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Anand A, Choudhary A, Dougall P, Bansal B, Chawla M. Parasitic Leiomyoma on PET-CT in A Suspected Case of Uterine Sarcoma - Report on Diagnosis and Management. Indian J Nucl Med 2019; 34:332-334. [PMID: 31579245 PMCID: PMC6771215 DOI: 10.4103/ijnm.ijnm_52_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case is a very good example of how a multimodality approach was taken in diagnosis and management of patient with suspected uterine sarcoma, which turned out to be uterine leiomyoma with parasitic leiomyoma mimicking the pararenal deposit. There has been an increased use of fluorodeoxyglucose avid positron emission tomography-computed tomography in pelvic malignancies, especially in the cases where there is suspected extrapelvic spread. It was an interesting finding of parasitic leiomyoma, which can be easily thought to be as deposit/mass in a patient with pelvic malignancy.
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Affiliation(s)
- Anuja Anand
- Department of Nuclear Medicine and PET-CT, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Amish Choudhary
- Department of Oncosurgery, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Pankaj Dougall
- Department of Nuclear Medicine and PET-CT, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Bhavna Bansal
- Department of Pathology, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Madhavi Chawla
- Department of Nuclear Medicine and PET-CT, Max Super Speciality Hospital, Saket, New Delhi, India
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102
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Stępniak A. Uterine artery embolization in the treatment of symptomatic fibroids - state of the art 2018. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2018; 17:141-143. [PMID: 30766459 PMCID: PMC6372851 DOI: 10.5114/pm.2018.81733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
Uterine fibroids are considered to be the most common benign tumours in females. The vast majority of these tumours are incidental findings and do not require any treatment. Symptomatic fibroids, with ailments such as abnormal uterine bleeding, dysmenorrhoea, pelvic pain, impaired urination, bowel dysfunction, infertility, and recurrent pregnancy loss, are indicated for medical treatment. Surgery remains a first-line treatment of symptomatic uterine fibroids; however, minimally invasive techniques and pharmacological management have become more available and popular. Among minimally invasive techniques uterine artery embolization (UAE) is the most well-established uterine preserving treatment. UAE was first introduced in obstetrics and gynaecology in 1987 and since then many studies have shown the safety and efficacy of UAE in fibroid treatment with low rates of complications. In this review we present a novel approach to UAE, which reflects the current state of knowledge based on recent clinical trials and long-term post-procedural follow-up.
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Affiliation(s)
- Anna Stępniak
- 3 Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
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103
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Do Women over 35 Years Old Who Have Undergone a Myomectomy Require More Acupuncture Sessions to Become Pregnant? JOURNAL OF ACUPUNCTURE RESEARCH 2018. [DOI: 10.13045/jar.2018.00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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104
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Gimovsky AC, Frangieh M, Phillips J, Vargas MV, Quinlan S, Macri C, Ahmadzia H. Perinatal outcomes of women undergoing cesarean delivery after prior myomectomy. J Matern Fetal Neonatal Med 2018; 33:2153-2158. [PMID: 30373417 DOI: 10.1080/14767058.2018.1542680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: The American College of Obstetricians and Gynecologists recommends that women who have had a prior myomectomy that entered the endometrial cavity undergo cesarean delivery in order to avoid the possible complication of uterine rupture. Women with prior myomectomies may also have intraabdominal adhesions, complicating future surgery and if myomas remain after myomectomy, they may have more bleeding complications during their subsequent pregnancies.Objectives: The purpose of this study was to evaluate maternal and neonatal outcomes after prior myomectomy in women undergoing planned cesarean delivery.Study design: We conducted a retrospective cohort study using the Maternal Fetal Medicine Units Cesarean Registry database comparing women undergoing a cesarean delivery with a history of prior myomectomy to women undergoing a cesarean delivery without a history of a prior myomectomy. Inclusion criteria were singleton gestations at term undergoing planned cesarean delivery. Exclusion criteria were stillbirth, cesarean delivery indication for nonreassuring fetal heart rate, macrosomia, abruption, previa or women undergoing planned trial of labor after cesarean. Primary outcome was incidence of blood transfusion. Maternal and neonatal outcomes were compared secondarily. Logistic regression was used to adjust for confounders.Results: The entire study population included 73,257 deliveries; 34,002 women met inclusion criteria, of which 367 had a prior myomectomy and 33,635 were controls. The demographics, which varied by maternal age, race and number of prior cesareans were adjusted for when calculating maternal outcomes. The rate of intraoperative transfusion in the prior myomectomy group was 1.4% (5/367) compared to 0.4% (131/33,635) in the control group (aOR 2.8; 95% CI 1.15-6.79). The prior myomectomy group had a higher incidence of postpartum transfusion rate (2.5%, 9/367) compared to the control group (1.2%, 416/33,635) (aOR 2.03; 1.06-3.92), uterotonic usage (5.4%, 20/367) compared to the control group (3.5%, 1165/33,635; aOR 1.57; 95% CI 1.01-2.45), bowel injury (0.5%, 2/367) compared to the control group (0.0%, 14/33,635; aOR 8.13; 95% CI 2.05-32.28) and cesarean hysterectomy (1.4%, 5/367) compared to the control group (77/33,635; aOR 3.43; 95% CI 1.32-8.91). Neonatal outcomes were not different between groups.Conclusion: Prior myomectomy in women with term, singleton gestations undergoing planned cesarean delivery was associated with an 180% increased risk of intraoperative transfusion compared to the control group. We also found that women in the myomectomy group are 57% more likely to use uterotonics, 713% more likely to experience a bowel injury, 243% more likely to undergo a cesarean hysterectomy, and 227% more likely to need a classical uterine incision during delivery. Neonatal morbidity was not statistically different between the groups.
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Affiliation(s)
- Alexis C Gimovsky
- Divison of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Michael Frangieh
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jaclyn Phillips
- Department of Obstetrics and Gynecology, the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Maria Victoria Vargas
- Department of Obstetrics and Gynecology, the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Scott Quinlan
- Department of Epidemiology and Biostatisitcs, Milken Institute of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Charles Macri
- Divison of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Homa Ahmadzia
- Divison of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Corachán A, Ferrero H, Aguilar A, Garcia N, Monleon J, Faus A, Cervelló I, Pellicer A. Inhibition of tumor cell proliferation in human uterine leiomyomas by vitamin D via Wnt/β-catenin pathway. Fertil Steril 2018; 111:397-407. [PMID: 30458994 DOI: 10.1016/j.fertnstert.2018.10.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/27/2018] [Accepted: 10/05/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the effect of vitamin D (VitD) on human uterine leiomyomas through Wnt/β-catenin pathway inhibition, apoptosis induction, and cell growth arrest. DESIGN A prospective study comparing leiomyoma vs. myometrium tissues. Paired design study comparing human uterine leiomyoma primary (HULP) cells treated with or without VitD. SETTING University hospital. PATIENT(S) Human uterine leiomyoma and myometrium were collected from women (aged 35-52 years) without hormonal treatment. INTERVENTION(S) Samples were collected from women undergoing surgery due to symptomatic uterine leiomyoma pathology. MAIN OUTCOME MEASURE(S) Uterine leiomyoma and myometrium tissues were analyzed by western blot (WB) to determine proliferation, Wnt/β-catenin, and apoptosis pathways. HULP cells were used to study VitD effect in cell proliferation (WB), cell cycle (flow cytometry), Wnt/β-catenin and apoptosis genes (polymerase chain reaction arrays), Wnt-related proteins (protein array), and apoptosis (terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling [TUNEL] assay). RESULTS Human leiomyoma tissues compared with matched myometrium showed higher proliferation (fold change = 8.16; P=.0006) and altered Wnt/β-catenin pathway (fold change = 5.5; P<.0001), whereas no differences in apoptosis were observed. VitD induced cell growth arrest and decreased proliferation in HULP cells (fold change = 0.74; P=.007). Moreover, VitD decreased Wnt-pathway expression in HULP cells at gene (activity score = -0.775; P<.001) and protein levels. However, VitD did not induce apoptosis expression. CONCLUSION Increased proliferation and Wnt/β-catenin pathway deregulation play a role in the development and growth of leiomyomas, whereas apoptosis appears not to contribute. VitD exerts an antiproliferative action on HULP cells through cell growth arrest and Wnt/β-catenin pathway inhibition, but not through apoptosis regulation, suggesting VitD as an effective therapy to stabilize leiomyoma size and prevent its growth.
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Affiliation(s)
- Ana Corachán
- Fundación IVI, Instituto Universitario IVI, Universidad de Valencia, Valencia; Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
| | - Hortensia Ferrero
- Fundación IVI, Instituto Universitario IVI, Universidad de Valencia, Valencia; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain.
| | | | - Nuria Garcia
- Hospital Universitario y Politécnico La Fe, Valencia
| | | | - Amparo Faus
- Fundación IVI, Instituto Universitario IVI, Universidad de Valencia, Valencia
| | - Irene Cervelló
- Fundación IVI, Instituto Universitario IVI, Universidad de Valencia, Valencia
| | - Antonio Pellicer
- Fundación IVI, Instituto Universitario IVI, Universidad de Valencia, Valencia; Hospital Universitario y Politécnico La Fe, Valencia
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Malek M, Gity M, Alidoosti A, Oghabian Z, Rahimifar P, Seyed Ebrahimi SM, Tabibian E, Oghabian MA. A machine learning approach for distinguishing uterine sarcoma from leiomyomas based on perfusion weighted MRI parameters. Eur J Radiol 2018; 110:203-211. [PMID: 30599861 DOI: 10.1016/j.ejrad.2018.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 11/09/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To propose a computer-assisted method for distinguishing uterine sarcoma from leiomyomas based on perfusion weighted magnetic resonance imaging (PWI). MATERIALS AND METHODS Forty-two women confirmed to have a total of 60 masses (10 uterine sarcomas and 50 benign leiomyomas) were included. The reference diagnosis was based on postoperative histopathological examination. All women underwent the standard MRI protocol with 3-Tesla MR imager (Magnetom Trio, Siemens, Erlangen, Germany) for assessment of myometrial masses, followed by PWI. For each mass, two regions of interest (ROI) were outlined manually by an experienced radiologist; one (ROIL) represented the entire tumor while the other (ROIs) was placed on the area of the lesion with the most marked contrast enhancement. Two additional ROIs with diameters similar to ROIs (3.0 to 3.1 mm) were placed on psoas muscle (ROIP) and myometrium (ROIM) in order to provide baselines for comparisons. The obtained ROIs of PWI images were then analyzed using the DCE Tool plug-in (version 2.0SP1) within ClearCanvas (Toronto, Ontario, Canada) framework. The DCE Tool provides seven parameters (Ktrans, kep, Vb, IAUC, initial slope, peak, the mean squared error) for modelling contrast uptake within an ROI using the modified Tofts model. Parameters extracted from the ROIs were fed into a decision tree ensemble, which classified the corresponding lesions either as malignant or benign. The leave-one-out cross validation (LOOCV) was utilized to evaluate the performance of the classifier. RESULTS None of the parameters extracted from ROIL or ROIs differed significantly between uterine sarcoma and benign leiomyomas (all p > 0.05). The overall accuracy of 66.7% was obtained by feeding seven parameters extracted from ROIL to the classifier. When 21 features extracted from ROIL, ROIM, and ROIP were fed into the classifier an accuracy of 91.7%, sensitivity of 100%, and specificity of 90% were achieved in the optimal operating point of classifier. CONCLUSION Although none of the PWI parameters differed significantly between benign and malignant lesions, when the information provided by the extracted features was aggregated using a machine learning method, a promising discriminative power was obtained. This suggests that the proposed model for combining the PWI parameters is potentially useful for differentiating uterine sarcoma from leiomyomas.
