case_images: PMC6077506_01
case_images: (a) Large tumor occupying the abdominal cavity on a computerized tomography scan. (b) The histopathological diagnosis is leiomyoma (H&E 200x), based on the absence of nuclear atypia and a low mitotic index. (c) Tumor cells stained strongly positive for Alcian blue at a pH of 2.5 (200x). (d) Alcian blue staining disappears after hyaluronidase digestion (200x).
case_images: CRIOG2018-4039183.001.jpg
case_images: PMC6077506_01_CRIOG2018-4039183.001.jpg
case_images: fig1
case_images: Computerized tomography (CT) revealed a large tumor occupying the abdominal cavity and multiple bilateral pulmonary nodules (Figure 1(a)). Thus, the final histopathological diagnosis was leiomyoma (Figure 1(b)). Moreover, the staining disappeared after hyaluronidase digestion, suggesting that the tumor contained abundant hyaluronan (Figures 1(c) and 1(d)).
case_images: PMC6077506_02
case_images: (a) Heterogeneous large tumor occupying the pelvic cavity on a computerized tomography scan. (b) Intravascular tumor within the dilated left internal iliac vein on a computerized tomography scan. (c) Multiple leiomyomas within the uterine corpus and cervix. (d) Tumor growth extending into the left ovarian vein.
case_images: CRIOG2018-4039183.002.jpg
case_images: PMC6077506_02_CRIOG2018-4039183.002.jpg
case_images: fig2
case_images: CT revealed a large heterogeneous tumor occupying the pelvic cavity and an intravascular tumor within the dilated left internal iliac and ovarian veins (Figures 2(a) and 2(b)). The resected uterus and adnexa weighed 897 g (Figures 2(c) and 2(d)). There was no residual tumor detected in the venous resection stump.
case_images: (a) The intravenous tumor (H&E magnifying lens). (b) Vessel endothelium cells and vascular smooth muscle layer covered the intravenous leiomyoma (H&E 40x); an enlarged view of the area in Figure 3(a) is surrounded by a large black box. (c) Tumor cells stained strongly for positive Alcian blue at a pH of 2.5 (200x); an enlarged view of the area in Figure 3(a) is surrounded by a small black box. (d) Alcian blue staining disappears after hyaluronidase digestion (200x); the same area as that in Figure 3(c) is shown.
case_images: CRIOG2018-4039183.003.jpg
case_images: PMC6077506_02_CRIOG2018-4039183.003.jpg
case_images: fig3
case_images: In addition, vessel endothelium cells and a vascular smooth muscle layer covered the IVL (Figures 3(a) and 3(b)). However, compared to that in Case 1, the intensity of the staining was weaker and less diffuse (Figures 3(c) and 3(d)).