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Ali M, Bariani MV, Vafaei S, Omran MM, Yang Q, Madueke-Laveaux OS, Al-Hendy A. Prevention of Uterine Fibroids: molecular mechanisms and potential clinical application. JOURNAL OF ENDOMETRIOSIS AND UTERINE DISORDERS 2023; 1:100018. [PMID: 37637856 PMCID: PMC10451784 DOI: 10.1016/j.jeud.2023.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Uterine fibroids (UFs; leiomyoma) are the most common benign neoplastic threat to women worldwide, exacting an immense personal burden on female health and a monetary expense to the healthcare system estimated in the hundreds of billions of dollars every year globally. With no long-term non-invasive treatment option currently available to treat UFs, deeper insights regarding tumor etiology are the key for developing newer therapies. Accordingly, in this review, we discuss new mechanistic paradigm to explain UF tumor development through an exquisite model involving developmental reprogramming of myometrial stem cells due to early life endocrine disruptors exposure, inflammation, fibrosis, DNA damage, and eventually tissue stiffness. Further, we propose to utilize shear wave elastography as a potential screening tool for the early identification of women at risk for developing UFs who can benefit from several simple preventive strategies, including the consumption of natural compounds such as vitamin D and green tea as a safe fertility friendly non-hormonal modality to delay or even arrest or reverse UF progression.
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Affiliation(s)
- Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Maria Victoria Bariani
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Somayeh Vafaei
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Mervat M. Omran
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Obianuju Sandra Madueke-Laveaux
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
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Harada T, Taniguchi F, Guo S, Choi YM, Biberoglu KO, Tsai SS, Alborzi S, Al‐Jefout M, Chalermchokcharoenkit A, Sison‐Aguilar AG, Fong Y, Senanayake H, Popov A, Hestiantoro A, Kaufman Y. The Asian Society of Endometriosis and Adenomyosis guidelines for managing adenomyosis. Reprod Med Biol 2023; 22:e12535. [PMID: 37701076 PMCID: PMC10493363 DOI: 10.1002/rmb2.12535] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 09/14/2023] Open
Abstract
This is the first guidelines for adenomyosis from the Asian Society of Endometriosis and Adenomyosis.
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Affiliation(s)
| | | | - Sun‐Wei Guo
- OB/GYN HospitalFudan UniversityShanghaiChina
| | | | | | | | | | - Moamar Al‐Jefout
- United Arab Emirates University, College of Medicine and Health SciencesAbu DhabiUAE
| | | | | | - Yoke‐Fai Fong
- National University of SingaporeSingapore CitySingapore
| | | | - Alexander Popov
- Moscow Regional Scientific Research Institute of Obstetrics and GynecologyMoscowRussia
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Bonanni V, Reschini M, La Vecchia I, Castiglioni M, Muzii L, Vercellini P, Somigliana E. The impact of small and asymptomatic intramural and subserosal fibroids on female fertility: a case-control study. Hum Reprod Open 2022; 2023:hoac056. [PMID: 36579123 PMCID: PMC9782921 DOI: 10.1093/hropen/hoac056] [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: 04/20/2022] [Revised: 11/02/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Do small and asymptomatic intramural and subserosal uterine fibroids affect female fertility? SUMMARY ANSWER Small and asymptomatic fibroids that do not encroach the endometrial cavity appear to not markedly affect female fertility. WHAT IS KNOWN ALREADY The available evidence on uterine fibroids and fertility is limited. Most information has been obtained in IVF settings by comparing the success in women affected and not affected by fibroids. These studies have shown a detrimental effect of submucosal and possibly intramural fibroids. However, this study design provides information only on embryo implantation, not on female fertility in general. STUDY DESIGN SIZE DURATION A retrospective observational case-control study on 200 women whose partner was diagnosed with severe male infertility and 200 women with unexplained infertility was conducted. If the null hypothesis (that fibroids do not affect fertility) is valid, one would expect a similar prevalence of fibroids in the two study groups. Conversely, if fibroids do impact fertility, one would expect a higher prevalence among women with unexplained infertility. The study was carried out at the Infertility Unit of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico covering a 5-year period between January 2014 and June 2020. PARTICIPANTS/MATERIALS SETTING METHODS We retrospectively recruited women seeking pregnancy whose partner was repeatedly documented to have a sperm concentration below 1 million/ml and matched them by age and study period to a group of women with unexplained infertility. The latter group of women was considered as a case group (infertile subjects), while the former group of women was considered as a control group (reflecting the general female population). Women with fibroids could be included in both study groups; only those with submucosal lesions were excluded. MAIN RESULTS AND THE ROLE OF CHANCE Fibroids were diagnosed in 31 women (16%) with unexplained infertility and in 32 women (16%) with severe male factor infertility. The adjusted odds ratio of carrying fibroids in women with unexplained infertility was 0.91 (95% CI: 0.52-1.58). Subgroup analyses according to number, dimension and location of fibroids failed to highlight an increased risk of infertility in any group. LIMITATIONS REASONS FOR CAUTION This is a retrospective study and some inaccuracies in fibroids detection cannot be ruled out. Moreover, the relatively small sample size hampers robust subgroup analyses. Even though we excluded women with patent causes of infertility, some women with specific causes of infertility could have been included among controls (yet are expected to account for <10% of the group). WIDER IMPLICATIONS OF THE FINDINGS This study suggests that small fibroids that do not encroach the endometrial cavity do not markedly affect female fertility. This information is clinically relevant when counseling infertile women with small fibroids and an otherwise unremarkable diagnostic work-up. Surgery may still be considered but only in selected cases. STUDY FUNDING/COMPETING INTERESTS This study was partially funded by Italian Ministry of Health: current research IRCCS. E.S. reports grants from Ferring, grants and personal fees from Merck, and grants and personal fees from Theramex outside the submitted work. All the other authors do not have any competing interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Valentina Bonanni
- Department of Gynecology, Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Marco Reschini
- Correspondence address. Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, Italy. Tel: +39-02-55034303; Fax: +39-02-55036581; E-mail:
| | - Irene La Vecchia
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Castiglioni
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Ludovico Muzii
- Department of Gynecology, Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Paolo Vercellini
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Transvaginal Ultrasound Combined with Strain-Ratio Elastography for the Concomitant Diagnosis of Uterine Fibroids and Adenomyosis: A Pilot Study. J Clin Med 2022; 11:jcm11133757. [PMID: 35807043 PMCID: PMC9267844 DOI: 10.3390/jcm11133757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023] Open
Abstract
Uterine fibroids (UFs) and adenomyosis (AM) represent two benign uterine conditions that can affect fertility and are most frequently commonly responsible for abnormal uterine bleeding and chronic pelvic pain. Their differential diagnosis still represents a challenge, and several authors advise the addition of elastography to transvaginal ultrasound (TVUS) for a more accurate imagistic recognition. Through this study, we aimed to assess the diagnostic accuracy of TVUS combined with strain-ratio elastography (SRE) in concomitant AM and UFs. We conducted a study on 17 patients diagnosed with concomitant UFs and AM undergoing hysterectomy and 46 healthy patients. TVUS combined with SRE was conducted in each patient, focusing on identifying rigidity patterns of the lesions. Significantly higher mean SR and maximum SR values were identified among both AM and UF lesions as opposed to controls (p < 0.01), with the highest tissue stiffness being encountered among AM lesions, which allows for the differentiation of UF (p < 0.01) and concomitant identification of both lesions. These results are reflected by higher cut-off values obtained for AM, both for mean SR (5.42 vs. 2.85) and maximum SR (5.80 vs. 3.30). TVUS combined with SRE showed good diagnostic performance in identifying coexisting UFs and AM within the same uterine specimen. Future studies on wider populations are required to validate our findings.
