smooth muscle tumors and may occur in places where these fibers are present, while the anorectal location is rare. They are commonly incidental imaging findings and in most cases, patients are asymptomatic. The therapeutic recommendation is tumor resection and postoperative follow-up. Case report: a 38-year-old Black woman had, one year ago, a swelling in perianal right region, which showed slow and progressive growth. She denied bowel habit alterations, local pain, hematochezia, or tenesmus. Proctologic examination showed a fibroelastic, regular, mobile, painless nodule measuring 10 cm at its largest diameter in the right perianal region, next to the anal verge. The soft tissue ultrasound image identified a solid, hypoechoic, and discreetly vascularized nodule in the perianal, superficial right gluteal region that did not reach the adjacent muscles. A complete resection of perineal tumor was carried out in the ventral position. Histological and immunohistochemical analyses disclosed a leiomyoma with a positive finding for actin smooth muscle and negative for desmin. She is currently asymptomatic and undergoing outpatient follow-up.

Resumo Os leiomiomas são tumores da musculatura lisa podendo ocorrer nos locais onde essas fibras estão presentes, sendo rara a localização anorretal. Na maioria dos casos os pacientes são assintomáticos, sendo comumente achados de exame de imagem. A recomendação terapêutica é a ressecção tumoral e o seguimento pós-operatório. Relato do caso: mulher, 38 anos, negra. Há um ano, apresentou abaulamento em região perianal direita, de crescimento lento e progressivo. Negava alteração do hábito intestinal, dor local, hematoquezia, puxo ou tenesmo. Ao exame proctológico, apresentava nodulação fibroelástica, regular, móvel, indolor, com 10 cm de diâmetro em região perianal à direita, próxima à borda anal. Realizou ultrassonografia de partes moles que identificou imagem nodular, sólida, hipoecogênica e discreta vascularização em parte superficial perianal e glútea direita, não envolvendo musculatura adjacente. Foi submetida à ressecção completa do tumor via perineal, em posição ventral. O laudo histológico e imuno-histoquímico revelou leiomioma, com achado positivo para actina de músculo liso e negativo para desmina. Atualmente está assintomática, em seguimento ambulatorial.

Translation and validation of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire for the Brazilian Portuguese language / Tradução e validação do questionário Uterine Fibroid Symptom and Quality of Life (UFS-QOL) para a língua portuguesa brasileira

ABSTRACT CONTEXT AND OBJECTIVE: Uterine fibroids (UF), also known as leiomyomas, are the most prevalent gynecological tumors. The Uterine Fibroid Symptoms and Quality of Life (UFS-QOL) is the only specific questionnaire that assesses symptom intensity and quality-of-life issues for women with symptomatic UF; however, it only exists in the English language. Thus, we aimed to translate and culturally validate the UFS-QOL questionnaire for the Brazilian Portuguese language. DESIGN AND SETTING: Cross-sectional study, Department of Gynecology and Obstetrics, FMRP-USP. METHODS: 113 patients with UF (case group) and 55 patients without UF (control group) were interviewed using the UFS-QOL questionnaire after translation and cultural adaptation. The Short Form-36 questionnaire was used as a control. Demographic and psychometric variables were analyzed. RESULTS: Women with UF presented higher mean age, body mass index, weight, parity and comorbidities than the control group (P < 0.05). The most prevalent complaints were abnormal uterine bleeding (93.8%), pelvic pain (36.3%) and extrinsic compression (10.6%) and these presented adequate construct validity regarding UFS-QOL severity (P < 0.05). The UFS-QOL questionnaire presented good internal consistency regarding symptom severity and quality-of-life-related domains (intraclass correlation coefficient, ICC = 0.82/0.88). Structural validity presented correlation coefficients ranging from 0.59 to 0.91. Test-retest comparison did not show differences among the UFS-QOL subscales. After treatment, women with UF presented improvements on all subscales. CONCLUSION: The UFS-QOL questionnaire presented adequate translation to the Brazilian Portuguese language, with good internal consistency, discriminant validity, construct validity, structural validity and responsiveness, along with adequate test-retest results.

