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The Journal of Maternal-fetal &... Dec 2023We report the case of a massive fetal cardiac rhabdomyoma recently occurred at our clinic. A woman at 23 weeks of gestational age was referred to our center for a fetal...
We report the case of a massive fetal cardiac rhabdomyoma recently occurred at our clinic. A woman at 23 weeks of gestational age was referred to our center for a fetal cardiac echogenic mass of 26 mm detected at the second-trimester screening ultrasound. During pregnancy, though, the mass progressively increased its dimensions until reaching 48 mm in diameter at 37 weeks of gestation. Fetal echoencephalography and brain magnetic resonance did not show any further fetal anomalies, but molecular genetic testing at amniocentesis revealed a heterozygotic missense variant of gene TSC2 associated with Tuberous Sclerosis. The mass was therefore most likely preferable to a single large rhabdomyoma of gradually increasing dimensions. The baby was delivered at term with a cesarean section. Because of the rhabdomyoma remarkable size and newborn ECG electrical alterations, postnatal therapies with Flecainide and Everolimus were started. Everolimus treatment led to a significant and progressive reduction in the cardiac mass volume. This case, therefore, shows the efficacy of what seems to be a promising treatment in pediatric patients with large rhabdomyomas.Learning points:Rhabdomyomas may present with different features: most often they appear as multiple masses along the interventricular sept, but they may also appear as a single large thoracic mass.When a rhabdomyoma is suspected, genetic counseling is recommended.Both before and after birth, a multidisciplinary approach is useful to choose the appropriate therapy for the newborn.mTOR inhibitors therapies look like promising therapeutic approaches to stimulate the involution of rhabdomyomas.
Topics: Infant; Infant, Newborn; Humans; Pregnancy; Child; Female; Rhabdomyoma; Everolimus; Cesarean Section; Ultrasonography; Tuberous Sclerosis; Heart Neoplasms
PubMed: 37031967
DOI: 10.1080/14767058.2023.2197099 -
Journal of Minimally Invasive Gynecology Nov 2023To investigate the incidence of venous thromboembolism (VTE) in patients undergoing large specimen hysterectomy for benign indications. To evaluate the impact of route...
STUDY OBJECTIVE
To investigate the incidence of venous thromboembolism (VTE) in patients undergoing large specimen hysterectomy for benign indications. To evaluate the impact of route of surgery and operative time in the development of VTE in this population.
DESIGN
Retrospective cohort study (Canadian Task Force Classification II2) of targeted hysterectomy data prospectively collected from the American College of Surgeons National Surgical Quality Improvement Program involving over 500 hospitals across the United States.
SETTING
National Surgical Quality Improvement Program Database.
PATIENTS
Women aged 18 years or older undergoing hysterectomy for benign indications between 2014 and 2019. Patients were further classified into 4 groups according to uterine weight: <100 g, 100-249 g, 250 g-499 g, and specimens ≥500 g.
INTERVENTIONS
Current Procedural Terminology codes were used to identify cases. Variables including age, ethnicity, body mass index, smoking status, diabetes, hypertension, blood transfusion, and American Society of Anesthesiologists classification system scores were collected. Cases were stratified by route of surgery, operative time, and uterine weight.
MEASUREMENTS AND MAIN RESULTS
A total of 122,418 hysterectomies occurring between 2014 and 2019 were included in our study, of which 28,407 (23.2%) patients underwent abdominal, 75,490 (61.7%) laparoscopic, and 18,521 (15.1%) vaginal hysterectomy. The overall rate of VTE in patients with large specimen hysterectomies (≥500 g) was 0.64%. After multivariable adjustment, there was no significant difference in the odds of VTE between uterine weight groups. Only 30% of the surgeries with uterine weight above 500 g were performed with minimally invasive surgical routes. Patients who underwent minimally invasive hysterectomy had lower odds of VTE via laparoscopic (adjusted odds ratio [aOR] 0.62; confidence interval [CI]: 0.48-0.81) and vaginal (aOR 0.46; CI: 0.31-0.69) routes compared to laparotomy. Prolonged operative time (>120 min) was associated with increased odds of VTE (aOR 1.86; CI:1.51-2.29).
CONCLUSION
The occurrence of VTE after a benign large specimen hysterectomy is rare. The odds of VTE is higher with longer operative times and lower with minimally invasive approaches, even for markedly enlarged uteri.
Topics: Humans; Female; United States; Venous Thromboembolism; Retrospective Studies; Postoperative Complications; Hysterectomy; Hysterectomy, Vaginal
PubMed: 37422052
DOI: 10.1016/j.jmig.2023.06.017 -
Gynecologic Oncology Jul 2023In the management of uterine myomas, laparoscopic surgery with morcellation enables a minimal invasive procedure. Cases of unsuspected uterine sarcoma dissemination have...
