Uterine leiomyomas are the most common benign neoplasms found in women of reproductive age. Lipoleiomyoma, a rare variant of leiomyomas, is composed of intermixed smooth muscle cells and mature adipocytes. These neoplasms are usually discovered incidentally in obese, perimenopausal, or postmenopausal women. In this report, we present a case of lipoleiomyoma in a postmenopausal woman who presented with vaginal bleeding and back pain.

Perivascular epithelioid cell tumor (PEComa), an uncommon mesenchymal neoplasm, arises from specialized perivascular epithelioid cells exhibiting distinct features of smooth muscle and melanocytic differentiation with unpredictable behavior. PEComa tends to occur more commonly in the uterus and kidneys; its occurrence in the liver is exceedingly rare. We presented a case of a 29-year-old woman with hepatic PEComa and evaluated the tumor with MRI, integrated 18F-fluorodeoxyglucose (FDG), and 68Ga-fibroblast activation protein inhibitor (FAPI) PET/CT scans at presentation. The patient had a history of intermittent utilization of oral contraceptive drugs for several years. An abdominal ultrasound in a physical examination from an outside institution revealed a mass in the liver. A contrast-enhanced abdominal MRI revealed restricted diffusion on diffusion-weighted imaging (DWI) and rapid contrast enhancement and washout patterns in the hepatic lesion, suggesting hepatic adenoma (HA) or hepatocellular carcinoma (HCC). Further assessment was carried out using 18F-FDG and 68Ga-FAPI PET/CT scans. The hepatic lesion was non-FDG avid, whereas increased tracer uptake was observed on the 68Ga-FAPI PET/CT. Subsequently, laparoscopic partial resection of liver segment V was performed. Immunohistochemical analyses demonstrated positive staining for HMB45, Melan-A, and SMA while showing negative results for AFP, glypican-3, hepatocyte, and arginase-1. The results were indicative of a hepatic PEComa diagnosis based on these findings. We also review the current literature on the clinical characteristics, pathological features, and challenges in the diagnosis of hepatic PEComa.

Dysmenorrhea affects women throughout their reproductive years but there has been a lack of effective and well-tolerated treatment options. Pain symptoms mainly result from inflammatory processes and increased contractile activity in the myometrium. The reported use of Bryophyllum pinnatum preparations against inflammation and pain in ethnomedicine as well as current pharmacological data on their inhibition of myometrial contractility led us to hypothesize that this medicinal plant might be a new treatment option for dysmenorrhea. In the first part of the present work, clinical, in vivo, and in vitro studies on the anti-nociceptive and anti-inflammatory, as well as on myometrium relaxing properties of B. pinnatum are reviewed. In the second part, cases of five women with dysmenorrhea who were tentatively treated with a B. pinnatum product are described. The review revealed thirty-three experimental in vivo and in vitro studies, but no clinical study, reporting anti-nociceptive and anti-inflammatory effects of B. pinnatum extracts and compounds in a wide range of conditions. Moreover, sixteen publications on smooth muscle contractility revealed relaxing effects. The latter consisted of clinical evidence, as well as of in vivo and in vitro data. The evidence reviewed therefore provided a rational basis for the use of B. pinnatum in the treatment of dysmenorrhea. We subsequently set out to tentatively treat patients with a well-tolerated B. pinnatum product that is registered (without indication) and commonly used in obstetrics and gynecology in Switzerland. All five treated patients reported a reduction in pain symptoms and 4 out of 5 indicated a reduced intake of painkillers during menstruation. Taken together, the reviewed information on the pharmacological properties and clinical evidence of B. pinnatum extracts and compounds as well as the outcomes of all five patients in the case series support our hypothesis in favor of B. pinnatum as a new, well-tolerated therapeutic approach for dysmenorrhea. Prospective clinical studies are urgently needed.

Disseminated peritoneal leiomyomatosis (DPL) or leiomyomatosis peritonealis disseminata is a sporadic benign disease characterized by several solid peritoneal smooth muscle nodules that proliferate along the abdominopelvic cavity. The source of the condition is undetermined, although suspected causes include iatrogenic and hormonal stimulation. It primarily affects women of reproductive age. Imaging investigations are important in determining the extent of lesions and the presence of malignancy. There are no conventional therapeutic guidelines for the therapy of DPL, hence the risk of malignant transformation is low. We discuss the case of a 41-year-old woman who had a previous laparoscopic hysterectomy and presented 4 years later with numerous peritoneal tumors the diagnosis of DPL was suspected by computed tomography and magnetic resonance imaging, and confirmed by histology.

