Leiomyoma cellulare in the broad ligament of the uterus.

There are only two reports on leiomyoma cellulare (LC) in the parametrium that have been published so far. Aim of the study was analysis of two cases of LC in the parametrium diagnosed postoperatively, and review of literature on the subject. Case 1: A 50-year-old patient was operated on for LC located in the right parametrium and concomitant malignant tumour in the right ovary. Leiomyoma cellulare was resected, hysterectomy and bilateral appendectomy performed, and bilateral iliac and obturator lymph nodes excised. Case 2: A 46-year-old patient was operated on for giant LC, on the left side, reaching the retroperitoneal space in the meso- and epigastrium. Leiomyoma cellulare was resected, and hysterectomy and bilateral appendectomy performed. The patient was reoperated twice due to haemorrhage within 24 hours following the operation. A literature review found reports on two cases of LC in 29- and 50-year-old patients with LC in the parametrium, located on the right and left side, respectively. Casuistic location of LC in the parametrium justifies reporting the cases in the literature. Preoperative diagnosis of LC in the parametrium is difficult. Conservative treatment, i.e. myomectomy should be reserved for those patients who wish to maintain fertility.

Leiomyoma and leiomyoma cellulare of the fallopian tube: review of the literature and case reports.

INTRODUCTION: Leiomyoma of the fallopian tube is extremely rare, and its version - leiomyoma cellulare (LC) of the fallopian tube is absolutely unique. Aim of the study was to review literature reports on leiomyomas of the fallopian tubes, and to present cases of leiomyoma and LC of the fallopian tubes in the patients operated on in our ward. MATERIAL AND METHODS: There were fewer than 100 cases of leiomyomas of the fallopian tubes discussed in the literature up to 1993. Case 1. Leiomyoma of the left fallopian tube was detected postoperatively in a 68-year-old patient, G.K., on histopathological examination after laparoscopic total hysterectomy with bilateral adnexa. Case 2. A 56-year-old patient, K.T., with LC of the fallopian tube was qualified for laparoscopy. At operation, the procedure was converted to microlaparotomy due to the tumor size. The adnexa on the right side with the tumor of the fallopian tube were excised, and the left fallopian tube was excised, too. Histopathological microscopy found leiomyoma cellulare partim epithelioides. RESULTS: In the presented cases, the extent of operation was connected with the clinical picture, and in the case of LC of the right fallopian tube, with intraoperative histopathological findings. In both cases the postoperative course was uneventful. CONCLUSIONS: Diagnosis of leiomyoma and LC of the fallopian tube, like in the other organs of the female genital tract, is possible only due to results of histopathological microscopy.

Uterine angioleiomyoma - a rare variant of uterine leiomyoma: review of literature and case reports.

INTRODUCTION: Uterine angioleiomyoma (AL) is an extremely rare variant of uterine leiomyoma. It is composed of smooth muscle cells and thick-walled blood vessels. Angioleiomyoma usually occurs in middle-aged women, 40-60 years old. Aim of the study was to review of literature research reports on uterine AL. Discussion of nine case reports of uterine AL in the patients operated on in our ward. MATERIAL AND METHODS: The paper presents analysis of accessible research reports on uterine AL, and medical records of the patients operated on in our ward. RESULTS: Mean age of the patients with uterine AL was 47.11 ±5.21, body mass index (BMI) 25.88 ±3.95. All women had given birth (1-5 natural deliveries, 2.44 mean). Uterine AL occurred in 0.34% to 0.40% cases of leiomyomas. Angioleiomyoma were located intramurally and subserosally in six and three patients (respectively, 66.7% and 33.3%). Laparotomy was undertaken in seven cases (77.8%), transvaginal access in two cases (22.2%), and myomectomy in one case (11.1%). Blood transfusion was required in four cases (44.4%). CONCLUSIONS: In the group of uterine leiomyomas, uterine ALs occurred in 0.34-0.40% of cases. Angioleiomyoma cases posed a greater risk of complications threatening the patient's health and life. Preoperative differentiation of AL with ovarian tumour was more difficult due to frequent degenerative lesions in the course of uterine AL.

Prevalence of cellular leiomyoma and partially cellular leiomyoma in postoperative samples - analysis of 384 cases.

