1
|
Bao YM, Ma WW, Li S, Jiang L, Yang MJ, Chen JY. The safety and efficacy of myomectomy in the treatment of recurrent uterine fibroids after HIFU. Int J Gynaecol Obstet 2024. [PMID: 38935313 DOI: 10.1002/ijgo.15757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of myomectomy for recurrent uterine fibroids (UFs) after high-intensity focused ultrasound (HIFU) ablation. METHODS This was a retrospective study. Patients who underwent abdominal myomectomy (AM) and laparoscopic myomectomy (LM) from January 2018 to December 2021 at the Three Gorges Hospital of Chongqing University were included. Among them, 73 had undergone prior HIFU ablation (Group 1), while 120 had not undergone HIFU (Group 2). Outcome measures included operating time, estimated blood loss (EBL), blood transfusion, postoperative activity times (PAT), duration of hospital stay (DOHS), and complications. RESULTS The operating time was 90.0 min (70.5, 115.0) for Group 1 and 110.0 min (81.5, 130.0) for Group 2 (P < 0.05). During all AM pathways, there were no significant differences observed between the two groups in EBL, blood transfusion, PAT, DOHS, and complications; however, operating time was shorter in Group 1. The operating time, EBL, blood transfusion, PAT, DOHS, and complications were similar in both groups during LM pathway. During the follow-up 40 (range: 24-53) months, the rate of relief, recurrence, and reintervention in Groups 1 and 2 was 78.1% versus 74.1%, 14.6% versus 16.4%, and 3.7% versus 2.6%, respectively (P > 0.05). CONCLUSION Myomectomy is a safe and effective surgical method for treating recurrent UFs after HIFU. Myomectomy for treating recurrent UFs resulted in a shorter operative and hospital stay, reduced blood loss, faster postoperative recovery, and fewer complications, better symptom relief rates, and lower risk of recurrence or reintervention. These findings indicate that previous HIFU ablation does not worsen the outcomes of the subsequent myomectomy.
Collapse
Affiliation(s)
- Yi-Ming Bao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Three Gorges Hospital of Chongqing University, Chongqing, China
| | - Wang-Wa Ma
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Shuang Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Li Jiang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Mei-Jie Yang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Jin-Yun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| |
Collapse
|
2
|
Giannini A, Cuccu I, D'Auge TG, De Angelis E, Laganà AS, Chiantera V, Caserta D, Vitale SG, Muzii L, D'Oria O, Perniola G, Bogani G, Di Donato V. The great debate: Surgical outcomes of laparoscopic versus laparotomic myomectomy. A meta-analysis to critically evaluate current evidence and look over the horizon. Eur J Obstet Gynecol Reprod Biol 2024; 297:50-58. [PMID: 38581885 DOI: 10.1016/j.ejogrb.2024.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
Myomectomy is one of the most common surgical procedure in the field of gynecology. However, the role of laparoscopic myomectomy is still debated for many factors, including surgical considerations, safety and fertility concerns, long-term outcomes, and cost-related issues. The aim of this study is to evaluate the surgical peri- and post-operative outcomes of laparoscopic and abdominal myomectomy. A systematic search for studies was performed up to June 2023 through MEDLINE, Pubmed, Embase. Studies reporting the comparison of surgical and obstetrical outcomes in laparoscopic versus laparotomic myomectomy were included for the following outcomes: time of surgery, estimated blood loss, decrease of postoperative hemoglobin, hospital stay, intra-operative complication rates, postoperative complications rates, postoperative analgesic use, postoperative pain at 24 h and pregnancy rate. The meta-analysis was performed using the Cochrane Review software. Fifty-six relevant articles were retrieved through the process of evidence acquisition. Eleven articles met inclusion criteria, for a total of 2,133 patients undergoing laparoscopic or laparotomic myomectomy. The estimated blood loss [standard mean differences (SMD) 0.72, IC 95 % 0.22 to 1.22], the hospital stays [SMD 3.12, IC 95 % 0.57 to 4.28], were significantly lower in laparoscopic than in open group. No statistically significant difference in intra-operative and post-operative complication rates, in pregnancy rate and others obstetrical outcomes between two surgical approaches were found. The findings of present metanalysis suggest that laparoscopic myomectomy offers multiple benefits, including reduced blood loss, shorter hospital stays, and less postoperative analgesic need, without a significant increase in complication rates and similar results in obstetrical outcomes when compared to abdominal myomectomy. However, the presence of few randomized studies on selected population may limit the generalizability of the findings to the entire population. Therefore, more well-designed studies or large population programdata to draw definitive conclusions are therefore warranted.