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Affiliation(s)
- Mahrooz Malek
- Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Masoumeh Gity
- Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Azadeh Alidoosti
- Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Zeinab Oghabian
- Neuroimaging and Analysis Group, Research Center for Molecular and Cellular Imaging, Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Pariya Rahimifar
- Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Seyede Mahdieh Seyed Ebrahimi
- Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Elnaz Tabibian
- Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Ali Oghabian
- Neuroimaging and Analysis Group, Research Center for Molecular and Cellular Imaging, Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign Leiomyoma Before Treatment? AJR Am J Roentgenol 2018; 211:1405-1415. [PMID: 30354268 DOI: 10.2214/ajr.17.19234] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to provide background on the epidemiologic, clinical, and economic impact of uterine leiomyomas, summarize the concerns associated with treating women with potential occult leiomyosarcomas (LMSs), and review the known and emerging imaging features of typical and atypical leiomyomas and explain how to differentiate them from LMSs. CONCLUSION Surgical management of presumed benign uterine leiomyomas received popular media attention when a case of disseminated LMS occurred after laparoscopic power morcellator-assisted hysterectomy. A subsequent U.S. Food and Drug Administration review found a higher prevalence of unsuspected uterine sarcoma and LMS among patients undergoing myomectomy or hysterectomy for presumed benign leiomyomas than was previously reported. This heightened concern has led to increased pressure on radiologists to distinguish LMSs from leiomyomas.
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108
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Giampieri F, Islam MS, Greco S, Gasparrini M, Forbes Hernandez TY, Delli Carpini G, Giannubilo SR, Ciavattini A, Mezzetti B, Mazzoni L, Capocasa F, Castellucci M, Battino M, Ciarmela P. Romina: A powerful strawberry with in vitro efficacy against uterine leiomyoma cells. J Cell Physiol 2018; 234:7622-7633. [PMID: 30317591 DOI: 10.1002/jcp.27524] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/10/2018] [Indexed: 12/14/2022]
Abstract
Uterine leiom yomas are benign tumors highly prevalent in reproductive women. In thecurrent study, initially, we aimed to screen five different strawberry cultivars (Alba, Clery, Portola, Tecla, and Romina) to identify efficient cultivars in terms of phytochemical characterization and biological properties by measuring phenolic and anthocyanin content as well as antioxidant capacity, and by measuring apoptotic rate and reactive oxygen species (ROS) production in uterine leiomyoma cells. Next, we focused on the most efficient ones, cultivar Alba (A) and Romina (R) as well as Romina anthocyanin (RA) fraction for their ability to regulate oxidative phosphorylation (oxygen consumption rate [OCR]) glycolysis (extracellular acidification rate [ECAR]), and also fibrosis. Leiomyoma and myometrial cells were treated with a methanolic extract of A and R (250 μg/ml) or with RA (50 μg/ml) for 48 hr to measure OCR and ECAR, as well as gene expression associated with fibrosis. In the leiomyoma cells, RA was more effective in inducing apoptosis and increasing intracellular ROS levels, followed by R and A. In myometrial cells, all strawberry treatments increased the cellular viability and decreased ROS concentrations. Leiomyoma cells showed also a significant decrease in ECAR, especially after RA treatment, while OCR was slightly increased in both myometrial and leiomyoma cells. R and RA treatment significantly decreased collagen 1A1, fibronectin, versican, and activin A messenger RNA expression in leiomyoma cells. In conclusion, this study suggests that Romina, or its anthocyanin fraction, can be developed as a therapeutic and/or preventive agent for uterine leiomyomas, confirming the healthy effects exerted by these fruits and their bioactive compounds.
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Affiliation(s)
- Francesca Giampieri
- Department of Clinical Science, Università Politecnica delle Marche, Ancona, Italy
| | - Md Soriful Islam
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy.,Department of Botany, Biotechnology and Microbiology Laboratory, University of Rajshahi, Rajshahi, Bangladesh
| | - Stefania Greco
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | | | | | | | | | - Andrea Ciavattini
- Department of Clinical Science, Università Politecnica delle Marche, Ancona, Italy
| | - Bruno Mezzetti
- Department of Agricultural, Food, and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Mazzoni
- Department of Agricultural, Food, and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Franco Capocasa
- Department of Agricultural, Food, and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Mario Castellucci
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Battino
- Department of Clinical Science, Università Politecnica delle Marche, Ancona, Italy
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy.,Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
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109
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Uterine Artery Embolization in Women with Symptomatic Cervical Leiomyomata: Efficacy and Safety. Cardiovasc Intervent Radiol 2018; 42:371-380. [PMID: 30288591 PMCID: PMC6373190 DOI: 10.1007/s00270-018-2081-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/17/2018] [Indexed: 11/06/2022]
Abstract
Purpose To perform an evaluation on safety and efficacy of uterine artery embolization (UAE) in the patients with symptomatic cervical leiomyomata. Methods Patients with symptomatic cervical leiomyomata who underwent UAE in one specialized hospital were retrospectively analyzed, both clinically and with MR imaging. The 3-month outcomes were assessed with MR imaging and a validated questionnaire. Long-term follow-up was assessed by direct contact or file review. To determine the efficacy of UAE for cervical leiomyomata, the primary objective was to assess the clinical outcome with the UFS-QOL questionnaire, containing the health-related quality of life (HRQOL) and symptom severity score (SSS). To assess safety, the secondary objective included leiomyomata volume reduction, the infarction/complication rate and secondary interventions were needed. Results Between 2006 and 2017, eight of 1180 patients underwent UAE and were eligible for inclusion. All embolizations were technically successful (n = 8). At 3 months, all patients showed cervical leiomyomata volume reduction with a median reduction of 41.5% (38.8 cm3) compared to baseline (p = 0.012). No complications occurred. At a median follow-up of 3 months (range 1–7, n = 7), the HRQOL and SSS improved with a median difference of 13 points (range − 5 to 60, p = 0.063) and − 13 points (range − 79 to 3, p = 0.046), respectively. Long-term follow-up showed two secondary interventions (median of 43.5 months). Six patients reported no symptom recurrence. Conclusion UAE in women with symptomatic cervical leiomyomata is effective and safe with significant improvement in symptoms and quality of life. UAE is a valuable option for women seeking a non-surgical solution. Electronic supplementary material The online version of this article (10.1007/s00270-018-2081-2) contains supplementary material, which is available to authorized users.
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110
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Gambacorti-Passerini ZM, Penati C, Carli A, Accordino F, Ferrari L, Berghella V, Locatelli A. Vaginal birth after prior myomectomy. Eur J Obstet Gynecol Reprod Biol 2018; 231:198-203. [PMID: 30396109 DOI: 10.1016/j.ejogrb.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this retrospective cohort study was to evaluate the obstetrical and perinatal outcomes of vaginal birth in case of pregnancies achieved after prior myomectomy. We also analyzed how operative characteristics at the time of surgery might influence the choice of obstetricians about mode of delivery. STUDY DESIGN We analyzed retrospectively all women who underwent laparoscopic (LPS) or laparotomic (LPT) myomectomy between January 2002 and December 2014, in a network of three Institutions belonging to the University of Milano Bicocca, Italy. Women were contacted by phone interview and only cases with available follow-up data and who had a subsequent pregnancy were included. Operative characteristics and subsequent obstetrical outcomes were recorded and analyzed. RESULTS 469 women who underwent myomectomy were contacted by phone interview, and 152 pregnancies were achieved after surgery, 96 after LPS and 56 after LPT. A total of 110 pregnancies ended in deliveries at ≥24 weeks. Seventy-three (66.4%) women had trial of labor after myomectomy (TOLAM), while 24 (21.8%) had a planned cesarean delivery (CD). Sixty-six (90.4%) of the TOLAM cases successfully accomplished vaginal delivery. No cases of uterine rupture (UR) were reported, and all deliveries ended in live births. The incidence of Neonatal Intensive Care Unit admission was 14.5% (16/110), with no cases of perinatal death. Comparing the surgical details at the time of myomectomy, the incidence of uterine cavity entered was significantly higher in planned CD group compared to TOLAM cases (p < 0.001). No other significant difference between the two groups was reported. CONCLUSIONS A successful vaginal delivery was accomplished by 90.4% of women who had TOLAM, without any case of UR or severe maternal and perinatal complications. TOLAM may be considered and offered as feasible and relatively safe option. Obstetricians' attitude toward mode of delivery after prior myomectomy seems to be influenced by the reported entry into the uterine cavity at the time of surgery.
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Affiliation(s)
| | - C Penati
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Vimercate, Italy
| | - A Carli
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, San Gerardo Hospital - FMBBM, Monza, Italy
| | - F Accordino
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, San Gerardo Hospital - FMBBM, Monza, Italy
| | - L Ferrari
- Department of Obstetrics and Gynecology, San Gerardo Hospital, ASST Monza, Italy
| | - V Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - A Locatelli
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Vimercate, Italy
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111
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Chen Q, Shi H, Lu W, Lu B. Unexpected uterine sarcomas in 4478 patients with electric power morcellation for leiomyomas. Eur J Obstet Gynecol Reprod Biol 2018; 230:85-89. [PMID: 30245442 DOI: 10.1016/j.ejogrb.2018.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/28/2018] [Accepted: 09/12/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Our objective is to investigate the prevalence, pathology and prognosis of uterine sarcomas in laparoscopic hysterectomy/myomectomy with electric power morcellation for presumed leiomyomas. STUDY DESIGN We retrospectively reviewed patients with laparoscopic power morcellation (LPM) for presumed leiomyomas in a Chinese tertiary institution by chart review from September 1, 2013 to December 31, 2016. RESULTS Twenty-four in 4478 patients (0.54%) with LPM for presumed leiomyomas had unexpected cancers. The patients showed the highest frequency of occult cancers (10/375, 2.6%) at 51-60 years and lowest (0/255) before 30 years. The pathology included 14 endometrial stromal sarcomas (ESS) (low-grade 12 and high-grade 2), 9 leiomyosarcomas, and 1 malignant mixed mesodermal tumor. The patients underwent abdominal re-exploration including total hysterectomy with bilateral salpingo-oophorectomy and staging surgery. Three patients were at advanced FIGO stage (IIIb-IVb) and 21 at stage I. Seven patients recurred within 1-25 (mean 6.29) months including 5 leiomyosarcomas, 1 high-grade and 1 low-grade ESS. Four recurrent patients with leiomyosarcomas and one with high-grade ESS died of disease in 1-3 months. Seventeen patients had no relapse and were alive for 6-41 (mean 24) months. CONCLUSIONS Our study suggests that patients with LPM for presumed leiomyomas appear to have a considerable risk of unexpected cancers. Moreover, morcellation is potentially associated with adverse prognosis in patients with high-grade sarcomas. Informed consent on unexpected cancers that should be discussed before morcellation.
