Objective To investigate the expression and clinicopathological features of fumarate hydratase (FH) in multiple leiomyoma of the uterus. Methods Relevant clinicopathological data of patients with multiple leiomyoma of the uterus diagnosed pathologically between September 1, 2018 and August 31, 2019 were collected from the Department of Pathology of West China Second University Hospital. The morphology, FH protein expression and prognosis of FH negative patients were observed. Results A total of 900 patients were included. Among them, there were 825 cases of nonatypical leiomyomas, 36 cases of leiomyoma with bizarre nuclei, 34 cases of cellular leiomyoma and 5 cases of mitotically active leiomyoma. A total of 69 patients with negative FH expression were included, with an average age of (37.28±8.22) years. Among them, there were 43 cases of nonatypical leiomyomas, 19 cases of leiomyoma with bizarre nuclei, 6 cases of cellular leiomyoma, and 1 cases of mitotically active leiomyoma. At low magnification, staghorn shaped blood vessels, alveolar pattern edema, palisade distribution of smooth muscle cells and bizarre nuclei smooth muscle cells could be seen in patients with negative FH expression. At high magnification, cytoplasmic eosinophilicglobules andeosinophilic nucleolus surrounded by a halo could be seen in patients with negative FH expression. Among the 69 cases with negative FH expression, 60 cases (86.96%, 60/69) were followed up. All patients survived, of which 24 cases (40%, 24/60) recurred. Conclusion Immunohistochemically, the marker FH for multiple leiomyoma of the uterus is helpful to improve the identification of FH deficient leiomyoma in clinical work as well as early diagnosis in hereditary leiomyomatosis renal cell cancer syndrome.
Abstract: Objective To explore the outcomes of videoassistedthoracoscopic surgery (VATS) in the treatment of esophageal leiomyoma. Me thods [WTBZ] We reviewed and analyzed the clinical data of 87 patients with esophageal leiomyoma treated with VATS in Changhai Hospital of Second Military Medical University between June 2002 and January 2009. [WTHZ]Results [WTBZ]Videoassisted thoracoscopic leiomyoma enucleations was performed in 80 patients, whilea conversion to minithoracotomy was required in 7 others. All procedures werecompleted smoothly and the postoperative recovery was uneventful, without mortality or severe complications. The patients were drinking liquids from postoperative day 1 and were eating a normal diet from day 3. All patients were pathologically diagnosed with leiomyoma after operation. Followups of 6 months to 6.5 years (mean: 3.8 years) found no recurrence. [WTHZ] Conclusion [WTBZ]Videoassisted thoracoscopic enucleation can be the first choice for esophageal leiomyomas derived from lamina propria. Patients with esophageal leiomyomas of diameter gt;1.0 cm should be treated with VATS .
Objective To explore the minimal invasiveness and practability of combined video-assisted thoracic surgery (VATS) with two trocars and endoscopic ultrasonography (EUS) in the treatment of esophageal leiomyoma. Methods Between February 2007 and February 2012, we retrospectively analysed the clinical data of 166 patients who underwent various surgeries for the treatment of esophageal leiomyoma. Among them, 62 received routine thoracotomy (group A), 49 accepted conventional VATS surgery with three trocars (group B), and 55 underwent combined VATS surgery with two trocars and EUS (group C). Then, we summarized the clinical indexes of patients in all the three groups for further comparative analysis. Results There was no significant difference among the three groups in age, gender, and lesion location, origin level and size (P > 0.05). There were significant differences between group A and C in blood loss, surgery time, intraoperative localization, postoperative incision pain, hospitalization expenses, length of hospital stay, fasting time, pulmonary infection, and the complications during the follow-up (P < 0.05). There were significant differences between group C and B in blood loss, surgery time, intraoperative localization, fasting time and pulmonary infection (P < 0.05). Conclusion Combined VATS surgery with two trocars and EUS is safe, minimally invasive, thorough with few complications, which is worthy of clinical promotion.
ObjectiveTo investigate the clinical and imaging features of patients with pulmonary lymphangioleiomyomatosis (PLAM),to improve the knowledge of this disease. MethodsEighteen patients with PLAM admitted into Zhongshan Hospital between 2003 and 2013 were retrospectively analyzed. Relevant literatures were reviewed. ResultsAll the 18 cases were female and had dyspnea on exertion. Three of them suffered from chylothorax,6 from pneumothorax and 5 from hemoptysis. The high resolution CT (HRCT) findings in all the 18 cases showed multiple small cysts with thin wall diffusely distributing in the bilateral lung. PLAM was confirmed by biopsy in 14 cases. Pulmonary function tests in 4 cases showed obstructive ventilatory dysfunction. Nine cases (50%) were misdiagnosed as other diseases. All the patients were given symptomatic and supportive treatment. Literatures review showed that as a rare diffuse lung disease,PLAM is more common in women of childbearing age,mainly presenting with dyspnea,hemoptysis,pneumothorax and chylothorax. Diagnosis of the disease relies on medical history,HRCT features and lung tissue biopsy pathology. HRCT examination has diagnostic value for PLAM. Although anti-estrogen treatment has certain effects,rapamycin may be a promising drug for PLAM therapy. ConclusionPatients with PLAM have characteristic clinical and radiographic manifestations. Early diagnosis and effective treatment are keys to the management of patients with PLAM.
Objective To develop a novel methylene blue staining technique to localize small esophageal leiomyomas (<1.5 cm) and evaluate its feasibility. Methods Between January 2013 and October 2016, 9 patients with small esophageal leiomyomas (<1.5 cm) underwent thoracoscopic enucleation in Tongji Hospital. There were 5 males and 4 females with an average age of 51 years. We preoperatively injected 0.5–1.0 ml methylene blue in the submucosa adjacent to the tumors under the guidance of gastroscope. Then, we transferred the patients to the operating room. Results Staining was successful in 9 patients. The unstained tumor was exposed after the blue-stained mediastinal pleura and overlying muscle were incised longitudinally during video-assisted thoracoscopic surgery via one utility port. No abnormalities were detected in the esophageal mucosa. No major complications, such as esophageal leakage or esophageal diverticulum occurred. Conclusion Endoscopic methylene blue staining is safe and feasible for localizing small esophageal leiomyomas during video-assisted thoracoscopic surgery via one utility port. This method will enable enucleation precise and easy.
Objective To evaluate the diagnostic value of vascular endothelial growth factor (VEGF)-D detection for the diagnosis of lymphangioleiomyomatosis (LAM) by Meta-analysis. Methods Literatures published before August 2017 were retrieved from PubMed, Embase, China Biology Medicine database, China National Knowledge Internet, Wangfang, and VIP database to retrieve the study about VEGF-D detection for LAM. The studies were screened according to the inclusive and exclusive criteria, the data were extracted, the quality was assessed and the Meta-analysis was performed with related statistical software. Results Six primary studies were included and 521 patients met the inclusion criterion. The Meta-analysis showed the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of 0.75 [95% confidence interval (CI) (0.70, 0.79)], 0.95 [95%CI (0.91, 0.98)], 16.20 [95%CI (8.70, 30.19)], 0.20 [95%CI (0.10, 0.40)] and 89.49 [95%CI (38.46, 208.22)], respectively. The area under the curve was 0.953 9. Conclusions VEGF-D detection showes a good diagnostic value for LAM. A positive result is more clinical meaningful compared with a negative result, helping for the confirmation of the disease.