Disseminated peritoneal leiomyomatosis

Disseminated peritoneal leiomyomatosis is usually discovered incidentally and symptoms are unusual. It occurs only in women. The lesions are completely benign and apparently undergo spontaneous regression, therefore minimal or no treatment is indicated after the diagnosis is confirmed by biopsy.     

Intravascular leiomyomatosis with uterine lipoleiomyoma

A very rare case of uterine lipoleiomyomata with intravascular leiomyoma in a 48-year-old woman is described. Located in the corpus of the uterus, the lipoleiomyomata showed proliferation of leiomyocytes intermingling with mature adipocytes. Intravascular leiomyoma was present in the broad ligament. It exhibited only spindle cells, and was reactive for HHF35 actin, without adipocytes. No continuity was detected between these tumors. Immunohistochemical studies revealed that the same portion of the intravascular leiomyoma was positive for S-100 alpha protein, NSE, factor VIII-related antigen, and HHF35 actin. These findings suggest that the leiomyomatous tumor components arise from multipotent undifferentiated mesenchymal stem cells.     

Multiple pulmonary leiomyomatosis hamartoma (author's transl)

The multiple pulmonary leiomyomatosis hamartoma (MPLH) is rare. Typical is the difference between the marked pulmonary alterations on chest X-ray film and the poor symptomatology. The (MPLH) is observed nearly only in women. The diagnosis is linked to pathological-histological findings.     

Cardiac extension of intravenous leiomyomatosis with successful resection

The density and fine structure of the peripheral nerve system in various skin lesions of 64 patients with atopic dermatitis (AD) was quantitatively analyzed by immunohistochemical staining with antibodies directed against protein gene product (PGP) and substance P (SP). The density of PGP-positive peripheral nerves was 2.5 x 10(3) microns2/delta s (delta s = 0.24 mm2 selected area) in early acute lesions, 3.8 x 10(3) microns2/delta s in subacute lesions, 4.9 x 10(3) microns2/delta s in lichenified lesions and 7.1 x 10(3) microns2/delta s in prurigo lesions of AD. The density of nerve fibers in subacute, lichenified and prurigo lesions was significantly higher than in uninvolved skin of AD patients (2.0 x 10(3) microns2/delta s). Electron microscopically, bulging of axons with many mitochondria and a loss of their surrounding sheath of Schwann cells suggests that the free nerve endings in skin lesions of AD are in an active state of excitation. Many pinocytotic vesicles in the periphery of basal keratinocytes facing nerve endings which contained many neurovesicles suggests reciprocal effects between keratinocytes and nerve endings. The number of SP-positive nerve fibers in AD lesions was far less than one-tenth of the number of PGP-positive nerve fibers.     

Diffuse peritoneal leiomyomatosis. A clinical case report

Leiomyomatosis peritonealis disseminata (LPD) is a rare condition characterized by numerous leiomyomas throughout the peritoneal cavity which appears grossly malignant but histologically benign. LPD occurs during reproductive age, especially the third and fourth decades. The etiology of the disorders is so far unknown, but presumedly hormonal. One case of LPD is presented and discussed. The patient, a 25-year-old nulliparous woman complained of aspecific colic type abdominal pain. Pelvic examination revealed a mass of about 4 x 5 cm occupying the cul de sac. Exploratory laparatomy revealed the mass and numerous nodules on the surface of the right ovary and of the omentum. After surgery no therapy was done and follow-up was done only by ultrasound. After 4 years follow-up the patient is well and is now pregnant at the XXV week of gestation. The number of cases of LPD documented in the literature to date is only about 50 cases, but they are likely to be much more, because of many asymptomatic cases. A conservative approach is recommended, but in the last years we have always had more reports of malignant degeneration (about 10%). So when surgical castration is not possible for age and or children desire, more aggressive follow-up should be recommended. In fact recidive is so far the most unfavourable prognostic factor.     

Triptorelin therapy in uterine leiomyomatosis. Study of 18 cases

Proximal spinal muscular atrophy (SMA) is an autosomal recessive disease in humans and other mammals, characterized by degeneration of anterior horn cells of the spinal cord. In humans, the survival of motor neuron gene (SMN) has been recognized as the SMA-determining gene and has been mapped to 5q13. In cattle, SMA is a recurrent, inherited disease that plays an important economic role in breeding programs of Brown Swiss stock. Now we have identified the full- length cDNA sequence of the bovine SMN gene. Molecular analysis and characterization of the sequence documents 85% identity to its human counterpart and three evolutionarily conserved domains in different species. Physical mapping data reveals that bovine SMN is localized to chromosome region 20q12-->q13, supporting the conserved synteny of this chromosomal region between humans and cattle.     

Two cases of metastasizing benign leiomyomatosis from myoma uteri]

Case 1. A 50-year-old woman was referred to our hospital because of multiple bilateral small round lesion on chest radiography. She had undergone total hysterectomy for myoma uteri at the age of 33. She underwent thoracoscopic tumor excision at left lung. The lesion was proved benign. Right side lesions were laterly excised using thoracotomy. Case 2. A 49-year-old woman was referred to us because of two ovoid lesion at left lung area of chest radiography. She also had undergone total hysterectomy for myoma uteri at the age of 37. She underwent tumor extirpation using thoracotomy. All samples of two patients revealed, pathologically, lesions were consisted of benign spindle-like calls similar to those of myoma uteri. Therefore, we consider these lesions were pulmonary metastasis of myoma uteri. Myoma uteri has certain potential of metastasizing to the lung, in spite of benign disease.     

