Retained myoma after laparoscopic supracervical hysterectomy with morcellation

Leiomyoblastomas account for a small percentage of smooth muscle tumors of the stomach. Intraperitoneal bleeding is an unusual and unexpected presenting sign. We herein present a 43-year-old woman who was urgently operated on due to signs of collapse. A large hemorrhagic mass measuring 25 x 18 x 15 cm was found arising from the greater curvature of the stomach. A histologic examination demonstrated rounded and spindle cells, and rare mitoses were also seen. Although the number of mitoses was small, the lesion was nevertheless felt to be consistent with malignant leiomyoblastoma because of its large size. Three years later the patient is doing well with no evidence of tumor recurrence. We conclude that intraperitoneal bleeding due to leiomyoblastoma of the gastrointestinal tract is an extremely rare phenomenon and has been described only in a few reports, and only one other previous case presented with signs of collapse.     

Laparoscopic resection of gastric leiomyoblastoma

Smooth muscle gastric tumors represent 2% of resected neoplasms of the stomach. Clinically, they are often silent and incidentally found at endoscopy or radiologic examination. These tumors can be histologically classified as benign (leiomyoma) or malignant (leiomyoblastoma), but clinical behavior is not strictly related to this classification. When symptomatic, they are present with anemia in 50% of cases due to mucosal ulceration. Surgical removal of the tumor is the accepted therapy, leaving a margin of surrounding free tissue: this treatment can be performed by laparoscopy, usefully associated with gastroscopy. We present one case of a patient with severe anemia due to bleeding from an ulcerated leiomyoblastoma 5 cm in diameter that we resected with combined gastroscopic-laparoscopic technique. We isolated the portion of gastric wall where the mass was located and resected the specimen under gastroscopic control. The postoperative period was uneventful, and the patient recovered promptly with minimal pain and discomfort.     

Magnetic resonance imaging in the diagnosis of jejunal leiomyoblastoma

We report a case of large leiomyoblastoma of the jejunum. The sagittal views in pre-operative magnetic resonance imaging (MRI) indicated that a cystic tumor with solid component was present, sequential from the small bowel. We suspected a smooth muscle tumor of the small bowel, but did not rule out the malignancy. The operative diagnosis was smooth muscle tumor of the proximal jejunum, and partial resection of the small bowel was performed. The pathological examination revealed benign leiomyoblastoma of the jejunum without metastasis. MRI contributed to the pre-operative diagnosis of the origin of this rare tumor, in a non-invasive fashion.     

Characterization of 5-HT receptors in rat proximal colon

Gastric leiomyoblastoma is a rare entity. In this report, we describe the magnetic resonance (MR) appearance of a recurrent gastric leiomyoblastoma 14 years after initial presentation. This tumor was heterogeneous and moderately low signal intensity on T1-weighted images and heterogeneous and moderately high signal intensity on T2-weighted images. The tumor also contained foci of low signal intensity on the post gadolinium images, consistent with areas of necrosis. The mass enhanced mildly and increased in enhancement on the delayed images, consistent with a hypovascular mass. Multiple liver metastases were noted. Magnetic resonance findings were confirmed with surgical specimens.     

Surgical treatment for primary cardiac malignant lymphoma

A 60-year-old woman who complained of palpitation was diagnosed as ventricular tachycardia on electrocardiography and admitted to our hospital. The ultrasonic cardiography showed cardiac tumor in right ventricle and right atrium. Due to the obstruction of the right ventricle inflow by the tumor, we immediately performed resection of cardiac tumor and repair of right ventricle wall under cardiopulmonary bypass. The tumor was diagnosed as malignant lymphoma by pathological examination for surgical specimen of tumor. After operation her general condition was good, but residual cardiac lymphoma developed large size. We performed radiation therapy for cardiac lymphoma. Therefore the lymphoma was reduced to minimum size. Six months after operation metastatic malignant lymphoma appeared at whole body. So we performed chemotherapy for reduction of systemic malignant lymphoma. At first the chemotherapy was very effective. But metastasis spread rapidly and effectiveness of chemotherapy reduced. Thirteen months after operation she died for respiratory distress, probably due to metastatic brain tumor.     