Collapse
Affiliation(s)
- Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in "Translational Medicine and Oncology", Sapienza University, Viale dell'Università, 37, 00185 Rome, Italy; Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; Unit of Gynecology, Sant'Andrea Hospital, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Ilaria Cuccu
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy.
| | - Tullio Golia D'Auge
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Emanuele De Angelis
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Via Giordano Alfonso, 3, 90127 Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy; Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Via Mariano Semmola, 53, 80131 Naples, Italy
| | - Donatella Caserta
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Via Università 40, 09124 Cagliari, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Ottavia D'Oria
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in "Translational Medicine and Oncology", Sapienza University, Viale dell'Università, 37, 00185 Rome, Italy; Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152 Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giorgio Bogani
- Department of Gynaecologic Oncology, IRCCS National Cancer Institute, Via Giacomo Venezian 1, 20133 Milan, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| |
Collapse
|
3
|
de Almeida TG, Ricci AR, Dos Anjos LG, Soares Junior JM, Maciel GAR, Baracat EC, Carvalho KC. FOXO3a deregulation in uterine smooth muscle tumors. Clinics (Sao Paulo) 2024; 79:100350. [PMID: 38636197 PMCID: PMC11031728 DOI: 10.1016/j.clinsp.2024.100350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE The present study aimed to investigate FOXO3a deregulation in Uterine Smooth Muscle Tumors (USMT) and its potential association with cancer development and prognosis. METHODS The authors analyzed gene and protein expression profiles of FOXO3a in 56 uterine Leiomyosarcomas (LMS), 119 leiomyomas (comprising conventional and unusual leiomyomas), and 20 Myometrium (MM) samples. The authors used techniques such as Immunohistochemistry (IHC), FISH/CISH, and qRT-PCR for the present analyses. Additionally, the authors conducted an in-silico analysis to understand the interaction network involving FOXO3a and its correlated genes. RESULTS This investigation revealed distinct expression patterns of the FOXO3a gene and protein, including both normal and phosphorylated forms. Expression levels were notably elevated in LMS, and Unusual Leiomyomas (ULM) compared to conventional Leiomyomas (LM) and Myometrium (MM) samples. This upregulation was significantly associated with metastasis and Overall Survival (OS) in LMS patients. Intriguingly, FOXO3a deregulation did not seem to be influenced by EGF/HER-2 signaling, as there were minimal levels of EGF and VEGF expression detected, and HER-2 and EGFR were negative in the analyzed samples. In the examination of miRNAs, the authors observed upregulation of miR-96-5p and miR-155-5p, which are known negative regulators of FOXO3a, in LMS samples. Conversely, the tumor suppressor miR-let7c-5p was downregulated. CONCLUSIONS In summary, the outcomes of the present study suggest that the imbalance in FOXO3a within Uterine Smooth Muscle Tumors might arise from both protein phosphorylation and miRNA activity. FOXO3a could emerge as a promising therapeutic target for individuals with Unusual Leiomyomas and Leiomyosarcomas (ULM and LMS), offering novel directions for treatment strategies.