Esophageal foreign bodies

BACKGROUND: Recent epidemiologic studies in Europe using antigliadin (AGA) and anti-endomysium antibodies (AEA) for initial screening have shown that the overall prevalence of celiac disease (CD) is about 1:300. There are no comparable scientific data for the USA, where CD is considered rare. The main aim of this study was to determine the prevalence of increased AEA in healthy blood donors in the USA. METHODS: Sera from 2000 healthy blood donors were screened for IgG AGA and IgA AGA with an enzyme-linked immunosorbent assay test. All those with increased AGA levels, those with intermediate levels, and random samples with low levels were tested for AEA, using both monkey esophagus (ME) and human umbilical cord (HUC) cryosections as substrates. RESULTS: The mean age of the blood donors was 39 years, with 52% being men, 85.2% being Caucasian, 11.8% African-American, 1.5% Asian, and 1.5% Hispanic. Eight healthy blood donors had positive AEA tests on both monkey esophagus and human umbilical cord. Among the eight subjects with increased AEA levels seven were Caucasian and one was African-American. All the four examined AEA-positive donors carried the known susceptibility alleles for CD. CONCLUSIONS: The prevalence of increased AEA levels in healthy blood donors in the USA is 1:250 (8:2000). This is similar to that reported in countries in Europe, where subsequent small-intestinal biopsies have confirmed CD in all those with AEA positivity. On the basis of a high positive predictive value of the AEA antibody test, it is likely that the eight blood donors identified in this study have CD. These data suggest that CD is not rare in the USA and that there is need for a large-scale epidemiologic study to determine the precise prevalence of the disease in the USA.     

Esophageal squamous carcinoma

Squamous cell carcinoma of the esophagus is a tumor with poor prognosis; it is usually in an advanced state when first diagnosed. Because a multimodal treatment approach is currently used, proper tumor staging is essential to determine whether therapy should be directed toward cure or palliation. Important prognostic features of squamous cell carcinoma include the depth of tumor infiltration into or through the esophageal wall and the presence of distant metastases. Imaging strategies should not be limited to visualization of the tumor but also should be directed toward accurate pretreatment staging. In this article, the authors review the use of barium swallow, CT scans, and endoscopic ultrasonography both alone and in combination to visualize and stage esophageal carcinoma. The strengths and limitations of each modality are also discussed.     

Esophageal intramural pseudodiverticulosis

Cows that develop a persistent lymphocytosis (PL) as a result of bovine leukemia virus (BLV) infection develop massive proliferation of B-lymphocytes expressing both IgM and CD5 markers. The association of these two markers on peripheral blood mononuclear cells (PBMC) derived from BLV-infected cows and also expressing BLV-gp51 antigen marker on these cells was determined by three-color cytometric analysis. After in vitro cultivation of PBMC in the presence of PHA for 24 h, the mean percentages of marker-reactive cells of five PL+ cows were as follows; 43% +/- 4.5 of the PBMC expressed BLV-gp51 antigen; 90% +/- 1.6 of these cells expressed both IgM and CD5 at the same time, whereas but 7.5% +/- 1.9 expressed only IgM and 2.9% +/- 0.4 expressed only CD5. The PBMC, IgM positive cells accounted for 77.8% +/- 6.8, while both CD5 and BLV-gp51 were detected simultaneously on 52.0% +/- 2.4 of the IgM+ cells, while the CD5 marker and BLV-gp51 antigen were detected independently on 35.0% +/- 1.9 and in 9.0% +/- 3.1, respectively of the IgM+ cells. Of the CD5+ cells (equivalent to 75.5% +/- 9.0 of the PBMC), 54.7% +/- 4.7 expressed simultaneously IgM and BLV-gp51, while BLV-gp51 and IgM were expressed separately by 3.0% +/- 0.5 and 37.8% +/- 3.3, respectively. An association between the B-cell phenotype and BLV tropism might exist. It is also possible that cells bearing both IgM and CD5 markers are the main target cells for BLV infection.     

Intravenous leiomyomatosis of the uterus: a clinicopathologic study of 22 cases

Sphingosine-1-phosphate (Sph-1-P) has been implicated as a second messenger in control of cell motility and proliferation (e.g., Sadahira Y, et al., PNAS 89:9686, 1992; Olivera A & Spiegel S, Nature 365:557, 1993). The control mechanism for its synthesis, as catalyzed by sphingosine kinase, is crucial in signal transduction. Synthesis of Sph-1-P in Balb/c 3T3 fibroblasts (A31 variant) is strongly up-regulated by brief treatment of cells with 12-O-tetradecanoylphorbol-13-acetate (TPA). Level of Sph-1-P in PKC-depleted cells is 10-fold higher than in undepleted cells, and a further 5-fold increase occurs after treatment with TPA. In Swiss 3T3 and B16 melanoma cells, Sph-1-P level was unaffected by TPA treatment. Thus, the effect of TPA on Sph-1-P synthesis appears to be cell type-specific.     

Esophageal resection for cancer

Currently, relatively safe, reliable resection techniques are available for most patients with esophageal carcinoma who present with nonmetastatic disease. For optimal results, the surgeon must be familiar with both transhiatal and transthoracic approaches and must individualize the approach depending on the tumor size and location and the patient's functional status. Whereas post-resection survival rates are good for patients with early-stage disease (Stage I or IIa), most patients present with locally advanced, Stage III disease. Although some progress has been made in the past decade in regard to early diagnosis among patients with Barrett's metaplasia undergoing endoscopic surveillance and additional progress has been made in adapting multimodality treatment programs successfully to patients with locally advanced disease, the overall cure rate for patients with esophageal carcinoma remains low.