Genital tumours are rare among cattle, largely due to their relatively short lifespans. Leio-myoma, a smooth muscle tumour being more prevalent in dogs, appears only at a rate of 1.00 - 2.00% in cattle, affecting reproductive efficiency in cases of complete uterine obstruction. This case report involves an 8-year-old cow with repeated insemination attempts unveiled 5.00 cm intra-luminal uterine mass, obstructing the right uterine horn. Transrectal sonography (TRUS) revealed a highly vascularized mass with normal ovarian function. Confirmation of clinical condition, i.e., uterine leiomyoma, via uterine biopsy concluded the presence of neoplastic smooth muscle cells arranged in interlacing bundles showing mild pleomorphism, and special staining using Masson\'s trichrome revealed an unappreciable amount of connective tissue; subsequently right flank celiotomy was performed to remove the benign tumour. Forty-five days after celiotomy, TRUS examination confirmed an unobstructed uterine horn, and bilateral oviduct patency was adjudged with 2.50% methylene blue. Following treatment for chronic endometritis, artificial insemination led to conception nearly 90 days post-procedure. The TRUS aids preliminary diagnosis, while definitive identification demands necropsy and surgical methods. This case underscores the diagnostic significance of TRUS, histopathology and celiotomy for identifying and managing uterine leiomyoma in cattle.

OBJECTIVE: Uterine tumours resembling ovarian sex cord tumours (UTROSCTs) are extremely rare. To date, most patients with UTROSCTs have undergone hysterectomy and had a benign clinical course. Fertility-preserving surgery should be considered because some patients with UTROSCTs are aged < 40 years. This paper reviews the treatment and prognosis for patients with UTROSCTs, with a focus on fertility.
METHODS: PubMed, MEDLINE and Scopus were searched systematically for case reports and case series of UTROSCTs published in English from inception to December 2022, and initial treatment and recurrence rates were compared. The following data were extracted: age; symptoms; initial therapy; metastasis at diagnosis; disease-free survival (DFS); and recurrence.
RESULTS: In total, 147 patients (72 studies) reporting the clinical course of UTROSCTs were analysed. The median age at diagnosis was 50 years, and 28 (19.0 %) patients were aged < 40 years. Most patients (n = 125, 85.0 %) underwent hysterectomy as the initial surgery, with a recurrence rate of 17.6 % (n = 22). The recurrence rate was 30 % (n = 6) in patients who underwent mass resection (n = 20). Among the 15 patients who underwent mass resection aged < 40 years, seven went on to achieve pregnancy (46.7 %) and six had successful deliveries (40.0 %). No significant differences in 5- and 10-year DFS were found between the hysterectomy and mass resection groups (p = 0.123 and 0.0612, respectively). Bilateral salpingo-oophorectomy in addition to hysterectomy was not significantly associated with 10-year DFS (p = 0.548).
CONCLUSIONS: While total hysterectomy is the recommended treatment for UTROSCTs based on recurrence rates, mass resection is an acceptable treatment option for patients who wish to retain their childbearing potential. It is recommended that these women should plan for pregnancy and delivery as soon as possible after mass resection, and should undergo hysterectomy within 5 years.

OBJECTIVE: To evaluate the magnetic resonance imaging (MRI) features that may help distinguish leiomyosarcomas from atypical leiomyomas (those presenting hyperintensity on T2-W images equal or superior to 50% compared to the myometrium).
METHODS: The authors conducted a retrospective single-centre study that included a total of 57 women diagnosed with smooth muscle tumour of the uterus, who were evaluated with pelvic MRI, between January 2009 and March 2020. All cases had a histologically proven diagnosis (31 Atypical Leiomyomas-ALM; 26 Leiomyosarcomas-LMS). The MRI features evaluated in this study included: age at presentation, dimension, contours, intra-tumoral haemorrhagic areas, T2-WI heterogeneity, T2-WI dark areas, flow voids, cyst areas, necrosis, restriction on diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) values, signal intensity and heterogeneity after contrast administration in T1-WI, presence and location of unenhanced areas. The association between the MRI characteristics and the histological subtype was evaluated using Chi-Square and ANOVA tests.
RESULTS: The MRI parameters that showed a statistically significance correlation with malignant histology and thus most strongly associated with LMS were found to be: irregular contours (p < 0.001), intra-tumoral haemorrhagic areas (p = 0.028), T2-WI dark areas (p = 0.016), high signal intensity after contrast administration (p = 0.005), necrosis (p = 0.001), central location for unenhanced areas (p = 0.026), and ADC value lower than 0.88 × 10-3 mm2/s (p = 0.002).
CONCLUSIONS: With our work, we demonstrate the presence of seven MRI features that are statistically significant in differentiating between LMS and ALM.

