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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe 16 cases of intravenous leiomyomatosis of the uterus with unusual histologic features. Most of the patients, who ranged in age from 28 to 76 years (median, 42 years), presented with abnormal uterine bleeding or pelvic pain. On pelvic examination, they had an enlarged uterus. Extension of tumor into the broad ligament was noted at operation in six patients; it was documented on pathologic examination in an additional three cases. Gross examination disclosed enlargement of the uterus by solitary or multiple masses; wormlike plugs of tumor within myometrial veins were noted on initial examination in only five cases. Histologic examination in each case revealed proliferations of benign-appearing smooth muscle within myometrial vessels, at least some of which were large veins. The tumors differed from typical intravenous leiomyomatosis (IVL). They were classified as cellular IVL (six cases), epithelioid IVL (four cases), IVL with bizarre nuclei (two cases), intravenous lipoleiomyomatosis (two cases), myxoid IVL (one case), and IVL with an endometrial component (one case). Of 13 patients with follow-up information, 11 are alive with no evidence of disease or have died of unrelated causes at postoperative intervals of 0.5 to 19 years. One patient underwent resection of pelvic recurrent tumor 2 years postoperatively and was alive with no evidence of disease 2 years later. Another patient had pulmonary metastases 9 years postoperatively, but was alive with stable disease after an additional 6 years. This analysis indicates that most of the histologic variants of benign uterine leiomyoma can exhibit the intravascular growth pattern of IVL. These variants of IVL, except for their cellular composition, resemble typical IVL in both their clinical and pathological features. They should be distinguished from other tumors, particularly endometrial stromal sarcoma and leiomyosarcoma, which differ in their behavior and management.
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PMID:Intravenous leiomyomatosis of the uterus. A clinicopathological analysis of 16 cases with unusual histologic features. 320 47

Clinical and pathological features of 41 homologous uterine stromal tumors classified by the criteria of Norris and Taylor were reviewed. These included stromal nodules (12 cases), endolymphatic stromal myosis (20 cases), and stromal sarcoma (nine cases). Patients ranged in age from 18 to 79 with a median of 45 years. Symptoms were similar in all three forms and included vaginal bleeding (63%), pelvic pain (11%), or an abdominal mass (6%), while 26% of patients were asymptomatic. Tumors characteristically resembled endometrial stroma histologically, but variations included hemangiopericytoma and "sex-cord-like" patterns, hyalinization, and foam cells. A sex-cord-like pattern was seen only with stromal nodules and endolymphatic stromal myosis. Necrosis was seen in all three lesions, whereas nuclear anaplasia was seen only with stromal sarcoma. Follow-up ranging from 2 months to 12 years (median interval: 5 years) was obtained in 23 cases. No recurrences were recorded among six stromal nodules. Endolymphatic stromal myosis behaved as an indolent low grade malignancy, with three recurrences but no deaths among 13 patients; these occurred at 3 to 7 years after initial diagnosis. Stromal sarcoma behaved as a high grade malignancy, with two deaths among five patients with follow-up, both occurring within 8 months of diagnosis.
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PMID:The clinical and histologic spectrum of endometrial stromal neoplasms: a report of 41 cases. 649 Mar 15

The authors report a case of endometrial stromal sarcoma which was detected by endometrial cytology. The tumour originates either in the stroma of the endometrium or in foci of myometrial adenomyosis. It occurs most frequently in patients who are more than 60 years of age. It appears as an intra-uterine polypoid mass and causes bleeding and pelvic pain. Its incidence is difficult to establish. Endometrial cytology is highly suggestive of stromal sarcoma when smears harbour numerous atypical sarcomatous cells mixed with regular endometrial cells. Biopsies of the endometrium show decidua-like arrangements of malignant cells. Stromal sarcoma constitutes the homologous form of mesenchymal tumours of the uterus. The prognosis depends on whether local recurrences occur and on the sites of metastases in which the sarcomatous component seems to be latent with lesions that resemble adenocarcinomata . The five years salvage rate is approximately 26 to 28%. Treatment is surgical with or without irradiation.
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PMID:[Detection of endometrial stromal sarcoma using endometrial cytology. Apropos of a case]. 672 76

We present a case of a 24-year-old woman, gravida 0, with menometrorrhagia and pelvic pain. A uterine hemorrhagic fibroid was diagnosed after ultrasound and magnetic resonance imaging (MRI). The endometrial biopsy was negative for malignancy. Laparoscopic sentinel lymph node sampling, lavage, and myometrial biopsy with negative results were performed before dissection of the uterine vessels. The final diagnosis of endometrial stromal sarcoma was made by myomectomy and hysterectomy one year later. This case should demonstrate the difficulty of making the right diagnosis of sarcoma before laparoscopic dissection of uterine vessels in patients with symptomatic fibroids.
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PMID:Laparoscopic uterine artery dissection in an undiagnosed endometrial stromal sarcoma. Case report. 1575 16

