Benign metastasizing leiomyoma (BML) is composed of well-differentiated smooth muscle cells and dense connective tissue. BML affects middle-aged women who have had previous hysterectomies due to a histologically benign-appearing uterine leiomyoma. We report here on a case of BML from the uterine leiomyoma in a 39-year-old woman that involved the soft tissues, skeletal muscles, lungs and breasts. She underwent a hysterectomy for the uterine leiomyoma, double oophorectomy for hormonal ablation and lung wedge resection to confirm the diagnosis. The microscopic findings of the breast and lung tumor were similar to those of the benign uterine leiomyoma. Therefore, we consider that these lesions were breast and pulmonary metastases of the uterine leiomyoma. We report here on a rare case of benign metastasizing uterine leiomyoma that involved the soft tissue, skeletal muscles, lungs and breasts, and we include a review of the relevant literature.
Uterine Neoplasms/*pathology/surgery ; Tamoxifen/therapeutic use ; Soft Tissue Neoplasms/*secondary ; Muscle, Skeletal/pathology ; Muscle Neoplasms/*secondary ; Lung Neoplasms/*secondary ; Leiomyoma/drug therapy/*pathology ; Hysterectomy ; Humans ; Female ; Breast Neoplasms/*secondary ; Antineoplastic Agents/therapeutic use ; Adult

OBJECTIVETo investigate the reasons for the rarity of metastases in skeletal muscle.

METHODSBy injecting tumor cells (Walker256 rat carcinosarcoma) through the iliac artery (experimental group) and the tail vein (control group), animal models of blood-borne metastases were established. The quadriceps femoris muscle and lungs were observed grossly and microscopically. Immunohistochemistry was applied to investigate the expression of vascular cell adhesion molecule-1 (VCAM-1) in the microvascular endothelium of these organs. Primary culture of rat skeletal muscle cells was established and conditioned medium (MCM) was collected. Effects of MCM on several tumor cell lines and the biochemical characteristics of skeletal muscle delivered tumor factor(s) were tested by MTT assay. Apoptosis and morphological examination were carried out to investigate the antitumor mechanisms of MCM.

RESULTSIn the experimental group, there were no definite metastases observed in muscle cells. In the control group, lung metastases were present in the lungs of all rats that were sacrificed at the 14th day or died spontaneously (17 rats in all). There was no significant difference between the increase in VCAM-1 in quadriceps femoris muscle 7 days after iliac artery injection and that in lungs 7 days after tail vein injection (P > 0.05). In vitro studies showed that the proliferation of tumor cell lines of mouse SP2/0 myeloma, rat Walker256 carcinosarcoma or human chronic granulocytic leukemia K562, human acute lymphatic leukemia HL-60, LS-174-T colon adenocarcinoma, PC3-M prostatic carcinoma and lung giant cell carcinoma with different metastatic potency (PLA801-C with low metastatic potency, PLA801-D with high metastatic potency) was significantly inhibited when cultured with MCM (P < 0.01 - 0.05). Proliferation of malignant cells showed a dose-dependent decrease, to a certain degree. Proliferation of normal rabbit joint epiphysial disk cells (RGP-2) were not affected by MCM. Proliferation of lung giant cell carcinoma cells with high metastatic potency showed a significant decrease even when cultured in highly diluted MCM (6.25% of primary MCM), when compared with the strain of low metastatic potency. Following ultrafiltration, boiling at 100 degrees C, and treatment with trypsin, skeletal muscle delivered tumor factor(s) were found to be a low molecular weight (MW

CONCLUSIONSThe rarity of metastases in skeletal muscles, generally accepted in the clinical setting, can be reproduced in an animal model. It does not seem to be related to VCAM-1 expression in the microvessels of these organs. Skeletal muscle delivered factor(s) play a key role in the mechanism of the rarity of metastases in skeletal muscle.

Animals ; Cell Division ; Humans ; Immunohistochemistry ; Muscle Neoplasms ; pathology ; secondary ; Muscle, Skeletal ; physiology ; Rats ; Rats, Wistar ; Tumor Cells, Cultured ; Vascular Cell Adhesion Molecule-1 ; analysis

OBJECTIVETo study the morphologic feature, immunohistochemistry phenotype of ESS and its metastases, with emphasis on the histogenesis, tumor differentiation and diagnostic criteria.

METHODSThe pathologic features of 15 cases and 4 metastases were studied. The immunohistochemical study was performed on selected sections by a panel of antibodies including CD10, smooth muscle actin, estrogen and progesterone receptors, keratin (AE1/3) and alpha-inhibin.