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Yıldırır M, Aytan H, Durukan H, Gürses İ. A clinical scoring system for the diagnosis of adenomyosis. Turk J Obstet Gynecol 2022; 19:138-144. [PMID: 35770456 PMCID: PMC9249356 DOI: 10.4274/tjod.galenos.2022.88289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To develop a scoring system using clinical evaluation methods to predict the presence of adenomyosis. Materials and Methods A cohort of 232 patients who underwent hysterectomy for benign gynecologic disorders was prospectively enrolled. A detailed anamnesis was obtained and physical/pelvic examinations with trans-vaginal ultrasound imaging were performed one day before the hysterectomy. The diagnosis of adenomyosis was based on histopathologic examination. Findings were compared between patients with (n=55) and without (n=166) adenomyosis. Factors associated with adenomyosis were assessed with regression analysis and odds ratios (OR) were calculated. The variables found to be significant were chosen for the scoring system. Receiver operating characteristic analysis was carried out to find the cut-off values for these variables. Results Number of parity, dyspareunia and dysmenorrhea visual analogue scale (VAS) scores, age of menarche, presence of uterine tenderness and detection of heterogeneous myometrium and myometrial cysts during ultrasonography were found to be the significant parameters. OR for the presence of myometrial heterogeneity, myometrial cysts, uterine tenderness were 27.2, 3.6 and 9.3 respectively. Cut-off values were calculated; 3 for parity (OR=2.8), 13-years for menarche (OR=1.6), 2 for dyspareunia VAS scores (OR=1.9) and 4 for dysmenorrhea VAS scores (OR=1.2). The total sum of maximum OR that a patient can obtain was calculated as 47.6 and this value was assumed to predict the presence of adenomyosis 100%. The multiplication of the sum of the OR in a patient by 2.1 (100/47.2) was found to have a predictive ability for the presence of adenomyosis. Conclusion A scoring system is developed to predict adenomyosis non-invasively based on clinical evaluation.
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Affiliation(s)
- Muhammet Yıldırır
- Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - Hakan Aytan
- Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - Hüseyin Durukan
- Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - İclal Gürses
- Mersin University Faculty of Medicine, Department of Pathology, Mersin, Turkey
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6
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Ren Z, Jiang B, Wu X, Zhang Z, Chen H, Cai H, Fu C. Diagnostic accuracy of dual-energy computed tomography angiography in the differentiation of benign and malignant pelvic masses. Eur J Radiol 2022; 150:110240. [DOI: 10.1016/j.ejrad.2022.110240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/27/2022] [Accepted: 03/05/2022] [Indexed: 11/24/2022]
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7
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Zhou Y, Ji X, Niu J, Sun T, Qian Z, Li Y, Yuan J, Fan Q, Huang Q, Bai J, Wang Y. Ultrasound-Guided High-Intensity Focused Ultrasound for Devascularization of Uterine Fibroid: A Feasibility Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2622-2635. [PMID: 34147312 DOI: 10.1016/j.ultrasmedbio.2021.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to establish the feasibility of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for devascularization of uterine fibroids. Ultrasound color Doppler flow imaging (CDFI) and B-mode imaging were used to target fibroid vascularity. The vessels were covered and ablated by high-intensity focused ultrasound spots. In this study, 42 fibroids with a volume of 66.98 ± 4.00 cm3 were treated. No blood flow was detected by post-treatment CDFI in 40 fibroids. The 6-mo non-perfusion volume rate was 75.23% ± 34.77% (n = 40). The mean shrinkage in fibroid volume was 38.20% and 43.89%, respectively, at 1 and 6 mo after treatment (p < 0.001). The uterine fibroid symptom and quality of life scores were reduced by 9.43% at 1 mo and 26.66% at 6-mo after treatment (p < 0.001). No serious adverse event was observed. This study demonstrates the feasibility of USgHIFU-induced fibroid devascularization, and more studies are required for the evaluation of safety and efficacy.
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Affiliation(s)
- Yun Zhou
- Department of Ultrasonography, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Ji
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jianmei Niu
- Department of Ultrasonography, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Taotao Sun
- Department of Radiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaoxia Qian
- Department of Radiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuhong Li
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiangjing Yuan
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiong Fan
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qianwen Huang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jingfeng Bai
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Yudong Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Flaxman TE, Cooke CM, Miguel OX, Sheikh AM, Singh SS. A review and guide to creating patient specific 3D printed anatomical models from MRI for benign gynecologic surgery. 3D Print Med 2021; 7:17. [PMID: 34224043 PMCID: PMC8256564 DOI: 10.1186/s41205-021-00107-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patient specific three-dimensional (3D) models can be derived from two-dimensional medical images, such as magnetic resonance (MR) images. 3D models have been shown to improve anatomical comprehension by providing more accurate assessments of anatomical volumes and better perspectives of structural orientations relative to adjacent structures. The clinical benefit of using patient specific 3D printed models have been highlighted in the fields of orthopaedics, cardiothoracics, and neurosurgery for the purpose of pre-surgical planning. However, reports on the clinical use of 3D printed models in the field of gynecology are limited. Main text This article aims to provide a brief overview of the principles of 3D printing and the steps required to derive patient-specific, anatomically accurate 3D printed models of gynecologic anatomy from MR images. Examples of 3D printed models for uterine fibroids and endometriosis are presented as well as a discussion on the barriers to clinical uptake and the future directions for 3D printing in the field of gynecological surgery. Conclusion Successful gynecologic surgery requires a thorough understanding of the patient’s anatomy and burden of disease. Future use of patient specific 3D printed models is encouraged so the clinical benefit can be better understood and evidence to support their use in standard of care can be provided.
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Affiliation(s)
- Teresa E Flaxman
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada. .,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Carly M Cooke
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Olivier X Miguel
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Adnan M Sheikh
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sukhbir S Singh
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
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9
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Zhan X, Zhou H, Sun Y, Shen B, Chou D. Long non-coding ribonucleic acid H19 and ten-eleven translocation enzyme 1 messenger RNA expression levels in uterine fibroids may predict their postoperative recurrence. Clinics (Sao Paulo) 2021; 76:e2671. [PMID: 34644730 PMCID: PMC8478142 DOI: 10.6061/clinics/2021/e2671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To investigate the predictive value of long non-coding RNA (lncRNA) H19 and the ten-eleven translocation enzyme 1 (TET1) transcriptional expression in postoperative recurrence of uterine fibroids (UFs). METHODS Seventy-five patients with UF, who underwent surgical treatment, were enrolled in the treatment group, and 60 healthy individuals were enrolled in the control group. The relative expression levels of lncRNA H19 and TET1 mRNA in the serum and UF tissues were analyzed. The patients were further divided into a better curative (BC) group and a poor efficacy (PE) group to analyze the predictive value of lncRNA H19 and TET1 and the independent risk factors affecting the recurrence of UF. RESULTS Compared with the control group, lncRNA H19 expression levels were significantly higher, while TET1 expression levels were significantly lower in the treatment group (p<0.001). The area under the receiver operating characteristic (ROC) curve (AUC) values of the two indicators for diagnostic importance were found to be 0.872 and 0.826, respectively. Compared with the PE group, lncRNA H19 expression levels were significantly lower, while TET1 expression levels were significantly higher in the BC group (p<0.001). The AUC values of the two indicators for their predictive efficacy were 0.788 and 0.812, respectively. Logistic regression analysis showed that age, menarche age, maximum diameter of UFs, number of UFs, lncRNA H19 levels, and TET1 levels were independent risk factors affecting UF recurrence. The AUC values of lncRNA H19 and TET1 for their predictive value for postoperative recurrence were 0.814 and 0.765, respectively. CONCLUSIONS The lncRNA H19 and TET1 have high diagnostic and predictive efficacy for determining the postoperative recurrence of UFs.