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Affiliation(s)
- Qin Chen
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Haiyan Shi
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Weiguo Lu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China; Center for Uterine Cancer Diagnosis & Therapy of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
| | - Bingjian Lu
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China; Center for Uterine Cancer Diagnosis & Therapy of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
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The Impact of Noncavity-Distorting Intramural Fibroids on the Efficacy of In Vitro Fertilization-Embryo Transfer: An Updated Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8924703. [PMID: 30255100 PMCID: PMC6142781 DOI: 10.1155/2018/8924703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/16/2018] [Indexed: 12/01/2022]
Abstract
Aim To address the impact of noncavity-distorting intramural fibroids on the efficacy of in vitro fertilization-embryo transfer (IVF-ET) outcomes. Methods The PubMed, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure were searched systematically. A meta-analysis was performed based on comparative or cohort studies that explored the impact of noncavity-distorting intramural fibroids on the efficacy of IVF-ET treatment. The IVE-ET outcomes of study group (women with noncavity-distorting intramural fibroids) and control group (women without fibroids) were compared, including live birth rate (LBR), clinical pregnancy rate (cPR), implantation rate (IR) , miscarriage rate (MR), and ectopic pregnancy rate (ePR). Results A total of 28 studies involving 9189 IVF cycles were included. Our meta-analysis showed a significant reduction of LBR in the study group compared to control group (RR = 0.82, 95% CI: 0.73-0.92, and P = 0.005). In addition, it indicated that study group had a significant reduction in cPR (RR = 0.86, 95% CI: 0.80-0.93, P = 0.0001) and IR (RR = 0.90, 95% CI: 0813-1.00, P = 0.04) and have a significantly increase in MR (RR = 1.27, 95% CI: 1.08-1.50, and P = 0.004) compared with control group. Conclusions The present evidence suggests that noncavity-distorting intramural fibroids would significantly reduce the IR, cRP, and LBR and significantly increase the MR after IVF treatment, but it would not significantly increase the ePR.
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Aydın S, Göksever Çelik H, Maraşlı M, Bakar RZ. Clinical predictors of successful vaginal myomectomy for prolapsed pedunculated uterine leiomyoma. J Turk Ger Gynecol Assoc 2018; 19:146-150. [PMID: 29449196 PMCID: PMC6085531 DOI: 10.4274/jtgga.2017.0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Uterine leiomyomas are the most common pelvic tumor in women. The calculated prevalence of prolapsed pedunculated leiomyoma was 2.5% in patients who underwent surgery. Although vaginal removal is safe and effective, hysterectomy demand is questionable. We aimed to analyze the association between patient characteristics, clinical features of prolapsed pedunculated submucosal leiomyoma, and the probability of successful vaginal myomectomy. Material and Methods: This study was conducted in 35 women who presented with prolapsed pedunculated uterine leiomyoma. Patients were grouped according to the treatment procedure, either vaginal myomectomy or hysterectomy. Results: Hysterectomy was performed in 14 patients and vaginal myomectomy was performed in 21 women. The mean ages and menopausal status were similar. Parity was higher in the hysterectomy group (p=0.02). The preoperative hematocrit value of patients undergoing vaginal myomectomy was significantly lower (p=0.04). There was no significant difference between the groups regarding the largest leiomyoma diameter. However, the median calculated leiomyoma volume was lower in the vaginal myomectomy group (p=0.04). None of the variables were independently associated with successful vaginal myomectomy on multivariable logistic regression analysis. Conclusion: The feasibility and choice of vaginal myomectomy is associated with low parity, absence of coexisting leiomyoma, high volume of leiomyoma estimated via ultrasound measurement, and severe anemia.
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Affiliation(s)
- Serdar Aydın
- Department of Obstetrics and Gynecology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Hale Göksever Çelik
- Department of Obstetrics and Gynecology, Saglik Bilimleri University, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Maraşlı
- Department of Obstetrics and Gynecology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Rabia Zehra Bakar
- Department of Obstetrics and Gynecology, Erbaa State Hospital, Tokat, Turkey
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114
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Association of Patient Race With Surgical Practice and Perioperative Morbidity After Myomectomy. Obstet Gynecol 2018; 132:291-297. [DOI: 10.1097/aog.0000000000002738] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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115
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Shin SJ, Kim J, Lee S, Baek J, Lee JE, Cho C, Ha E. Ulipristal acetate induces cell cycle delay and remodeling of extracellular matrix. Int J Mol Med 2018; 42:1857-1864. [PMID: 30015921 PMCID: PMC6108884 DOI: 10.3892/ijmm.2018.3779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/05/2018] [Indexed: 11/06/2022] Open
Abstract
Uterine leiomyoma is a benign tumor that grows within the muscle tissue of the uterus. Ulipristal acetate (UPA) is a pre-operative drug used to reduce the size of leiomyoma. The aim of the present study was to examine the in vitro mechanistic details of action of UPA on uterine leiomyomas. Primary cultures of leiomyoma cells were isolated from patient myomectomy specimens and incubated in the presence or absence of UPA at various concentrations. The proliferation, cell viability and doubling time properties of the treated cells were analyzed. In addition, the mRNA and protein expression levels of p21, p27, cyclin E, cyclin-dependent kinase 2 (CDK2), matrix metalloproteinase (MMP)-2 and MMP-9 were examined, as well as the structure of F-actin in the primary-cultured leiomyoma cells. The results demonstrated that UPA exerted inhibitory effects on proliferation of primary-cultured leiomyoma cells. Expression of p21 and p27 was upregulated, while cyclin E and CDK2 were downregulated in UPA-treated primary-cultured leiomyoma cells. An increased expression of MMP-2 was observed in primary-cultured leiomyoma cells and a leiomyoma tissue sample of a patient with previous history of UPA treatment. Furthermore, a pronounced formation of F-actin stress fibers was observed in leiomyoma cells of the UPA-treated patient. These data suggest that UPA treatment attenuated the proliferation of uterine fibroid cells via upregulation of p21 and p27, resulting in cell cycle delay. The findings in the current study also suggest that UPA may cause extracellular matrix constriction, leading to the shrinkage in size of the leiomyoma possibly via stimulation of MMP-2 expression and induction of actin stress fibers.
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Affiliation(s)
- So-Jin Shin
- Department of Gynecology and Obstetrics and Institute for Cancer Research, School of Medicine, Keimyung University, Daegu, North Gyeongsang 42403, Republic of Korea
| | - Jinyoung Kim
- Department of Internal Medicine, School of Medicine, Keimyung University, Daegu, North Gyeongsang 42403, Republic of Korea
| | - Seungmee Lee
- Department of Gynecology and Obstetrics and Institute for Cancer Research, School of Medicine, Keimyung University, Daegu, North Gyeongsang 42403, Republic of Korea
| | - Jongwoo Baek
- Department of Obstetrics and Gynecology, Gumi CHA Hospital, CHA University, Gumi, North Gyeongsang 39295, Republic of Korea
| | - Jin Eui Lee
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Chiheum Cho
- Department of Gynecology and Obstetrics and Institute for Cancer Research, School of Medicine, Keimyung University, Daegu, North Gyeongsang 42403, Republic of Korea
| | - Eunyoung Ha
- Department of Biochemistry, School of Medicine, Keimyung University, Daegu, North Gyeongsang 42403, Republic of Korea
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Ciebiera M, Włodarczyk M, Ciebiera M, Zaręba K, Łukaszuk K, Jakiel G. Vitamin D and Uterine Fibroids-Review of the Literature and Novel Concepts. Int J Mol Sci 2018; 19:E2051. [PMID: 30011902 PMCID: PMC6073230 DOI: 10.3390/ijms19072051] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/06/2018] [Accepted: 07/12/2018] [Indexed: 02/08/2023] Open
Abstract
This article provides a detailed review of current knowledge on the role of vitamin D and its receptor in the biology and management of uterine fibroids (UFs). Authors present ideas for future steps in this area. A literature search was conducted in PubMed using the following key words: "uterine fibroid" and "vitamin D". The results of the available studies, published in English from January 2002 up to April 2018, have been discussed. Vitamin D is a group of steroid compounds with a powerful impact on many parts of the human body. This vitamin is believed to regulate cell proliferation and differentiation, inhibit angiogenesis, and stimulate apoptosis. Nowadays, hypovitaminosis D is believed to be a major risk factor in the development of UFs. In many studies vitamin D appears to be a powerful factor against UFs, resulting in inhibition of tumor cell division and a significant reduction in its size, however, the exact role of this compound and its receptor in the pathophysiology of UFs is not fully understood. According to available studies, vitamin D and its analogs seem to be promising, effective, and low-cost compounds in the management of UFs and their clinical symptoms, and the anti-tumor activities of vitamin D play an important role in UF biology. The synergy between vitamin D and selected anti-UF drugs is a very interesting issue which requires further research. Further studies about the biological effect of vitamin D on UF biology are essential. Vitamin D preparations (alone or as a co-drugs) could become new tools in the fight with UFs, with the additional beneficial pleiotropic effect.
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Affiliation(s)
- Michał Ciebiera
- Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Marta Włodarczyk
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy with Division of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland.
- Center for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Magdalena Ciebiera
- Students' Scientific Association at the Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
| | - Kornelia Zaręba
- Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Krzysztof Łukaszuk
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland.
- INVICTA Fertility and Reproductive Center, 80-172 Gdansk, Poland.
| | - Grzegorz Jakiel
- Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
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117
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Martingano D. Massively Enlarged Leiomyomatous Uterus. J Osteopath Med 2018; 118:493. [PMID: 29946677 DOI: 10.7556/jaoa.2018.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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118
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Xie L, Liu Y, Wang D, Liu C, Zhou H, Lin Z, Lu H. Application of a 'Baseball' Suture Technique in Uterine Myomectomy Following Laparoscopic Enucleation of Uterine Leiomyoma (Fibroid). Med Sci Monit 2018; 24:3042-3049. [PMID: 29742071 PMCID: PMC5968838 DOI: 10.12659/msm.909143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this study was to evaluate the safety and efficacy of a ‘baseball’ suture technique for uterine myomectomy incision closure in laparoscopic surgical enucleation of uterine leiomyoma (fibroid). Material/Methods The study included 20 patients who underwent laparoscopic myomectomy with a ‘baseball’ suture technique, compared with 20 patients who underwent laparoscopic myomectomy with a standard suture method. Clinical characteristics, perioperative and follow-up data were compared between the two groups. Results For the study group, compared with the standard or control group, had a significantly reduced operation time (60.15±9.97 min vs. 71.85±9.74 min) and suturing time (18.05±4.71 min vs. 28.35±3.13 min) (both p<0.05), significantly less intraoperative blood loss (93.25±19.62 ml vs. 121.50±24.87 ml) (p<0.05) and significantly less reduction in postoperative hemoglobin levels (8.9±1.97 g/L vs. 11.15±2.23 g/L) (p<0.05). There were no statistically significant differences between the two groups in duration of the use of the indwelling drainage tube, drainage volume, or time to recovery of gastrointestinal function (all, p>0.05). Following surgery, blood transfusion was given to one patient in the study group and two patients in the control group. One patient from each group had a fever. There was no significant difference in pregnancy outcomes between the two groups. Conclusions The ‘baseball’ suture technique for closure of the uterine incision is a safe and effective method for use in laparoscopic myomectomy. However, the long-term recovery outcomes require further study.