INTRODUCTION
In the management of uterine myomas, laparoscopic surgery with morcellation enables a minimal invasive procedure. Cases of unsuspected uterine sarcoma dissemination have been reported and led to regulative restrictions. To help to distinguish preoperatively myomas from sarcomas, we assessed the value of six sonographic criteria (Basel Sarcoma Score, BSS) in a prospective outpatient cohort of consecutive patients with uterine masses.
MATERIAL AND METHODS
We prospectively evaluated all patients presenting with myoma-like masses planned for surgery with standardized ultrasound examination. BSS including the following criteria was investigated: rapid growth in past three months, high blood flow, atypical growth, irregular lining, central necrosis and oval solitary lesion. For each criterion, a score 0/1 was given. BSS (0-6) equals the sum of all given scores. Histological diagnosis was used as reference.
RESULTS
Among 545 patients, 522 had the final diagnosis of myoma, 16 had peritoneal masses with sarcomatous components (PMSC), and seven had other malignancies. Median BSS for PMSC was 2.5 (range: 0-4) vs 0 for myomas (range: 0-3). The most common sonographic criteria leading to a false positive score in myomas were rapid growth in past three months and high blood flow. For the detection of sarcomatous masses with BSS threshold of >1, sensitivity was 93.8%, specificity 97.9%, and positive predictive value (PPV) and negative predictive value (NPV) were 57.7% and 99.8%, respectively (AUC 0.95).
CONCLUSION
BSS can help distinguishing between myomas and sarcomatous masses, with high NPV. Caution is required when >1 criterion is present. As a simple tool, it could easily be integrated into routine myoma sonographic examination and help develop standardized assessment of uterine masses for better preoperative triage.
Topics: Female; Humans; Prospective Studies; Uterine Neoplasms; Leiomyoma; Sarcoma; Pelvic Neoplasms; Myoma
PubMed: 37210928
DOI: 10.1016/j.ygyno.2023.05.005 -
Journal of Perinatology : Official... Jul 2023To investigate the prenatal imaging characteristics, genetic characteristics and pregnancy outcome of fetuses with cardiac rhabdomyoma.
OBJECTIVE
To investigate the prenatal imaging characteristics, genetic characteristics and pregnancy outcome of fetuses with cardiac rhabdomyoma.
STUDY DESIGN
The prenatal ultrasound, cranial MRI imaging information and genetic test results of 35 fetuses prenatally diagnosed with cardiac rhabdomyoma were collected and retrospectively analyzed, and the pregnancy outcome was followed up.
RESULT
Cardiac rhabdomyomas mainly occurred in left ventricular wall and ventricular septum; cranial MRI imaging was found abnormal in 38.1% (8/21) of the fetuses; genetic test was found abnormal in 58.82% (10/17) of the fetuses; the fetus was born in 12 cases and the pregnancy was terminated in 23 cases.
CONCLUSION
TRIO whole exome sequencing (TrioWES) is recommended as the genetic test regime for cardiac rhabdomyoma. The comprehensive evaluation of prognosis of fetuses needs to consider the genetic results and whether the brain is involved; the prognosis of fetuses with simple cardiac rhabdomyoma is good.
Topics: Female; Pregnancy; Humans; Pregnancy Outcome; Rhabdomyoma; Retrospective Studies; Tuberous Sclerosis; Fetal Diseases; Prenatal Diagnosis; Fetus; Heart Neoplasms; Ultrasonography, Prenatal
PubMed: 37330616
DOI: 10.1038/s41372-023-01673-w -
Veterinary Clinical Pathology Dec 2023This report describes the cytologic, histopathologic, and immunohistochemical features of adult-type rhabdomyoma located within the subcutaneous tissue in a 14-year-old...
This report describes the cytologic, histopathologic, and immunohistochemical features of adult-type rhabdomyoma located within the subcutaneous tissue in a 14-year-old female Border Collie (thigh) and a 13-year-old male Mongrel (flank). In both cases, fine-needle aspiration biopsy revealed cluster-forming, epithelial-like polygonal cells with abundant foamy cytoplasm, and moderate to marked anisocytosis and anisokaryosis; therefore, an epithelial tumor was suspected. After surgical excision, tumors underwent histopathologic examination with additional immunohistochemistry. Both tumors were well-demarcated and located within the subcutaneous tissue in the vicinity of the cutaneous muscle. The tumor mass consisted of densely packed round or polygonal cells with distinct vacuolation of the cytoplasm. Tumor cells expressed vimentin, desmin, and NSE and were cytokeratin and α-SMA negative. Based on histologic features and immunophenotyping, adult-type rhabdomyoma was diagnosed in both cases. This study highlights that the cytologic features of rhabdomyoma can be misleading and may suggest an epithelial tumor.