Collapse
Affiliation(s)
- Thais Gomes de Almeida
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Instituto Brasileiro de Controle do Cancer, Mooca, São Paulo, SP, Brazil; Departamento de Ginecologia Oncológica, Hospital Santa Marcelina, São Paulo, SP, Brazil
| | - Anamaria Ritti Ricci
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Laura Gonzalez Dos Anjos
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Jose Maria Soares Junior
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Gustavo Arantes Rosa Maciel
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Katia Candido Carvalho
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| |
Collapse
|
4
|
Ren R, Li H, Zhang J, Li X, Yuan L, Li D, Shan S, Shi B, Jiang J. Knowledge, attitudes, and practices among Chinese reproductive-age women toward uterine adenomyosis. Front Med (Lausanne) 2024; 11:1361671. [PMID: 38651069 PMCID: PMC11033394 DOI: 10.3389/fmed.2024.1361671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Objective This study aimed to assess the knowledge, attitudes and practices (KAP) among Chinese reproductive-age women toward uterine adenomyosis. Methods This web-based cross-sectional study was conducted between April 2023 and September 2023 at the Second Hospital of Hebei Medical University. A self-designed questionnaire was developed to collect demographic information of reproductive-age women, and assess their KAP toward uterine adenomyosis. Results A total of 520 valid questionnaires were collected. Among the participants, 127 (24.42%) were diagnosed with uterine adenomyosis, and 120 (23.08%) were accompanied by uterine fibroids. The mean knowledge, attitudes and practices scores were 3.54 ± 3.72 (possible range:0-10), 20.96 ± 3.19 (possible range:5-25) and 24.01 ± 4.95 (possible range:7-35), respectively. The structural equation model demonstrated that knowledge had direct effects on attitudes and practices, as indicated by a path coefficient of 0.714 (p < 0.001) and 1.510 (p < 0.001), respectively. Moreover, attitudes had direct effects on practices, with a path coefficient of 0.226 (p = 0.001). Conclusion The findings revealed that reproductive-age women have insufficient knowledge, negative attitudes, and poor practices toward the uterine adenomyosis. Comprehensive training programs are needed to improve reproductive-age women practices in this area.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jing Jiang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| |
Collapse
|
5
|
Lugata J, Smith C, Mrosso O, Rwenyagila D, Shao B, Mremi A. Management of a pure uterine corpus rhabdomyosarcoma in a postmenopausal patient: A rare case report and review of the literature. Clin Case Rep 2024; 12:e8631. [PMID: 38455863 PMCID: PMC10918699 DOI: 10.1002/ccr3.8631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/28/2024] [Accepted: 02/11/2024] [Indexed: 03/09/2024] Open
Abstract
Key Clinical Message Rhabdomyosarcoma of the female genital tract often involves the vagina and cervix. It usually occurs in infants and children. Such tumors are uncommon in the uterus, especially in adults. Treatment options are based on studies of younger individuals. Abstract Rhabdomyosarcoma (RMS) is a malignant mesenchymal neoplasm with a tendency to differentiate into skeletal muscle cells. RMS is an aggressive tumor that tends to develop in children and younger patients. A vast majority of genital tract RMSs occur in the vagina and cervix. Such tumors rarely occur in adults. Usually, these tumors either occur as a component of a biphasic uterine tumor (carcinosarcoma or adenosarcoma) or can be a pure heterologous tumor. Pure uterine RMSs are extremely rare in adult patients and difficult to diagnose. Accurate diagnosis of these tumors depends on precise histopathological evaluation. The present report describes a rare case of embryonal RMS of the uterus in a postmenopausal female and explores the most recent literature. The aim is to strengthen the existing literature and aid clinicians in the management of similar cases. A 64-year-old postmenopausal female presented with a history of abdominal pain associated with abdominal distension, per vaginal bleeding, and foul-smelling discharge for 6 months. A transabdominal ultrasound revealed a bulky uterus with a well-circumscribed heterogeneous lesion. Histopathology confirmed the diagnosis of high-grade embryonal RMS within the corpus region of the uterus. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed, followed by adjuvant chemotherapy to prevent relapse of the disease. Six months after oncological care has passed, the patient remains symptoms-free without evidence of recurrence or metastasis.