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Affiliation(s)
- Lingling Xie
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Yunyun Liu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Dongyan Wang
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Changhao Liu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Hui Zhou
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Zhongqiu Lin
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Huaiwu Lu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
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119
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Tian YC, Wu JH, Wang HM, Dai YM. Improved Fertility Following Enucleation of Intramural Myomas in Infertile Women. Chin Med J (Engl) 2018; 130:1648-1653. [PMID: 28685713 PMCID: PMC5520550 DOI: 10.4103/0366-6999.209900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The relationship between intramural myomas and fertility remains unclear. The main debate rests on whether cavity-distorting intramural myomas (CDMs) adversely affect fertility more than non-CDMs. We aimed to compare the effects of enucleating non-CDMs and CDMs on fertility improvement in females with unexplained infertility. Methods: We prospectively recruited 83 women undergoing myomectomy for unexplained infertility with intramural myomas between June 2008 and November 2012 and classified them into non-CDMs group (n = 45) and CDMs group (n = 38). We then compared postoperative infertility rates, spontaneous pregnancy rates, pregnancy outcomes, live birth rates, and obstetric complications. For continuous variables, we calculated the mean ± standard deviation, median and interquartile range, and analyzed the data using Student's t-test and the Mann-Whitney U-test. For categorical variables, the Pearson's Chi-square test, the continuity correction test, and Fisher's exact test were used. Results: Patients’ demographics and myoma characteristics were comparable between the two groups. The overall spontaneous pregnancy rate increased from 0% to 68.42% following myomectomy. The postoperative infertility rate was significantly higher in the non-CDMs group than that in the CDMs group (50.00% vs. 23.53%, t = 5.579, P = 0.018), whereas the postoperative spontaneous pregnancy rate was significantly lower in the non-CDMs group than that in the CDMs group (47.62% vs. 70.59%, t = 4.067, P = 0.044). Compared with the enucleation of non-CDM, the enucleation of CDM patients was a protective factor for the fertility restoration (risk ratio [RR] = 3.717, 95% confidence interval [CI]: 1.284–10.753, P = 0.015), although postoperative fertility restoration declined with age (RR = 1.141, 95% CI: 1.005–1.295, P = 0.041). Conclusions: Intramural myomas are associated with impaired fertility. Women experiencing unexplained infertility, and possessing intramural myomas, have a better chance of conception following myomectomy, and these benefits are more obvious for younger patients and patients with CDM.
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Affiliation(s)
- Yu-Cui Tian
- Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Jian-Hong Wu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Hong-Mei Wang
- Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Yin-Mei Dai
- Department of Minimal Invasive Gynecology Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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120
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Gehring A, Gerber B, Tolla-Jensen C, Wiessner R. Disseminated peritoneal leiomyomatosis (DPL): a case report. J OBSTET GYNAECOL 2018; 38:1179-1180. [PMID: 29620425 DOI: 10.1080/01443615.2018.1431614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Alexander Gehring
- a Department of General and Visceral Surgery , Bodden-Kliniken Ribnitz-Damgarten GmbH , Ribnitz-Damgarten , Germany
| | - Bernd Gerber
- b Women's Center , University Südstadt Klinik Rostock , Rostock , Germany
| | - Claudia Tolla-Jensen
- a Department of General and Visceral Surgery , Bodden-Kliniken Ribnitz-Damgarten GmbH , Ribnitz-Damgarten , Germany
| | - Reiko Wiessner
- a Department of General and Visceral Surgery , Bodden-Kliniken Ribnitz-Damgarten GmbH , Ribnitz-Damgarten , Germany
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121
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Islam MS, Castellucci C, Fiorini R, Greco S, Gagliardi R, Zannotti A, Giannubilo SR, Ciavattini A, Frega NG, Pacetti D, Ciarmela P. Omega-3 fatty acids modulate the lipid profile, membrane architecture, and gene expression of leiomyoma cells. J Cell Physiol 2018; 233:7143-7156. [PMID: 29574773 DOI: 10.1002/jcp.26537] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 02/12/2018] [Indexed: 12/13/2022]
Abstract
Uterine leiomyomas (fibroids or myomas) are the most common benign tumors of premenopausal women and new medical treatments are needed. This study aimed to determine the effects of omega-3 fatty acids on the lipid profile, membrane architecture and gene expression patterns of extracellular matrix components (collagen1A1, fibronectin, versican, or activin A), mechanical signaling (integrin β1, FAK, and AKAP13), sterol regulatory molecules (ABCG1, ABCA1, CAV1, and SREBF2), and mitochondrial enzyme (CYP11A1) in myometrial and leiomyoma cells. Myometrial tissues had a higher amount of arachidonic acid than leiomyoma tissues while leiomyoma tissues had a higher level of linoleic acid than myometrial tissues. Treatment of primary myometrial and leiomyoma cells with eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) reduced the monounsaturated fatty acid (MUFA) content and increased the polyunsaturated fatty acid (PUFA) content in both cell types. Myometrial and leiomyoma cell membranes were in the liquid-crystalline phase, but EPA- and DHA-treated cells had decreased membrane fluidity. While we found no changes in the mRNA expression of ECM components, EPA and DHA treatment reduced levels of ABCG1, ABCA1, and AKAP13 in both cell types. EPA and DHA also reduced FAK and CYP11A1 expression in myometrial cells. The ability of omega-3 fatty acids to remodel membrane architecture and downregulate the expression of genes involved in mechanical signaling and lipid accumulation in leiomyoma cells offers to further investigate this compound as preventive and/or therapeutic option.
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Affiliation(s)
- Md Soriful Islam
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy.,Biotechnology and Microbiology Laboratory, Department of Botany, University of Rajshahi, Rajshahi, Bangladesh
| | - Clara Castellucci
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Rosamaria Fiorini
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Stefania Greco
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | | | - Alessandro Zannotti
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Stefano R Giannubilo
- Department of Clinical Science, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Ciavattini
- Department of Clinical Science, Università Politecnica delle Marche, Ancona, Italy
| | - Natale G Frega
- Department of Agricultural, Food and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Deborah Pacetti
- Department of Agricultural, Food and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy.,Department of Information Engineering, Università Politecnica delle , Marche, Ancona, Italy
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Chiang CS, Chen PL, Kuo TT, Chen IM, Wu NY, Chang HH. One-stage surgery for removal of intravascular leiomyomatosis extending to right ventricle. Medicine (Baltimore) 2018; 97:e0051. [PMID: 29538195 PMCID: PMC5882389 DOI: 10.1097/md.0000000000010051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intravascular leiomyomatosis (IVL) is a rare nonmalignant tumor that can be fatal if untreated. PATIENT CONCERNS A 49-year-old nulliparous Asian woman who underwent hysterectomy and left salpingo-oophorectomy for multiple uterine leiomyomas 18 months prior presented complaining of intermittent palpitation and chest tightness for approximately 1 month. Echocardiography revealed a large mobile tumor mass extending from the inferior vena cava (IVC) to the right atrium that partially obstructed IVC flow and tricuspid inflow. Thoracicabdominopelvic computed tomography revealed a left adnexal tumor (4.8 × 2.5 cm) causing intravascular obstruction extending from the left internal iliac vein to the IVC, right atrium, and right ventricle. DIAGNOSIS IVL with right heart involvement INTERVENTIONS:: Under cardiopulmonary bypass, a one-stage surgery combining sternotomy and laparotomy was performed. The tumor was approached and extracted via sternotomy, and tumor detachment and removal of residual tumors was accomplished via laparotomy. OUTCOMES A firm, smooth, and regularly shape tumor 15.5 × 5.5 × 2.5 in size was completely removed and histopathologically confirmed as IVL. The patient tolerated the surgical procedure well and no postoperative complication was noted. LESSONS We describe a one-stage surgical approach to completely remove an IVL extending to the right ventricle.
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Affiliation(s)
| | - Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Ting Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Huang Chang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, Taipei Medical University
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan
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Oskovi Kaplan ZA, Taşçi Y, Topçu HO, Erkaya S. 25-Hydroxy vitamin D levels in premenopausal Turkish women with uterine leiomyoma. Gynecol Endocrinol 2018; 34:261-264. [PMID: 29067857 DOI: 10.1080/09513590.2017.1391774] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We aimed to evaluate the relationship between serum 25-hydroxy vitamin D levels and the risk of uterine fibroids in premenopausal women in Turkish population in this prospective observational cross-sectional study. Sixty-eight women with at least one uterine leiomyoma ≥10 mm were compared with 56 healthy controls. Serum 25-(OH) vitamin D3 levels were measured by electrochemiluminescence immunoassay. The groups were similar in terms of age, BMI, gravidity and parity numbers. The mean level of 25-(OH) D3 were 7.28 ± 4.94 ng/ml and 78% of patients (n = 97) had severe vitamin D deficiency ( < 10 ng/mL). Vitamin D levels were significantly lower in the study group (6.54 ± 4.66 ng/ml vs. 8.18 ± 5.16 ng/ml, respectively; p = .009). Vitamin D levels were not correlated with size, volume, localization and number of leiomyomas. Traditional covered clothing style, low education level and being housewife were risk factors for Vitamin D deficiency. This is the first study that investigates the vitamin D levels in women with leiomyomas in Turkish population. Influence of vitamin D on uterine leiomyoma formation to may lead to new preventive strategies in the future.
