以肠梗阻为首发表现的系统性红斑狼疮相关平滑肌病1例

1临床资料 患者,女,62岁,因＂排便习惯改变伴腹痛、腹胀2年,加重伴停止排气3 d＂于2017年7月17日于大连医科大学附属第一医院消化内科入院治疗。2年前出现排便习惯改变,稀水样便与干结粪便交替,无脓血便及粘液便,伴下腹胀痛,餐后明显,排便或排气腹痛减轻。上述症状持续存在,未系统诊治。

1例子宫颈上皮样平滑肌肉瘤病例报道及文献回顾

Background. Epithelioid leiomyosarcomas arising from the uterine cervix are extremely rare neoplasms, with only three cases reported in the English literature. Case. A 53- year- old Japanese woman was admitted to our university hospital due to massive vaginal bleeding from a cervical tumor. A total hysterectomy with bilateral salpingooop- horectomy was performed. Histological findings, including immunohistochemical study using desmin, SMA, cytokeratin, S- 100, HMB- 45, vimentin, mela- A, and CD68, led to a diagnosis of epithelioid leiomyosarcoma of the uterine cervix. The patient underwent adjuvant chemotherapy and has been disease- free for over 20 months. Conclusion. Immunohistochemical studies may be needed to differentiate among the alternative diagnoses of malignant melanoma, metastatic carcinoma, and epithelioid sarcoma. Additional cases are needed to develop optimal management strategies and to predict prognosis.

卵巢上皮样平滑肌肉瘤

Introduction. Leiomyosarcoma of the ovary is a rare lesion usually seen in postmenopausal women. Epithelioid leiomyosarcoma of the ovary is exceptionally rare, with only one previously reported case. Case. A 42- year- old nulliparous woman undergoing ovulation induction presented with a left adnexal mass. An exploratory laparotomy was performed. Frozen section diagnosis was read as fibrothecoma, and an oophorectomy was performed. The final diagnosis was epithelioid leiomyosarcoma of the ovary. Subsequently, a staging procedure including hysterectomy was performed with no residual disease. Discussion. This is an unusual case for several reasons. Most leiomyosarcomas of the ovary have occurred in postmenopausal women and were of advanced stage at diagnosis. Our case had an epithelioid histology, occurred in a premenopausal woman, and was confined to the ovary. The fact that the patient was undergoing ovulation induction at the time of diagnosis raises the question of the risk of developing ovarian neoplasms with these medications.

静脉内平滑肌瘤病20例临床分析

目的 分析静脉内平滑肌瘤病的临床特点、影像学特征、治疗及预后随访情况。方法 回顾性分析2022年6月至2023年10月期间济宁医学院附属医院20例静脉内平滑肌瘤病患者的临床病理资料,总结静脉内平滑肌瘤病的影像学特征及其临床症状与复发风险的相关性,并分析漏诊、误诊的影响因素。结果 患者平均年龄(45.8±3.2)岁,影像学表现以子宫增大、盆腔肿物伴静脉占位为主,临床表现与肿瘤受累部位密切相关,8例(40%)既往有子宫肌瘤史或子宫肌瘤切除术史,2例(10%)未绝经,所有患者均行手术治疗且术后病理证实为静脉内平滑肌瘤病。1例(5%)失访,1例(5%)复发,18例(90%)随访未见复发,目前仍在随诊中。结论 静脉内平滑肌瘤病需借助影像学联合病理金标准方能正确做出诊断,且该病易复发,首选手术治疗,术后需要定期随访。

系统性红斑狼疮合并假性肠道梗阻及输尿管肾盂积水一例并文献复习

系统性红斑狼疮（SLE）是一种多因素参与的（遗传、性激素、环境、感染、药物、食物及遗传背景等）系统性自身免疫性疾病,突出表现有多种自身抗体并通过免疫复合物等途径造成全身系统受累。作为全身系统性疾病,临床常常会遇到以消化系统为首发症状的SLE患者,给临床诊疗带来困难。该病患者若得不到及时救治,常会危及生命。因此,宁波市泌尿肾病医院将最近收治的1例患者结合文献报道如下。

Giant Fibrovascular Polyp of Esophagus:One Case Report

Esophageal polyps are very rare,One case of giant fibrovascular polyp of the esophagus was described.The patient had symptoms of dysphagia and hematemesis.After examinations,the diagnosis of esophageal leiomyoma was made,In the process of thoracie exploration,esophageal polyp was removed,The pathological diagnosis postoperation was giant fibrovascular polyp of the esophagus associated with mucoid degeneration.