An 11-year-old female Persian cat underwent ovariohysterectomy due to dilation of the uterine cavity with irregular thickening of the wall. Macroscopically, the middle and distal regions of the left uterine horn were swollen and the uterine wall was irregularly thickened due to the development of multiple coalescent, variably sized nodules. Microscopically, the nodules had originated in the endometrium and were composed of round to polygonal neoplastic cells arranged in dense sheets or ill-defined fascicles. The neoplastic cells had locally invaded the myometrium and reached the subserosa, with lymphovascular invasion. Immunohistochemically, the neoplastic cell population was partially positive for CD10, an established marker of endometrial stromal sarcoma (ESS) in humans, with focal and diffuse nuclear immunopositivity for oestrogen and progesterone receptors and immunonegativity for desmin and α-smooth muscle actin. Based on these findings, the uterine tumour was diagnosed as ESS and was considered to correspond morphologically to high-grade ESS in humans.

OBJECTIVE: In 2017, a subset of cellular variants of myofibroma and myopericytoma with a smooth muscle-like immunophenotype and harbouring recurrent SRF::RELA gene fusions was reported. Although the anatomical distribution was found to be quite broad, no tumours with these gene fusions in the female reproductive system have been illustrated to date.
RESULTS: Herein, we report the histological and immunophenotypical features of three uterine tumours with SRF::RELA gene fusions. Microscopically, all three tumours were composed of cellular oval to spindle cells arranged in intersecting fascicles with variable amounts of collagen and a rich capillary network. Mitotic figures were scant. Regarding immunohistochemistry, diffuse staining for desmin, oestrogen receptor and progesterone receptor was observed in all three cases. The first case exhibited focal staining for h-caldesmon, whereas the latter two cases had diffuse staining. Furthermore, SRF::RELA rearrangement was observed in all three cases by using next-generation sequencing (NGS). Follow-up, ranging from 11 to 15 months, was available for these three patients, all of whom were well without evidence of disease.
CONCLUSIONS: In conclusion, we reported a special group of uterine neoplasms with myogenic differentiation harbouring SRF::RELA rearrangement. Although the follow-up time was limited, morphological characteristics and other studies with follow-up data supported that this type of uterine neoplasm appeared to behave in a benign manner. Further studies with longer follow-up are needed to clarify the biological nature of this particular type of uterine tumour.

BACKGROUND: Uterine sarcomas are rare gynaecologic tumours representing 3-7% of all uterine malignancies. The aetiology of sarcomas is still unclear: it is thought, that chromosomal translocations have influence on wide histological variety of sarcomas. Presenting symptoms are vague and nonspecific. Usually sarcoma causes abnormal vaginal bleeding, can cause abdominal or pelvic pain, or manifests as a rapidly growing uterine tumour. The diagnosis of sarcoma is often made retrospectively after surgical removal of a presumed benign uterine neoplasm, because imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign leiomyoma and malignant pathology. If there are certain clinical features that raise a suspicion of malignancy in the uterus, it is recommended to avoid the use of power morcellation through laparoscopic surgery in order to prevent disease dissemination.
METHODS: We present a clinical case of a 64-year-old patient, who was referred to hospital due to abdominal pain and tenesmus that lasted for two days. From a past medical history it was known that previously the patient had been diagnosed with uterine myoma. Transvaginal ultrasonography showed a 10.4 cm × 9.8 cm uterine tumour of nonhomogeneous structure with signs of necrosis and good vascularization. The patient refused urgent hysterectomy, that was advised to her. The patient was operated on one month later and total hysterectomy with bilateral salpingooforectomy was performed. Postoperative histological evaluation showed undifferentiated sarcoma uterus pT1b L/V0. Imaging modalities were made to evaluate possible dissemination of the disease. In the absence of signs of disease progression, the patient received radiotherapy and brachytherapy and was followed-up by doctors.
CONCLUSIONS: Uterine sarcomas are highly malignant tumours that originate from smooth muscles and connective tissue elements of the uterus and make up 1% of all malignant gynaecological tumours and about 3-7% of all malignant uterine tumours. Imaging modalities cannot yet reliably distinguish benign myomas from malignant sarcomas. It is important not to damage the wholeness of uterus during operation in order to prevent dissemination of the disease in the abdominal cavity. The low-grade endometrial stromal sarcoma has the best survival prognosis, while carcinosarcoma and undifferentiated uterine sarcoma have the lowest survival rates.
UNASSIGNED: SantraukaTikslas. Gimdos sarkomos yra reti ginekologiniai navikai, sudarantys 3–7 % visų piktybinių gimdos navikų. Sarkomų atsiradimo etiologija nėra aiški, manoma, kad įtakos tam turi skirtingos genų ir chromosomų mutacijos, lemiančios didelę sarkomų histologinę įvairovę. Simptomatika nėra specifiška tik sarkomoms, šie navikai dažniausiai sukelia nenormalius kraujavimus iš gimdos, neaiškius pilvo ir dubens skausmus ar gali pasireikšti greitu gimdos darinio augimu. Diagnozė dažniausiai nustatoma po operacijos, pašalinus iki tol gerybiniu laikytą gimdos darinį ir ištyrus histologiškai, nes ikioperaciniai vaizdiniai tyrimai negali patikimai atskirti gerybinių gimdos lejomiomų nuo piktybinių sarkomų. Jeigu tiriant pastebimi požymiai, kad gali būti gimdos sarkoma, reikėtų vengti tokias pacientes operuoti naudojant morceliatorių operaciniams dariniams smulkinti, nes kyla grėsmė, kad piktybiniai dariniai išsisės pilvo ertmėje. Straipsnio tikslas – konkretaus klinikinio atvejo pavyzdžiu aprašyti diagnostikos ir gydymo metodus nustačius gimdos naviką moteriai po menopauzės.Medžiaga ir metodai. Pristatome 64 metų pacientės klinikinį atvejį, kuri atvyko į ligoninę dėl dvi paras besitęsiančių pilvo skausmų ir pasunkėjusio tuštinimosi. Iš anamnezės buvo žinoma, kad pacientei prieš penkerius metus ambulatoriškai diagnozuota gimdos mioma. Ultragarsiniu tyrimu per makštį pacientei nustatyta 10,4 × 9,8 cm dydžio nehomogeniškos struktūros su nekrozės požymiais, gerai vaskuliarizuota gimdos intramuralinė mioma. Ligonei dėl pilvo skausmų buvo rekomenduotas operacinis gydymas skubos tvarka, įtariant miomos mazgo nekrozę, tačiau moteris atsisakė skubios operacijos. Rekomendavus operacinį gydymą planine tvarka ir paskyrus ambulatorinį ištyrimą bei gydymą, pacientė išvyko į namus. Po vieno mėnesio ligonei buvo atlikta planinė operacija – totalinė histerektomija su abipusiais gimdos priedais. Ištyrus gimdą histologiškai buvo diagnozuota nediferencijuota gimdos sarkoma pT1b L/V0. Kadangi vaizdinių tyrimai nerodė ligos išplitimo, pacientei buvo paskirta adjuvantinė spindulinė terapija ir endovagininė brachiterapija bei rekomenduotas tolimesnis stebėjimas.Rezultatai ir išvados. Gimdos sarkoma yra didelio piktybiškumo navikas, augantis iš gimdos lygiųjų raumenų bei jungiamojo audinio, sudarantis 1 % visų piktybinių ginekologinių navikų ir apie 3–7 % visų piktybinių gimdos navikų. Vaizdiniais tyrimais negalima patikimai atskirti gerybinių gimdos miomų nuo piktybinių gimdos sarkomų. Labai svarbu operuojant ligonę, kuriai diagnozuotas gimdos navikas, nepažeisti gimdos sienelės vientisumo norint išvengti patologinio proceso išplitimo į pilvo ertmę. Mažo laipsnio endometriumo stromos sarkomos atveju ligonių išgyvenamumo prognozė yra geriausia, o karcinosarkomos ir nediferencijuotos gimdos sarkomos atvejais – blogiausia.Raktažodžiai: gimdos tumoras, piktybinė gimdos neoplazija, gimdos sarkoma, nediferencijuota gimdos sarkoma, gimdos sarkomos diagnostika ir gydymas.