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Affiliation(s)
| | - Yasemin Taşçi
- a Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Hasan Onur Topçu
- a Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Salim Erkaya
- a Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
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Hayden MA, Ordulu Z, Gallagher CS, Quade BJ, Anchan RM, Middleton NR, Srouji SS, Stewart EA, Morton CC. Clinical, pathologic, cytogenetic, and molecular profiling in self-identified black women with uterine leiomyomata. Cancer Genet 2018; 222-223:1-8. [PMID: 29666002 DOI: 10.1016/j.cancergen.2018.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/08/2018] [Accepted: 01/15/2018] [Indexed: 11/16/2022]
Abstract
Black women are disproportionately affected by uterine leiomyomata (UL), or fibroids, compared to other racial groups, having a greater lifetime risk of developing UL and an earlier age of diagnosis. In order to elucidate molecular and genetic mechanisms responsible for the increased prevalence and morbidity associated with UL in black women, clinical, pathologic, cytogenetic, and select molecular profiling (MED12 mutation analysis) of 75 self-reported black women undergoing surgical treatment for UL was performed. Our observations are broadly representative of previous cytogenetic studies of UL: karyotypically abnormal tumors were detected in 30.7% of women and 17.4% of analyzed tumors. No notable association was observed between race and increased occurrence of cytogenetic abnormalities that might contribute to any population-specific morbidity or prevalence rate. Our data on MED12 mutation analyses (73.2% of tumors harbored a MED12 mutation) provide additional support for a significant role of MED12 in tumorigenesis. Although the effect of MED12-mediated tumorigenesis appears significant irrespective of race, other genetic events such as the distribution of karyotypic abnormalities appear differently in black women. This case series indicates that presently recognized genetic and molecular characteristics of UL do not appear to explain the increased prevalence and morbidity of UL in black women.
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Affiliation(s)
- Mark A Hayden
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Zehra Ordulu
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - C Scott Gallagher
- Harvard Medical School, Boston, MA 02115, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Bradley J Quade
- Harvard Medical School, Boston, MA 02115, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Raymond M Anchan
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Nia Robinson Middleton
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Serene S Srouji
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Elizabeth A Stewart
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Cynthia C Morton
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Undiagnosed Uterine Sarcomas Identified During Surgery for Presumed Leiomyoma at a National Tertiary Hospital in Thailand: A 10-Year Review. Int J Gynecol Cancer 2018; 27:973-978. [PMID: 28498251 DOI: 10.1097/igc.0000000000000968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the rate, clinical characteristics, and survival outcomes of an undiagnosed uterine malignancy in patients who underwent surgical treatment for presumed leiomyomas. METHODS Medical records of patients who underwent surgical treatment for presumed leiomyomas, from January 2004 to September 2013, were retrospectively reviewed, and the data were followed until September 2016. Demographic data, tumor characteristics, oncologic treatment, and response rate were analyzed by descriptive statistics. Kaplan-Meier method was used for survival analysis. This study includes follow-up data through December 31, 2016. RESULTS A total of 11,258 medical records of presumed leiomyoma patients undergoing hysterectomy during the studied period were reviewed. Pathology of uterine sarcoma was found in 22 patients (0.2%), all of whom were included. Nineteen patients had leiomyosarcoma, and 3 had endometrial stromal sarcoma. Mean age of patients was 48.3 ± 6.9 years. All patients underwent total abdominal hysterectomy, with 20 patients undergoing concurrent bilateral salpingo-oophorectomy. Uterine sarcoma was classified as stage IB in 21 patients and stage IIIC in 1 patient. Fifteen patients were prescribed the following adjuvant treatment: chemotherapy in 13 patients and megestrol acetate in 2 patients. Thirteen patients had recurrent disease, and 3 patients died of their disease. The mean progression-free survival was 50.1 ± 41.3 months, and overall survival was 59.3 ± 43.0 months. CONCLUSIONS One in 512 patients who underwent hysterectomy because of presumed uterine leiomyomas had inadvertent uterine sarcomas. Even with adjuvant therapy, treatment outcome was rather poor, with almost 60% recurrence rate and median progression-free survival and overall survival of less than 5 years.
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Islam MS, Akhtar MM, Segars JH, Castellucci M, Ciarmela P. Molecular targets of dietary phytochemicals for possible prevention and therapy of uterine fibroids: Focus on fibrosis. Crit Rev Food Sci Nutr 2018; 57:3583-3600. [PMID: 28609115 DOI: 10.1080/10408398.2016.1245649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Uterine fibroids (myomas or leiomyomas) are common benign tumors of reproductive aged women. Fibroids are clinically apparent in 20-50% of women, and cause abnormal uterine bleeding, abdominal pain and discomfort, pregnancy complications and infertility. Unfortunately, limited numbers of medical treatment are available but no effective preventive strategies exist. Moreover, the benefits of medical treatments are tempered by lack of efficacy or serious adverse side effects. Fibrosis has recently been recognized as a key pathological event in leiomyoma development and growth. It is defined by the excessive deposition of extracellular matrix (ECM). ECM plays important role in making bulk structure of leiomyoma, and ECM-rich rigid structure is believed to be a cause of abnormal bleeding and pelvic pain/pressure. Dietary phytochemicals are known to regulate fibrotic process in different biological systems, and being considered as potential tool to manage human health. At present, very few dietary phytochemicals have been studied in uterine leiomyoma, and they are mostly known for their antiproliferative effects. Therefore, in this review, our aim was to introduce some dietary phytochemicals that could target fibrotic processes in leiomyoma. Thus, this review could serve as useful resource to develop antifibrotic drugs for possible prevention and treatment of uterine fibroids.
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Affiliation(s)
- Md Soriful Islam
- a Department of Experimental and Clinical Medicine , Faculty of Medicine, Università Politecnica delle Marche , Ancona , Italy.,b Biotechnology and Microbiology Laboratory, Department of Botany , University of Rajshahi , Rajshahi , Bangladesh
| | - Most Mauluda Akhtar
- a Department of Experimental and Clinical Medicine , Faculty of Medicine, Università Politecnica delle Marche , Ancona , Italy.,c Department of Clinical and Molecular Sciences , Faculty of Medicine, Università Politecnica delle Marche , Ancona , Italy
| | - James H Segars
- d Howard W. and Georgeanna Seegar Jones Division of Reproductive Sciences, Department of Gynecology and Obstetrics , Johns Hopkins School of Medicine , Baltimore , Maryland , USA
| | - Mario Castellucci
- a Department of Experimental and Clinical Medicine , Faculty of Medicine, Università Politecnica delle Marche , Ancona , Italy
| | - Pasquapina Ciarmela
- a Department of Experimental and Clinical Medicine , Faculty of Medicine, Università Politecnica delle Marche , Ancona , Italy.,e Department of Information Engineering , Università Politecnica delle Marche , Ancona , Italy
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Lee SR, Kim YJ, Kim KG. A Fast 3-Dimensional Magnetic Resonance Imaging Reconstruction for Surgical Planning of Uterine Myomectomy. J Korean Med Sci 2018; 33:e12. [PMID: 29215821 PMCID: PMC5729653 DOI: 10.3346/jkms.2018.33.e12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 10/14/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Uterine myoma is the most common benign gynecologic tumor in reproductive-aged women. During myomectomy for women who want to preserve fertility, it is advisable to detect and remove all myomas to decrease the risk of additional surgery. However, finding myomas during surgery is often challenging, especially for deep-seated myomas. Therefore, three-dimensional (3D) preoperative localization of myomas can be helpful for the surgical planning for myomectomy. However, the previously reported manual 3D segmenting method takes too much time and effort for clinical use. The objective of this study was to propose a new method of rapid 3D visualization of uterine myoma using a uterine template. METHODS Magnetic resonance images were listed according to the slide spacing on each plane of the multiplanar reconstruction, and images that were determined to be myomas were selected by simply scrolling the mouse down. By using the selected images, a 3D grid with a slide spacing interval was constructed and filled on its plane and finally registered to a uterine template. RESULTS The location of multiple myomas in the uterus was visualized in 3D and this proposed method is over 95% faster than the existing manual-segmentation method. Not only the size and location of the myomas, but also the shortest distance between the uterine surface and the myomas, can be calculated. This technique also enables the surgeon to know the number of total, removed, and remaining myomas on the 3D image. CONCLUSION This proposed 3D reconstruction method with a uterine template enables faster 3D visualization of myomas.
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Affiliation(s)
- Sa Ra Lee
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, Gachon University, Incheon, Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gachon University, Incheon, Korea.
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Vallejo Benitez A, Rodríguez Zarco E, Pabón Carrasco S, de la Chica Rubio V, Pereira Gallardo S, Cabezas Palacios N. Fracasos de la embolización en el tratamiento del mioma uterino. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2018. [DOI: 10.1016/j.gine.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Minimally invasive procedures in the management of uterine fibroids. MENOPAUSE REVIEW 2017; 16:122-125. [PMID: 29483853 PMCID: PMC5824681 DOI: 10.5114/pm.2017.72756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/05/2017] [Indexed: 11/17/2022]
Abstract
Uterine fibroids are benign uterine tumors. In women during the reproductive period, uterine fibroids occur in about 25%, whereas after this time, they are observed in more than 40% of women. In the majority of women (about 20-50%), such tumors do not cause discomfort and do not require treatment. Asymptomatic uterine fibroids usually undergo only regular medical control, whereas symptomatic fibroids are an indication for treatment. Current treatment methods include surgical, pharmacological and minimally invasive treatment. Among the current commonly used methods, there are minimally invasive treatment options, which include Uterine Artery Embolization (UAE), Magnetic Resonance Guided Ultrasound Surgery (MRgFUS), MR-guided High Intensity Focused Ultrasound (MR-HIFU) and Laparoscopic Uterine Artery Occlusion (LUAO). The minimally invasive Ultrasound-guided High Intensity Focused Ultrasound method (US-HIFU) is new, but still experimental. The use of MRgFUS/MR-HIFU for the thermoablative treatment of fibroids was approved by the FDA (Food and Drug Administration) in 2004. As a minimally invasive method, it enables preservation of the uterus and eliminates the need for general anesthesia. LUAO is based on the use of the vascular clip, which is placed on the uterine artery at the level of the internal iliac artery. This procedure is performed bilaterally. The use of UAE in obstetrics and gynecology was first described in 1987 as an effective method in the treatment of hemorrhage, which allows avoiding surgical intervention and enables the uterus to be preserved. An appropriate qualification of patients is crucial for high clinical efficacy and prevention of complications after UAE. The candidates should be women with symptomatic uterine fibroids, without other pathologies within the pelvis, who do not plan to get pregnant in the future. The variety of uterine fibroids as for the location, size, and symptoms they can evoke, has enforced a very individual approach to each patient, to begin with observation and regular gynecological control, through a number of pharmacological and minimally invasive treatment methods, and ending with the removal of the uterus. It gives the doctors the tools, which, if used properly, can manage uterine fibroids and fulfil the expectations of the patient.
