Vaginal superficial myofibroblastoma: a rare mesenchymal tumor of the lower female genital tract and a study of its association with viral infection.

Superficial myofibroblastoma is a rare mesenchymal tumor in the lower female genital tract. The exact etiology of superficial myofibroblastoma remains unclear. The association of viral infection and mesenchymal tumors has been well established in some particular types of soft tissue tumors. In the lower female genital tract, the intimate correlation of viral infection and tumor pathogenesis has been also proposed. We present a 59-year-old woman with postcoital bleeding for 1 month. The pelvic examination revealed a 2-cm polypoid mass mimicking leiomyoma at the vaginal fornix. Local excision was performed, and the pathological examination revealed a superficial myofibroblastoma. No tumor recurrence was noted during the 12-month follow-up. Pathological differential diagnosis of this tumor from other mesenchymal tumors is essential because of its distinct clinicopathological features. Furthermore, fluorescence in situ hybridization of human papilloma virus (HPV) and Epstein-Barr virus (EBV), as well as immunohistochemical staining of human herpesvirus 8 (HHV8), was negative in tumor cells. To the best of our knowledge, we are the first group to study the possible relationship of viral infection and the occurrence of this mesenchymal tumor. Our results suggested no association of vaginal superficial myofibroblastoma and infection with HPV, EBV, or HHV8.

Meigs' syndrome with elevated serum cancer antigen 125 levels in a case of ovarian sclerosing stromal tumor.

OBJECTIVE: Meigs' syndrome presenting as an ovarian tumor with elevated serum cancer antigen 125 (CA 125) levels is unusual. Only 37 cases have been reported, including three cases of ovarian sclerosing stromal tumor (SCT). Many reports have suggested that the presence of ascites is the major factor inducing mesothelial expression of CA 125. CASE REPORT: An 18-year-old woman presented with massive ascites, elevated serum CA 125 levels, and radiographic evidence of ovarian tumor. The histological and immunohistochemical examinations revealed a benign SCT. CONCLUSION: SCT is a benign ovarian tumor and complete excision is curative. We also review all 37 cases and discuss possible mechanisms of Meigs' syndrome and elevated serum CA 125 level.

Perivascular epithelioid cell tumor (PEComa) of the uterus with aggressive behavior at presentation.

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor composed of histologically and immunohistochemically distinctive perivascular epithelioid cells (PECs). Both benign and malignant tumors have been identified, but the criteria for diagnosis of malignancy have not been fully established due to the rarity of the tumor. We report on a case of uterine PEComa in a 33-year old woman with lymph node metastasis at presentation. The tumor had the characteristic histologic features of PEComa with cytologic atypia, mitotic activity of 2/10 high power field (HPF), and necrosis; it exhibited immunopositivity for HMB-45, calponin and desmin and was negative for melan-A. The patient received neoadjuvant chemotherapy, debulking surgery and adjuvant chemotherapy. No evidence of recurrence or metastasis was apparent 8 months after surgery.

Prenatal diagnosis of persistent right umbilical vein using three-dimensional sonography with power Doppler.

OBJECTIVE: To investigate the incidence and the importance of isolated persistent right umbilical vein (PRUV) in our obstetric population and to determine the role of three-dimensional (3D) ultrasound in prenatal diagnosis of isolated PRUV. MATERIAL AND METHODS: A total of 1,302 women who received regular antenatal care by a sole obstetrician at our hospital were prospectively evaluated between July 2003 and April 2005. Detailed anatomical evaluation of the fetus was performed by one sonographer. When the diagnosis of PRUV was made, it was confirmed by a senior obstetrician. 3D ultrasound with power Doppler was applied to delineate local anatomy. Echocardiography was performed in all the newborns by pediatric cardiologists to confirm the prenatal diagnosis and to evaluate for the presence of associated anomalies. RESULTS: Six fetuses with PRUV were detected among the 1,302 study subjects. The incidence of PRUV in our population was 0.46% (1:217 live births). Vascular anatomy was easy to demonstrate using 3D power Doppler. The ductus venous (DV) was present in all six fetuses. An atrial septal defect was shown to exist in four newborns by neonatal echocardiography, but spontaneous closure had occurred in the follow-up scan. CONCLUSION: PRUV is a common vascular anomaly that is easy to be overlooked. Reconstruction of the portal system in the affected fetuses using 3D ultrasound facilitated the identification of the DV. If the DV is present, and other anomalies are excluded, the fetus with PRUV has a good outcome.