Surgical treatment of primary neurogenic mediastinal tumors

In the years 1968-1989 out of 300 patients with surgically treated mediastinal tumors in 63 (21%) they were of neurogenic origin. Eighteen of these (29%) proved to be malignant. These tumors occurred in 23 males and 40 females, age range 14 months-67 years (mean 36 years). In all 45 patients with benign tumors and in 12 (66.7%) with malignant tumors the tumors were totally resected. In 4 patients the tumor was only partially resected in further two only a biopsy of the lesion was taken. During postoperative period one patient with a malignant tumor died. Ten (71.4%) patients survived 5 years with malignant lesions, while only 8 (61.5%) survived ten years. All patients that underwent resection of the benign tumor survived 10 years.     

A case of primary cardiac hemangiosarcoma

A case of primary hemangiosarcoma of right atrium was reported. The patient was 43 years old female. She had the symptoms of tamponade due to massive bloody pericardial effusion. Echocardiography, computed tomography, NMR imaging and angiography revealed the precise delineation and extension of tumor, and also allowed diagnosis of hemangiosarcoma. Extirpation of tumor was performed under the cardiopulmonary bypass. The patient was died 3 months later after the operation for liver metastasis. The bloody pericardial effusion seems to be an important symptom of the primary malignant cardiac tumor, and early and precise diagnosis may allow successful operation and long survival of the patients.     

Incidence of implantable defibrillator discharges after coronary revascularization in survivors of ischemic sudden cardiac death

Coronary revascularization has been suggested as sole therapy for secondary prevention of sudden cardiac arrest associated with ischemia. The use of implantable defibrillators (ICD) in combination with coronary revascularization for this patient population is unclear. Among 412 consecutive patients receiving an ICD, 23 (6%) were identified as sudden cardiac arrest survivors who were noninducible with programmed stimulation and had unstable angina or ischemia on a functional study; they underwent successful coronary revascularization. During a follow-up of 34 +/- 18 months, 10 (43%) of the 23 patients received ICD shocks (8 +/- 8 per patient, range 1 to 22 shocks), and nine of the 10 patients had syncope/presyncope associated with at least one ICD discharge. Patients with ICD discharges were compared with those without ICD discharges, and no clinical characteristics were statistically different between the two groups. In conclusion, revascularization alone may be inadequate therapy for survivors of sudden cardiac arrest associated with ischemia who are noninducible with programmed stimulation, and clinical variables cannot predict which patients are likely to have recurrent malignant ventricular arrhythmias.     

Comparison of dose standard units for drug utilisation studies

Primary malignant melanoma of the esophagus is rare. We identified one patient over a period of 15 years. This patient was a 80 years-old caucasian man. No association was found with tobacco or ethanol use, nor was there a personal or family history of malignant melanoma. Symptoms were related to obstruction. This tumor was polypoid in its upper part and ulcero-infiltrant in its lower part. Histologically the melanoma had epithelioid spindle cells. The neoplasm was immunoreactive for S-100 protein and non reactive with anti-cytokeratins. This patient was treated by Garlock type, esophagectomy with excision of 13 cm of esophagus and 2 cm of stomach. The survival was of only 3 days, because he developed acute respiratory and cardiac disease syndrome and died.     

Cardiac malignant pheochromocytoma with bone metastases

A patient with malignant cardiac pheochromocytoma with bone metastases is described. The primary tumor was located between the pulmonary trunk and the left atrium, while metastatic lesions were found in the iliac bones. Treatments with antihypertensive agents, alpha-methylparatyrosine, and combination chemotherapy with cyclophosphamide, vincristine, and dacarbazine partially improved the patient's symptoms, catecholamine levels, and the metastatic lesion of the iliac bones. However, the primary tumor in the heart progressively increased in size and the patient died of disseminated intravascular coagulation and other various complications about 4 years after the diagnosis of the disease.     