Surgical treatment of giant esophageal leiomyoma

AIM： To summarize the operative experiences for giant leiomyoma of esophagus.METHODS： Eight cases of giant esophageal leiomyoma （GEL） whose tumors were bigger than 10 cm were treated surgically in our department from June 1980 to March 2004.All of these cases received barium swallow roentgenography and esophagoscopy. Leiomyoma located in upper thirds of the esophagus in one case, middle thirds of the esophagus in five cases, lower thirds of the esophagus in two cases. Resection of tumors was performed successfully in all of these cases. Operative methods included transthoracic extramucosal enucleation and buttressing the muscular defect with pedicled great omental flap （one case）, esophagectomy and esophagogastrostomy above the arch of aorta （three cases）, total esophagectomy and esophageal replacement with colon （four cases）. Histological examination confirmed that all of these cases were leiomyoma.RESULTS： All of the eight patients recovered approvingly with no mortality and resumed normal diet after operation. Vomiting during meals occurred in one patient with esophagogastrostomy, and remained 1 mo. Reflux esophagitis occurred in one patient with esophagogastrostomy and was alleviated with medication. Thoracic colon syndrome （TCS） occurred in one patient with colon replacement at 15 mo postoperatively. No recurrence occurred in follow-up from 6 mo to 8 years.CONCLUSION： Surgical treatment for GEL is both safe and effective. The choices of operative methods mainly depend on the location and range of lesions. We prefer to treat GEL via esophagectomy combined with esophagogastrostomy or esophagus replacement with colon. The long-time quality of life is better in the latter.

Inhibitory effects of genistein and resveratrol on guinea pig gallbladder contractility in vitro

AIM: To observe and compare the effects of phytoestrogen genistein, resveratrol and 17β-estradiol on the tonic contraction and the phasic contraction of isolated gallbladder muscle strips and to study the underlying mechanisms. METHODS: Isolated strips of gallbladder muscle from guinea pigs were suspended in organ baths containing Kreb’s solution, and the contractilities of strips were measured before and after incubation with genistein, resveratrol and 17β-estradiol respectively. RESULTS: Similar to 17β-estradiol, genistein and resveratrol could dose-dependently inhibit the phasic contractile activities, they decreased the mean contractile amplitude and the contractile frequencies of gallbladder muscle strips, and also produced a marked reduction in resting tone. The blocker of estrogen receptor ICI 182780 failed to alter the inhibitory effects induced by genistein and resveratrol, but potassium bisperoxo (1, 10 phenanthroline) oxovanadate bpV (phen), a potent protein tyrosine phosphatase inhibitor, markedly attenuated the inhibitory effects induced by genistein and resveratrol. In calcium-free Kreb’ssolution containing 0.01 mmol/L egtazic acid (EGTA), genistein and resveratrol inhibited the first phasic contraction induced by acetylcholine (ACh), but did not affect the second contraction induced by CaCl_2. In addition, genistein, resveratrol and 17β-estradiol also could reduce the contractile responses of ACh and KCl, and shift their cumulative concentration-response curves rightward. CONCLUSION: Phytoestrogen genistein and resveratrol can directly inhibit the contractile activity of isolated gallbladder muscle both at rest and in response to stimulation. The mechanisms responsible for the inhibitory effects probably due mainly to inhibition of tyrosine kinase, Ca^(2+) influx through potential-dependent calcium channels (PDCs) and Ca^(2+) release from sarcoplasmic reticulum (SR), but were not related to the estrogen receptors.