RESULTSPatients were 22 to 75 years of age (mean 45). The endometrial stromal component predomominated in 7 cases. Three cases showed a picture of smooth muscle differentiation. Endometrial stromal sarcoma with fibromyxoid features were present in 2 cases. There were 3 sarcomas of poorly differentiated. The morphology features of the metastatic foci in 3 of the 4 metastasis cases were not similar to that of the primary counterpart in uteri. Among 14 ESS and 4 metastases, 15 of 18, 5 of 18, 7 of 18, and 10 of 18 were positive for CD10, SMA, ER and PR, respectively. AE1/3 and alpha-inhibin were only positive in the adenomatous area of ESS. Strong expression of SMA was obtained in all 10 cellular leiomyomas, and CD10 was only weakly expressed in 1 case (P < 0.05).

CONCLUSIONSESS are morphologically heterogeneous with multipotential differentiation. The histologic features of the metastases may not be similar to those of the primary. CD10 and SMA are diagnostically useful markers for ESS.

Actins ; metabolism ; Adult ; Aged ; Cell Differentiation ; Endometrial Neoplasms ; metabolism ; pathology ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; metabolism ; secondary ; Middle Aged ; Muscle, Smooth ; pathology ; Neoplasm Recurrence, Local ; Neprilysin ; metabolism ; Radiography ; Sarcoma, Endometrial Stromal ; metabolism ; secondary ; Uterus ; metabolism ; pathology

Intrahepatic cholangiocarcinoma is a rare malignancy that originates from the epithelial cells of the intrahepatic bile ducts. Intrahepatic cholangiocarcinoma can metastasize in lymphatic chains, including the hepatoduodenal ligament, and it often invades adjacent organs or metastasizes to other visceral organs such as the lungs, bones, adrenal glands, and brain. However, distant skeletal muscle metastasis is very rare. Moreover, a metastatic skeletal muscle tumor rarely shows specific symptoms, making it difficult to identify in a routine examination. A 45-year-old man with a chief complaint of right upper quadrant abdominal pain was admitted to our hospital. Abdominal ultrasound and computed tomography with contrast enhancement showed a malignant mass in the right hepatic lobe, and 2-[18F] fluoro-2-deoxy-D-glucose positron-emission tomography revealed distant skeletal muscle metastases in the thorax and buttock. The patient underwent an ultrasound-guided percutaneous needle biopsy for the metastatic low-echo masses in the skeletal muscle.
Bile Duct Neoplasms/diagnosis/radionuclide imaging/secondary ; Cholangiocarcinoma/diagnosis/radionuclide imaging/secondary ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Liver Neoplasms/*diagnosis/pathology/radionuclide ; Male ; Middle Aged ; Muscle Neoplasms/diagnosis/*radionuclide imaging/secondary ; Positron-Emission Tomography ; Radiopharmaceuticals/*diagnostic use ; Tomography, X-Ray Computed

We performed gene expression profiling in bladder cancer patients to identify cancer-specific survival-related genes in muscle invasive bladder cancer (MIBC) patients. Sixty-two patients with MIBC were selected as the original cohort and another 118 MIBC patients were chosen as a validation cohort. The expression of USP18, DGCR2, and ZNF699 genes were measured and we analyzed the association between gene signatures and survival. USP18 and DGCR2, were significantly correlated to cancer-specific death (P=0.020, P=0.007, respectively). Cancer-specific survival in the low USP18 or DGCR2 expression group was significantly longer than the high expression group (P=0.018, P=0.006, respectively). In multivariate Cox regression analysis, a combination of USP18 and DGCR2 mRNA expression levels were significant risk factors for cancer-specific death (HR, 2.106; CI, 1.043-4.254, P=0.038). Overall survival and cancer-specific survival rates in the low-combination group were significantly longer than those in the high-expression group (P=0.001, both). In conclusion, decreased expressions of USP18 and DGCR2 were significantly associated with longer cancer-specific survival, and also the combination of two genes was correlated to a longer survival for MIBC patients. Thus, the combination of USP18 and DGCR2 expression was shown to be a reliable prognostic marker for cancer-specific survival in MIBC.
Adult ; Aged ; Aged, 80 and over ; Biological Markers/metabolism ; Carrier Proteins/genetics/metabolism ; Endopeptidases/genetics/*metabolism ; Female ; Gene Expression Profiling ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Muscle Neoplasms/*secondary ; Neoplasm Invasiveness ; Neoplasm Staging ; Platelet Glycoprotein GPIb-IX Complex/genetics/*metabolism ; Predictive Value of Tests ; ROC Curve ; Regression Analysis ; Risk Factors ; Urinary Bladder Neoplasms/*diagnosis/metabolism/*mortality/pathology