OBJECTIVE: To report a rare case of orbital angioleiomyoma (ALM) and its management.
METHODS: A 22-year-old woman presented with slowly progressive painless axial proptosis. Computed tomography and magnetic resonance imaging demonstrated a well-defined intraconal mass that was isointense in T1 and hyperintense in T2 weighted images, heterogeneously enhanced by gadolinium.
RESULTS: The tumor, despite having significant adhesions to surrounding tissues and noticeable hemorrhage, was excised completely via the lateral orbitotomy approach. Histopathologic analysis of the specimen was consistent with an orbital ALM. The patient recovered from the operation uneventfully.
CONCLUSIONS: ALM must be considered in the differential diagnoses of orbital tumors.

Myofibroma is a benign, soft tissue neoplasm that predominantly affects infants and young children. Most occur in the skin or subcutaneous tissues, with a predilection for the head and neck regions. We describe the magnetic resonance (MR) imaging and histophathologic findings of a rare case of intramuscular myofibroma of the right deltoid in a healthy 30-year-old male. MR imaging revealed a well-circumscribed intramuscular mass, with isointense signal on T1-weighted images, hyperintense signal on T2-weighed images, and a \"target-sign\" with peripheral rim enhancement after gadolinium administration. The lesion was surgically excised with no complications, and the histopathologic analysis revealed the typical morphologic and histochemical markers of a myofibroma. We conclude that, although rare, myofibroma can be considered in the differential diagnosis of adults with lesions the above signal characteristics.

Smooth muscle hamartomas are benign dermal proliferations of smooth muscle cells. Smooth muscle hamartomas are sub-divided into congenital or acquired; the latter is a rare entity with less than 20 cases being reported in the English literature. Most often asymptomatic, acquired smooth muscle hamartomas follow an indolent course. Treatment in the form of surgical excision can be utilized for symptomatic or cosmetic purposes. Here, we report the first case of an acquired smooth muscle hamartomas of the shin which also uniquely presented with hidrosis. This case highlights the varied clinical spectrum of acquired smooth muscle hamartomas.

Context: Primary leiomyosarcomas are malignant tumors of smooth muscles, with few reported cases occurring in the cervical spine. The authors report a case involving a 29-year-old man with primary leiomyosarcoma in the spinal canal posterior to the C3-C5 vertebrae. Findings: No obvious osteolytic lesions could be found in neither X-ray nor computed tomography scan. Because of the confusion of nontypical imaging findings, a decompressive surgery of anterior cervical corpectomy of C4 and reconstruction with a mesh cage filled with allogenic bone grafts were performed. The patient refused a second operation and then was advised to receive the radiotherapy. No recurrence of the symptoms was evident 6 months after surgery. Conclusion: When a patient suffers from upper cervical tumor, the leiomyosarcoma should be kept in mind as possible diagnoses despite its low occurring ratio. Early detection, early diagnosis, and early treatment must be the goal of the strategy.

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UNASSIGNED: A 10-year-old male neutered domestic shorthair cat presented with nausea and 1.2 kg weight loss over a 6 month period. Physical examination was unremarkable, and haematological and biochemical results were considered clinically unremarkable. Abdominal ultrasound revealed an 18 mm diameter heterogeneous mass in the stomach at the pyloric sphincter, protruding into the gastric lumen with loss of gastric wall layering. The remainder of the intestinal tract and abdominal viscera were unremarkable and no free fluid was detected. The mass was surgically resected via celiotomy and the adjacent lymph node excised for histopathology. Histopathology of the mass demonstrated neoplastic spindle cell proliferation, which was considered most likely to be of smooth muscle origin, and so a preliminary diagnosis of gastric leiomyosarcoma was given. Complete excision was confirmed. Immunohistochemistry excluded a gastrointestinal stromal cell tumour as a differential and strongly supported the diagnosis of gastric leiomyosarcoma. The cat recovered well postoperatively with supportive treatment. Repeat abdominal ultrasonography 3 and 6 months postoperatively showed no evidence of mass regrowth. Survival time at the time of reporting is 10 months.
UNASSIGNED: To our knowledge, this is the first report of gastric leiomyosarcoma in a cat. Based on this case, gastric leiomyosarcoma should be a differential diagnosis for cats presenting with a gastric mass.