RESUMO CONTEXTO E OBJETIVO: O leiomioma uterino (LU) é o tumor ginecológico mais comum. Existe apenas um questionário específico que avalia a intensidade de sintomas e qualidade de vida de mulheres com LU sintomático, o Uterine Fibroid Symptom and Quality of Life (UFS-QOL), porém somente na língua inglesa. Dessa forma, objetivamos traduzir e validar culturalmente o questionário UFS-QOL para a língua portuguesa brasileira. TIPO DE ESTUDO E LOCAL: Estudo transversal, Departamento de Ginecologia e Obstetrícia da FMRP-USP. MÉTODOS: 113 pacientes portadoras de LU (grupo caso) e 55 pacientes-controle foram entrevistadas com o questionário UFS-QOL após tradução e adaptação cultural. O questionário Short Form-36 foi utilizado para controle. Variáveis demográficas e psicométricas foram analisadas. RESULTADOS: As mulheres com LU apresentaram maior média de idade, índice de massa corporal, peso, paridade e comorbidades do que o grupo controle (P < 0,05). As queixas mais prevalentes foram sangramento uterino anormal (93,8%), dor pélvica (36,3%) e compressão extrínseca (10,6%) e estas apresentaram adequada validade de constructo com a gravidade indicada pelo UFS-QOL (P < 0,05). O questionário UFS-QOL apresentou boa consistência interna com a gravidade dos sintomas e com os domínios relacionados a qualidade de vida (coeficiente de correlação intraclasse, CCI = 0,82/0,88). A validade estrutural mostrou coeficientes de correlação variando de 0,59 até 0,91. A comparação teste-reteste não mostrou diferença entre as subscalas do UFS-QOL. Depois do tratamento, as mulheres com LU apresentaram melhora em todas as subscalas. CONCLUSÃO: O questionário UFS-QOL apresentou adequada tradução para a língua portuguesa brasileira, com boa consistência interna, validade de constructo/discriminatória, estrutural e responsividade, assim como adequados resultados teste-reteste.

Uterine Fibroid Symptom - Quality of Life questionnaire translation and validation into Brazilian Portuguese / Tradução e validação para língua portuguesa do questionário Uterine Fibroid Symptom - Quality of Life

Abstract Purpose To translate into Portuguese, culturally adapt and validate the Uterine Fibroid Symptom - Quality of Life (UFS-QoL) questionnaire for Brazilian women with uterine leiomyoma. Methods Initially, the UFS-QoL questionnaire was translated into Brazilian Portuguese in accordance with international standards, with subsequent cultural, structural, conceptual and semantic adaptations, so that patients were able to properly answer the questionnaire. Fifty patients with uterine leiomyoma and 19 patients without the disease, confirmed by abdominal pelvic examination and/or transvaginal ultrasound, were selected at the outpatient clinics of the Department of Gynecology of the Universidade Federal de São Paulo (Unifesp). The UFS-QoL questionnaire was administered to all women twice on the same day, with two different interviewers, with an interval of 15 minutes between interviews. After 15 days, the questionnaire was readministered by the first interviewer. Reliability (internal consistency and test-retest), construct and discriminative validity were tested to ratify the questionnaire. Results The reliability of the instrument was assessed by Cronbach’s α coefficient with an overall result of 0.97, indicating high reliability. The survey results showed a high correlation (p= 0.94; p 0.001). Conclusion The UFS-QoL questionnaire was successfully adapted to the Brazilian Portuguese language and Brazilian culture, showing reliability and validity.

Resumo Objetivo Traduzir para o português, adaptar culturalmente e validar o questionário Uterine Fibroid Symptom - Quality of Life (UFS-QoL) para as mulheres brasileiras com leiomioma uterino. Métodos Inicialmente, o questionário UFS-QoL foi traduzido para o português brasileiro, em conformidade com as normas internacionais, com adaptações culturais, estruturais, conceituais e semânticas subsequentes, de modo que as pacientes fossem capazes de responder o questionário de forma adequada. Cinquenta pacientes com leiomioma uterino e 19 pacientes sem a doença, confirmada por exame pélvico abdominal e/ou ultrassonografia transvaginal, foram selecionados nos ambulatórios do Departamento de Ginecologia da Universidade Federal de São Paulo (Unifesp). A todas as mulheres foi administrado o questionário UFS-QoL por duas vezes no mesmo dia, por dois entrevistadores diferentes, com um intervalo de 15 minutos entre as entrevistas. Após 15 dias, o questionário foi novamente administrado pelo primeiro entrevistador. Confiabilidade (consistência interna e teste-reteste), constructo e validade discriminativa foram testados para ratificar o questionário. Resultados A confiabilidade do instrumento foi avaliada pelo coeficiente α de Cronbach com um resultado global de 0,97, indicando alta confiabilidade. Os resultados da pesquisa mostraram uma correlação elevada (p= 0,94; p 0,001). Conclusão O questionário UFS-QoL foi adaptado com sucesso para a língua portuguesa e cultura brasileira, mostrando confiabilidade e validade.

