IntroductionLeiomyoma is the most frequent benign pathology in females and arises from uterine smooth muscle.AimWe present an uncommon example of a big, cystic-solid extra-uterine myoma that seemed on sonography and magnetic resonance imaging to be a primary malignant tumor.Case studyA woman was admitted to our hospital with a palpable abdominopelvic mass. Imaging studies described a large semisolid mass of 30 × 25 × 23 cm that filled the abdomen from the pelvis to the xiphoid process. Preoperatively, a primary malignant ovarian cancer or teratoma was identified.Results and discussionHistological analysis confirmed a leiomyoma with myxoid degeneration without any malignancy.ConclusionsThere is a high risk of malignancy in a giant uterus/mass and fast-growing myomas. For the treatment of large leiomyomas/large extra-uterine leiomyomas, a surgical approach is usually chosen. Myxoid leiomyoma of the broad ligament is very rare, its diagnosis remains histological to date like uterine myxoid leiomyoma. Malignancy should always be ruled out.

SUMMARY OBJECTIVE: The expression of cytotoxic T lymphocyte-associated antigen 4, E-cadherin, and CD44 in the area of tumor budding was investigated in breast carcinomas in our study. METHODS: Tumor budding was counted at the invasive margins in 179 breast carcinomas. To understand the microenvironment of tumor budding, we examined the expression status of the immune checkpoint molecules such as cytotoxic T lymphocyte-associated antigen 4, E-cadherin, and CD44. RESULTS: Tumors were separated into low (≤5) and high tumor budding groups (>5) based on the median budding number. Lymphovascular, perineural invasion, and the number of metastatic lymph nodes were significantly higher in high-grade budding tumors (p=0.001, p<0.001, and p=0.019, respectively). Tumor-infiltrating lymphocytes were significantly higher in tumors without tumor buddings (p<0.001). When the number of budding increases by one unit, overall survival decreases by 1.07 times (p=0.013). Also, it increases the risk of progression by 1.06 times (p=0.048). In high tumor budding groups, the cytotoxic T lymphocyte-associated antigen 4 staining percentage of lymphocytes was significantly higher (p=0.026). With each increase in the number of buds, an increase in the percentage of cytotoxic T lymphocyte-associated antigen 4 staining was seen in lymphocytes in the microenvironment of TB (p=0.034). CONCLUSION: Tumor budding could predict poor prognosis in breast carcinomas, and anti-cytotoxic T lymphocyte-associated antigen 4 immunotherapies may be beneficial in patients with high tumor budding tumors.