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Affiliation(s)
- Xiangjuan Zhan
- Department of Gynecology, The Second People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Hui Zhou
- Department of Obstetrics and Gynecology, The Second People's Hospital of Dongying, Dongying, Shandong, China
| | - Yuhong Sun
- Department of Gynecology, The Second People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Baomei Shen
- Department of Oncology, Binzhou Hospital of Traditional Chinese Medicine, Binzhou, Shandong, China
| | - Di Chou
- Department of Obstetrics and Gynecology, The People's Hospital of Pingyi County, Linyi, Shandong, China
- Corresponding author. E-mail:
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Chapron C, Vannuccini S, Santulli P, Abrão MS, Carmona F, Fraser IS, Gordts S, Guo SW, Just PA, Noël JC, Pistofidis G, Van den Bosch T, Petraglia F. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update 2020; 26:392-411. [PMID: 32097456 DOI: 10.1093/humupd/dmz049] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 11/20/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adenomyosis is a benign uterine disorder where endometrial glands and stroma are pathologically demonstrated within the uterine myometrium. The pathogenesis involves sex steroid hormone abnormalities, inflammation, fibrosis and neuroangiogenesis, even though the proposed mechanisms are not fully understood. For many years, adenomyosis has been considered a histopathological diagnosis made after hysterectomy, classically performed in perimenopausal women with abnormal uterine bleeding (AUB) or pelvic pain. Until recently, adenomyosis was a clinically neglected condition. Nowadays, adenomyosis may also be diagnosed by non-invasive techniques, because of imaging advancements. Thus, a new epidemiological scenario has developed with an increasing number of women of reproductive age with ultrasound (US) or magnetic resonance imaging (MRI) diagnosis of adenomyosis. This condition is associated with a wide variety of symptoms (pelvic pain, AUB and/or infertility), but it is also recognised that some women are asymptomatic. Furthermore, adenomyosis often coexists with other gynecological comorbidities, such as endometriosis and uterine fibroids, and the diagnostic criteria are still not universally agreed. Therefore, the diagnostic process for adenomyosis is challenging. OBJECTIVE AND RATIONALE We present a comprehensive review on the diagnostic criteria of adenomyosis, including clinical signs and symptoms, ultrasound and MRI features and histopathological aspects of adenomyotic lesions. We also briefly summarise the relevant theories on adenomyosis pathogenesis, in order to provide the pathophysiological background to understand the different phenotypes and clinical presentation. The review highlights the controversies of multiple existing criteria, summarising all of the available evidences on adenomyosis diagnosis. The review aims also to underline the future perspective for diagnosis, stressing the importance of an integrated clinical and imaging approach, in order to identify this gynecological disease, so often underdiagnosed. SEARCH METHODS PubMed and Google Scholar were searched for all original and review articles related to diagnosis of adenomyosis published in English until October 2018. OUTCOMES The challenge in diagnosing adenomyosis starts with the controversies in the available pathogenic theories. The difficulties in understanding the way the disease arises and progresses have an impact also on the specific diagnostic criteria to use for a correct identification. Currently, the diagnosis of adenomyosis may be performed by non-invasive methods and the clinical signs and symptoms, despite their heterogeneity and poor specificity, may guide the clinician for a suspicion of the disease. Imaging techniques, including 2D and 3D US as well as MRI, allow the proper identification of the different phenotypes of adenomyosis (diffuse and/or focal). From a histological point of view, if the diagnosis of diffuse adenomyosis is straightforward, in more limited disease, the diagnosis has poor inter-observer reproducibility, leading to extreme variations in the prevalence of disease. Therefore, an integrated non-invasive diagnostic approach, considering risk factors profile, clinical symptoms, clinical examination and imaging, is proposed to adequately identify and characterise adenomyosis. WIDER IMPLICATIONS The development of the diagnostic tools allows the physicians to make an accurate diagnosis of adenomyosis by means of non-invasive techniques, representing a major breakthrough, in the light of the clinical consequences of this disease. Furthermore, this technological improvement will open a new epidemiological scenario, identifying different groups of women, with a dissimilar clinical and/or imaging phenotypes of adenomyosis, and this should be object of future research.
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Affiliation(s)
- Charles Chapron
- Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016 (Doctor Vaiman), Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016 (Professor Batteux), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Silvia Vannuccini
- Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Obstetrics and Gynecology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.,Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Florence, Italy.,Department of Molecular and Developmental Medicine, University of Siena, viale Mario Bracci, 16, 53100, Siena, Italy
| | - Pietro Santulli
- Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016 (Doctor Vaiman), Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016 (Professor Batteux), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Mauricio S Abrão
- Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Gynecologic Division, BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Francisco Carmona
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ian S Fraser
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
| | - Stephan Gordts
- Leuven Institute for Fertility & Embryology, Schipvaartstraat 4, 3000 Leuven, Belgium
| | - Sun-Wei Guo
- Department of Biochemistry, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Pierre-Alexandre Just
- Faculté de Médecine, Hôpitaux Universitaires Paris Centre (AP-HP), Hôpital Cochin, Service de pathologie, CAncer Research for PErsonalized Medicine (CARPEM), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Christophe Noël
- Department of Pathology, Erasme University Hospital/Curepath, Free University of Brussels (ULB), Brussels, Belgium
| | - George Pistofidis
- Department of Gynecologic Endoscopy, Lefkos Stavros Hospital, Athens, Greece
| | - Thierry Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Sun F, Zhang Y, You M, Yang Y, Yu Y, Xu H. Laparoscopic adenomyomectomy combined with levonorgestrel-releasing intrauterine system in the treatment of adenomyosis: Feasibility and effectiveness. J Obstet Gynaecol Res 2020; 47:613-620. [PMID: 33174318 DOI: 10.1111/jog.14571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/30/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022]
Abstract
AIM To evaluate the clinical efficacy and safety of laparoscopic adenomyomectomy combined with intraoperative replacement of levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of symptomatic adenomyosis. METHODS This is a case-series study in a university medical center. A total of 52 patients with symptomatic adenomyosis were treated by laparoscopic adenomyomectomy combined with intraoperative replacement of LNG-IUS from January 2015 to July 2018. Visual analog scale, menstrual flow and uterine volume were compared before and after the surgery (3, 12 and 24 months). Meanwhile, LNG-IUS-induced adverse reactions (e.g. irregular vaginal bleeding, amenorrhea, expulsion, and perforation) were also recorded. RESULTS All operations were successfully completed via laparoscopy without conversion to laparotomy. No severe complications were noted during the surgical procedure or follow-up period. The mean postoperative visual analog scale and menstrual flow scores and the volume of the uterus were significantly decreased (all P < 0.001) at 3, 12, and 24 months postoperatively, compared with preoperative scores. The clinical effective rates among the patients with dysmenorrhea were 98%, 96% and 96% at 3, 12 and 24 months after the operation, respectively. And the clinical effectiveness rate of menorrhagia was 97.6%, 95.2% and 95.2% at 3, 12 and 24 months after treatment, respectively. Among all related adverse reactions, amenorrhea was the most common (n = 12, 23.1%). There was one case of LNG-IUS perforation (1.9%) and two cases of expulsion (3.8%). CONCLUSION Laparoscopic adenomyomectomy combined with intraoperative replacement of LNG-IUS is a novel and effective conservative surgical procedure for symptomatic adenomyosis treatment.
