1/257. sciatic neuropathy secondary to a uterine fibroid: a case report.Lesions of the sciatic nerve outside the pelvis have been well described. Lesions within the pelvis, however, are far less common. We report the case of a 55-yr-old woman with a history of chronic low back pain who presented with progressive right buttock and posterolateral right lower limb pain associated with right foot numbness and tingling. She denied any associated low back or left lower limb pain. The patient was initially treated for a probable right lumbosacral radiculopathy, without improvement. A subsequent magnetic resonance image of the lumbosacral spine revealed multilevel disc degeneration at L3-4 through L5-S1, without disc herniation or canal stenosis. A magnetic resonance image of the pelvis revealed a markedly enlarged uterus, with a large pedunculated myoma impinging on the right sciatic foramen. The patient underwent a subtotal abdominal hysterectomy, with resolution of her right lower limb pain. This case illustrates the importance of considering intrapelvic causes of sciatic neuropathy. To our knowledge, this is the first reported case of sciatic neuropathy secondary to a uterine fibroid.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/257. Primary orbital leiomyoma and leiomyosarcoma.A case of an extremely rare primary orbital leiomyoma in a 25-year-old male patient is presented who had a lifelong history of deviation of the left eye globe with slight enophthalmos and reduced motility. Because of pain and increasing deviation of the eye the tumor was totally resected. On histologic examination the tumor showed ossification which is extremely rare so that a calcifying fibroma had to be ruled out. In immunohistochemistry, however, this tumor stained with smooth muscle antigen. Less than 2% of cells stained positive for Ki-S1, a proliferation marker. The second case is a rare primary orbital leiomyosarcoma in an 84-year-old female patient that showed massive growth. After exenteration histologic examination showed a dedifferentiated highly malignant soft tissue tumor which expressed desmin and smooth muscle actin but was negative for myoglobin, S-100 and HMB-45.- - - - - - - - - - ranking = 0.25keywords = pain (Clic here for more details about this article) |
3/257. Multiple piloleiomyomas associated with solitary angioleiomyoma.A 58 year-old male had reddish scattered papules strictly confined to the right side of his upper back and neck, right shoulder, and right upper arm. Additionally, he also noticed a subcutaneous nodule on his left thigh. Histopathological examinations revealed that the papules on the back, nape of the neck, shoulder, and arm were multiple piloleiomyomas, as shown by the proliferation of bundles of smooth muscles in the dermis. The subcutaneous nodule of the thigh was angioleiomyoma with a well-circumscribed lesion composed of smooth muscles and blood vessels. Ipsilaterality and segmentality of the distribution of the papules of piloleiomyomas and probable family history that his mother had similar papules with a similar distribution suggest the nevoid character of our case. Piloleiomyomas are often reported to be associated with leiomyoma of the uterus or other organs. This is the first reported case of multiple piloleiomyomas with solitary angioleiomyoma in the literature.- - - - - - - - - - ranking = 0.075187872524141keywords = upper (Clic here for more details about this article) |
4/257. Combined clear and granular cell leiomyoma of soft tissue: evidence of transformation to a histiocytic phenotype.AIMS: We present an unusual case of leiomyoma with a clear and granular cell pattern in which there was immunohistochemical evidence of transformation to a histiocytic phenotype. methods AND RESULTS: A 64-year-old man presented with mild scrotal swelling and pain. A local excision was performed after the clinical diagnosis of epidermal inclusion cyst. In the pathological specimen, another tumour nodule was identified which was composed predominantly of clear cells, with an occasional mixture of granular cells. Immunohistochemical analysis demonstrated positive staining for vimentin, lysozyme, CD68 and HAM56, but complete negativity for desmin, alpha-smooth muscle actin, HHF35, S100 protein, neurone-specific enolase and CD34. Ultrastructural study revealed dilated rough endoplasmic reticulum, glycogen granules, abundant vacuolar structures and also thin microfilaments with subplasmalemmal dense bodies. CONCLUSIONS: Based on these findings, we have interpreted it to be a rare case of leiomyoma with extensive clear cell and granular cell degeneration (combined clear and granular cell leiomyoma). This complete transformation of the immunohistochemical profile into the histiocytic phenotype has not been previously described in the literature.- - - - - - - - - - ranking = 0.25keywords = pain (Clic here for more details about this article) |
5/257. Case of the month: March 1999--A 26 year old hiv positive male with dura based masses.A 26-year-old male with AIDS presented with a chief complaint of headaches and neck pain. An MRI revealed two enhancing extra-axial dura based masses, one in the area of the left sphenoid wing and one at the level of C2-3. In both cases, microscopic sections showed actin positive spindle cell neoplasms with long slender nuclei, consistent with leiomyomas. Both tumors were positive for Epstein Barr virus by in situ hybridization. This case report serves to emphasize the importance of considering soft tissue tumors such as leiomyoma in the differential diagnosis of mass lesions that occur in the central nervous system in AIDS and discusses the role of EBV in tumorigenesis.- - - - - - - - - - ranking = 0.25keywords = pain (Clic here for more details about this article) |
6/257. Torsion of a functional ovarian cyst in a premenopausal patient receiving tamoxifen.We report a case of torsion of an ovarian follicular cyst that developed during treatment with tamoxifen for breast cancer. A 40-year-old Japanese woman was admitted complaining of acute lower abdominal pain. Eight months earlier, she had undergone a partial mastectomy and local irradiation for ductal carcinoma of her left breast, estrogen receptor-positive stage I (T(1a) N(1b) M(0)). The administration of tamoxifen, 20 mg/day, and doxifluridine, 600 mg/day, were started immediately postoperatively. Pelvic examination after admission revealed the left ovarian cyst and enlarged uterus. Transvaginal ultrasonography and computed tomography revealed a multilocular cystic mass in the pelvic cavity. The pathological diagnosis of the tumor after total hysterectomy and bilateral salpingo-oophorectomy was a typical follicular cyst with torsion and uterine leiomyoma. This ovarian cyst was believed to have developed during tamoxifen administration.- - - - - - - - - - ranking = 1.1462297574837keywords = abdominal pain, pain (Clic here for more details about this article) |
