, Min Hyouk Beak, Won-joong Kim Although sciatica is commonly associated with lumbar spinal issues, it is important to acknowledge that non-spinal factors can also play a significant role in this condition. This is particularly relevant for female patients, in whom gynecologic conditions can lead to secondary sciatic neuropathy. Herein, we report the case of a 66-year-old woman who experienced posterolateral right lower extremity radiating pain. We initially performed a lumbar transforaminal epidural steroid injection, but the pain persisted. Subsequently, hip MRI revealed sciatic neuropathy adjacent to the pedunculated portions of a uterine myoma. We then performed a sub-gluteal sciatic nerve block under ultrasound guidance, resulting in significant relief of her pain. In conclusion, hip MRI can be helpful for the differential diagnosis of sciatica, and ultrasound-guided sciatic nerve block can be considered an appropriate and effective treatment option.
Citations
, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim Esophageal subepithelial tumors (SETs) are commonly encountered during screening endoscopy, and leiomyomas are the most common SET of the esophagus. Almost all patients with esophageal leiomyomas are asymptomatic; however, some present with dysphagia, depending on the size of the tumor and the extent to which it encroaches on the lumen. The typical endosonographic features of esophageal leiomyomas include well-demarcated, homogeneously hypoechoic lesions with echogenicity similar to that of the surrounding proper muscle layer, but without cystic changes. Histopathologically, esophageal leiomyomas do not undergo cystic or myxoid degeneration. This report presents a case involving a 65-year-old man with a symptomatic esophageal SET and endosonographic features indicative of malignant neoplasms, who was diagnosed with esophageal leiomyoma with cystic and myxoid degeneration following surgical resection.
, Ji-Eun Ban Cardiac rhabdomyomas are typically presented in the tuberous sclerosis. Although benign and often associated with spontaneous regression, in rare circumstances huge mass size and critical location can lead to heart failure, ventricular outflow tract obstruction and refractory tachyarrhythmias. An 1-day-old girl was diagnosed as cardiac tumor during perinatal period. At birth, transthoracic echocardiography revealed huge cardiac mass located in septal area of both ventricle measuring 34×30 mm. It protruded into the left ventricular (LV) outflow tract, potentially obstructing it. A surface ECG revealed atrial tachycardia with nonsustained ventricular tachycardia with heart rate of 217 beats per min. The tachyarrhythmias were controlled with intravenous amiodarone. Reduction of the giant cardiac mass was treated with mammalian target of rapamycin pathway inhibitor sirolimus. However, she unfortunately died at 10 days-old because of sudden cardiac arrest maybe due to LV outflow tract obstruction during therapy. Gene analysis revealed TSC2 mutation after death. (Ewha Med J 2022;45(3):e5)
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, Eunhye Cho, Hae Kyung Yoo In the reproductive age, many women have several uterine myomas and present with abnormal uterine bleeding, dysmenorrhea, and occasionally infertility. There are three surgical approaches to perform myomectomy, including robotic-assisted, laparoscopic, and abdominal myomectomy. Compared to laparoscopic procedures, robotic myomectomy allows free approach of myoma bases using fine instruments and endoscopes. Fine uterine wall sutures can be performed layer-by-layer with robots. However, robotic surgery is difficult to perform because there is no sense of touch during the operation. We report two clinical myomectomy cases with replaced lack of haptic feedback during robot surgery. The patients received robotic myomectomy with/without right ovarian cystectomy and adhesiolysis. Sixty-five leiomyomas were removed in case 1. Forty-six leiomyomas were removed in case 2. Lack of haptic feedback is replaced by more developed visual sense during robot myomectomy of multiple tiny intramural myomas, and robotic surgery can be performed much more effectively even in complicated cases.
, Hyun Soo Park, Myung Hwa Lee, Sung Hee Kim, Jung Hwan Shin Ectopic pregnancy is an implantation of the fertilized ovum outside the uterine cavity. Most of ectopic pregnancies are located within the fallopian tube. We describe a rare case of 34-year-old woman complaining of lower abdominal pain and positive urinary pregnancy test. Pelvic ultrasound exam suggested tubal pregnancy with hemoperitoneum. However, pelviscopy revealed the bleeding point was subserosal myoma located just next to the right ovary. Uterus and both fallopian tubes were grossly free. Laparoscopic myomectomy with ectopic mass excision was performed and we observed the serial decrease of β-hCG level. Patient was well recovered and postoperative finding was not remarkable. Hereby, we report a rare case of ectopic pregnancy on uterine myoma with subserosal type with a brief review of literatures.