Topics: Male; Female; Dogs; Animals; Rhabdomyoma; Epithelial Cells; Immunohistochemistry; Biopsy, Fine-Needle; Neoplasms, Glandular and Epithelial; Dog Diseases
PubMed: 37914534
DOI: 10.1111/vcp.13305 -
Medicina (Kaunas, Lithuania) May 2024Uterine fibroids (leiomyomas and myomas) are the most common benign gynecological condition in patients presenting with abnormal uterine bleeding, pelvic masses causing... (Review)
Review
UNLABELLED
Uterine fibroids (leiomyomas and myomas) are the most common benign gynecological condition in patients presenting with abnormal uterine bleeding, pelvic masses causing pressure or pain, infertility and obstetric complications. Almost a third of women with fibroids need treatment due to symptoms.
OBJECTIVES
In this review we present all currently available treatment modalities for uterine fibroids.
METHODS
An extensive search for the available data regarding surgical, medical and other treatment options for uterine fibroids was conducted.
REVIEW
Nowadays, treatment for fibroids is intended to control symptoms while preserving future fertility. The choice of treatment depends on the patient's age and fertility and the number, size and location of the fibroids. Current management strategies mainly involve surgical interventions (hysterectomy and myomectomy hysteroscopy, laparoscopy or laparotomy). Other surgical and non-surgical minimally invasive techniques include interventions performed under radiologic or ultrasound guidance (uterine artery embolization and occlusion, myolysis, magnetic resonance-guided focused ultrasound surgery, radiofrequency ablation of fibroids and endometrial ablation). Medical treatment options for fibroids are still restricted and available medications (progestogens, combined oral contraceptives andgonadotropin-releasing hormone agonists and antagonists) are generally used for short-term treatment of fibroid-induced bleeding. Recently, it was shown that SPRMs could be administered intermittently long-term with good results on bleeding and fibroid size reduction. Novel medical treatments are still under investigation but with promising results.
CONCLUSIONS
Treatment of fibroids must be individualized based on the presence and severity of symptoms and the patient's desire for definitive treatment or fertility preservation.
Topics: Humans; Leiomyoma; Female; Uterine Neoplasms; Hysterectomy; Uterine Artery Embolization; Uterine Myomectomy
PubMed: 38929485
DOI: 10.3390/medicina60060868 -
Physics in Medicine and Biology Feb 2024Medical image segmentation algorithms based on deep learning have achieved good segmentation results in recent years, but they require a large amount of labeled data....
Medical image segmentation algorithms based on deep learning have achieved good segmentation results in recent years, but they require a large amount of labeled data. When performing pixel-level labeling on medical images, labeling a target requires marking ten or even hundreds of points along its edge, which requires a lot of time and labor costs. To reduce the labeling cost, we utilize a click-based interactive segmentation method to generate high-quality segmentation labels. However, in current interactive segmentation algorithms, only the interaction information clicked by the user and the image features are fused as the input of the backbone network (so-called early fusion). The early fusion method has the problem that the interactive information is much sparse at this time. Furthermore, the interactive segmentation algorithms do not take into account the boundary problem, resulting in poor model performance. So we propose early fusion and late fusion strategy to prevent the interaction information from being diluted prematurely and make better use of the interaction information. At the same time, we propose a decoupled head structure, by extracting the image boundary information, and combining the boundary loss function to establish the boundary constraint term, so that the network can pay more attention to the boundary information and further improve the performance of the network. Finally, we conduct experiments on three medical datasets (Chaos, VerSe and Uterine Myoma MRI) to verify the effectiveness of our network. The experimental results show that our network greatly improved compared with the baseline, and NoC@80(the number of interactive clicks over 80% of the IoU threshold) improved by 0.1, 0.1, and 0.2. In particular, we have achieved a NoC@80 score of 1.69 on Chaos. According to statistics, manual annotation takes 25 min to label a case(Uterine Myoma MRI). Annotating a medical image with our method can be done in only 2 or 3 clicks, which can save more than 50% of the cost.