Gestational trophoblastic neoplasia (GTN) is a disease of women in reproductive age. It is one of the most chemotherapy responsive and highly curable cancer. It is diagnosed when there is clinical, radiologic, pathologic, and/or hormonal evidence of persistent or relapsed gestational trophoblastic disease. In most instances, it is cured by surgical evacuation of the uterus. If persistent, it is treated with chemotherapy which provides response in >90% of the cases. In the unresponsive persistent cases and if the women has completed her child bearing, hysterectomy is generally recommended. Here, we report a rare case of chemoresistant GTN which was confirmed to be placental-site trophoblastic tumour (PSTT) on biopsy.

High grade uterine sarcoma and recurrent endometrial carcinoma are aggressive cancers with limited treatment options, resulting in a poor prognosis. In this research we focused in the first place on the detection of a highly immunogenic tumour-associated antigen Wilms\' tumour gene 1 (WT1) in uterine tumours. We were able to reveal its overexpression in the tumour cells of high grade sarcomas and carcinosarcomas . Moreover, patients with WT1 positive tumours had a significantly worse prognosis than patients who were WT1 negative. For carcinomas, WT1 was present in only a minority of tumour cells, but in the majority of intratumoural blood vessels. Small blood vessels in the normal tissue surrounding the carcinoma were also WT1 positive, suggesting a role for WT1 in angiogenesis. WT1 was hardly expressed or absent in the non-tumour or benign tumoural uterus (myoma, polyp). The next step was to develop a targeted treatment against WT1. We opted for dendritic cell (DC) based immunotherapy. Nevertheless a basal expression of WT1 in monocytes and in vitro cultured unloaded DC was observed, the electroporation of in vitro cultured DC with WT1-mRNA resulted in a higher expression of WT1 by the DC. WT1-mRNA loaded DC were used for in vivo stimulations of T cells, resulting in the rise of WT1-specific T cells and a transient molecular response (decrease of CA125) in an end stage endometrial carcinoma patient. No toxic side effects were reported. Future in vivo research, carried out in a phase I clinical trial in our center, will reveal the ability of this new therapy to induce an immunological and possible clinical response in WT1 positive uterine cancer patients.

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