Mioma vaginal intraabdominal, masa pélvica de localización atípica / Intra-abdominal vaginal myoma, a pelvic mass of atypical location

La patología miomatosa del tracto genital inferior es uno de los motivos más frecuentes de consulta en Ginecología. Sin embargo, su localización vaginal resulta una situación infrecuente de difícil diagnóstico. En muchas ocasiones se lleva a cabo tras un hallazgo casual intraoperatorio. Las manifestaciones clínicas que producen los leiomiomas en esta localización son inespecíficas; el tratamiento quirúrgico es el de elección, generalmente mediante un abordaje por la vía vaginal(AU)

Myomatous disease of the lower genital tract is one of the most common reasons for gynecological consultation. However, vaginal location is infrequent and difficult to diagnose. On many occasions diagnosis is based on a fortuitous intraoperative finding. The clinical manifestations of vaginal leiomyomas are unspecific. Surgery is the treatment of choice, which is generally performed by vaginal approach(AU)

Aspectos clínicos, cirúrgicos, histológicos e pós-operatórios de oito cadelas com leiomioma vaginal / Clinical, surgical, histological and postoperative aspects in the case of eight bitches with vaginal leiomyoma

O presente trabalho reporta as características clínicas e cirúrgicas de oito casos de cadelas portadoras de leiomioma vaginal, com histórico de aumento de volume na região perineal, aparecimento de massa pela vulva, disquezia, tenesmo e disúria. As pacientes foram submetidas à cirurgia de episiotomia para ressecção da massa neoplásica, e em quatro casos foi necessária a ovariossalpingo-histerectomia. Porém, uma delas apresentou recidiva, e, no segundo procedimento cirúrgico de exérese de neoformação, o histopatológico diagnosticou leiomiossarcoma. A paciente ainda apresentou mais duas recidivas, até o proprietário optar pela eutanásia. Decorridos quatro meses, as sete cadelas diagnosticadas com leiomioma não apresentaram recidiva, e os proprietários relataram ausência de sinais relacionados com a doença descrita. Conclui-se que a episiotomia para ressecção da massa vaginal e a ovariossalpingo-histerectomia nas cadelas inteiras nos casos de tumores vaginais benignos são tratamentos satisfatórios, com bom prognóstico, ao contrário do leiomiossarcoma.

This study reports the clinical and surgical procedures of eight cases of bitches with vaginal leiomyoma. All animals presented increased volume in the perineal region, and exteriorization of the vulva, dyschezia, tenesmus and dysuria. The patients underwent episiotomy surgery for resection of the neoplastic mass, and ovariosalpingohisterectomy in four cases. However, one had recurrence on the second surgical procedure for removal of neoformation, histopathological diagnosed leiomyosarcoma, the patient also had two more relapses, until the owner chose euthanasia. After four months, the seven dogs diagnosed with leiomyoma showed no recurrence and the owners reported no signs of the disease described. We concluded that episiotomy for vaginal mass resection combined with ovariohysterectomy in cases of benign vaginal tumors have shown satisfactory treatment with good prognostic.

A Rare Case of Intra-Endometrial Leiomyoma of Uterus Simulating Degenerated Submucosal Leiomyoma Accompanied by a Large Sertoli-Leydig Cell Tumor

A 50-year-old peri-menopausal woman presented with hard palpable mass on her lower abdomen and anemia from heavy menstrual bleeding. Ultrasonography showed a 13x12 cm sized hypoechoic solid mass in pelvis and a 2.5x2 cm hypoechoic cystic mass in uterine endometrium. Abdomino-pelvic computed tomography revealed a hypodense pelvic mass without enhancement, suggesting a leiomyoma of intraligamentary type or sex cord tumor of right ovary with submucosal myoma of uterus. Laparoscopy revealed a large Sertoli-Leydig cell tumor of right ovary with a very rare entity of intra-endometrial uterine leiomyoma accompanied by adenomyosis. The final diagnosis of ovarian sex-cord tumor (Sertoli-Leydig cell), stage Ia with intra-endometrial leiomyoma with adenomyosis, was made. Considering the large size of the tumor and poorly differentiated nature, 6 cycles of chemotherapy with Taxol and Carboplatin regimen were administered. There is neither evidence of major complications nor recurrence during 20 months' follow-up.