7/257. leiomyoma of the epididymis.Epididymal leiomyomas are rare intrascrotal neoplasms. It is a slow growing tumour and usually present as an enlarged, painless scrotal mass. A case with an unusual presentation is reported with a review of the possible sonographic findings of this entity and the differential diagnosis of a mass in the epididymis.- - - - - - - - - - ranking = 0.25keywords = pain (Clic here for more details about this article) |
8/257. Transcatheter uterine artery embolization for the management of symptomatic uterine leiomyomas.Transcatheter arterial embolization has been applied traditionally in obstetrics and gynecology for the emergency control of pelvic hemorrhage, usually after failure of conventional surgical measures. Pelvic trauma is the most common, nongynecologic etiology of uncontrollable pelvic hemorrhage requiring use of this hemostatic technique. Recently, elective transcatheter arterial embolization of uterine leiomyomas has been performed to decrease related symptomatology in an attempt to avoid surgical intervention. Our objective was to review current pertinent data regarding this new therapeutic modality. To this goal, all manuscripts published in the literature regarding this topic obtained from a medline search for 1966 through September 1998 were selected and reviewed. Additional sources were identified through cross-referencing. Currently, approximately 193 patients worldwide have been managed with this investigational procedure. Main indications include symptomatic uterine leiomyomata with menometrorrhagia, anemia, or pain. Success rates seem promising with a very low failure rate. This procedure results in significant (uterine and leiomyoma) volume reduction of between 20 and 80 percent. Postprocedural pain is common during the first day after the procedure, often requiring intravenous nonsteroidal antiinflammatory drugs and narcotic analgesia. Rare complications include endometritis, pyometra, and uterine necrosis, which may require hysterectomy. Reported follow-up time ranges between 6 and 60 months. Implications on subsequent fertility have not been established. Although successful pregnancies subsequent to this procedure have been reported, because of the unknown long-term effect of this procedure on fertility or perinatal outcome, this technique should not be performed when future fertility is desired. This review suggests that although not currently accepted as standard of care, transcatheter embolization of the uterine arteries can be considered as a nonsurgical technique for the management of appropriately selected patients. TARGET AUDIENCE: Obstetricians & Gynecologists, family physicians learning OBJECTIVES: After completion of this article, the reader will be able to explain the current indications and contraindications of transcatheter uterine artery embolization of leiomyomas; to identify the various complications of the procedure and the type of embolic materials used; and to estimate the success rate of this procedure in the current literature.- - - - - - - - - - ranking = 0.5keywords = pain (Clic here for more details about this article) |
9/257. hemoperitoneum from spontaneous bleeding of a uterine leiomyoma: a case report.Bleeding from uterine leiomyoma is a rare cause of hemoperitoneum. In most cases bleeding is a result of trauma or torsion. Spontaneous rupture of a superficial vein is extremely rare. Fewer than 100 cases have been reported. Our patient is a 44-year-old black woman who presented in the emergency room with acute onset of epigastric pain. Past medical and surgical history was not contributory except for a uterine "fibroid." In the emergency room, the patient's abdomen became diffusely tender. Her pregnancy test was negative, and the abdominal ultrasound showed fluid in the peritoneal cavity. The patient became hemodynamically unstable, and there was a significant drop of the hemoglobin/hematocrit. A surgical consultation was requested, and the patient underwent exploratory laparotomy. A subserosal uterine leiomyoma was found, with an actively bleeding vein on its dome. The leiomyoma was excised and 3 liters of blood and blood clots were evacuated from the peritoneal cavity. The patient was premenopausal and had a known leiomyoma. The clinical course was similar to that of previously reported cases. Although extremely rare, when there is no history of trauma, pregnancy, or other findings, spontaneous bleeding from uterine leiomyoma should be in the differential diagnosis. Emergent surgical intervention is recommended to establish the diagnosis and stop the hemorrhage.- - - - - - - - - - ranking = 0.25keywords = pain (Clic here for more details about this article) |
10/257. A huge 6.2 kilogram uterine myoma coinciding with omental leiomyosarcoma: case report.Surgery for massive abdominal tumors is both interesting and challenging. We present a case involving a multiple uterine myoma weighing 6.2 Kg which coincided with omental leiomyosarcoma. To our knowledge, this is the first report of this type of condition in the English literature. A 44-year-old nulliparous woman had suffered from abdominal pain for a long time. A huge abdominal mass was palpated on physical examination. Computed tomography scanning revealed a huge pelvic-abdominal mass with the possibility of small bowel loops invaded by the mass. A 6-cm omental mass was incidentally found during the subsequent hysterectomy procedure. Perforation of the urinary bladder occurred during the dissection of adhesion. Resection of the omental mass, wide wedge resection of the invaded small bowel, primary repair of the bladder, and hysterectomy were performed. The final pathologic diagnosis was uterine leiomyomata with omental leiomyosarcoma. The patient returned home on postoperative day 14 and was well at the 18-month follow-up examination. The challenge of these tumors lies in their proper diagnosis and surgical management. More case reports and follow-up studies are needed to confirm the efficacy of their management.- - - - - - - - - - ranking = 1.1462297574837keywords = abdominal pain, pain (Clic here for more details about this article) |
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