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Ferrero S, Vellone VG, Barra F. Pharmacokinetic drug evaluation of ulipristal acetate for the treatment of uterine fibroids. Expert Opin Drug Metab Toxicol 2017; 14:107-116. [DOI: 10.1080/17425255.2018.1417389] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Valerio Gaetano Vellone
- Department of Surgical and Diagnostic Sciences, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
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Api M, Boza A, Ceyhan M. Could the female-to-male transgender population be donor candidates for uterus transplantation? Turk J Obstet Gynecol 2017; 14:233-237. [PMID: 29379666 PMCID: PMC5780567 DOI: 10.4274/tjod.55453] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/05/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To evaluate the eligibility of female-to-male (FtM) transgender people as donor candidates with regard to histologic, surgical, and social aspects. MATERIALS AND METHODS In this prospective cohort study, 31 FtM transgender people underwent standard hysterectomy and bilateral salpingo-oophorectomy for gender reassignment upon their request. The pelvic viscera of the transgender people was intraoperatively observed and the histology of the removed uteri were evaluated for fertility capacity and procurement surgery. A questionnaire was administered to explore their attitude towards uterus donation. RESULTS The mean ± standard deviation age was 28.5±5 years. The median duration of testosterone supplementation was 2.4 years; therefore, they all had irregular menstrual periods during this therapy. None had any previous abdominal surgery or additional morbidity. The mean uterine volume was 138±48 cm3. No adenomyosis, endometriosis, polyps, adhesions or uterine anomalies were either observed or reported. Endometrial histology was reported as proliferative (58%), atrophic (29%), and secretory (13%) pattern. Of the 31 transgender people, 30 (96.7%) had a positive attitude; only one had no opinion at the beginning. After detailed information about the procedure was given, 26 (84%) still wanted to volunteer for donation, but 4 (12%) changed their opinion to negative (p=0.12, McNemar test). CONCLUSION The proposal of the FtM transgender population as uterus donor is a hypothetical model that has not been experienced before. Nevertheless, our experience revealed that the FtM transgender population would be good candidates socially, legally, and biologically.
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Affiliation(s)
- Murat Api
- İstanbul Medipol University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ayşen Boza
- American Hospital, Women’s Health Centre Assisted Reproduction Unit, İstanbul, Turkey
| | - Mehmet Ceyhan
- University of Health Sciences, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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Abstract
BACKGROUND Uterine fibroids occur in up to 40% of women aged over 35 years. Some are asymptomatic, but up to 50% cause symptoms that warrant therapy. Symptoms include anaemia caused by heavy menstrual bleeding, pelvic pain, dysmenorrhoea, infertility and low quality of life. Surgery is the first choice of treatment. In recent years, medical therapies have been used before surgery to improve intraoperative and postoperative outcomes. However, such therapies tend to be expensive.Fibroid growth is stimulated by oestrogen. Gonadotropin-hormone releasing analogues (GnRHa) induce a state of hypo-oestrogenism that shrinks fibroids , but has unacceptable side effects if used long-term. Other potential hormonal treatments, include progestins and selective progesterone-receptor modulators (SPRMs).This is an update of a Cochrane Review published in 2000 and 2001; the scope has been broadened to include all preoperative medical treatments. OBJECTIVES To assess the effectiveness and safety of medical treatments prior to surgery for uterine fibroids. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group specialised register, CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL in June 2017. We also searched trials registers (ClinicalTrials.com; WHO ICTRP), theses and dissertations and the grey literature, handsearched reference lists of retrieved articles and contacted pharmaceutical companies for additional trials. SELECTION CRITERIA We included randomised comparisons of medical therapy versus placebo, no treatment, or other medical therapy before surgery, myomectomy, hysterectomy or endometrial resection, for uterine fibroids. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included a total of 38 RCTs (3623 women); 19 studies compared GnRHa to no pretreatment (n = 19), placebo (n = 8), other medical pretreatments (progestin, SPRMs, selective oestrogen receptor modulators (SERMs), dopamine agonists, oestrogen receptor antagonists) (n = 7), and four compared SPRMs with placebo. Most results provided low-quality evidence due to limitations in study design (poor reporting of randomisation procedures, lack of blinding), imprecision and inconsistency. GnRHa versus no treatment or placebo GnRHa treatments were associated with reductions in both uterine (MD -175 mL, 95% CI -219.0 to -131.7; 13 studies; 858 participants; I² = 67%; low-quality evidence) and fibroid volume (heterogeneous studies, MD 5.7 mL to 155.4 mL), and increased preoperative haemoglobin (MD 0.88 g/dL, 95% CI 0.7 to 1.1; 10 studies; 834 participants; I² = 0%; moderate-quality evidence), at the expense of a greater likelihood of adverse events, particularly hot flushes (OR 7.68, 95% CI 4.6 to 13.0; 6 studies; 877 participants; I² = 46%; moderate-quality evidence).Duration of hysterectomy surgery was reduced among women who received GnRHa treatment (-9.59 minutes, 95% CI 15.9 to -3.28; 6 studies; 617 participants; I² = 57%; low-quality evidence) and there was less blood loss (heterogeneous studies, MD 25 mL to 148 mL), fewer blood transfusions (OR 0.54, 95% CI 0.3 to 1.0; 6 studies; 601 participants; I² = 0%; moderate-quality evidence), and fewer postoperative complications (OR 0.54, 95% CI 0.3 to 0.9; 7 studies; 772 participants; I² = 28%; low-quality evidence).GnRHa appeared to reduce intraoperative blood loss during myomectomy (MD 22 mL to 157 mL). There was no clear evidence of a difference among groups for other primary outcomes after myomectomy: duration of surgery (studies too heterogeneous for pooling), blood transfusions (OR 0.85, 95% CI 0.3 to 2.8; 4 studies; 121 participants; I² = 0%; low-quality evidence) or postoperative complications (OR 1.07, 95% CI 0.43 to 2.64; I² = 0%; 5 studies; 190 participants; low-quality evidence). No suitable data were available for analysis of preoperative bleeding. GnRHa versus other medical therapies GnRHa was associated with a greater reduction in uterine volume (-47% with GnRHa compared to -20% and -22% with 5 mg and 10 mg ulipristal acetate) but was more likely to cause hot flushes (OR 12.3, 95% CI 4.04 to 37.48; 5 studies; 183 participants; I² = 61%; low-quality evidence) compared with ulipristal acetate. There was no clear evidence of a difference in bleeding reduction (ulipristal acetate 5 mg: OR 0.71, 95% CI 0.3 to 1.7; 1 study; 199 participants; moderate-quality evidence; ulipristal acetate 10 mg: OR 0.39, 95% CI 0.1 to 1.1; 1 study; 203 participants; moderate-quality evidence) or haemoglobin levels (MD -0.2, 95% CI -0.6 to 0.2; 188 participants; moderate-quality evidence).There was no clear evidence of a difference in fibroid volume between GnRHa and cabergoline (MD 12.71 mL, 95% CI -5.9 to 31.3; 2 studies; 110 participants; I² = 0%; low-quality evidence).The included studies did not report usable data for any other primary outcomes. SPRMs versus placebo SPRMs (mifepristone, CDB-2914, ulipristal acetate and asoprisnil) were associated with greater reductions in uterine or fibroid volume than placebo (studies too heterogeneous to pool) and increased preoperative haemoglobin levels (MD 0.93 g/dL, 0.5 to 1.4; 2 studies; 173 participants; I² = 0%; high-quality evidence). Ulipristal acetate and asoprisnil were also associated with greater reductions in bleeding before surgery (ulipristal acetate 5 mg: OR 41.41, 95% CI 15.3 to 112.4; 1 study; 143 participants; low-quality evidence; ulipristal acetate 10 mg: OR 78.83, 95% CI 24.0 to 258.7; 1 study; 146 participants; low-quality evidence; asoprisnil: MD -166.9 mL; 95% CI -277.6 to -56.2; 1 study; 22 participants; low-quality evidence). There was no evidence of differences in preoperative complications. No other primary outcomes were measured. AUTHORS' CONCLUSIONS A rationale for the use of preoperative medical therapy before surgery for fibroids is to make surgery easier. There is clear evidence that preoperative GnRHa reduces uterine and fibroid volume, and increases preoperative haemoglobin levels, although GnRHa increases the incidence of hot flushes. During hysterectomy, blood loss, operation time and complication rates were also reduced. Evidence suggests that ulipristal acetate may offer similar advantages (reduced fibroid volume and fibroid-related bleeding and increased haemoglobin levels) although replication of these studies is advised before firm conclusions can be made. Future research should focus on cost-effectiveness and distinguish between groups of women with fibroids who would most benefit.
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Affiliation(s)
- Anne Lethaby
- University of AucklandDepartment of Obstetrics and GynaecologyPrivate Bag 92019AucklandNew Zealand1142
| | - Lucian Puscasiu
- University of Medicine and Pharmacy Targu MuresStrada Gheorghe Marinescu 50Targu MuresRomania540136
| | - Beverley Vollenhoven
- Monash UniversityDepartment of Obstetrics and GynaecologyLevel 5, Monash Medical Centre246 Clayton RoadClaytonVictoriaAustralia3168
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Vlahos NF, Theodoridis TD, Partsinevelos GA. Myomas and Adenomyosis: Impact on Reproductive Outcome. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5926470. [PMID: 29234680 PMCID: PMC5694987 DOI: 10.1155/2017/5926470] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/19/2017] [Accepted: 08/30/2017] [Indexed: 12/26/2022]
Abstract
Among uterine structural abnormalities, myomas and adenomyosis represent two distinct, though frequently coexistent entities, with a remarkable prevalence in women of reproductive age. Various mechanisms have been proposed to explain the impact of each of them on reproductive outcome. In respect to myomas, current evidence implies that submucosal ones have an adverse effect on conception and early pregnancy. A similar effect yet is not quite clear and has been suggested for intramural myomas. Still, it seems reasonable that intramural myomas greater than 4 cm in diameter may negatively impair reproductive outcome. On the contrary, subserosal myomas do not seem to have a significant impact, if any, on reproduction. The presence of submucosal and/or large intramural myomas has also been linked to adverse pregnancy outcomes. In particular increased risk for miscarriage, fetal malpresentation, placenta previa, preterm birth, placenta abruption, postpartum hemorrhage, and cesarean section has been reported. With regard to adenomyosis, besides the tentative coexistence of adenomyosis and infertility, to date a causal relationship among these conditions has not been fully confirmed. Preterm birth and preterm premature rupture of membranes, uterine rupture, postpartum hemorrhage due to uterine atony, and ectopic pregnancy have all been reported in association with adenomyosis. Further research on the impact of adenomyosis on reproductive outcome is welcome.