Mioma cervical gigante en adolescente / Giant cervical myoma in an adolescent

Se reporta el caso de una paciente de 13 años con presencia de una masa perineal que protruía a través del introito, cuya patología correspondió a un leiomioma cervical polipoideo gigante. Se realizó miomectomía vaginal con buena evolución. El objetivo de esta comunicación es presentar un caso clínico de baja frecuencia.

We report the case of a patient of 13 years old, who presented with a bulky perineal mass expelled from the introitus. It was a huge prolapsed cervical leyomioma. We performed a vaginal myomectomy with a good outcome. The aim of this report was to present a clinical case of low occurrence.

Broad Ligament Fibroid: A Case Series.

Fibroids are most common benign tumors of the uterus, mostly situated in the body of the uterus. Rarely, they arise from extra-uterine sites with broad ligament fibroids being uncommon. Although by clinical examination and newer imaging modalities, we can easily know about size, number, and origin of these tumors and any anatomical distortion of surrounding vital organs, but some time it is very difficult to differentiate pre-operatively between large broad ligament leiomyomas and ovarian/adnexal pathology specially if cystic degeneration or necrosis is present in leiomyoma. We report four patients with broad ligament fibroids to emphasize the importance of their location, the diagnostic difficulties, and surgical complications they can pose.

Leiomioma parauretal / Leiomyoma paraurethral

Se reporta un caso de leiomioma parauretral en una paciente femenina, con síntomas de cuerpo extraño en vagina y dificultad para micción, El examen físico revela masa en pared anterior de vagina. El diagnóstico fue realizado por ultrasonido transperineal. La escisión quirúrgica fue realizada sin lesionar tracto urinario. Se realiza revisión de la literatura.

A case of paraurethral leiomyoma is reported in a female patient, with symptoms of a foreign body in the vagina and difficulty in urination. Physical examination reveals mass in the anterior wall of the vagina. The diagnosis was made by transperineal ultrasound. Surgical excision was performed without injuring urinary tract. Systematic literature review is performed.

Lipoleiomioma uterino: un hallazgo inusual / Uterine lipoleiomyoma: an unusual finding

Los tumores lipomatosos uterinos son lesiones generalmente benignas, de patogenia incierta y muy baja incidencia. Habitualmente se presentan en mujeres posmenopáusicas y el diagnóstico preoperatorio es difícil debido a que se confunden clínicamente y ecográficamente con leiomiomas. Usualmente son asintomáticos pero pueden manifestarse con metrorragia, dolor pélvico y masa palpable. El tumor lipomatoso uterino más frecuente es el lipoma mixto cuya denominación dependerá de las proporciones de tejido adiposo y conectivo que lo constituyan. El manejo puede ser conservador o quirúrgico dependiendo del tamaño y sintomatología de la paciente. Se presenta el caso de una mujer de 50 años, con un tumor uterino diagnosticado preoperatoriamente como leiomioma y con diagnóstico histopatológico de lipoleiomioma.

The uterine lipomatous tumors are usually benign lesions, of uncertain pathogenesis and very low incidence. They are often presented in postmenopausal women and the preoperative diagnosis is difficult because they are confounded clinically and sonographically with leiomyomas. They are frequently asymptomatic but may present with metrorrhagia, pelvic pain and palpable mass. The most common uterine lipomatous tumor is the mixed lipoma whose denomination depends on the proportions of fat and connective tissue. The conservative or surgical management will depend on the size of the tumor and the patient symptoms. We present a case report of a 50 year- old woman with a uterine tumor diagnosed preoperatively as leiomyoma and whose histopathological diagnosis was lipoleiomyoma.

Imaging Findings of Common Benign Renal Tumors in the Era of Small Renal Masses: Differential Diagnosis from Small Renal Cell Carcinoma: Current Status and Future Perspectives

The prevalence of small renal masses (SRM) has risen, paralleling the increased usage of cross-sectional imaging. A large proportion of these SRMs are not malignant, and do not require invasive treatment such as nephrectomy. Therefore, differentation between early renal cell carcinoma (RCC) and benign SRM is critical to achieve proper management. This article reviews the radiological features of benign SRMs, with focus on two of the most common benign entities, angiomyolipoma and oncocytoma, in terms of their common imaging findings and differential features from RCC. Furthermore, the role of percutaneous biopsy is discussed as imaging is yet imperfect, therefore necessitating biopsy in certain circumstances to confirm the benignity of SRMs.