Introduction: the epidemiology of uterine leiomyomas

Expression of von Willebrand's factor, CD34, CD31, and vascular endothelial growth factor in uterine leiomyomas

OBJECTIVE

To compare the vascular parameters of uterine leiomyomas and normal myometrium, to correlate these parameters with vascular endothelial growth factor (VEGF) expression and clinical/pathological parameters, and to compare vascular parameters according to the endothelial markers used.

DESIGN

An immunohistochemical technique was applied to formalin-fixed paraffin-embedded tissue samples, using antibodies against von Willebrand's factor (FvW), CD34, CD31, and VEGF. The intratumoral vascular area (VA), microvessel density (MVD), and vascular luminal area (VLA) were determined with an image analyser.

SETTING

University teaching hospital.

PATIENT(S)

Thirty-two patients with uterine leiomyomas underwent conservative surgery. Twenty leiomyoma-free patients undergoing hysterectomy were the controls.

INTERVENTION(S)

Immunohistochemical and morphometrical analysis.

MAIN OUTCOME MEASURE(S)

Measurements of VA, MVD, and VLA.

RESULT(S)

The CD34 labeling showed decreased VA in myomas compared with myometrium. Decreased MVD and an increased VLA in myomas were found with FvW and CD34 labeling. The VA, MVD, and VLA were not related to VEGF expression or to clinical/pathological parameters. Similar results for VA and MVD were obtained with FvW and CD34 labeling.

CONCLUSION(S)

Leiomyomas have a smaller vascular area, a lower microvessel density, and a higher vascular luminal area than normal myometrium.

Estrogen-associated genes in uterine leiomyoma

Uterine leiomyomas or fibroids are classified as a benign uterine disease in that the polyps display no malignant growth. However, uterine leiomyomas are a leading cause of morbidity, infertility, and hysterectomy in women. Since leiomyomas are known to be sensitive to estrogen for their growth, we have examined uterine genes known to be estrogen responsive in affected and unaffected uterine tissue. This information will be useful in determining the contribution, if any, of hormonally active environmental chemicals to this highly prevalent reproductive disorder.

Alternative treatment for symptomatic fibroids

The present review discusses treatment options for symptomatic fibroids. Although the standard treatment of fibroids has been surgical hysterectomy, an increasing number of reports indicate that uterine artery embolization with preservation of the uterus is a promising alternative. Other surgical and medical approaches reported during the past year are also addressed. The review summarizes patient selection, contraindications, results, complications and future considerations. Complications following uterine artery embolization treatment for symptomatic fibroids have been minor in comparison with those following hysterectomy. Although patient satisfaction is good, none of the studies included control individuals and further studies are needed to optimize patient selection and to evaluate long-term results of treatment.

Soy product intake and premenopausal hysterectomy in a follow-up study of Japanese women

OBJECTIVE

The estrogenicity of dietary soy may increase the risk of diseases, such as uterine leiomyoma and endometriosis, which originate from uterine tissue and are predominant indications for hysterectomy. We sought to determine whether soy product intake is associated with an increased risk of premenopausal hysterectomy.

DESIGN

Prospective cohort study.

SETTING

Takayama City, Gifu, Japan.

SUBJECTS

A cohort of 1172 female residents randomly selected from participants in the Takayama Study who were aged 35-54 and premenopausal at the time they entered the study in 1992.

MEASUREMENTS

Diet including soy product and isoflavone intake was assessed by a validated semiquantitative food frequency questionnaire at baseline. Information on the onset of menopause and hysterectomy were obtained by a follow-up mail questionnaire in 1998.

RESULTS

During the 6 y study period, 31 women underwent premenopausal hysterectomies. The second tertile of isoflavone intake was significantly associated with an decreased risk of premenopausal hysterectomy compared to the lowest tertile of intake after controlling for age and total energy (rate ratio=0.35, 95% confidence interval 0.13-0.97), although the dose-response relationship was not statistically significant.

CONCLUSIONS

It is possible that soy product intake may be inversely associated with diagnoses leading to hysterectomy. Future studies focusing on specific diseases will be required to examine this possibility.

SPONSORSHIP

Grants from the Ministry of Education, Science, Sports and Culture, Japan.

An immunohistochemical analysis of fibroid vasculature

This study aimed to compare vascular parameters between fibroid and myometrium. From 10 uteri, specimens were taken from small fibroids (<0.5 cm), from the inner and outer parts of large fibroids (>3 cm), and from myometrium. Antibodies to endothelial cell markers CD31, CD34, factor VIII-related antigen (FVIII), and Ulex europaeus lectin were used in routine immuno- and lectin chemistry protocols. Parameters calculated were vascular area (VA), microvascular density (MD) and vascular luminal diameter. VA measures showed that myometrium had a greater area stained than small fibroids (P = 0.03) using CD31 and both inner (P = 0.04) and outer (P = 0.01) regions of large fibroids using FVIII, and than all groups (small, P = 0.02; inner, P = 0.02; outer, P = 0.006) using the lectin U. europaeus. MD was higher in myometrium than all uterine fibroid groups (small, P = 0.009; inner, P = 0.01; outer, P = 0.01) using U. europaeus lectin, than both regions of large (inner, P = 0.04; outer, P = 0.02) fibroids using FVIII, and than outer regions of large fibroids using CD31 (P < 0.05). There were significantly larger diameter vessels in myometrium and large fibroids compared with small fibroids using CD34, FVIII and the lectin U. europaeus (P </= 0.04). These differences in vasculature may represent differences in angiogenesis and vascular remodelling.

Uterine artery embolisation for symptomatic fibroids

Traditional operative treatments for symptomatic fibroids--hysterectomy and myomectomy--involve considerable morbidity. Although morbidity is reduced with endoscopic surgery, this technique is not widely available, and has limitations. Embolisation of the pelvic vasculature is not a new procedure, having been used to treat postpartum and postsurgical bleeding for 20 years. It has only recently been used to treat symptomatic fibroids. Uterine artery embolisation can produce a mean reduction of 29%-51% in uterine volume at the time of the three-month review, with longer follow-up showing continued shrinkage and no regrowth. The range of shrinkage is highly variable, which needs to be explained to all potential candidates. Symptomatic relief is a more certain outcome, with relief of pelvic pressure symptoms in 91%-96% of women. There is a small risk of complications requiring hysterectomy, and the long-term effect on ovarian function is unknown.