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Affiliation(s)
- Nikos F. Vlahos
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, National and Kapodistrian University of Athens, School of Medicine, 76 Vasilissis Sofias Av., 11528 Athens, Greece
| | - Theodoros D. Theodoridis
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Faculty of Health Sciences, School of Medicine, Ring Road, Municipality of Pavlos Melas, Area of N. Efkarpia, 56403 Thessaloniki, Greece
| | - George A. Partsinevelos
- Assisted Reproduction-IVF Unit, MITERA Hospital, 6 Erithrou Stavrou Str., Marousi, 15123 Athens, Greece
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Pisco JM, Duarte M, Bilhim T, Branco J, Cirurgião F, Forjaz M, Fernandes L, Pereira J, Costa N, Pisco JBM, Oliveira AG. Spontaneous Pregnancy with a Live Birth after Conventional and Partial Uterine Fibroid Embolization. Radiology 2017; 285:302-310. [DOI: 10.1148/radiol.2017161495] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- João M. Pisco
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
| | - Marisa Duarte
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
| | - Tiago Bilhim
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
| | - Jorge Branco
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
| | - Fernando Cirurgião
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
| | - Marcela Forjaz
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
| | - Lúcia Fernandes
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
| | - José Pereira
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
| | - Nuno Costa
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
| | - Joana B. M. Pisco
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
| | - António G. Oliveira
- From the Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal (J.M.P., M.D., T.B., L.F., J.P., N.C., J.B.M.P.); University Department of Radiology (T.B., L.F., J.P., N.C.) and Department of Obstetrics and Gynecology (J.B.), Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Obstetrics and Gynecology, S. Francisco Xavier Hospital, Lisbon, Portugal
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Wang HL, Liu J, Qin ZM. A novel method to identify differential pathways in uterine leiomyomata based on network strategy. Oncol Lett 2017; 14:5765-5772. [PMID: 29113205 PMCID: PMC5661392 DOI: 10.3892/ol.2017.6928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 06/02/2017] [Indexed: 01/21/2023] Open
Abstract
The aim of the present study was to identify differential pathways in uterine leiomyomata (UL) using a novel method based on protein-protein interaction networks and pathway analysis. The pathway networks were constructed by examining the intersections of the Reactome database and the Search Tool for the Retrieval of Interacting Genes/proteins (STRING) protein-protein interaction (PPI) networks. The Objective network was defined as the differential expressed genes (DEGs) associated with the interactions identified by STRING. Topological centrality (degree) analysis was performed for the Objective network to explore the hub genes and hub networks. Subsequent to isolating the intersections between the Pathway and Objective networks, randomization tests were conducted to identify the differential pathways. There were 559,598 interactions in the Pathway networks. A total of 657 genes with 3,835 interactions were mapped in the Objective network, which included 20 hub genes. It was identified that 358 pathways demonstrated interaction with the Objective network, such as Signal Transduction, Immune System and Signaling by G-protein-coupled receptor (GPCR). By accessing the randomization tests, P-values of these pathways were close to 0, which indicated that they were significantly different. The present study successfully identified differential pathways (such as signal transduction, immune system and signaling by GPCR) in UL, which may be potential biomarkers in the detection and treatment of UL.
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Affiliation(s)
- Hui-Ling Wang
- First Gynecological Ward, Binzhou People's Hospital, Binzhou, Shandong 256610, P.R. China
| | - Jing Liu
- Department of Health Checkup, Binzhou People's Hospital, Binzhou, Shandong 256610, P.R. China
| | - Zhao-Min Qin
- Department of Nursing, Shandong Medical College, Jinan, Shandong 250002, P.R. China
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The Rising Phoenix-Progesterone as the Main Target of the Medical Therapy for Leiomyoma. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4705164. [PMID: 29312996 PMCID: PMC5615958 DOI: 10.1155/2017/4705164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/06/2017] [Indexed: 11/17/2022]
Abstract
Leiomyomas, also known as uterine fibroids, are a common benign tumor in women of reproductive age. These lesions disrupt the function of the uterus causing menorrhagia and pelvic pressure as well as reproductive disorders. These women pose a true challenge for clinicians in the attempt of choosing the suitable treatment for each patient. Patient's age, interest in fertility preservation, and leiomyoma location and size are all factors to be taken into account when deciding upon the preferable therapeutic option. For the past few decades, surgical treatment was the only reliable long-term treatment available. A variety of surgical approaches have been developed over the years but these developments have come at the expense of other treatment options. The classical medical treatment includes gonadotropin-releasing hormone (GnRH) agonists and antagonists. These agents are well known for their limited clinical effect as well as their broad spectrum of side effects, inspiring a need for new pharmacological treatments. In recent years, promising results have been reported with the use of selective progesterone receptor modulators (SPRM). Long-term clinical trials have shown a reduction in bleeding and shrinkage of leiomyoma mass. These results instill hope for women suffering from symptomatic leiomyomas seeking an effective, long-term medical option for their condition.
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Sun C, Zou J, Wang Q, Wang Q, Han L, Batchu N, Ulain Q, Du J, Lv S, Song Q, Li Q. Review of the pathophysiology, diagnosis, and therapy of vulvar leiomyoma, a rare gynecological tumor. J Int Med Res 2017; 46:663-674. [PMID: 28875758 PMCID: PMC5971502 DOI: 10.1177/0300060517721796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this article is to discuss the pathophysiology, diagnosis, differential diagnosis, and therapy of vulvar leiomyoma. We performed a review of all English-language reports of vulvar leiomyoma published in PubMed from 1978 to 2015 using the following search terms: “vulval leiomyoma,” “vulvar leiomyoma,” “vulval smooth muscle tumor,” and “external genitalia smooth muscle tumor.” Vulvar leiomyomas, which are rare benign monoclonal tumors, most commonly occur in the fourth and fifth decades of life. The genetics of vulvar leiomyoma remain undefined. Three principal histological patterns have been identified: spindled, epithelioid, and myxoid. Imaging tests such as ultrasound, endoscopic ultrasound, and magnetic resonance imaging are used in diagnosis. Surgical excision is the only curative treatment for vulvar leiomyomas. Establishment of a full differential diagnosis list and correct final diagnosis before surgery are essential for optimal clinical management. Although recurrence of vulvar leiomyoma is extremely rare, long-term follow-up of all cases is advisable.
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Affiliation(s)
- Chao Sun
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Junkai Zou
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qing Wang
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qi Wang
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Lu Han
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Nasra Batchu
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qurat Ulain
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Jiang Du
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Shulan Lv
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qing Song
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China.,2 Center of Big Data and Bioinformatics, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China.,3 Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Qiling Li
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China.,2 Center of Big Data and Bioinformatics, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
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Monitoring Leiomyoma Response to Uterine Artery Embolization Using Diffusion and Perfusion Indices from Diffusion-Weighted Imaging. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3805073. [PMID: 28929111 PMCID: PMC5591964 DOI: 10.1155/2017/3805073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 07/07/2017] [Accepted: 07/25/2017] [Indexed: 01/12/2023]
Abstract
Purpose To investigate the potential of diffusion and perfusion indices (ADC and perfusion fraction f) from DWI at 3.0 T in monitoring treatment response to uterine artery embolization (UAE) at 6-month follow-up. Methods Twelve female patients with uterine fibroids who underwent 3.0-T pelvic DWI before and 6 months after UAE were included. ADC and perfusion fraction f were calculated from DWI. The Wilcoxon signed-rank test and Spearman rank correlation test were used for statistics. Results Seventeen fibroids were studied. The median ADCs showed a significant increase from 1.20 × 10−3 mm2/s (range, 0.86–1.66 × 10−3 mm2/s) at baseline to 1.56 × 10−3 mm2/s (range, 1.00–1.86 × 10−3 mm2/s) at 6-month follow-up (P = 0.0003). Conversely, the median perfusion fraction f was significantly decreased after UAE (P = 0.0001), with a median pre-UAE value of 14.2% (range, 6.7%–17.6%) and a median post-UAE value of 9.2% (range, 3.2%–14.6%). Significant correlations were found between fibroid volume reduction rate and percentage changes in ADC and perfusion fraction f at 6-month follow-up relative to baseline, with ρ values of −0.50 (P = 0.04) and 0.55 (P = 0.02), respectively. Conclusion ADC and perfusion fraction f obtained from DWI at 3.0 T may help to evaluate treatment response to UAE.
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Li B, Zhang S, Ma N, Jiao Y, Zhou Y, Ni S, Han X, Liu X, Ouyang L. Combining situ-morcellation with continuous-fill-mattress suture in laparoscopic myomectomy: A surgical approach of choice for patients with large uterine fibroids. Medicine (Baltimore) 2017; 96:e7672. [PMID: 28767590 PMCID: PMC5626144 DOI: 10.1097/md.0000000000007672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To investigate the efficacy and advantage of combining situ-morcellation with continuous-fill-mattress suture compared with conventional morcellation and suture in laparoscopic myomectomy. METHODS One hundred sixteen patients who underwent laparoscopic myomectomy from March 2014 to October 2016. INTERVENTIONS Patients were divided into combining situ-morcellation with continuous-fill-mattress suture group (n = 62) and conventional group (n = 54), and subsequent statistical analysis the clinical data of the 2 groups. RESULTS The combining situ-morcellation with continuous-fill-mattress suture group shows significantly decrease of surgery time, incision size, blood loss, postoperative drainage volume and time, postoperative vent time, hospital stay and the loss of hemoglobin value. Moreover, there is significant significance between the 2 groups in the surgery time (P = .018), the postoperative drainage volume (P = .000), and the loss of hemoglobin value (P = .000). CONCLUSIONS The combining situ-morcellation with continuous-fill-mattress suture shows significant advantages in shortening surgery time and reducing blood loss compared with conventional group in laparoscopic myomectomy.
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140
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Kassam Z, Petkovska I, Wang CL, Trinh AM, Kamaya A. Benign Gynecologic Conditions of the Uterus. Magn Reson Imaging Clin N Am 2017; 25:577-600. [DOI: 10.1016/j.mric.2017.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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141
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Eroglu S, Haskul İ, Aziz V, Yurtcu E, Karatas F, Neşelioğlu S, Erel O. Dynamic thiol/disulphide homeostasis in patients with Uterine Myoma. Eur J Obstet Gynecol Reprod Biol 2017; 216:24-26. [PMID: 28697394 DOI: 10.1016/j.ejogrb.2017.06.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/23/2017] [Accepted: 06/30/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study is to measure and compare the dynamic thiol and disulphide homeostasis between patients with Uterine Myoma (UM) and healthy subjects. MATERIAL AND METHOD A total of 54 patients with UM who were diagnosed by transvaginal ultrasonography and 37 age- and body mass index-matched healthy individuals were included in this study. Thiol/disulphide homeostasis was measured by a novel automatic spectrophotometric method. RESULTS The mean serum native thiol, disulphide, and thiol levels were statistically lower in UM group than those in the control group [(284.66±59.41μmol/L vs. 320.98±56.17μmol/L, P<0.0001), (17.27±5.59μmol/L vs. 22.38±6.93μmol/L, P<0.0001) and (319.21±61.69 vs. 365.76±61.46μmol/L, P<0.0001), respectively]. There were no statistically significant differences in ratios of the disulphide/native thiol, native thiol/total thiol, and disulphide/total thiol among patients with UM versus healthy control group (P=0.096, 0.092, 0.092, respectively). CONCLUSION It was found that the native thiol, total thiol, and disulphide levels in patients with UM decreased while the ratio of native thiol/disulphide remained unchanged.It is necessary to investigate whether these findings have a role in the etiology and clinical course of the UM.