Collapse
Affiliation(s)
- John Lugata
- Department of Obstetrics and GynecologyKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Caleigh Smith
- Department of Obstetrics and GynecologyKilimanjaro Christian Medical CentreMoshiTanzania
- School of MedicineUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Onesmo Mrosso
- Department of Obstetrics and GynecologyKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Doris Rwenyagila
- Department of Obstetrics and GynecologyKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Baraka Shao
- Department of Obstetrics and GynecologyKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Alex Mremi
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of PathologyKilimanjaro Christian Medical CenterMoshiTanzania
| |
Collapse
|
6
|
Ma Y, Li L, Yu L, He W, Yi L, Tang Y, Li J, Zhong Z, Wang M, Huang S, Xiong Y, Xiao P, Huang Y. Optimization of Diagnosis-Related Groups for 14,246 Patients with Uterine Leiomyoma in a Single Center in Western China Using a Machine Learning Model. Risk Manag Healthc Policy 2024; 17:473-485. [PMID: 38444948 PMCID: PMC10913598 DOI: 10.2147/rmhp.s442502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024] Open
Abstract
Background Uterine leiomyoma (UL) is one of the most common benign tumors in women, and its incidence is gradually increasing in China. The clinical complications of UL have a negative impact on women's health, and the cost of treatment poses a significant burden on patients. Diagnosis-related groups (DRG) are internationally recognized as advanced healthcare payment management methods that can effectively reduce costs. However, there are variations in the design and grouping rules of DRG policies across different regions. Therefore, this study aims to analyze the factors influencing the hospitalization costs of patients with UL and optimize the design of DRG grouping schemes to provide insights for the development of localized DRG grouping policies. Methods The Mann-Whitney U-test or the Kruskal-Wallis H-test was employed for univariate analysis, and multiple stepwise linear regression analysis was utilized to identify the primary influencing factors of hospitalization costs for UL. Case combination classification was conducted using the exhaustive chi-square automatic interactive detection (E-CHAID) algorithm within a decision tree framework. Results Age, occupation, number of hospitalizations, type of medical insurance, Transfer to other departments, length of stay (LOS), type of UL, admission condition, comorbidities and complications, type of primary procedure, other types of surgical procedures, and discharge method had a significant impact on hospitalization costs (P<0.05). Among them, the type of primary procedure, other types of surgical procedures, and LOS were the main factors influencing hospitalization costs. By incorporating the type of primary procedure, other types of surgical procedures, and LOS into the decision tree model, patients were divided into 11 DRG combinations. Conclusion Hospitalization costs for UL are mainly related to the type of primary procedure, other types of surgical procedures, and LOS. The DRG case combinations of UL based on E-CHAID algorithm are scientific and reasonable.
Collapse
Affiliation(s)
- Yuan Ma
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, People’s Republic of China
| | - Li Li
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Li Yu
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Wei He
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Ling Yi
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yuxin Tang
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jijie Li
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zhigang Zhong
- Department of Prevention, Office of Cancer Prevention and Treatment, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital Affiliate to University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Meixian Wang
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Shiyao Huang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, People’s Republic of China
| | - Yiquan Xiong
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, People’s Republic of China
| | - Pei Xiao
- Medical Insurance Office, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yuxiang Huang
- Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| |
Collapse
|
7
|
Guo B, Zhao S, Li J, Wang X. Magnetic resonance imaging findings of intravascular leiomyomatosis of the uterus: a case report. Front Med (Lausanne) 2024; 10:1328339. [PMID: 38327276 PMCID: PMC10847346 DOI: 10.3389/fmed.2023.1328339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024] Open
Abstract
Background Intravascular leiomyomatosis (IVL) is often a non-malignant condition that grows inside the blood vessels and does not invade surrounding tissues. However, its presence within the blood vessels can lead to obstructions. The majority of IVL cases manifest symptoms related to blockage. Case presentation We present a case of a 50-year-old female patient who was referred to our institution due to the presence of a common non-cancerous tumor in the uterus, known as a benign uterine leiomyoma. The tumor was identified during an ultrasound examination during a routine physical examination. Postoperative pathology established the existence of intrapelvic IVL. Conclusion Intrapelvic IVL often not present with complications when it is confined to the pelvic cavity. Furthermore, the imaging features of intrapelvic IVL resemble those of typical benign uterine leiomyomas. This can often result in the clinical misdiagnosis of the tumor as a typical benign uterine leiomyoma.