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Affiliation(s)
- Feng Sun
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Ye Zhang
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Min You
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - YePing Yang
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - YingYing Yu
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Hong Xu
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
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12
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Zannoni L, Ambrosio M, Raimondo D, Arena A, Del Forno S, Borghese G, Paradisi R, Seracchioli R. Question Mark Sign and Transvaginal Ultrasound Uterine Tenderness for the Diagnosis of Adenomyosis: A Prospective Validation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1405-1412. [PMID: 32030800 DOI: 10.1002/jum.15237] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of the classic ultrasound (US) signs of adenomyosis, the question mark sign and transvaginal ultrasound (TVUS) uterine tenderness, in the diagnosis of adenomyosis. METHODS This was a prospective study including 78 patients waiting for hysterectomy for uterine benign diseases and undergoing preoperative US examinations to evaluate all criteria for US diagnosis of adenomyosis as reported by the consensus statement of the Morphological Uterus Sonographic Assessment group. A US diagnosis of adenomyosis was made in the presence of 2 or more Morphological Uterus Sonographic Assessment features. Moreover, the question mark sign and TVUS uterine tenderness were evaluated. Ultrasound features were compared with the histologic examination, which was considered the reference standard for the diagnosis of adenomyosis. The Cohen κ coefficient was used to measure the accordance between US and histologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each US feature were calculated. RESULTS The prevalence of adenomyosis in the sample was 33.3%. The sensitivity, specificity, PPV, NPV, and accuracy of TVUS in the diagnosis of adenomyosis were 77%, 96%, 91%, 89%, and 90%, respectively. Myometrial heterogeneity was the most frequently encountered feature (100%) but showed low specificity (7%). The question mark sign and TVUS uterine tenderness showed sensitivity, specificity, PPV, NPV, and accuracy of 41%, 96%, 83%, 77%, and 69% and 69%, 65%, 66%, 81%, and 67%. CONCLUSIONS The question mark sign and TVUS uterine tenderness are useful tools for the diagnosis of adenomyosis.
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Affiliation(s)
- Letizia Zannoni
- Department of Gynecology and Human Reproduction Pathophysiology, Saint'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Marco Ambrosio
- Department of Gynecology and Human Reproduction Pathophysiology, Saint'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Department of Gynecology and Human Reproduction Pathophysiology, Saint'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Arena
- Department of Gynecology and Human Reproduction Pathophysiology, Saint'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Simona Del Forno
- Department of Gynecology and Human Reproduction Pathophysiology, Saint'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giulia Borghese
- Department of Gynecology and Human Reproduction Pathophysiology, Saint'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Roberto Paradisi
- Department of Gynecology and Human Reproduction Pathophysiology, Saint'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Department of Gynecology and Human Reproduction Pathophysiology, Saint'Orsola Hospital, University of Bologna, Bologna, Italy
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13
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Ambrosio M, Raimondo D, Savelli L, Salucci P, Arena A, Borghese G, Mattioli G, Giaquinto I, Scifo MC, Meriggiola MC, Casadio P, Seracchioli R. Transvaginal Ultrasound and Doppler Features of Intraligamental Myomas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1253-1259. [PMID: 31944342 DOI: 10.1002/jum.15213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/05/2019] [Accepted: 12/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe the ultrasound (US) features of intraligamental myomas (IMs) using Morphological Uterus Sonographic Assessment group standardized terminology. METHODS This was a retrospective monocentric study. A total of 125 consecutive women with a preoperative US diagnosis of a myoma located close to the uterine isthmus (International Federation of Gynecology and Obstetrics stages 5, 6, and 7) from 2016 to 2019 who underwent laparoscopic or laparotomic myomectomy or hysterectomy were included for study analyses. The US data were retrieved from US reports and stored digital images by 2 authors. Ultrasound features of myomas were described according to Morphological Uterus Sonographic Assessment terminology. Clinical data for the study population were retrieved from the patients' records. RESULTS Nineteen women with a surgical confirmation of an IM were included in the study group; the remaining population constituted the control group (n = 106). Non-uniform echogenicity was detected in 17 of 19 (89%) of IMs compared to 26 of 106 (25%) fibroids in the control group (P < .001). The presence of shadowing was detected in 12 of 19 (63%) IMs compared to 94 of 106 (89%) cases in the control group (P = .004). Intraligamental myomas were more vascularized tumors compared to myomas in the control group (P = .004). Transvaginal US showed high specificity for the diagnosis of an IM (0.93; 95% confidence interval, 0.87-0.96). CONCLUSIONS On US imaging, IMs appear as vascularized solid tumors with nonuniform echogenicity; cones of shadows were less frequent in IMs than the control group, and this finding can help in the differential diagnosis. Knowledge of their specific US features could help sonographers make an accurate diagnosis, allowing them to plan correct surgery and avoid severe complications.
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Affiliation(s)
- Marco Ambrosio
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Savelli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Salucci
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Arena
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Borghese
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Mattioli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ilaria Giaquinto
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Cristina Scifo
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Cristina Meriggiola
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
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14
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Knudsen NI, Wernecke KD, Kentenich H, David M. Comparison of Clinical Symptoms of Assumed vs. Actual Uterine Fibroids - Symptoms Described by Patients and Ultrasound Findings. Geburtshilfe Frauenheilkd 2020; 80:316-323. [PMID: 32139921 PMCID: PMC7056396 DOI: 10.1055/a-0991-0105] [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: 02/12/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose
How many women assume that they have fibroids but are found not to have fibroids on ultrasound examination? How severe are the physical symptoms reported by these women compared to the symptoms reported by women with actual uterine fibroids? Are the symptoms more severe if the patient believes that she has at least one relatively large (dominant) fibroid or more than 3 fibroids?
Material and Methods
A total of 1548 patients completed an anonymous questionnaire in which they were asked about the number of their fibroids, dysmenorrhea and premenstrual symptoms, dyspareunia and bleeding disorders (using a numerical analog scale between 0 – 10). The questionnaire was administered in a hospital-based fibroid clinic. The information provided by the patients was then compared with transvaginal or abdominal ultrasound findings. The symptoms reported by women with and without fibroid(s) were compared.
Results
1045 out of 1548 patients fulfilled the studyʼs inclusion criteria. Contrary to the information they provided, no fibroid(s) were detected in 6% (62 of 1045 patients) of patients on ultrasound examination. Of these women, 87% had dysmenorrhea, 79% had premenstrual pain and 57% reported dyspareunia. The severity of the symptoms was found not to be associated with the assumed size or number of fibroid(s). There was no significant difference in the pain reported by women without and by women with fibroids. Reporting a feeling of strong pressure on the bladder (OR: 1.18) or abdomen (OR: 1.12) or constipation (OR: 1.16) increased the likelihood of detecting a fibroid on ultrasound investigation.