Coexistence of esophageal superficial carcinoma and multiple leiomyomas:A case report

Leiomyomas are the most common benign tumors of the esophagus. They usually occur as a single lesion or as two or three nodules. Only two cases of esophageal multiple leiomyomas comprising more than 10 nodules have been reported previously. Moreover, there have been few reports of esophageal squamous cell carcinoma overlying submucosal tumors. We describe a 71-yearold man who was diagnosed as having a superficial esophageal cancer coexisting with two or three leiomyoma nodules. During surgery, 10 or more nodules that had not been evident preoperatively were palpable in the submucosal and muscular layers throughout the esophagus. As intramural metastasis of the esophageal cancer was suspected, we considered additional lymphadenectomy, but had to rule out this option because of the patient＇s severe anoxemia. Microscopic examination revealed that all the nodules were leiomyomas （20 lesions, up to 3 cm in diameter）, and that invasion of the carcinoma cells was limited to the submucosal layer overlying a relatively large leiomyoma. This is the first report of superficial esophageal cancer coexisting with numerous solitary leiomyomas. Multiple minute leiomyomas are often misdiagnosed as intramural metastasis, and a leiomyoma at the base of a carcinoma lesion can also be rnisdiagnosed as tumor invasion. The present case shows that accurate diagnosis is required for the management of patients with coexisting superficial esophageal cancer and multiple leiomyomas.

Is it possible to differentiate gastric GISTs from gastric leiomyomas by EUS?

AIM: To evaluate the ultrasonog raphy (EUS) features of gastric gastrointestinal stromal tumors (GISTs) as compared with gastric leiomyomas and then to determine the EUS features that could predict malignant GISTs.METHODS: We evaluated the endoscopic EUS features in 53 patients with gastric mesenchymal tumors conf irmed by histopathologic diagnosis. The GISTs were classif ied into benign and malignant groups according to the histological risk classif ication.RESULTS: Immunohistochemical analyses demon-strated 7 leiomyomas and 46 GISTs. Inhomogenicity, hyperechogenic spots, a marginal halo and higher echogenicity as compared with the surrounding muscle layer appeared more frequently in the GISTs than in the leiomyomas (P < 0.05). The presence of at least two of these four features had a sensitivity of 89.1% and a specifi city of 85.7% for predicting GISTs. Except for tumor size and irregularity of the border, most of the EUS features were not helpful for predicting the malignant potential of GISTs. On multivariate analysis, only the maximal diameter of the GISTs was an independent predictor. The optimal size for predicting malignant GISTs was 35 mm. The sensitivity and specificity using this value were 92.3% and 78.8%, respectively.CONCLUSION: EUS may help to differentiate gastric GISTs from gastric leiomyomas. Once GISTs are suspected, surgery should be considered if the size is greater than 3.5 cm.

Sigmoid schwannoma: A rare case

Schwannomas are rare tumors derived from the cells of Schwann that form the neural sheath. When located in the gastrointestinal tract, they constitute together with leiomyoma, leiomyoblastoma, and leiomyosarcoma, the gastrointestinal stromal tumors (GIST). Peripheral nerve sheath tumors represent 2-6% GIST with most common location, the stomach and the small intestine. Schwannomas of the colon and rectum are extremely rare and radical excision with wide margins is mandatory, due to their tendency to recur locally and become malignant, if left untreated. In the present study, we report a rare case of a sigmoid schwannoma, which was successfully treated in our department and reviewed the literature.

Effect of serum concentration on adhesion of monocytic THP-1 cells onto cultured EC monolayer and EC-SMC co-culture