The detection of ureteral injuries after hysterectomy.

STUDY OBJECTIVE: To identify the incidence and outcomes of ureteral injuries in patients undergoing hysterectomy, and to evaluate the effect of intraoperative cystoscopy and early postoperative ureteral jet ultrasonography. DESIGN: Retrospective comparative study (Canadian Task Force classification II-2). SETTING: Tertiary medical center. PATIENTS: Fifteen patients who experienced ureteral injuries while undergoing hysterectomy out of 4950 total patients during a 6-year period. INTERVENTIONS: All patients underwent hysterectomy, and intraoperative cystoscopy or early postoperative ureteral jet ultrasonography were used to evaluate ureteral integrity. MEASUREMENTS AND MAIN RESULTS: The incidence of ureteral injury recognized after hysterectomy was 0.32%, and all ureteral injuries occurred during laparoscopic hysterectomy. The initial detection of ureteral injury resulted from intraoperative cystoscopy in five patients, early postoperative ureteral jet ultrasonography in two patients, and signs and symptoms in eight patients. The patients whose injuries were detected by either intraoperative cystoscopy or early postoperative ureteral jet ultrasonography were diagnosed earlier (1.7 and 19.9 postoperative days, respectively; p<.01) and tended toward more conservative treatment (p=.119; OR=10; 95% CI 0.78-128.78) than those who were diagnosed based on signs and symptoms alone. CONCLUSIONS: Use of intraoperative cystoscopy or early postoperative ureteral jet ultrasonography leads to earlier diagnosis of posthysterectomy ureteral injury, thereby allowing for more conservative treatment.

Prenatal sonographic features of hypospadia: two- and three-dimensional findings.

OBJECTIVE: To present our experience of applying three-dimensional ultrasonography in prenatal diagnosis of hypospadia. CASE REPORT: A 28-year-old woman, gravida 1, para 0, visited our hospital at 17 weeks' gestation. No gross anomaly was found on the scan at 21 weeks' gestation. Fetal growth was appropriate for gestational age on two-dimensional (2D) ultrasonography at 27 weeks' gestation, but an abnormally curved and shortened fetal penis was found incidentally. Three-dimensional (3D) imaging in surface-rendered mode was used to reconstruct the fetal penis. Multiplanar and surface-rendered images were obtained in the midsagittal, axial, and coronal planes to precisely delineate the ventral curvature of the penis. At 39 weeks' gestation, a term newborn was delivered by vacuum extraction. On examination, the fetus was confirmed to have hypospadia. Karyotyping revealed 46,XY. CONCLUSION: 2D ultrasonography could only give indirect clues of hypospadia that was later more precisely delineated by 3D ultrasonography in surface-rendered mode.

Complex decongestive physiotherapy for patients with chronic cancer-associated lymphedema.

BACKGROUND AND PURPOSE: Lymphedema of the limbs after cancer therapy is the most common cause of lymphedema in developed countries. There is no cure for chronic cancer-associated lymphedema. Multidisciplinary complex decongestive physiotherapy (CDP) is commonly used as a primary treatment. This prospective study assessed the efficacy of intensive CDP treatment in chronic cancer-associated lymphedema. METHODS: Thirty women who had unilateral upper or lower limb chronic lymphedema after breast or pelvic cancer therapy were enrolled in the study. All patients received CDP once per day, in consecutive full treatment sessions, which took place between 4 and 21 times. Assessment of the results of therapy included measuring the circumference, calculated volume, and edema ratio (excess volume/unaffected side volume) of the limb volume. The main outcome measure was the percentage reduction in excess limb volume. RESULTS: The pretreatment edema ratio demonstrated a high correlation with the patient's age (r = 0.508, p = 0.004) and the duration of the lymphedema (r = 0.634, p < 0.000). After the intensive CDP, the limb circumference, calculated volume, and edema ratio were significantly reduced compared with their pretreatment values (p < 0.000). The mean percentage reduction of excess volume was 67.8 +/- 33.2% in all patients. CONCLUSIONS: Intensive CDP was effectively able to reduce the limb volume of patients with chronic cancer-associated lymphedema. Further follow-up study is needed to confirm the effectiveness of CDP in the maintenance phase, and its long-term effectiveness in Taiwanese.