Conclusions
The presence of manifest symptoms (dysmenorrhea, dyspareunia, premenstrual pain, bleeding disorders) does not allow conclusions to be made about the number or size of fibroids or about which therapy is indicated. Even an erroneous assumption about the presence of fibroids may result in patients experiencing symptoms.
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Affiliation(s)
- Nina Isabelle Knudsen
- Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Klinik für Gynäkologie, Berlin, Germany
| | | | | | - Matthias David
- Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Klinik für Gynäkologie, Berlin, Germany
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15
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Diagnosis of uterine adenomyosis in patients of reproductive age. GINECOLOGIA.RO 2020. [DOI: 10.26416/gine.28.2.2020.3181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
This article reviews normal pelvic anatomic findings during ultrasound and discusses how to obtain and measure these images. Representative images of normal pelvic anatomy, with select videos, are included to assist in understanding the presented concepts and normal anatomic images.
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Exacoustos C, Morosetti G, Conway F, Camilli S, Martire FG, Lazzeri L, Piccione E, Zupi E. New Sonographic Classification of Adenomyosis: Do Type and Degree of Adenomyosis Correlate to Severity of Symptoms? J Minim Invasive Gynecol 2019; 27:1308-1315. [PMID: 31600574 DOI: 10.1016/j.jmig.2019.09.788] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE To correlate the type and degree of adenomyosis, scored through a new system based on the features of transvaginal sonography, to patients' symptoms and fertility. DESIGN This is a multicenter, observational, prospective study. SETTING Two endometriosis tertiary referral centers (University of Rome "Tor Vergata" and University of Siena). PATIENTS A total of 108 patients with ultrasonographic signs of adenomyosis. INTERVENTIONS A new ultrasonographic scoring system designed to assess the severity and the extent of uterine adenomyosis was used to stage the disease in correlation with the clinical symptoms. Menstrual uterine bleeding was assessed by a pictorial blood loss analysis chart, painful symptoms were evaluated using a visual analog scale, and infertility factors were considered. MEASUREMENTS AND MAIN RESULTS A total of 108 patients with ultrasonographic signs of adenomyosis (mean age ± standard deviation, 37.7 ± 7.7 years) were classified according to the proposed scoring system. Women with ultrasound diagnosis of diffuse adenomyosis were older (p = .04) and had heavier menstrual bleeding (p = .04) than women with focal disease; however, no statistically significant differences were found regarding the presence and severity of dyspareunia and dysmenorrhea. Higher values of menstrual bleeding were found for severe diffuse adenomyosis, with the highest values being found in those with adenomyomas. In patients trying to conceive, the presence of ultrasound findings of focal disease was associated with a higher percentage of infertility than in those with diffuse disease, and the focal involvement of the junctional zone showed a higher percentage of at least 1 miscarriage than in those with diffuse adenomyosis. CONCLUSION The ultrasonographic evaluation of the type and extension of adenomyosis in the myometrium seems to be important in correlation to the severity of symptoms and infertility.
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Affiliation(s)
- Caterina Exacoustos
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Giulia Morosetti
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Francesca Conway
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Sara Camilli
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Francesco Giuseppe Martire
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena (Dr. Lazzeri), Siena, Italy..
| | - Emilio Piccione
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
| | - Errico Zupi
- Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata" (Drs. Exacoustos, Morosetti, Conway, Camilli, Giuseppe Martire, Piccione, and Zupi), Rome
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Mas A, Alonso R, Garrido-Gómez T, Escorcia P, Montero B, Jiménez-Almazán J, Martín J, Pellicer N, Monleón J, Simón C. The differential diagnoses of uterine leiomyomas and leiomyosarcomas using DNA and RNA sequencing. Am J Obstet Gynecol 2019; 221:320.e1-320.e23. [PMID: 31121144 DOI: 10.1016/j.ajog.2019.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although uterine leiomyomas and leiomyosarcomas are considered biologically unrelated tumors, they share morphologic and histologic characteristics that complicate their differential diagnosis. The long-term therapeutic option for leiomyoma is laparoscopic myomectomy with morcellation, particularly for patients who wish to preserve their fertility. However, because of the potential dissemination of undiagnosed or hidden leiomyosarcoma from morcellation, there is a need to develop a preoperative assessment of malignancy risk. OBJECTIVE Through an integrated comparative genomic and transcriptomic analysis, we aim to identify differential genetic targets in leiomyomas vs leiomyosarcomas using next-generation sequencing as the first step toward preoperative differential diagnosis. STUDY DESIGN Targeted sequencing of DNA and RNA coding regions for solid tumor-associated genes was performed on formalin-fixed paraffin-embedded samples from 13 leiomyomas and 13 leiomyosarcoma cases. DNA sequencing was used to identify copy number variations, single-nucleotide variants, and small insertions/deletions. RNA sequencing was used to identify gene fusions, splice variants, and/or differential gene expression profiles. RESULTS In leiomyosarcomas, tumor mutation burden was higher in terms of copy number variations, single nucleotide variants, small insertions/deletions, and gene fusions compared with leiomyomas. For copy number variations, 20 genes were affected by deletions in leiomyosarcomas, compared with 6 observed losses in leiomyomas. Gains (duplications) were identified in 19 genes in leiomyosarcomas, but only 3 genes in leiomyomas. The most common mutations (single-nucleotide variants and insertions/deletions) for leiomyosarcomas were identified in 105 genes of all analyzed leiomyosarcomas; 82 genes were affected in leiomyomas. Of note, 1 tumor previously diagnosed as leiomyosarcoma was established as inflammatory myofibroblastic tumor along this study with a novel ALK-TNS1 fusion. Finally, a differential transcriptomic profile was observed for 11 of 55 genes analyzed in leiomyosarcomas; 8.5% of initially diagnosed leiomyosarcomas showed high-confidence, novel gene fusions that were associated with these tumors. CONCLUSION Through integrated comparative genomic and transcriptomic analyses, we identified novel differential genetic targets that potentially differentiate leiomyosarcomas and leiomyomas. This provides a new insight into the differential diagnosis of these myometrial tumors.
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Tamhane N, McDowell M, Oliva M, Tanner JP, Hochberg L, Baker M, Imudia AN, Mikhail E. Association between Preoperative Adenomyosis Detection Rate during Pelvic Ultrasonography and the Specialty of the Reading Physician. J Minim Invasive Gynecol 2019; 27:504-509. [PMID: 31004795 DOI: 10.1016/j.jmig.2019.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/05/2019] [Accepted: 04/12/2019] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To compare the detection rate of adenomyosis when ultrasound is performed by a radiologist compared with a gynecologic expert sonologist. DESIGN A retrospective, single-center study. SETTING A university teaching hospital. PATIENTS All women above 18 years of age with a positive histopathology diagnosis of adenomyosis obtained in a hysterectomy specimen from October 1, 2011, to October 1, 2017, were screened for inclusion. Cases without a preoperative pelvic ultrasound report, those with coexisting premalignant/malignant conditions, and patients presenting to the clinic with symptoms other than abnormal uterine bleeding, dysmenorrhea, or abdominal pain were excluded. A total of 412 cases were included in the final analysis. MEASUREMENTS AND MAIN RESULTS The preoperative ultrasound was performed by a radiologist in 241 patients (59%) and by an expert gynecologic sonologist in 171 patients (42%). Patients' age, body mass index, race, ethnicity, parity, and history of prior cesarean section were comparable between the 2 groups. The adenomyosis detection rate was significantly higher in the expert gynecologic sonologist group compared with radiologists (95 [56%] vs 29 [12%], p <.01). After controlling for patients' race, body mass index, prior cesarean sections, and presence of myomas using multivariable logistic regression, gynecologic expert sonologists were 7.8 times more likely to detect adenomyosis than radiologists (odds ratio = 7.84; 95% confidence interval, 4.58-13.44). Regardless of medical specialty, the presence of myomas significantly decreased the detection of adenomyosis compared with the absence of myomas (odds ratio = 0.23; 95% confidence interval, 0.13-0.39). CONCLUSION The detection rate of adenomyosis was significantly higher when ultrasound was performed by expert gynecologic sonologists compared with radiologists. The presence of myomas significantly decreased detection rates regardless of specialty. Ultrasound evaluation for detecting adenomyosis should be preferentially performed by gynecologic expert sonologists.