Background:The adhesion of monocytes to the endothelium following accumulation of low-density lipoprotein (LDL) in subendothelial spaces is an important step in the development of intimal hyperplasia in arterially implanted vein grafts and atherosclerosis in both animals and humans. However, it is not well known how serum factors affect the adhesion of monocytes. Methods: We have studied the effect of fetal calf serum (FCS), which we considered a source of LDL, on the adhesion of monocytes to endothelial cells (ECs) by using human monocytic THP-1 cells and both a monolayer of cultured bovine aortic endothelial cells (EC monoculture) and a co-culture with bovine aortic smooth muscle cells (EC-SMC co-culture). Results: It was found that the addition of FCS to the medium greatly affected the adhesion of THP-1 cells, and the higher the concentration of FCS in the medium, the greater the adhesion of THP-1 cells to endothelial cells. Adhesion of THP-1 cells to an EC-SMC co-culture was approximately twofold greater than that to an EC monoculture, and after adhering to endothelial cells, many THP-1 cells trans-migrated into the layer of smooth muscle cells. Conclusion: The results suggest that the elevation of the LDL (cholesterol) level in blood provides a favorable condition for the development of intimal hyperplasia and atherosclerosis by promoting the adhesion of monocytes to the endothelium and their subsequent migration into subendothelial spaces.

Lymphangioma of the small bowel mesentery: A case report and review of the literature

Lymphangioma is a rare benign condition characterized by proliferation of lymphatic spaces. It is usually found in the head and neck of affected children. Lymphangioma of the small-bowel mesentery is rare, having been reported for less than 1% of all lymphangiomas. Importantly, it can cause fatal complications such as volvulus or involvement of the main branch of the mesenteric arteries, requiring emergency surgery. Moreover, the gross and histopathologic findings may resemble benign multicystic mesothelioma and lymphangiomyoma. Immunohistochemical study for factor Ⅷ-related antigen, D2-40, calretinin and human melanoma black-45 (HMB-45) are essential for diagnosis. Factor Ⅷ-related antigen and D2-40 are positive in lymphangioma but negative in benign multicystic mesothelioma. HMB-45 shows positive study in the smooth-muscle cells around the lymphatic spaces of the lymphangiomyoma. We report a case of smallbowel volvulus induced by mesenteric lymphangioma in a 2-year-and-9-mo-old boy who presented with rapid abdominal distension and vomiting. The abdominal computed tomography scan showed a multiseptated mass at the right lower quadrant with a whirllike small-bowel dilatation, suggestive of a mesenteric cyst with midgut volvulus. The intraoperative findings revealed a huge, lobulated, yellowish pink, cystic mass measuring 20 cm × 20 cm × 10 cm, that was originated from the small bowel mesentery with small-bowel volvulus and small-bowel dilatation. Cut surface of the mass revealed multicystic spaces containing a milky white fluid. The patient underwent tumor removal with small-bowel resection and end-to-end anastomosis. Microscopic examination revealed that the cystic walls were lined with flat endothelial cells and comprised of smooth muscle in the walls. The flat endothelial cells were positive for factor Ⅷ-related antigen and D2-40 but negative for calretinin. HMB-45 showed negative study in the smooth-muscle cells around the lymphatic spaces. Thus, the diagnosis was lymphangioma of the small bowel mesentery with associated small bowel volvulus.

Hepatic angiomyolipoma: Dynamic computed tomography features and clinical correlation

AIM: To study the dynamic computed tomography (CT) features of hepatic angiomyolipoma (AML) in patients with or without tuberous sclerosis complex (TSC).METHODS: The clinical information, CT fi ndings and histopathological results of hepatic AML were analyzed retrospectively in 10 patients.RESULTS: Hepatic AML was prone to occur in female patients (7/10), and most of the patients (8/10) had no specific symptoms. All tumors presented as well-def ined, unenveloped nodules in the liver. Six patients with sporadic hepatic AML had a solitary hepatic nodule with a definite fat component. Non-fat components of the hepatic lesions were enhanced earlier and persistently. Prominent central vessels were noted in the portal venous phase in three patients. In four patients with hepatic AML and TSC, most of the nodules were within the peripheral liver. Seven fat-deficient nodules were found with earlier contrast enhancement and rapid contrast material washout in two patients. Lymphangioleiomyomatosis was found in one patient.CONCLUSION: Imaging features of hepatic AML are characteristic. Correct diagnosis preoperatively can be made in combination with clinical features.

