Uterine angiolipoleiomyomas are rare, benign mixed mesenchymal lesions. A manifestation in the gynecological region is quite uncommon, with few cases described in the literature so far. We present an interesting case of a 59-year-old woman diagnosed with uterine angiolipoleiomyoma, and the results of the conducted systematic review of the literature. The patient presented with a pelvic mass masquerading as a leiomyoma on the ultrasound and postmenopausal vaginal bleeding. At laparotomy, a large uterus was noticed and the histopathology set the diagnosis of angiolipoleiomyoma. Immunohistochemistry revealed negativity for Melan-A and HMB-45 melanoma-specific antibodies and positivity for Van Gieson and orcein histochemical stains. We systematically reviewed the literature. The eligible articles were those written in English, excluding animal studies and studies reporting angiolipoleiomyomas in other regions beside the uterus. The present case is one of the 10 cases of uterine angiolipoleiomyoma reported in the literature. In 8 out of 11 (72.7%) cases, uterine angiolipoleiomyomas arose from the corpus of the uterus, while in 2 (18.1%) cases they were located at the cervix, and in one case (9%) angiolipoleiomyoma was located in the broad ligament. Concerning symptoms, four of the patients (36.4%) presented with abdominal and pelvic pain, two (18.1%) with postmenopausal vaginal bleeding, one with menometrorrhagia (9%), and one with uterine prolapse and cystocele (9%). Immunohistochemical staining of uterine angiolipoleiomyomas was positive for SMA in 4 patients (36.4%), positive for desmin in 3 cases (27.3%), positive for anti-S-100 protein antibody in 2 patients (18.1%), while in one case (9%) immunopositivity was observed for CD31. Only our case (9%) was also tested for CD34, Van Gieson and orcein, the first of these being negative and the other two positive (at the blood vessels in a specialized pattern). Three of the patients (27.3%) were also tested for HMB-45 and all three were immunonegative. In order to establish the diagnosis of uterine angiolipoleiomyomas, ultrasonography and additional MRI may help the preoperative prediction of a benign mass. Immunohistochemistry will show strong positivity of alpha-smooth muscle actin and desmin. Complete abdominal hysterectomy is the preferable treatment.
surgical approach. To account for these differences, inverse probability weighting was performed to consider both groups fully comparable.We used inverse probability weighting to define two comparable groups (sentinel node biopsy vs lymphadenectomy). We performed a logistic regression to calculate the odds of having positive nodes after a sentinel node biopsy compared with a lymphadenectomy in the weighted sample. We also compared the disease-free survival and the overall survival between groups in the weighted cohort. Result(s)* We found that women who underwent a sentinel node biopsy had smaller tumours and were more using minimally invasive surgery . In the weighted cohort we found that women who underwent a sentinel node biopsy had a 15.7% of positive nodes vs. 10-7 % in the lymphadenectomy arm. Sentinel node patients had 1.63-fold higher odds (95% CI: 1.00-2.64) of having a diagnosis of positive nodes. We did not find that undergoing a sentinel node biopsy had any association neither with disease free survival nor with overall survival. Conclusion* After applying an Inverse Probability Weighting using a propensity score, the use of Sentinel Lymph Node Biopsy increased the detection of positive nodes by 63% in the SUCCOR study . The standard pelvic lymphadenectomy might underdiagnose the nodal status in early cervical cancer.
Ambroise Paré is considered to be one of the fathers of surgery and a pioneer in surgical techniques. He was one of the first surgeons to encourage primary amputation for the treatment for gunshot wounds, he designed "bec du corbin", the predecessor to modern hemostats, he designed limb protheses and some ocular protheses and he also aimed for the progress of obstetrics. Besides from being an extraordinary scientist, Ambroise Paré had a compassionate character and he spent his whole life helping others. The motto that characterized his scientic personality and his life was "I treated him, but God healed him".
Crohn’s disease is a multi-systemic chronic inflammatory disease that can affect various organs besides the gastrointestinal tract such as joints, uvea, and the skin. Vulvar Crohn’s disease is a rare entity occurring with vulvar lesions that show typical Crohn’s disease granulomatous inflammation but are not contiguous with the gastrointestinal involvement. Vulvar Crohn’s disease can be easily confused with other granulomatous diseases and awareness that such involvement may precede gastrointestinal symptoms must be raised. Few cases of vulvar Crohn’s disease have been reported in the literature to date. Here, we report a case of a 43-year-old woman with a 6-month history of a vulvar lesion; the patient was diagnosed with Crohn’s disease of the large bowel just over a year ago.
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