Six-year survival after excision of cardiac malignant lymphoma

We report a patient with a postoperative survival period of 6 years after the surgical excision of a cardiac malignant lymphoma. A 35-year-old woman underwent total excision of the tumor arising from the left ventricular outflow tract. After the operation, she was treated with chemotherapy for 6 months. She has been doing well thereafter without any medication. To date there is no evidence of recurrence.     

Malignant blue nevus with metastasis to lymph nodes and brain

We report a patient who developed malignant transformation of a cellular blue nevus. At the age of 19 years the congenital, pigmented tumor on the left buttock was histopathologically diagnosed as cellular blue nevus. Thirty years later the tumor dramatically increased in size, involving the entire left buttock within several months. Multiple biopsies revealed the presence of a cellular blue nevus within the papillary dermis and an invasive, pleomorphic pigmented sarcoma in the depth of the tissue spreading into subcutis and skeletal muscle. Both benign and malignant cells were S100+, vimentin+ and HMB-45+, but only the malignant tumor cells stained positive for the proliferating cell nuclear antigen. General examination disclosed multiple metastases in the paraaortal lymph nodes and the retroperitoneum as well as a single brain metastasis. Despite palliative therapy with ionizing radiation and chemotherapy, the patient developed generalized metastases and died within weeks. This case clearly confirms that cellular blue nevi have the potential for malignant transformation and that the malignant variant may behave aggressively just as a malignant melanoma.     

Primary bilateral malignant melanoma of the choroid (author's transl)

Report on an extremely rare case of primary bilateral malignant melanoma of the choroid with histological verification of both tumors. The patient was a 54-year-old woman; the presumptive clinical diagnosis was a primary bilateral melanoblastoma. A thorough general examination did not reveal any metastases. Six months later the patient underwent surgery. The left eye, in which the tumor was larger, was enucleated and a B-type malignant melanoma of the choroid with invasion of the sclera was diagnosed histologically. Two months later the patient died of a lung embolism. Histological verification of the tumor of the right eye led to the same diagnosis as in the left eye, but without invasion of neighbouring structures. No distant metastases were found at autopsy. A thin layer of slender spindle nevus cells was found between the tumor and the sclera during the histological study. The author agrees with Yanoff and Zimmerman (1967) that this may be regarded as the origin of the malignant tumor.     

Malignant carcinoid tumor and synchronous malignant extraadrenal paraganglioloma

Gastrointestinal carcinoid tumor is often considered the most common neuroendocrine tumor of the small intestine. The overall incidence of 1% in the general population is quite low. Extraadrenal paragangliomas are rarer still, and the incidence of both of these tumors in the malignant state is exceedingly rare. This article describes the case of a patient who had both a malignant carcinoid tumor as well as a malignant retroperitoneal paraganglioma occurring synchronously. A review of the literature concerning these tumors is also presented.     

Salazopyrine and male fertility

We report on a young patient with a positive family history for malignant hyperthermia (MH), who was diagnosed as susceptible to MH in our malignant hyperthermia laboratory by the in vitro-contracture test. Prior to the investigation of MH-susceptibility, the patient had been on medication with moclobemide, a monoamine oxidase (MAO) inhibitor, over a period of 13 months for treatment of a hyperactivity disorder. During the therapy with moclobemide no signs of relevant side effects were observed. However, some authors regard MAO-inhibitors as MH-triggering agents. The risk of MH-patients due to the therapy with MAO-inhibitors and the association between MH and the neuroleptic malignant syndrome is discussed in this case report.     