Topics: Humans; Deep Learning; Algorithms; Time; Myoma; Image Processing, Computer-Assisted
PubMed: 38198729
DOI: 10.1088/1361-6560/ad1cf8 -
International Journal of Gynaecology... Jun 2024Uterine leiomyomas (ULs) are non-cancerous tumors composed of smooth muscle cells that develop within the myometrium and represent the most prevalent pathological... (Review)
Review
Uterine leiomyomas (ULs) are non-cancerous tumors composed of smooth muscle cells that develop within the myometrium and represent the most prevalent pathological condition affecting the female genital tract. Despite the volume of available research, many aspects of ULs remain unresolved, making it a "paradoxical disease" where the increase in available scientific literature has not been matched by an increase in solid evidence for clinical management. Fertility stands at the top of the list of clinical issues where the role of ULs is still unclear. The leiomyoma subclassification system, released by the International Federaion of Gynecology and Obstetrics (FIGO) in 2008, introduced a new and more effective way of categorizing uterine fibroids. The aim was to go beyond the traditional classification "subserosal, intramural and submucosal", facilitating a detailed examination of individual ULs impact on the female reproductive system. The "type 3 UL" is a special type of myoma, characterized by its complete myometrial development while encroaching the endometrium. It is a unique "hybrid" between a submucous and an intramural UL, that may exert a detrimental "double hit" mechanism, which is of particular interest in patients wishing pregnancy. To date, no robust evidence is available regarding the management of type 3 ULs. The aim of this narrative review is to provide a comprehensive overview of the physiopathological mechanisms that type 3 UL may exert on fertility, and to present new perspectives that may help us to better understand both the need for and the methods of treating this unique type of fibroid.
Topics: Humans; Female; Leiomyoma; Uterine Neoplasms; Infertility, Female; Pregnancy; Myometrium
PubMed: 38009829
DOI: 10.1002/ijgo.15260 -
Computerized Medical Imaging and... Sep 2023Submucosal invasion depth is a significant prognostic factor when assessing lymph node metastasis and cancer itself to plan proper treatment for the patient....
Submucosal invasion depth is a significant prognostic factor when assessing lymph node metastasis and cancer itself to plan proper treatment for the patient. Conventionally, oncologists measure the invasion depth by hand which is a laborious, subjective, and time-consuming process. The manual pathological examination by measuring accurate carcinoma cell invasion with considerable inter-observer and intra-observer variations is still challenging. The increasing use of medical imaging and artificial intelligence reveals a significant role in clinical medicine and pathology. In this paper, we propose an approach to study invasive behavior and measure the invasion depth of carcinoma from stained histopathology images. Specifically, our model includes adaptive stain normalization, color decomposition, and morphological reconstruction with adaptive thresholding to separate the epithelium with blue ratio image. Our method splits the image into multiple non-overlapping meaningful segments and successfully finds the homogeneous segments to measure accurate invasion depth. The invasion depths are measured from the inner epithelium edge to outermost pixels of the deepest part of particles in image. We conduct our experiments on skin melanoma tissue samples as well as on organotypic invasion model utilizing myoma tissue and oral squamous cell carcinoma. The performance is experimentally compared to three closely related reference methods and our method provides a superior result in measuring invasion depth. This computational technique will be beneficial for the segmentation of epithelium and other particles for the development of novel computer-aided diagnostic tools in biobank applications.
Topics: Humans; Carcinoma, Squamous Cell; Artificial Intelligence; Mouth Neoplasms; Epidermis; Epidermal Cells; Coloring Agents
PubMed: 37611486
DOI: 10.1016/j.compmedimag.2023.102276 -
Current Pharmaceutical Biotechnology Jan 2024SERPINA3 (α-1-antichymotrypsin, AACT, ACT) is produced by the liver and released into plasma in an anti-inflammatory response and plays a role as a modulator of...
BACKGROUND
SERPINA3 (α-1-antichymotrypsin, AACT, ACT) is produced by the liver and released into plasma in an anti-inflammatory response and plays a role as a modulator of extracellular matrix (ECM) by inhibiting serine proteases. Numerous studies proved an increased level of SERPINA3 in many types of cancer, which could be linked to SERPINA3's anti-apoptotic function.
AIM
In the context of progressive ECM fibrosis during the development of uterine fibroids, which are one of the most common hypertrophic changes within the uterus, it is interesting to describe the level of SERPINA3 protein in this type of lesion and the surrounding tissues.
METHODS
We used immunohistochemical staining of the SERPINA3 protein and compared the intensity of the signal between the myoma tissue and the surrounding normal tissue.
RESULTS
We showed a surprising reduction in the amount of the SERPINA3 protein within uterine fibroids compared to surrounding tissues.
CONCLUSION
This observation sheds new light on the role of this protein in the formation of proliferative changes and suggests that understanding the mechanism of its action may become the basis for the development of new diagnostic and therapeutic tools.
PubMed: 38204235
DOI: 10.2174/0113892010264673231111082438