, Seok Heun Jang, Hak Ryong Choi, Bong Suck Shim, Sung Won Kwon Urethral masses are not common in urogenital disease. The purpose of this study is to investigate and analyze urethral masses.
We reviewed 82 cases of urethral mass which were confirmed pathologically at Urology Department of Ewha Womans University Hospital from January 1985 to December 1994.
1) Age distribution was between 10 and 82 years(mean age 48.7 years), showing the highest incidence in 31 to 60 years(53/82, 64.6%) and female to male ratio was 5.8:1.
2) Major symptoms were foreign body sensation of urethra(42/82, 51.2%), vaginal spotting (20/82,24.4%), dysuria(12/82, 14.6%), residual urine sensation and urinary frequency.
3) Among them, 40 cases were urethral caruncle(40/82,48.8%), 13 were urethral diver-ticulum(13/82, 15.9%), 10 were urethral condyloma(10/82, 12.2%), and 8 were urethral leiomyoma(8/82, 9.8%).
4) Among urethral caruncles, 24 cases were telangiectatic type(24/40, 60%), 8 were papillomatous type(8/40, 20%) and 8 were granulomatous type(8/40, 20%).
5) Surgical excision with electrocauterization or laser fulguration was performed in all cases and radiation therapy was added in case of leiomyosarcoma.
These results suggest that urethral masses are more common in female than male, most of them are benign condition, urethral caruncle is a major disease, and surgical excision with electrocauterization or laser fulguration is a good treatment.
To evaluate the treatment failure (TF) rate of leiomyoma after uterine artery embolization (UAE) for uterine leiomyomas in cases of the presence of anastomoses between the ovarian arteries (OA) and uterine arteries (UA).
The results of 163 consecutive UAE for uterine fibroid were reviewed. Mean patient age was 42.8 years (range, 25 to 57 years). TF was evaluated according to the anastomoses between OA and UA on pre-embolization angiography. Magnetic resonance images (MRIs) were obtained at 1~6 months or 12 months after UAE. MRIs were gadolinium (Gd)-enhanced images and/or T2-weighted images. MRIs exhibited focal enhancement portion on fibroid and evaluated the TF rate of the leiomyoma in patients of presence of anastomoses between OA and UA.
Fifty six patients had anastomoses between UA and OA on pre-embolization angiography (56/163, 34.4%). Angiographic subtypes were type Ia (n=19), type Ib (n=16), type II (n=11) and type III (n=10). Of all patients, 10 patients showed the focal enhancements of the leiomyomas on follow-up enhanced MRIs (10/163, 6.1%). Three treatments failed in patients demonstrated type Ia (3/19, 15,8%). One had type Ib (1/16, 6.3%). Other 6 had no anastomoses. There was no TF rate difference between patients with communication (4/56, 7.1%) and without communication (6/107, 5.7%). However, TF rate in patients with type Ia communication (15.8%) was higher than that without communication (5.7%; P<0.05).
Type Ia utero-ovarian anastomoses communication could be a contraindication for embolization treatment for leiomyoma.
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, So-Ra Kang Leiomyoma is a benign tumor arise from smooth muscle and distributed wherever smooth muscle is present. Its common elective location is in uterus muscle and limb localization is rare. When it occurs in the extremity, it is more common in the legs, ankle, and foot than it is in the upper extremities. Especially on leiomyoma on the finger tip is extremely rare. This 36-year-old woman presented with a painful mass of the distal phalanx of her left thumb. It was about rice sized movable mass with firm consistency.
The round shaped mass in the left thumb was approximately 0.5×0.4cm in size. It was slowly growing mass without skin color change, bleeding nor ulceration. Under the local anesthesia, The patient underwent surgical excision .The masses were in deep subcutaneous and no connection with right maxillary sinus.
Macrosopic description of the mass is round and encapsuled, grayish nodule with size of 0.5×0.4cm. Microscopic study demonstrated a capsulease lesion of elongated cells white monomorphic cigar-shaped nuclei without atypia. The immunohistological phenotype was positive for Actin, which is marker for smooth muscle, but negative for S-100.
It is extremely rare to find leiomyoma origin from finger tip. Therefore the tumor is difficult to diagnosed before surgery. Only histological study can confirm the diagnosis. Complete surgical excision provides the most effective means of treatment.
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