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Affiliation(s)
- Nupur Tamhane
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida (Drs. Tamhane, Oliva, Hochberg, Baker, Imudia, and Mikhail)
| | - Megan McDowell
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts (Dr. McDowell)
| | - Mariana Oliva
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida (Drs. Tamhane, Oliva, Hochberg, Baker, Imudia, and Mikhail)
| | - Jean Paul Tanner
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida (Dr. Tanner)
| | - Lauri Hochberg
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida (Drs. Tamhane, Oliva, Hochberg, Baker, Imudia, and Mikhail)
| | - Marisa Baker
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida (Drs. Tamhane, Oliva, Hochberg, Baker, Imudia, and Mikhail)
| | - Anthony N Imudia
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida (Drs. Tamhane, Oliva, Hochberg, Baker, Imudia, and Mikhail)
| | - Emad Mikhail
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida (Drs. Tamhane, Oliva, Hochberg, Baker, Imudia, and Mikhail).
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21
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Heikkinen T, Äyräväinen A, Hänninen J, Ahvenainen T, Bützow R, Pasanen A, Vahteristo P. MED12 mutations and fumarate hydratase inactivation in uterine adenomyomas. Hum Reprod Open 2018; 2018:hoy020. [PMID: 30895261 PMCID: PMC6276694 DOI: 10.1093/hropen/hoy020] [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] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/09/2018] [Accepted: 10/26/2018] [Indexed: 01/16/2023] Open
Abstract
STUDY QUESTION Do the uterine leiomyoma driver events – mediator complex subunit 12 (MED12) mutations, high mobility group AT-hook (HMGA2) overexpression, and fumarate hydratase (FH) inactivation – also contribute to the development of uterine adenomyomas? SUMMARY ANSWER MED12 mutations and FH deficiency occur in a subset of uterine adenomyomas, but at lower frequencies than in leiomyomas. WHAT IS KNOWN ALREADY Uterine adenomyomas are benign tumours with clinical features very similar to uterine leiomyomas. Mutations affecting MED12, HMGA2 and FH account for up to 80–90% of leiomyomas, but their contribution to adenomyomas is not known. STUDY DESIGN, SIZE, DURATION Formalin-fixed paraffin-embedded adenomyoma samples from 21 patients operated on during 2012–2014 were collected at the pathology department’s archives and analysed for uterine leiomyoma driver events. PARTICIPANTS/MATERIALS, SETTING, METHODS Adenomyoma diagnoses were verified by a specialized pathologist and representative areas were marked on haematoxylin-eosin slides. DNA was extracted from the tissue samples and sequenced to detect mutations in MED12. Expression levels of HMGA2 and 2SC, a robust indirect method to detect FH inactivation, were analysed by immunohistochemistry (IHC). The coding region of FH was sequenced in one adenomyoma sample showing strong 2SC staining as well as in the same patient’s normal tissue sample. All patients’ medical histories were collected and reviewed. MAIN RESULTS AND THE ROLE OF CHANCE MED12 mutation c.131G > A, p.G44D, the most common mutation in uterine leiomyomas, was identified in two samples (2/21; 9.5%). One adenomyoma displayed strong 2SC positivity and subsequent sequencing revealed a frameshift FH mutation c.911delC, p.P304fs in the tumour. The mutation was also present in the patient’s normal tissue sample, indicating that she has a hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome. HMGA2 protein expression was normal in all adenomyomas. LIMITATIONS, REASONS FOR CAUTION Restricted sample size limits the determination of exact mutation frequencies of the studied aberrations in adenomyomas. WIDER IMPLICATIONS OF THE FINDINGS Uterine leiomyoma driver mutations do contribute to the development of some adenomyomas. We also report an adenomyoma in the context of hereditary HLRCC syndrome. Despite clinical similarities, the pathogenic mechanisms of adenomyomas and leiomyomas are likely different. Large-scale genomic analyses are warranted to elucidate the complete molecular background of adenomyomas. STUDY FUNDING/COMPETING INTERESTS This study was supported by The Academy of Finland, the Sigrid Jusélius Foundation, and the Cancer Society of Finland. The authors declare no conflict of interest.
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Affiliation(s)
- Tuomas Heikkinen
- Research Programs Unit, Genome-Scale Biology Research Program and Medicum, Department of Medical and Clinical Genetics., FIN-00014 University of Helsinki, Helsinki, Finland
| | - Anna Äyräväinen
- Research Programs Unit, Genome-Scale Biology Research Program and Medicum, Department of Medical and Clinical Genetics., FIN-00014 University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Janne Hänninen
- Research Programs Unit, Genome-Scale Biology Research Program and Medicum, Department of Medical and Clinical Genetics., FIN-00014 University of Helsinki, Helsinki, Finland
| | - Terhi Ahvenainen
- Research Programs Unit, Genome-Scale Biology Research Program and Medicum, Department of Medical and Clinical Genetics., FIN-00014 University of Helsinki, Helsinki, Finland
| | - Ralf Bützow
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annukka Pasanen
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia Vahteristo
- Research Programs Unit, Genome-Scale Biology Research Program and Medicum, Department of Medical and Clinical Genetics., FIN-00014 University of Helsinki, Helsinki, Finland
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Gracia M, Alcalà M, Ferreri J, Rius M, Ros C, Saco MA, Martínez-Zamora MÁ, Carmona F. Ulipristal Acetate Improves Clinical Symptoms in Women with Adenomyosis and Uterine Myomas. J Minim Invasive Gynecol 2018; 25:1274-1280. [DOI: 10.1016/j.jmig.2018.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
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Abstract
This article provides an overview of ultrasonographic evaluation of the normal female pelvis. Pertinent pelvic anatomy is reviewed, and there is an in-depth discussion of the normal appearance of the uterus and ovaries. In addition, the indications and technique for performing 3-dimensional imaging and saline-infused sonohysterography are covered.
