Leiomyosarcoma of the vulva: a case report

Sarcomas represent only 1% to 3% of vulvar malignancies. Leiomyosarcoma is a rare malignant tumor of the vulva; it can be mistaken for a benign tumor, which can lead to misdiagnosis and incorrect or delayed treatment. We report the case of a 51-year-old woman with leiomyosarcoma of the vulva. The patient presented to her primary gynecologist with a vulvar mass that she had first noticed 20 years prior. The tumor was suspected to be aggressive angiomyxoma, and biopsy of the mass and treatment with gonadotrophin-releasing hormone agonist (GnRHa) therapy were recommended. The patient declined treatment and opted instead for observation; however, the tumor grew rapidly in the following year and the patient was referred to our hospital. She underwent tumor resection, and pathology revealed leiomyosarcoma. The patient declined adjuvant chemo- and radiotherapy but has had no recurrence for 32 months

Clinical Characteristics of Patients with Gastroesophageal Reflux Disease Refractory to Proton Pump Inhibitors and the Effects of Switching to 20 mg Esomeprazole on Reflux Symptoms and Quality of Life

Background: Refractory gastroesophageal reflux disease (GERD) may deteriorate patient quality of life (QOL) despite proton pump inhibitor (PPI) therapy. Material/Methods: Nineteen Japanese institutions were surveyed to determine the clinical characteristics and QOL of patients with refractory GERD. Those patients treated with a conventional PPI were switched to 20 mg esomeprazole for 4 weeks. Symptoms and QOL were assessed using Global Overall Symptom and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires at baseline and at 2 and/or 4 weeks of esomeprazole treatment. Results: Of 120 patients who completed the survey, 58 (48.3%) had refractory GERD. Of these, 69.0% were aged >65 years, 79.3% were prescribed a PPI at a standard or high dose, and 22.4% were prescribed a PPI together with another drug. After switching to esomeprazole, patients reported significant improvements in heartburn, acid regurgitation, and excessive belching at 2 weeks using a symptom diary, as well as the total score, reflux, ab dominal pain, and indigestion, which were assessed using the GSRS at 4 weeks. Conclusions: About half of Japanese patients with GERD may be refractory to conventional PPIs. Their reflux-related symp toms are often severe and may impair QOL. Switching to esomeprazole could be used to improve their symptoms and QOL