Leiomyomas, originating in the bile duct, are very rare, and only few cases have been reported in the literature. We experienced a case of leiomyoma of the distal common bile duct, mimicking bile duct cancer. A 39-year-old woman presented with intermittent jaundice and general weakness for three months. Clinical profiles showed obstructive jaundice, and the abdominal computed tomography and cholangiography revealed diffuse bile duct dilatation with distal common bile duct stricture. A pylorus-preserving pancreaticoduodenectomy was performed and the pathologic specimen disclosed leiomyoma of the common bile duct accompanying severe fibrosis. This is the first case of leiomyoma in the bile duct reported in Korea.
Adult ; Common Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Female ; Humans ; Leiomyoma/*diagnosis/pathology/surgery ; Pancreaticoduodenectomy

While endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal tumors, it is rarely used for subepithelial tumors (SETs) originating from the muscularis propria of the esophagus and gastric cardia because of the risk of perforation and problems with inadequate space and field of view during procedures. Submucosal tunneling endoscopic resection (STER) is a new therapeutic method for treating SETs in specific locations in the esophagus and stomach. This technique is highly skill-dependent, using a mucosal flap that covers a deeper part of the gut wall, but is safe and minimally invasive compared with conventional endoscopic approaches such as ESD in SETs originating from the muscularis propria.We report a patient who underwent STER to remove a SET located at the gastric cardia. The patient recovered without any complications. We believe that our case shows the efficacy and safety of the STER technique for patients with a SET originating from the muscularis propria.
Cardia/pathology/surgery ; Endosonography ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Leiomyoma/*diagnosis/surgery ; Male ; Middle Aged ; Stomach Neoplasms/*diagnosis/surgery

Adult ; Female ; Humans ; Hysterectomy ; Leiomyoma ; diagnosis ; Middle Aged ; Muscle Neoplasms ; complications ; surgery ; Uterine Neoplasms ; complications ; surgery

OBJECTIVETo study the characteristics of diagnosis and surgical treatment of esophageal leiomyoma.

METHODSPreoperative radiology, esophagoscopy and results of surgical treatment were retrospectively analyzed in 141 patients with esophageal leiomyoma.

RESULTSDysphagia (64.5%) and chest or epigastric pain (20.6%) were the most common presenting symptoms with a mean duration of 15.7 months. Eleven patients had been misdiagnosed as malignant esophageal disease, mediastinal or retroperitoneal tumor before operation. Thirteen patents received partial esophageal resection, including 2 patients with gigantic tumor, 3 still misdiagnosed as malignancy in the operation theater and 8 accompanied with esophageal or gastric cardiac carcinoma. 128 patients were treated with tumor removal only, among whom the esophageal mucosa was ruptured and sutured in 13 patents. The tumor was single in 130 patients and multiple in 11 patients. The tumor shape was either oval, horseshoe-or ginger-like. Tumor surrounded the esophagus less than half circumference in 75 patients, more than half in 59 patients and involved the whole circumference in 7 patients. The tumor was polypoid and intraluminal in one patient. It was extraluminal in 2 patients and was intramural in all the others. The morbidity and 30-day mortality rates were 3.6% and 0%.

CONCLUSIONPreoperative differentiation of esophageal leiomyoma is important for it may be misdiagnosed as esophageal malignant disease or mediastinal tumor. Tumor removal only is indicated if possible. Biopsy is inadvisable if leiomyoma has been suspected by esophagoscopy. The incidence of esophageal carcinoma complicating esophageal leiomyoma is high, of which the reason needs further study.

Adolescent ; Adult ; Aged ; Esophageal Neoplasms ; diagnosis ; surgery ; Female ; Humans ; Leiomyoma ; diagnosis ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

INTRODUCTIONThe clinical management of Smooth Muscle Tumours of Uncertain Malignant Potential (STUMPs) remains controversial because little is known about the natural history of these tumours and pathological classifications do not correlate well with clinical outcomes and therefore cannot direct management. The objective of this study was to review a single institution's experience with STUMP and recommend a rational clinical approach to the management of patients with this histological diagnosis.

MATERIALS AND METHODSA systematic review of all diagnoses of STUMP and leiomyosarcoma from the gynaecologic oncology and pathology databases between January 1970 and February 2006.

RESULTSA total of 18 diagnoses of STUMP and 72 diagnoses of Ieiomyosarcoma were made during the study period. None of these 72 cases of leiomyosarcoma had a prior diagnosis of STUMP. There were no recurrences in the 18 cases of STUMP with all 18 cases being registered as disease-free after 5 years.

CONCLUSIONSWe recommend that patients with a diagnosis of STUMP be expectantly managed given the low likelihood of leiomyosarcomatous transformation, the lack of any evidence that adjuvant treatments result in better long-term outcomes and that recurrences are amenable to surgical resection with good outcomes.