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Liu X, Ding D, Ren Y, Guo SW. Transvaginal Elastosonography as an Imaging Technique for Diagnosing Adenomyosis. Reprod Sci 2018; 25:498-514. [DOI: 10.1177/1933719117750752] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Xishi Liu
- Department of Gynecology, Shanghai OB/GYN Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Ding Ding
- Department of Gynecology, Shanghai OB/GYN Hospital, Fudan University, Shanghai, China
| | - Yunyun Ren
- Department of Ultrasound Imaging, Shanghai OB/GYN Hospital, Fudan University, Shanghai, China
| | - Sun-Wei Guo
- Department of Gynecology, Shanghai OB/GYN Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
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25
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From Clinical Symptoms to MR Imaging: Diagnostic Steps in Adenomyosis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1514029. [PMID: 29349064 PMCID: PMC5733957 DOI: 10.1155/2017/1514029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/09/2017] [Indexed: 12/27/2022]
Abstract
Adenomyosis or endometriosis genitalis interna is a frequent benign disease of women in fertile age. It causes symptoms like bleeding disorders and dysmenorrhea and seems to have a negative effect on fertility. Adenomyosis can be part of a complex genital and extragenital endometriosis but also can be found as a solitary uterine disease. While peritoneal endometriosis can be easily diagnosed by laparoscopy with subsequent biopsy, the determination of adenomyosis is difficult. In the following literature review, the diagnostic methods clinical history and symptoms, gynecological examination, 2D and 3D transvaginal ultrasound, MRI, hysteroscopy, and laparoscopy will be discussed step by step in order to evaluate their predictive value in the diagnosis of adenomyosis.
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26
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Kara Bozkurt D, Bozkurt M, Cil AS, Barut MU, Ersahin AA, Çalıskan E. Concomitant use of transvaginal sonography and Doppler indices improve diagnosis of adenomyosis. J OBSTET GYNAECOL 2017; 37:888-895. [DOI: 10.1080/01443615.2016.1256952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Duygu Kara Bozkurt
- Department of Radiology, Kafkas University School of Medicine, Kars, Turkey
| | - Murat Bozkurt
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
| | - Ahmet Said Cil
- Department of Radiology, Universal Hospital Group, Malatya, Turkey
| | - Mert Ulaş Barut
- Department of Obstetrics and Gynecology, Health Woman Research Hospital, Ankara, Turkey
| | - Aynur Adeviye Ersahin
- Department of Obstetrics and Gynecology, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Eray Çalıskan
- Department of Obstetrics and Gynecology, Bahcesehir University Medical Faculty, Istanbul, Turkey
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27
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Adenomyosis and Abnormal Uterine Bleeding (AUB-A)—Pathogenesis, diagnosis, and management. Best Pract Res Clin Obstet Gynaecol 2017; 40:68-81. [DOI: 10.1016/j.bpobgyn.2016.09.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/23/2016] [Indexed: 11/18/2022]
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Abstract
Ultrasound (US) has transformed the fertility evaluation. With 1 consultation, blood work and 1 to 2 USs, the female fertility status can be fully evaluated. The initial US is best done early in the follicular cycle to evaluate the pelvic anatomy and ovarian reserve. A three-dimensional US is important to evaluate for uterine anomalies and color Doppler for any masses. A mid-cycle saline infusion sonohysterogram assesses the endometrial cavity better than a hysterosalpingogram as it identifies the cause of any filling defects. By concurrently adding contrast or agitated saline, tubal patency can be tested. This US-based approach reliably, efficiently, and cost-effectively assesses female infertility.
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29
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Abnormal Uterine Bleeding in Women with Infertility. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0188-0] [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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30
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Abstract
Transvaginal ultrasound is the first-line imaging test for the evaluation of abnormal uterine bleeding in both premenopausal and postmenopausal women. Transvaginal ultrasound can be used to diagnose structural causes of abnormal bleeding such as polyps, adenomyosis, leiomyomas, hyperplasia, and malignancy, and can also be beneficial in making the diagnosis of ovulatory dysfunction. Traditional 2-dimensional imaging is often enhanced by the addition of 3-dimension imaging with coronal reconstruction and saline infusion sonohysterography. In this article we discuss specific ultrasound findings and technical considerations useful in the diagnosis of abnormal uterine bleeding.
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31
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Gangadhar K, Mahajan A, Sable N, Bhargava P. Magnetic Resonance Imaging of Pelvic Masses: A Compartmental Approach. Semin Ultrasound CT MR 2016; 38:213-230. [PMID: 28705369 DOI: 10.1053/j.sult.2016.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Magnetic resonance imaging (MRI) is often "one stop shop" for evaluating female pelvic masses that helps in diagnosis, staging, and restaging of these tumors. A pelvic mass can arise from any tissue present within the pelvis. Although most masses in the female pelvis arise from the reproductive organs, masses may also arise from the gastrointestinal tract, urinary system, adjacent soft tissues, peritoneum, etc. It may not always be possible to determine the site of origin or distinguish these masses based on imaging characteristics. However, familiarity with the clinicopathologic and MRI features of most common pelvic masses helps in narrowing the differential diagnosis. Diagnosis of these masses needs a holistic approach as required for any tumor including clinical history, laboratory data, and imaging characteristics. We focus on MRI characteristics of commonly encountered pelvic masses. A compartmental imaging approach is discussed in this article that helps in identifying and characterizing these masses.
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Affiliation(s)
- Kiran Gangadhar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Nilesh Sable
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA.
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Liu Y, Zhang H, Li X, Qi G. Combined Application of Ultrasound and CT Increased Diagnostic Value in Female Patients with Pelvic Masses. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:6146901. [PMID: 27867419 PMCID: PMC5102714 DOI: 10.1155/2016/6146901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/17/2016] [Accepted: 09/22/2016] [Indexed: 11/22/2022]
Abstract
Purpose. The current study aimed to evaluate whether combined application of ultrasound and CT had increased Diagnostic Value in Female Patients with Pelvic Masses over either method alone. Patients and Methods. 240 female patients with pelvic masses were detected preoperatively with ultrasound and CT prior to surgery. The sensitivity, specificity, and accuracy of ultrasound, CT, and combined ultrasound/CT application were evaluated, respectively. Results. The sensitivity, specificity, and accuracy of ultrasound were 52.8%, 86.7%, and 68.75%, respectively. The sensitivity, specificity, and accuracy of CT were 80.3%, 90.3%, and 85%, respectively. The sensitivity, specificity, and accuracy of combined application of ultrasound and CT were 89%, 94.7%, and 91.7%. The sensitivity, specificity, and accuracy of combined application of ultrasound and CT were higher than those of either ultrasound or CT. Conclusions. The combined application of ultrasound and CT had higher Diagnostic Value in Female Patients with Pelvic Masses than either method alone.