Collapse
Affiliation(s)
- Bin Guo
- Department of Radiology, Jinan Maternal and Child Care Hospital, Jinan, Shandong Province, China
| | - Shuhui Zhao
- Department of Gynecology, Jinan Maternal and Child Care Hospital, Jinan, Shandong Province, China
| | - Juan Li
- Department of Pathology, Jinan Maternal and Child Care Hospital, Jinan, Shandong Province, China
| | - Xiaoyan Wang
- Department of Radiology, Jinan Maternal and Child Care Hospital, Jinan, Shandong Province, China
| |
Collapse
|
8
|
Dai QH, Zhang L, Chen AE. Prognostic and reproductive outcomes in women who had uterine myomas removed during cesarean section and sutured using different techniques. BMC Womens Health 2024; 24:7. [PMID: 38166995 PMCID: PMC10763254 DOI: 10.1186/s12905-023-02852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In this study, the prognostic and reproductive outcomes of women who underwent excision of uterine myomas and were sutured using different techniques while undergoing a cesarean section were investigated. METHODS A total of 299 females who underwent cesarean section between January 2015 and June 2022 due to a scarred uterus were enrolled in this study. These participants were segregated into two categories: the experimental group (comprising 155 cases) in which uterine myoma (single lesion) was excised during the cesarean procedure, and the control group (consisting of 144 cases) in which only the cesarean section was conducted. A comparison between the two groups was carried out based on the following parameters: volume of intraoperative bleeding (mL), additional measures taken for intraoperative hemostasis (n, %), percentage (%) of patients experiencing postoperative fever, duration required for the passage of gas (hours [h]), length of hospital stay (days [d]), weight of newborns (kg) and their Apgar scores, and the reproductive outcomes of the experimental group assessed two years after the surgical procedure. RESULTS In the experimental group, the amount of bleeding during surgery, occurrence of postoperative fever among women, time taken for patients to resume passing gas, and length of hospital stay were 540.65 ± 269.12 mL, 9.03%, 15.99 ± 4.68 h, and 5.08 ± 1.18 days, respectively. In contrast, the control group had values of 409.03 ± 93.24 mL, 2.77%, 16.24 ± 4.92, and 4.47 ± 0.70 days, respectively (P < 0.05). No notable increase was observed in the need for additional intraoperative hemostasis measures, and there was no significant difference in the time it took for patients to pass gas after the surgery. All newborns had positive health status. In the experimental group, 25 patients underwent subsequent pregnancies, and 15 of them successfully reached full-term deliveries, all of which had positive outcomes. CONCLUSION Combining myomectomy with various suture methods during cesarean delivery did not cause excessive bleeding and resulted in healthy newborns. This approach offers the advantage of avoiding additional surgeries under anesthesia and can be considered a viable option. Subsequent pregnancies after myomectomy were considered high-risk.
Collapse
Affiliation(s)
- Qiao-Hong Dai
- Department of Gynecology and Obstetrics, Ningbo Women and Children's Hospital, 339 Liuting Street, Haishu District, Ningbo, Zhejiang, 315000, China
| | - Lu Zhang
- Department of Internal Medicine, Ningbo Urology & Nephrology Hospital, Ningbo, 315000, China
| | - An-Er Chen
- Department of Gynecology and Obstetrics, Ningbo Women and Children's Hospital, 339 Liuting Street, Haishu District, Ningbo, Zhejiang, 315000, China.
| |
Collapse
|
9
|
Yang L, Cai Y, Wang Y, Huang Y, Zhang C, Ma H, Zhou JG. Fibroblast Growth Factor 23 is a Potential Prognostic Biomarker in Uterine Sarcoma. Technol Cancer Res Treat 2024; 23:15330338241245924. [PMID: 38613349 PMCID: PMC11015760 DOI: 10.1177/15330338241245924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Uterine sarcoma (US) is a highly malignant cancer with poor prognosis and high mortality in women. In this study, we evaluated the expression of human fibroblast growth factor 23 (FGF23) in different US subtypes and the relationship between survival and clinicopathological characteristics. METHODS We conducted a comparative analysis of FGF23 gene expression in different pathological types of US. Utilizing a cohort from The Cancer Genome Atlas of 57 patients, a 50-patient microarray dataset (GSE119043) from the Gene Expression Omnibus and a Suining cohort of 44 patients, we analyzed gene expression profiles and corresponding clinicopathological information. Immunohistochemistry was used to examine the expression level of FGF23 in four US subtypes. Survival analysis was used to assess the relationship between FGF23 expression and prognosis in US patients. RESULTS Compared with uterine normal smooth muscle and uterine leiomyoma, FGF23 expression was significantly upregulated in US and was differentially expressed in four US subtypes. Uterine carcinosarcoma exhibited the highest expression of FGF23 among the subtypes. Survival analysis revealed no correlation between FGF23 expression and either overall survival or progression-free survival in US (P > 0.05). Similar results were obtained from the validation cohorts. Univariate and multivariate analyses showed no significant correlation between FGF23 expression and the US prognosis. Tumor stage, CA125, and tumor recurrence were independent prognostic factors for survival of US patients. CONCLUSION FGF23 was highly expressed in US and was promising as a novel potential biomarker for the diagnosis and prognosis of US.