Adult ; Female ; Humans ; Leiomyoma ; diagnosis ; pathology ; surgery ; Retrospective Studies ; Smooth Muscle Tumor ; diagnosis ; pathology ; surgery ; Uterine Neoplasms ; diagnosis ; pathology ; surgery ; Uterus ; pathology ; surgery

Diagnostic Errors ; Female ; Humans ; Hysterectomy ; Leiomyoma ; diagnosis ; surgery ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography ; Uterine Neoplasms ; diagnosis ; surgery ; Uterus ; blood supply ; diagnostic imaging ; Venous Thrombosis ; diagnosis ; surgery

BACKGROUND/AIMS: Submucosal tumors of the esophagus are rare lesions among all esophageal neoplasms. The purpose of this study was to evaluate the clinicopathologic features of esophageal submucosal tumors treated by surgical approach. METHODS: We analyzed the clinicopathologic and endoscopic ultrasonographic features of 18 esophageal submucosal tumors which were treated by surgical approach at Boramae Medical Center and Seoul National University Bundang Hospital from January 2005 to June 2012. RESULTS: The mean age was 48.9 years old and male to female ratio was 2.6:1. Asymptomatic patients were most common (77.8%). In endoscopic ultrasonographic finding, the majority tumor arouse in the middle (55.6%) and lower (44.4%) esophagus, and appeared as hypoechoic lesion (72.2%) in the 4th layer (83.3%). The most common indication for surgical approach was unclear biological behavior of the tumor. Minimally-invasive technique using thoracoscopy was applied for the enucleation (83.3%). The mean diameter of the tumor was 5.4 cm, and the final diagnosis was leiomyoma (89.9%) and gastrointestinal stromal tumor (11.1%). CONCLUSIONS: Leiomyoma was the most common submucosal tumor in esophagus. However, endoscopic ultrasonography was not able to differentiate between leiomyoma and gastrointesinal stromal tumor. For more accurate diagnosis and treatment, minimally-invasive approaches may be suitable for the surgical enucleation of indicated esophageal submucosal tumor.
Adult ; Aged ; Esophageal Neoplasms/*pathology/*surgery/ultrasonography ; Esophagus/pathology ; Female ; Gastrointestinal Stromal Tumors/diagnosis/surgery ; Humans ; Intestinal Mucosa/*pathology ; Leiomyoma/diagnosis/surgery ; Male ; Middle Aged ; Retrospective Studies ; Thoracoscopy

The technique of endoscopic submucosal dissection is occasionally used for resection of myogenic tumors originating from muscularis mucosa or muscularis propria of stomach and esophagus. However, endoscopic treatments for esophageal myogenic tumors >2 cm have rarely been reported. Herein, we report a case of large leiomyoma originating from muscularis propria in the upper esophagus. A 59-year-old woman presented with dysphagia. Esophagoscopy and endoscopic ultrasonography revealed an esophageal subepithelial tumor which measured 25x20 mm in size, originated from muscularis propria, and was located at 20 cm from the central incisors. The tumor was successfully removed by endoscopic submucosal dissection and there were no complications after en bloc resection. Pathologic examination was compatible with leiomyoma.
Esophageal Neoplasms/*diagnosis/pathology/surgery ; Esophagus/surgery/ultrasonography ; Female ; Gastroscopy ; Humans ; Leiomyoma/*diagnosis/pathology/surgery ; Middle Aged ; Mucous Membrane/pathology ; Stents ; Tomography, X-Ray Computed

INTRODUCTIONUterine fibroids are the most common type of gynaecologic benign tumours, occurring in 25% to 50% of women during their reproductive lives. About half of the affected women have clinically significant symptoms, including abnormal bleeding, menstrual pain, frequent urination, constipation and abdominal distension. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) has been used to treat patients with benign lesions and a variety of malignancies. The objective of this study is to evaluate symptom relief before and after MR-guided ultrasound ablation of fibroids.

MATERIALS AND METHODSA total of 37 patients with symptomatic uterine fibroids were treated in this study.

RESULTSMRgFUS treatment led to a significant, time-dependent decrease in not only Symptom Severity Scores (SSS), but also the mean fibroid volume. The average reductions in volume were 41.6% and 52.6% at 6 months and 12 months respectively (P <0.05). The mean SSS of the 37 patients was 41.7 ± 2.8 before treatment whereas the average SSS was 26.9 ± 3.6, 20.7 ± 3.4, 18.5 ± 3.6, 16.5 ± 7.1, 9.8 ± 3.6 at 3 months, 6 months, 1 year, 2 years, and 3 to 4 years respectively. The decrease in scores was significant at all time points up to 3 to 4 years (P <0.05 and P <0.001).

CONCLUSIONMRgFUS is a safe and effective non-invasive treatment for patients with symptomatic fibroids.

Adult ; Female ; Humans ; Leiomyoma ; diagnosis ; surgery ; Magnetic Resonance Imaging ; Middle Aged ; Prospective Studies ; Singapore ; Surgery, Computer-Assisted ; Treatment Outcome ; Ultrasonography, Interventional ; Uterine Neoplasms ; diagnosis ; surgery

A 47-year-old man presented with a scrotal swelling. Ultrasonography of the testes showed that it was an extratesticular swelling. However, the swelling was intraoperatively found to be intratesticular. Histology showed an intratesticular leiomyoma, which is extremely rare.
Diagnosis, Differential ; Humans ; Leiomyoma ; diagnosis ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Scrotum ; pathology ; Testicular Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Treatment Outcome ; Ultrasonography