OBJECTIVES: The aim of the study was to evaluate the prevalence of cellular leiomyomas and partially cellular leiomyomas in postoperative samples. MATERIAL AND METHODS: A total of 2144 cases of uterine leiomyomas were diagnosed in postoperative samples at the Department of Obstetrics and Gynecology, RSzS, Radom, Poland, between 1998 and 2014. We analyzed 384 cases which were subdivided into 4 groups, taking into account the co-occurrence of leiomyomas and/or endometriosis. The following variables were investigated: age, weight, BMI, parity, type of surgical procedure, prevalence of atypical and borderline tumor forms, and concomitant malignancy of the reproductive system. RESULTS: The prevalence of cellular leiomyomas and partially cellular leiomyomas was estimated at 17.9%. Nulliparous patients were significantly more numerous in the subgroups without endometriosis. Concomitant malignancy of the reproductive system was > 2 fold more commonin the subgroups with endometriosis as compared to the other subgroups. CONCLUSIONS: The fact that cellular leiomyomas have a varying degree of cell atypia, together with clinical observations reported in the literature, support the view that cellular leiomyomas and partially cellular leiomyomas can progress to malignant leiomyosarcoma (LMS). Hysterectomy and the subsequent follow-up should be the mainstay of therapy for cellular leiomyoma. Conservative management (myomectomy) should be recommended only tothose patients who wish to preserve their fertility.

Clinical analysis of 52 obstetric hysterectomies.

OBJECTIVES: Analysis of obstetric (peripartum and postpartum) hysterectomies with regard to their frequency, indications, complications, and risk factors. MATERIAL AND METHODS: The study included 52 women operated between 1985-2012. Obstetric hysterectomies were performed in 39 (75%) and 13 (25%) women, respectively. The results were statistically analyzed as arithmetic mean and standard deviation (SD). RESULTS: Peri- and postpartum hysterectomies accounted for 0.123% of all births (0.092% and 0.031%, respectively). Mean pa-tient age, length of pregnancy, and number of deliveries was 32.6 years [SD ± 6.2], 38.1 weeks [SD ± 7.0], and 3.2 [SD ± 2.4], respectively. In the study group, 92.31% of the women were multiparous, and 86.54% gave birth by cesarean section and had a history of CS. Placental pathology accounted for 44.4% of indications for hysterectomy. Blood transfusion was required in 94.2% of the cases, symptoms of hypovolemic shock were observed in 21.2%, and ICU admission was required in 15.4% of the patients. Relaparotomy was necessary in 4 (7.7%) cases. Intrauterine fetal death occurred in 4 (7.6%) cases and extremely poor neonatal status was observed in 4.1% of the newborns. CONCLUSIONS: Hemorrhage due to placental pathology was the most frequent indication for obstetric hysterectomy. Risk factors for obstetric hysterectomy included multiparity, history of CS, recent CS, and age > 35 years. Postpartum hysterec-tomy accounted for 25% of the obstetric surgeries.

[PEComa of the uterus--a case report]. / PEComa trzonu macicy--opis przypadku.

INTRODUCTION: Soft tissue sarcomas constitute about 1% of all malignancies registered among adult population. In Poland its incidence is less than 1.000 new cases per year They can occur in any anatomical locality with approximately 20% found in the peritoneal cavity. One of them is an extremely rare mezynchemal tumor originating from epithelioid tissues, i.e. perivascular epithelioid cell tumor (PEComa). It was first reported in 1991 and in 1996 the name PEComa was proposed for the tumors that originate from the perivascular epithelioid cells. So far 100 cases of PEComa have been described, with 1/3 of them located in the uterus. In most reports the disease follows a mild course, although there are also reports on its recurrence after several years from initial detection. Additionally the reports emphasize difficulties to differentiate them from leiomyosarcomas. PURPOSE: The article presents a rare case of PEComa located in the uterine corpus in a 26-year-old patient. CASE STUDY: A 26-year-old woman operated on for USG findings and increased betahcg with suspected ectopic pregnancy USG scan revealed hyperechogenic mass, 4 cm in diameter well vascularized with low resistance, with hypoechogenic space of 5.8 mm in diameter. No gestational sack was seen inside the uterus. The ovaries were normal on USG. No free fluid was visualized in the abdominal cavity. A mass of 4 cm in diameter located in the right round ligament of the uterus, with firm margins, covered by the peritoneum was totally enucleated by laparoscopy SUM-UP: PEComa is a rare soft tissue tumor often originating from the uterus. In some atypical uterine tumors gynecologist should consider its occurrence and plan the surgery accordingly