Light and electron microscopic observation of malignant gastric leiomyoblastoma

There were only a few cases of gastric leiomy-oblastoma reported in domestic literature,while themalignant ones were even more seldom.One ofthese was diagnosed by gastroscopic biopsy with lightand electron microscopy in our department in 1988.CASE REPORTA 57-yeat old- male worker,suffered from re-current dull pain over the upper abdomen for 2

Pancreatic metastasis of leiomyosarcoma in the right thigh:A case report

Pancreatic tumors are primary in most of the cases. Pancreatic metastases associated with other primary malignancies, especially pancreatic metastasis of leiomyosarcoma, are uncommon. A 66-year-old woman underwent surgical resection of malignant mesenchymoma （70% osteosarcoma and 30% leiomyosarcoma） in the right thigh. In the postoperative period, a pancreatic mass was identified radiologically by abdominal computed tomography. Pylorus-preserving pancreaticoduodenectomy was performed. The surgical specimen revealed leiomyosarcoma metastasized to the pancreas. A metastatic nodule on the remnant pancreatic tail was discovered 9 mo after the first pancreatic resection, and distal pancreatectomy was performed. Cases of pancreatic metastasis from leiomyosarcoma are extremely rare, especially when the tumor was resectable. We report here a unique case of pancreatic metastasis from a leiomyosarcoma in the dght thigh that had been treated surgically.

Endoscopic management of gastrointestinal smooth muscle tumor

AIM: To systematically evaluate the efficacy and safety of endoscopic resection of gastrointestinal smooth muscle tumors (SMTs, including leiomyoma and leiomyosarcoma) and to review our preliminary experiences on endoscopic diagnosis of gastrointestinal SMTs. METHODS: A total of 69 patients with gastrointestinal SMT underwent routine endoscopy in our department. Endoscopic ultrasonography (EUS) was also performed in 9 cases of gastrointestinal SMT. The sessile submucosal gastrointestinal SMTs with the base smaller than 2 cm in diameter were resected by "pushing" technique or "grasping and pushing" technique while the pedunculated SMTs were resected by polypectomy. For those SMTs originating from muscularis propria or with the base size ≥ 2 cm, ordinary biopsy technique was performed in tumors with ulcers while the "Digging" technique was performed in those without ulcers. RESULTS: 54 cases of leiomyoma and 15 cases of leiomyosarcoma were identified. In them, 19 cases of submucosal leiomyoma were resected by "pushing" technique and 10 cases were removed by "grasping and pushing" technique. Three cases pedunculated submucosal leiomyoma were resected by polypectomy. No severe complications developed during or after the procedure. No recurrence was observed. The diagnostic accuracy of ordinary and the "Digging" biopsy technique was 90.0% and 94.1%, respectively. CONCLUSION: Endoscopic resection is a safe and effective treatment for leiomyomas with the base size ≤2 cm. The "digging" biopsy technique would be a good option for histologic diagnosis of SMTs.

EFFECTS OF ALCOHOL INTAKE ON PENILE STRUCTURE AND FUNCTION IN RATS

Objective To investigate the effects of alcohol intake on penile structure and function in rats. Methods Thirty adult male Wistar rats were randomly divided into two groups: control group and alcohol intake group. They were administered with 2 mL of normal saline and 40% alcohol solution respectively through gastric tubes every day. Three months later, the animal model of alcohol intake was evaluated by modified Nayagida's method, and the effects of alcohol on the rats were studied by sexual behavior, the number of apomorphine-induced penile erection, level of testosterone in the sera, and the content of penile smooth muscle. Results The scores of animal model of alcohol intake evaluated by Nayagida's method were 0.66±2.05 in the control group and 9.26±5.50 in the alcohol intake group(P<0.05), which indicated that an animal model of alcohol intake was successfully established. Sexual behavior, the number of apomorphine-induced penile erection, testosterone level in the sera, and the content of penile smooth muscle of the alcohol intake group were all statistically different as compared with the control group(P<0.05). Conclusion Alcohol intake induces sexual dysfunction in rats, which may be due to the decline of testosterone level in the sera and decline of penile smooth muscle.