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Affiliation(s)
- Semra Eroglu
- Karabuk University Faculty of Medicine, Department of Gynecology and Obstetrics, Turkey
| | - İsmail Haskul
- Karabuk University Faculty of Medicine, Department of Clinical Biochemistry, Turkey
| | - Vüsale Aziz
- Karabuk University Faculty of Medicine, Department of Gynecology and Obstetrics, Turkey
| | - Engin Yurtcu
- Karabuk University Faculty of Medicine, Department of Gynecology and Obstetrics, Turkey
| | - Fatih Karatas
- Karabuk University Faculty of Medicine, Department of Medical Oncology, Turkey.
| | - Salim Neşelioğlu
- Yıldırım Beyazit University Faculty of Medicine, Department of Clinical Biochemistry, Turkey
| | - Ozcan Erel
- Yıldırım Beyazit University Faculty of Medicine, Department of Clinical Biochemistry, Turkey
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143
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Wang D, Wang L, Wang Y, Lin X. The efficiency and safety of tranexamic acid for reducing blood loss in open myomectomy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017; 96:e7072. [PMID: 28591045 PMCID: PMC5466223 DOI: 10.1097/md.0000000000007072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This meta-analysis aimed to perform a meta-analysis including randomized controlled trials (RCTs) to assess the efficiency and safety of tranexamic acid (TXA) for reducing blood loss and transfusion requirements in patients undergoing open myomectomy. METHODS A systematic search was performed in Medline (1966-2017.03), PubMed (1966-2017.03), Embase (1980-2017.03), ScienceDirect (1985-2017.03,) and the Cochrane Library. Study evaluated the efficiency and safety of TXA in myomectomy was selected. Meta-analysis was performed using Stata 11.0 software. RESULTS Four RCTs including 328 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of total blood loss (standard mean difference [SMD] = -1.512, 95% confidence interval [CI]: -2.746 to -0.278, P = .016), postoperative hemoglobin level (SMD = 0.650, 95% CI: 0.045-1.255, P = .035), transfusion requirements (SMD = -0.102, 95% CI: -0.199 to -0.006, P = .038), and duration of surgery (SMD = -0.514, 95% CI: -0.749 to -0.280, P = .000). In addition, no adverse effect was identified in treatment groups. CONCLUSIONS Intravenous administration of TXA in open myomectomy was associated with significantly reduced total blood loss, postoperative hemoglobin decline, duration of surgery, and transfusion requirements. Based on the limitations of the current meta-analysis, high-quality RCTs with long-term follow-up are still required.
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Affiliation(s)
| | - Lixia Wang
- Department of Gynaecology and Obstetrics, The Second Hospital of Dalian Medical University, Liaoning, China
| | - Yifei Wang
- Department of Gynaecology and Obstetrics, The Second Hospital of Dalian Medical University, Liaoning, China
| | - Xinyan Lin
- Department of Gynaecology and Obstetrics, The Second Hospital of Dalian Medical University, Liaoning, China
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144
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Lőrincz J, Jakab A, Török P. Vaginal Fibroma: An Unusual Vaginal Tumor. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Judit Lőrincz
- Department of Obstetrics and Gynecology, Kenézy Gyula County Hospital, Debrecen, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Clinical Center, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
| | - Péter Török
- Department of Obstetrics and Gynecology, Clinical Center, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
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Silberzweig JE, Powell DK, Matsumoto AH, Spies JB. Management of Uterine Fibroids: A Focus on Uterine-sparing Interventional Techniques. Radiology 2017; 280:675-92. [PMID: 27533290 DOI: 10.1148/radiol.2016141693] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Uterine fibroids occur in approximately 50% of women over the age of 40 years, and an estimated 50% of those are symptomatic. Menorrhagia is the most common symptom and the primary indication for treatment, although bulk symptoms often occur and can be treated. Pharmacotherapy is typically inadequate unless it can be expected to successfully bridge to menopause or allow for a less-invasive intervention. However, hormonal therapies have risks. Hysterectomy is still the most commonly performed procedure for symptomatic fibroids and has the lowest rate of reintervention (compared with myomectomy or uterine artery embolization [UAE]), but rates of more serious complications are higher and patient satisfaction and ability to return to normal activities may also be less favorable. Myomectomy is not necessarily less morbid than hysterectomy and may have a greater failure rate than UAE. Techniques and devices vary with little standardization, and operator experience is crucial to success. The largest studies of UAE show very low rates of serious complications and rapid recovery. UAE significantly improves symptoms related to uterine fibroids in 85%-90% of patients. Herein, this article will discuss the nature of fibroids and their diagnosis, pharmacotherapy, surgical treatment, and nonsurgical interventional treatment, including UAE and magnetic resonance-guided focused ultrasound. (©) RSNA, 2016.
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Affiliation(s)
- James E Silberzweig
- From the Department of Radiology, Mount Sinai Beth Israel, New York, NY (J.E.S.); West Cancer Center, University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, TN 38138 (D.K.P.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (A.H.S.); and Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (J.B.S.)
| | - Daniel K Powell
- From the Department of Radiology, Mount Sinai Beth Israel, New York, NY (J.E.S.); West Cancer Center, University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, TN 38138 (D.K.P.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (A.H.S.); and Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (J.B.S.)
| | - Alan H Matsumoto
- From the Department of Radiology, Mount Sinai Beth Israel, New York, NY (J.E.S.); West Cancer Center, University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, TN 38138 (D.K.P.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (A.H.S.); and Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (J.B.S.)
| | - James B Spies
- From the Department of Radiology, Mount Sinai Beth Israel, New York, NY (J.E.S.); West Cancer Center, University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, TN 38138 (D.K.P.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (A.H.S.); and Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (J.B.S.)
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146
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Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG 2017; 124:1501-1512. [DOI: 10.1111/1471-0528.14640] [Citation(s) in RCA: 483] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 12/14/2022]
Affiliation(s)
- EA Stewart
- Division of Reproductive Endocrinology and Infertility; Departments of Obstetrics and Gynecology and Surgery; Mayo Clinic; Rochester MN USA
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Abstract
Leiomyomas are the most common uterine tumor and the most common cause of uterine enlargement in the nonpregnant patient. Sonography is the imaging modality of choice for the initial diagnosis and imaging workup of uterine leiomyomas and is also extremely helpful in determining the etiology of a broad range of pelvic symptoms in the female patient. Although the classic sonographic appearance of uterine leiomyomas is well established and easily recognizable, other pelvic masses may occasionally be confused with uterine leiomyomas, and the ability to distinguish between these entities is crucial in optimizing appropriate patient care. This article will review pelvic abnormalities that can be confused on ultrasound with uterine leiomyomas and potential methods that can be used to avoid these pitfalls.
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148
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Nezhat C, Li A, Abed S, Balassiano E, Soliemannjad R, Nezhat A, Nezhat CH, Nezhat F. Strong Association Between Endometriosis and Symptomatic Leiomyomas. JSLS 2017; 20:JSLS.2016.00053. [PMID: 27647977 PMCID: PMC5019190 DOI: 10.4293/jsls.2016.00053] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background and Objectives: The relationship between leiomyoma and endometriosis is poorly understood. Both contribute to considerable pain and may cause subfertility or infertility in women. We conducted this retrospective study to assess the rate of coexistence of endometriosis in women with symptomatic leiomyoma. The primary outcome measured was the coexistence of histology-proven endometriosis in women with symptomatic leiomyoma. Methods: This is a retrospective review of a data-based collection of medical records of 244 patients treated at a tertiary medical center, who were evaluated for symptomatic leiomyoma from March 2011 through December 2015. Of those, 208 patients underwent laparoscopic or laparoscopic-assisted myomectomy or hysterectomy. All patients provided consent for possible concomitant diagnosis and treatment of endometriosis. The remaining 36 patients underwent medical therapy and were excluded from the study. All patients who had myomectomy or supracervical hysterectomy underwent minilaparotomy for extracorporeal morcellation and specimen removal beginning in April 2012. Results: Of the 208 patients with the presenting chief concern of symptomatic leiomyoma and who underwent surgical therapy, 181 had concomitant diagnoses of leiomyoma and endometriosis, whereas 27 had leiomyoma. Of the 27 patients, 9 also had adenomyosis. Patients with only fibroid tumors were, on average, 4.0 years older than those with endometriosis and fibroids (mean age, 44 vs 40 ± SD). Patients with both pathologies were also more likely to present with pelvic pain and nulliparity than those with fibroid tumors alone. Conclusions: In our patient population, 87.1% of patients with a chief concern of symptomatic fibroids also had a diagnosis of histology-proven endometriosis, which affirms the need for concomitant diagnosis and intraoperative treatment of both conditions. Overlooking the coexistence of endometriosis in women with symptomatic leiomyoma may lead to suboptimal treatment of fertility and persistent pelvic pain. It is important for physicians to be aware of the possibility of this association and to thoroughly evaluate the abdomen and pelvis for endometriosis at the time of myomectomy or hysterectomy in an effort to avoid the need for reoperation.
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Affiliation(s)
- Camran Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | - Anjie Li
- Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | | | - Erika Balassiano
- Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | - Rose Soliemannjad
- Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | - Azadeh Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | - Ceana H Nezhat
- Nezhat Medical Center, Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia, USA
| | - Farr Nezhat
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, New York, USA
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Lee SW, Park EK, Lee SJ, Lee KH. Comparison study of consecutive 100 cases of single port vs. multiport laparoscopic myomectomy; technical point of view. J OBSTET GYNAECOL 2017; 37:616-621. [PMID: 28393585 DOI: 10.1080/01443615.2017.1281896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We report our experience with single-port and multiple-port laparoscopic myomectomy with operative outcomes and surgical skills. Hundred consecutive patients underwent single-port laparoscopic myomectomy (SP-LM) and 69 multi-port laparoscopic myomectomy (MP-LM). The operative outcomes were compared between the two methods. All procedures were successfully completed without conversion to abdominal myomectomy. The mean maximum diameter of the largest myoma was 7.4 (5-13) vs. 6.8 (5-12) cm and the mean number of myomas was 1.7 vs. 1.6 in SP-LM and MP-LM group, respectively. Mean operative time was 134.2 vs. 122.9 min in SP-LM and MP-LM group (p = .109). We showed that SPL myomectomy is a safe and feasible technique compared to MPL myomectomy with respect to postoperative pain, mean operating time, mean estimated blood loss and length of stay. To improve suturing technique of SP-LM, the working instruments were placed external to the telescope with 'micro-triangulation'.
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Affiliation(s)
- Suk Woo Lee
- a Department of Obstetrics and Gynecology , Hallym University Sacred Heart Hospital, Hallym University College of Medicine , Anyang , Korea
| | - Eun Kyung Park
- b Department of Obstetrics and Gynecology , The Catholic University of Korea , Seoul , Korea
| | - Sung Jong Lee
- b Department of Obstetrics and Gynecology , The Catholic University of Korea , Seoul , Korea
| | - Keun Ho Lee
- b Department of Obstetrics and Gynecology , The Catholic University of Korea , Seoul , Korea
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Uterine Fibroids in the Setting of Infertility: When to Treat, How to Treat? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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