Collapse
Affiliation(s)
- Ling Yang
- Department of Pathology, Suining Central Hospital, Suining, China
| | - Ying Cai
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yunjia Wang
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yue Huang
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chi Zhang
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hu Ma
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jian-Guo Zhou
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| |
Collapse
|
10
|
Borella F, Mancarella M, Preti M, Mariani L, Stura I, Sciarrone A, Bertschy G, Leuzzi B, Piovano E, Valabrega G, Turinetto M, Pino I, Castellano I, Bertero L, Cassoni P, Cosma S, Franchi D, Benedetto C. Uterine smooth muscle tumors: a multicenter, retrospective, comparative study of clinical and ultrasound features. Int J Gynecol Cancer 2023:ijgc-2023-004880. [PMID: 38054268 DOI: 10.1136/ijgc-2023-004880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To evaluate a wide range of clinical and ultrasound characteristics of different uterine smooth muscle tumors to identify features capable of discriminating between these types. METHODS This was a retrospective, multicenter study that included 285 patients diagnosed with uterine smooth muscle tumors (50 leiomyosarcomas, 35 smooth muscle tumors of uncertain malignant potential, and 200 leiomyomas). The patients were divided into three groups based on the histological type of their tumors, and the groups were compared according to the variables collected. RESULTS Leiomyosarcomas were more common in older and post-menopausal women. Compared with leiomyomas, smooth muscle tumors of uncertain malignant potential and leiomyosarcomas had similar ultrasound features such as absence of normal myometrium, multilocular appearance, hyper-echogenicity in case of uniform echogenicity, absence of posterior shadows, echogenic areas, and hyperechoic rim. Leiomyosarcomas were larger, had more cystic areas, and were associated with a higher prevalence of pelvic free fluid. Smooth muscle tumors of uncertain malignant potential were characterized by a higher frequency of International Federation of Gynecology and Obstetrics (FIGO) type 6-7, the absence of internal shadows, and, in the case of cystic area, the presence of a regular internal wall. Tumor outline varied among the three histological types. A color score of 1 was typical of leiomyoma, a color score 2 was mainly observed in leiomyomas and smooth muscle tumors of uncertain malignant potential, a color score 3 did not differ among the tumors, while a color of score 4 was related to leiomyosarcomas. When combining color scores 3 and 4, leiomyosarcomas and smooth muscle tumors of uncertain malignant potential showed a high percentage of both circumferential and intra-lesional vascularization. A cooked appearance was not statistically different among the tumors. CONCLUSIONS Based on our findings, specific ultrasonographic features as well as age and menopausal status are associated with different uterine smooth muscle tumor types. Integration of these data can help the pre-operative assessment of these lesions for proper management.
