Intravascular leiomyomatosis: A case report and review of the literature

Intravascular leiomyomatosis (IVL) is a rare condition in which histologically benign smooth muscle neoplasms arising from the intrauterine vessels infiltrate and invade systemic veins, including the inferior vena cava (IVC) (CitationCho et al. 2011). These tumours can further extend to the right heart and into the pulmonary arterial system, causing a pulmonary embolism (CitationFasih et al. 2008). This is called intracardiac leiomyomatosis and may result in the development of cardiac symptoms, a murmur, syncope and even death (CitationLou et al. 2011). To correctly diagnose IVL pre-operatively, comprehensive imaging using computerised tomography (CT) and magnetic resonance imaging (MRI), and possibly other modalities, need to be incorporated (CitationPan et al. 2013). Treatment is surgical, with excision of the primary uterine mass and often cardiotomy to remove any intracardiac lesion; though, unusually, we present a case without the need for cardiotomy, a staged approach or cardiothoracic surgery (CitationLam et al. 2003)

Cytological follow-up after hysterectomy: is vaginal vault cytology sampling a clinical governance problem? The University Hospital of North Staffordshire approach

ObjectivesVaginal vault cytology sampling following hysterectomy is recommended for specific indications in national guidelines. However, clinical governance issues surround compliance with guidance. Our first study objective was to quantify how many patients undergoing hysterectomy at the University Hospital of North Staffordshire (UHNS) had vault cytology advice in their histology report and, if indicated, whether it was arranged. The second was to devise a vault cytology protocol based on local experience and national guidance.MethodsThe local cancer registry was searched. Clinical, clerical and histological data for all patients undergoing hysterectomy were collected.ResultsIn total, 271 patients were identified from both the gynae-oncology and benign gynaecology teams. Of these, 24% (65/271) were gynae-oncology patients with a mean age of 69 years. The benign gynaecology team had 76% (206/271) of patients with a mean age of 55 years. Subsequently, 94% (256/271) had cytology follow-up advice in their histopathology report. Ultimately, from both cohorts, 39% (18/46) had follow-up cytology performed when indicated.ConclusionA high proportion of cases complied with national guidance. However, a disappointingly high number did not have vault cytology sampling when this was indicated. This is probably a result of the complex guidance that is misunderstood in both primary and secondary care. Vault follow-up of patients after hysterectomy rests with the team performing the surgery. Vault cytology, if indicated, should be performed in secondary care and follow-up should be planned. The protocol set out in this article should be followed to avoid unnecessary clinical governance failings

Cytological follow-up after hysterectomy: Is vaginal vault cytology sampling a clinical governance problem? The University Hospital of North Staffordshire approach

ObjectivesVaginal vault cytology sampling following hysterectomy is recommended for specific indications in national guidelines. However, clinical governance issues surround compliance with guidance. Our first study objective was to quantify how many patients undergoing hysterectomy at the University Hospital of North Staffordshire (UHNS) had vault cytology advice in their histology report and, if indicated, whether it was arranged. The second was to devise a vault cytology protocol based on local experience and national guidance.MethodsThe local cancer registry was searched. Clinical, clerical and histological data for all patients undergoing hysterectomy were collected.ResultsIn total, 271 patients were identified from both the gynae-oncology and benign gynaecology teams. Of these, 24% (65/271) were gynae-oncology patients with a mean age of 69 years. The benign gynaecology team had 76% (206/271) of patients with a mean age of 55 years. Subsequently, 94% (256/271) had cytology follow-up advice in their histopathology report. Ultimately, from both cohorts, 39% (18/46) had follow-up cytology performed when indicated.ConclusionA high proportion of cases complied with national guidance. However, a disappointingly high number did not have vault cytology sampling when this was indicated. This is probably a result of the complex guidance that is misunderstood in both primary and secondary care. Vault follow-up of patients after hysterectomy rests with the team performing the surgery. Vault cytology, if indicated, should be performed in secondary care and follow-up should be planned. The protocol set out in this article should be followed to avoid unnecessary clinical governance failings