Endometrial stromal sarcoma is a rare malignant uterine tumor. We report 4 cases of low-grade endometrial stromal sarcoma, corresponding to the form with a mitotic index at less than 10 mitoses per 10 high power fields (HPF), from which we carried out a review of the literature and defined the potential interest of hormone therapy and chemotherapy by etoposide. Generally diagnosed in pre-menopause, the main clinical signs, which are not very specific, are metrorrhagia and pelvic pain. The etiologic diagnosis is established from the pathology analysis. Intravascular extension, which is observed in nearly 50% of patients, should evoke the disease. The initial treatment is mainly based open surgery, generally total hysterectomy with annexectomy. There is no effective adjuvant treatment. The potential of reccurences remains around 50% with a 34-month median. Several therapeutic options are possible after recurrence but no standard treatment has been established. We are mainly interested in three medical options but the surgery remains an alternative of choice. Chemotherapy by oral etoposide offers easy administration, good compliance and acceptable toxicity with median 20-month remission in 3 patients before progression. Hormone therapy with progestogens (hormone receptor expression of the tumor is 71% for estrogens and 95% for progesterone) is widely studied in the literature with a 46% response rate and 46% rate of disease stabilization. Hormone therapy with an anti-aromatase appears to be a promising treatment according to the bibliographic references on this subject. Overall, prognosis of low-grade endometrial sarcoma is relatively good with 100% survival at 5 years. The progression pattern is slow, requiring regular and prolonged surveillance.
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PMID:[Low-grade endometrial stromal sarcoma: contribution of hormone therapy and etoposide]. 1576 16

This report describes a rare case of high-grade endometrial stromal sarcoma (ESS) arising from pathologically confirmed endometriosis in the cul-de-sac. A 37-year-old woman presented with irregular menstruation, pelvic pain, and diarrhea. Magnetic resonance imaging and colon biopsy suggested endometriotic nodule of the cul-de-sac. The tumor size was reduced with hormonal therapy, and the residual tumor was excised, resulting in the pathologic diagnosis of endometriosis. Two years later, a soft mass reappeared with rapid growth. Tumor extraction was performed, and the histopathologic diagnosis was high-grade ESS. Neither hormonal therapy nor chemotherapy was effective, and the patient died 6 months postoperatively. ESS should be included in the differential diagnosis of malignant transformation of endometriosis.
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PMID:A case of high-grade endometrial stromal sarcoma arising from endometriosis in the cul-de-sac. 1668 80

Endometrial stromal sarcomas (ESSs) are rare malignant tumors of the uterus that arise from the endometrial stroma, the annual incidence of ESS being 1-2/million women. Patients present with nonspecific complaints of abnormal uterine bleeding, pelvic pain, and pressure symptoms. Postmenopausal women rarely present with a low-grade ESS, as it is more common in younger women. ESS is usually confused with leiomyomas radiologically. Histopathological examination and immunohistochemistry are essential for the diagnosis. We, herein, report a case of a postmenopausal female who presented with something coming out per vagina. The clinical impression was that of a third-degree uterovaginal prolapse that on histopathological examination was diagnosed as a low-grade ESS.
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PMID:Low-Grade Endometrial Stromal Sarcoma in a Postmenopausal Woman with Third-Degree Uterovaginal Prolapse: A Rare Case with Review of the Literature. 3029 91

We present a compelling case of a 45-year-old female with a history of endometriosis and leiomyomas, who presented to her gynecologist with chronic pelvic pain complaints. Both a transvaginal ultrasound (US) and an MRI (magnetic resonance imaging) were ordered. The US demonstrated multiple uterine lesions, likely fibroids, and an endometrioma within the right ovary. The MRI of the pelvis with and without gadolinium identified a mass within the right ovary with homogenous intermediate T2-signal, restricted diffusion, and delayed enhancement relative to the myometrium. Several irregular-shaped lesions were also noted within the external myometrium, anterior pelvic wall, and the peritoneum, which were intermediate signal on T2-weighted images, restricted diffusion, and an enhancement pattern similar to the myometrium. The patient underwent a right adnexectomy. The histopathology findings were consistent with a low-grade endometrial stromal sarcoma (low grade-ESS) arising from the endometrial stroma of the right ovary. A debulking surgery confirmed the involvement of external myometrium, anterior pelvic wall, and the peritoneum secondary to a low-grade ESS without the endometrial cavity's involvement. The underlying hypothesis is that the endometriosis stroma from extra-uterine structures such as the right ovary, pelvic and anterior peritoneum, and external myometrium may have subsequently resulted in a low-grade ESS. Low-grade extra-uterine ESS without endometrial involvement is a rare entity. Based on our literature search, this is one of the few reports covering the radiological features of low-grade extra-uterine ESS arising outside the uterus with a concomitant deep infiltrating endometriosis, but without the involvement of the endometrial cavity.
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PMID:Extra-uterine endometrial stromal sarcoma arising from deep infiltrating endometriosis. 3289 Sep 9