Laparoscopic adrenalectomy in asymptomatic pheochromocytoma

A patient with asymptomatic pheochromocytoma associated with catecholamine hypersecretion but no hypertension was treated by right laparoscopic adrenalectomy. The 63-year-old male patient was referred to us for treatment of an incidentaloma. The diameter of the adrenal tumor was 50 mm, and the peripheral blood nonrepinephrine level was 1.12 ng/ml (normal level, 0.4 ng/ml). Blood pressure was normal. A flexible electron laparoscope was used for open laparoscopy, and four trocars were inserted. The retroperitoneum was incised to the right of the inferior vena cava, and the tumor was excised. During the operation, blood pressure rose transiently, and a blocker and nitroglycerin were administered. The tumor bled extremely easily. The duration of surgery was 3 hours and 20 minutes, and blood loss was 210 ml. The excised tumor was 55 mm in diameter. The patients's postoperative course was uneventful. If the size of asymptomatic pheochromocytoma is not large, and blood pressure and cardiac function are stable, laparoscopic adrenalectomy is indicated for this type of tumor as long as it is performed by experienced surgeons.     

A rare case of primary malignant mesothelioma originating from the rectovaginal tissue

A 35 year-old female patient with pelvic malignant mesothelioma is described. The patient underwent total pelvic exenteration due to a pelvic tumor. Macroscopically, the resected tumor was located in the rectovaginal lesion with invasion into the rectal and vaginal wall, and around the internal urethral ostium. Light microscopically, the tumor predominantly consisted of sheets of plump round cells with acidophilic cytoplasm, and focally of tumor cells showing papillary growth pattern. The tumor cells showed remarkable cellular pleomorphism, and were both alcian blue and periodic acid-Schiff stain negative. Electron microscopically, these tumor cells had numerous long bush-like microvilli on their surface with increased length/width ratios. Positive staining with epithelial membrane antigen, cytokeratin, and vimentin, and negative staining with the carcinoembryonic antigen and S-100 protein were observed immunohistochemically. Based on these histological and immunohistochemical estimations, the tumor was diagnosed as a primary malignant mesothelioma originating from the rectovaginal tissue. Review of the literature confirmed the rarity of pelvic malignant mesothelioma. The possibilities of the pathogenesis of the tumor include the tumor's arising from the peritoneal remnant in the rectovaginal tissues, or from the epithelium of the secondary Mullerian system, which shares the same ancestry with the peritoneum.     

Right atrial metastatic melanoma in a patient with transient ischemic attacks

A 65-year-old-man was admitted for evaluation of a transient ischemic attack. A 4.5 x 5.3-cm right atrial mass and a patent foramen ovale were identified by echocardiography. A 0.5-cm lesion was identified in the left temporal lobe of the brain by magnetic resonance imaging. Positron emission tomography was used to differentiate a tumor from an infarct in the brain. The cardiac and the brain lesions were successfully resected. Histopathologic study of the atrial and cerebral tissue demonstrated that these were metastases from a previously excised scalp desmoplastic malignant melanoma. The patient remains well at 14 months' follow-up.     

Diabetes insipidus, Sheehan''s syndrome and pregnancy

We diagnosed a case of primary cardiac lymphoma using transthoracic needle biopsy. A 70-year-old man was admitted because of dyspnea. Magnetic resonance imaging revealed a tumor mass in the right ventricular free wall. We performed ultrasound guided transthoracic needle biopsy using an 18-G needle, and diagnosed as malignant lymphoma by the biopsy specimen. This method may be useful for the diagnosis of cardiac lymphoma.     

Child psychiatric consultation service to community agencies: a collaborative approach involving three community agencies

A patient with malignant mixed tumor of the parotid gland with myoepithelial carcinomatous and papillary cyst adenocarcinomatous components is presented. Clinically the patient had a giant mass in the parotid location for 20 years, with a growth progression during the last 6 months. The undefined connection of two carcinomatous components of malignant mixed tumor is reviewed.