Collapse
Affiliation(s)
- Fulvio Borella
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Matteo Mancarella
- Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Mario Preti
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Luca Mariani
- Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, University of Turin, Torino, Piemonte, Italy
| | | | - Gianluca Bertschy
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Beatrice Leuzzi
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Elisa Piovano
- Division of Gynecology and Obstetrics 2, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | | | | | - Ida Pino
- Preventive Gynecology Unit, Istituto Europeo di Oncologia, Milan, Italy
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Stefano Cosma
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Dorella Franchi
- Preventive Gynecology Unit, Istituto Europeo di Oncologia, Milan, Italy
| | - Chiara Benedetto
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| |
Collapse
|
11
|
Yuk JS, Yoon SH. Relationship between myomectomy and risk of osteoporosis or fracture: A population-based cohort study. PLoS One 2023; 18:e0294405. [PMID: 37972094 PMCID: PMC10653470 DOI: 10.1371/journal.pone.0294405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/08/2023] [Indexed: 11/19/2023] Open
Abstract
Myomectomy, a surgery to remove multiple leiomyomas from the uterus, is a treatment option for uterine fibroids (UF) in premenopausal patients. Osteoporosis and bone fractures are known to be strongly associated with menopausal status or hormonal changes. However, no studies have discussed the association between myomectomy and osteoporosis or fractures. This study investigated the risk of osteoporosis or fractures (vertebrae, hip, and others) in Korean patients who had undergone myomectomy without bilateral oophorectomy. We used data from the 10-year claims database of the Korean National Health Insurance from January 2009 to December 2020. Data for patients who had undergone myomectomy without oophorectomy (n = 211,969) and the control group (n = 450,124) who were randomly selected from the database were extracted. The incidence and hazard ratios (HRs) of osteoporosis or fracture between the myomectomy patients and the control group were calculated. A Cox proportional hazards model was used to analyze hazard ratios and 95% confidence intervals (CI). Subgroup analyses were performed based on age. The adjusted hazard ratios for osteoporosis and total fractures were 0.934 (95% CI: 0.916-0.954, P<0.001) and 0.919 (95% CI: 0.896-0.941, P<0.001), respectively, in the myomectomy group. The adjusted hazard ratios according to fracture site were 0.857 (95% CI: 0.799-0.92, P<0.001) for vertebral fractures, 0.706 (95% CI: 0.48-1.037, P = 0.076) for hip fractures, and 0.919 (95% CI: 0.896-0.943, P<0.001) for other fractures. In conclusion, patients who have undergone myomectomy might have a decreased risk of osteoporosis or fractures.
Collapse
Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Sang-Hee Yoon
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| |
Collapse
|
12
|
Chapagain U, Krigman HR, Hagemann IS, Weiss MC, Sun L. COL1A1::PDGFB fusion-associated uterine sarcoma and response to Imatinib: A case report. Gynecol Oncol Rep 2023; 49:101270. [PMID: 37711974 PMCID: PMC10498399 DOI: 10.1016/j.gore.2023.101270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
Uterine sarcomas are rare neoplasms of the uterus, some of which are associated with distinctive gene fusions. COL1A1::PDGFB fusion uterine sarcoma is a recently described entity that shares the same genetic alteration as dermatofibrosarcoma protuberans. These uterine sarcomas have a nonspecific spindle cell sarcoma appearance and are CD34 positive by immunohistochemistry. Accurate diagnosis relies on identification of the characteristic fusion by molecular genetic methods. The importance of diagnosing this entity lies in its potential response to targeted therapy with imatinib, a tyrosine kinase inhibitor successfully used in dermatofibrosarcoma protuberans, but only one prior case of COL1A1::PDGFB fusion uterine sarcoma treated with imatinib has been reported. Here, we describe a case of COL1A1::PDGFB fusion uterine sarcoma with response to imatinib after recurrence, with a brief review of this rare tumor.
Collapse
Affiliation(s)
- Udita Chapagain
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
| | - Hannah R. Krigman
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
| | - Ian S. Hagemann
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
| | - Mia C. Weiss
- Division of Medical Oncology, Department of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Lulu Sun
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
| |
Collapse
|
13
|
Huang YQ, Wang Q, Xiang DD, Gan Q. Intravenous leiomyoma of the uterus extending to the pulmonary artery: A case report. World J Clin Cases 2023; 11:5729-5735. [PMID: 37727731 PMCID: PMC10505993 DOI: 10.12998/wjcc.v11.i24.5729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Uterine intravenous leiomyomatosis is defined as leiomyoma tissue invading the vein outside the leiomyoma. Reports of extension to the right pulmonary artery are relatively rare. CASE SUMMARY We describe a 31-year-old woman with a benign leiomyoma that extended into the right ventricular lumen, causing mechanical obstruction and corresponding clinical symptoms. Tumors located in the pulmonary artery can cause pulmonary artery obstruction. After diagnosis, surgical treatment should be performed as soon as possible. CONCLUSION In this case, the uterine leiomyoma extended to the right pulmonary system, which is clinically rare.
Collapse
Affiliation(s)
- Yuan-Qin Huang
- Department of Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, Hubei Province, China
| | - Qi Wang
- Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai Institute of Digestive Disease, Shanghai 200127, China
| | - Dou-Dou Xiang
- Department of Pathology, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, Hubei Province, China
| | - Quan Gan
- Department of Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, Hubei Province, China
| |
Collapse
|