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Affiliation(s)
- Yan Liu
- Department of Ultrasound, The Hospital Affiliated to Taishan Medical University, 706 Taishan Avenue, Tai'an 271000, China
| | - Hui Zhang
- Department of Gynaecology, The Hospital Affiliated to Taishan Medical University, 706 Taishan Avenue, Tai'an 271000, China
| | - Xiaoqian Li
- Department of Radiology, The Hospital Affiliated to Taishan Medical University, 706 Taishan Avenue, Tai'an 271000, China
| | - Guiqin Qi
- Department of Out-Patient, The Hospital Affiliated to Taishan Medical University, 706 Taishan Avenue, Tai'an 271000, China
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Groszmann YS, Benacerraf BR. Complete evaluation of anatomy and morphology of the infertile patient in a single visit; the modern infertility pelvic ultrasound examination. Fertil Steril 2016; 105:1381-93. [DOI: 10.1016/j.fertnstert.2016.03.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/07/2016] [Accepted: 03/10/2016] [Indexed: 11/30/2022]
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Wise LA, Sponholtz TR, Rosenberg L, Adams-Campbell LL, Kuohung W, LaValley MP, Palmer JR. History of uterine leiomyoma and risk of endometrial cancer in black women. Cancer Causes Control 2016; 27:545-52. [PMID: 26923705 PMCID: PMC4798859 DOI: 10.1007/s10552-016-0728-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have found an association between uterine leiomyomata (UL) and uterine malignancies. This relation has not been studied in black women, who are disproportionately affected by UL. METHODS We investigated prospectively the association between self-reported physician-diagnosed UL and endometrial cancer in the Black Women's Health Study. During 1995-2013, 47,267 participants with intact uteri completed biennial health questionnaires. Reports of endometrial cancer were confirmed by pathology data from medical records and cancer registries. Cox regression was used to derive incidence rate ratios (IRR) and 95% confidence intervals (CI). RESULTS There were 300 incident endometrial cancer cases during 689,546 person-years of follow-up. In multivariable models, UL history was associated with a 42% greater incidence of endometrial cancer compared with no such history (95% CI 1.12-1.80). IRRs for cancer diagnosed 0-2, 3-9, and ≥10 years after UL diagnosis were 3.20 (95% CI 2.06-4.98), 0.95 (95% CI 0.60-1.52), and 1.35 (95% CI 1.03-1.77), respectively. Stronger overall associations between UL history and endometrial cancer were observed for later stages at cancer diagnosis (IRR = 2.25, 95% CI 1.09-4.63) and type II/III cancers (IRR = 3.13, 95% CI 1.64-5.99). CONCLUSIONS In this large cohort of black women, a history of UL was positively associated with endometrial cancer, particularly type II/III tumors. The strongest association was observed for cancer diagnosed within 2 years of UL diagnosis, a finding that might be explained by greater surveillance of women with UL or misdiagnosis of cancer as UL. However, an association was also observed for cancer reported ≥10 years after UL diagnosis.
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Affiliation(s)
- Lauren A Wise
- Slone Epidemiology Center at Boston University, Boston, MA, USA.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Todd R Sponholtz
- Slone Epidemiology Center at Boston University, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Michael P LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
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35
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Chong GO, Lee YH, Hong DG, Cho YL, Lee YS. Long-Term Efficacy of Laparoscopic or Robotic Adenomyomectomy with or without Medical Treatment for Severely Symptomatic Adenomyosis. Gynecol Obstet Invest 2016; 81:346-52. [PMID: 26894488 DOI: 10.1159/000441783] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To determine the long-term efficacy of laparoscopic or robotic adenomyomectomy with or without gonadotropin-releasing hormone (GnRH) for the treatment of severely symptomatic adenomyosis. METHODS Between August 2008 and May 2011, we prospectively observed 33 patients who underwent laparoscopic or robotic adenomyomectomy with uterine artery ligation for the treatment of symptomatic adenomyosis. Seventeen patients (52%) received 3-course GnRH agonist treatment after the adenomyomectomy. RESULTS The mean operating time was 147.4 ± 52.0 min, and the mean blood loss was 36.1 ± 37.4 ml. Postoperative complications occurred in 5 patients, including 4 cases of febrile morbidity, 1 case of ileus and 1 case of pelvic abscess. Patients had statistically significant symptom relief during the 3-year follow-up period. Four of the 33 patients (12%) showed symptom relapse; 3 patients showed a relapse with dysmenorrhea and 1 patient showed a relapse with menorrhagia. There were no significant differences in terms of therapeutic outcomes between surgical-only and surgical-medical treatment. CONCLUSION Laparoscopic or robotic adenomyomectomy was feasible and safe for women with severely symptomatic adenomyosis who requested uterine preservation. Moreover, this procedure provided long-term symptom control, regardless of postoperative GnRH agonist administration.
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Affiliation(s)
- Gun Oh Chong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Medical Center, Daegu, Korea
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36
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Bogani G, Ditto A, Martinelli F, Signorelli M, Chiappa V, Lorusso D, Sabatucci I, Carcangiu ML, Fiore M, Gronchi A, Raspagliesi F. Morcellator's Port-site Metastasis of a Uterine Smooth Muscle Tumor of Uncertain Malignant Potential After Minimally Invasive Myomectomy. J Minim Invasive Gynecol 2016; 23:647-9. [PMID: 26851127 DOI: 10.1016/j.jmig.2016.01.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 01/23/2016] [Accepted: 01/27/2016] [Indexed: 12/29/2022]
Abstract
Since the safety warning from the US Food and Drug Administration on the use of power morcellators, minimally invasive procedures involving the removal of uterine myomas and large uteri are under scrutiny. Growing evidence suggests that morcellation of undiagnosed uterine malignancies is associated with worse survival outcomes of patients affected by uterine sarcoma. However, to date, only limited data regarding morcellation of low-grade uterine neoplasms are available. In the present article, we reported a case of a (morcellator) port-site implantation of a smooth muscle tumor that occurred 6 years after laparoscopic morcellation of a uterine smooth muscle tumor of uncertain potential. This case highlights the effects of intra-abdominal morcellation, even in low-grade uterine neoplasms. Caution should be used when determining techniques for tissue extraction; the potential adverse consequences of morcellation should be more fully explored.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | - Antonino Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Mauro Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Ilaria Sabatucci
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Maria L Carcangiu
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Marco Fiore
- Department of Surgery, IRCCS National Cancer Institute, Milan, Italy
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The challenge of preoperative identification of uterine myomas: Is ultrasound trustworthy? A prospective cohort study. Arch Gynecol Obstet 2015; 293:1235-41. [DOI: 10.1007/s00404-015-3937-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/21/2015] [Indexed: 11/25/2022]
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38
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Hokenstad AN, El-Nashar SA, Khan Z, Hopkins MR, Famuyide AO. Endometrial Ablation in Women With Abnormal Uterine Bleeding Related to Ovulatory Dysfunction: A Cohort Study. J Minim Invasive Gynecol 2015; 22:1225-30. [DOI: 10.1016/j.jmig.2015.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/05/2015] [Accepted: 06/24/2015] [Indexed: 11/26/2022]
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39
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Wang CJ, Chin HY, Yu HT, Ho SY. Laparoscopic management of intraligamentary fibroid originating from the round ligament. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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40
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Tsui KH, Lee WL, Chen CY, Sheu BC, Yen MS, Chang TC, Wang PH. Medical treatment for adenomyosis and/or adenomyoma. Taiwan J Obstet Gynecol 2015; 53:459-65. [PMID: 25510683 DOI: 10.1016/j.tjog.2014.04.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 01/12/2023] Open
Abstract
Uterine adenomyosis and/or adenomyoma is characterized by the presence of heterotopic endometrial glands and stroma within the myometrium, >2.5 mm in depth in the myometrium or more than one microscopic field at 10 times magnification from the endometrium-myometrium junction, and a variable degree of adjacent myometrial hyperplasia, causing globular and cystic enlargement of the myometrium, with some cysts filled with extravasated, hemolyzed red blood cells, and siderophages. Hysterectomy is a "gold standard" and definitive therapy for uterine adenomyosis, and many cases of adenomyosis have been diagnosed by pathological review retrospectively. As such, the diagnosis of adenomyosis is difficult, and this subsequently results in difficulty in the management of these patients, especially those who are symptomatic but have a strong desire to preserve their uterus. In our previous review, we found that the use of uterine-sparing surgery in the management of uterine adenomyosis and/or adenomyoma is still controversial, although some data support its feasibility. Conservative treatment is still needed in the group of patients that requires preservation of fertility and improvement of quality of life. However, studies focusing on the topic of medical treatment for adenomyosis are rare. In this article, current knowledge regarding the use of medical therapy for uterine adenomyosis, partly based on the understanding of endometriosis, is reviewed.
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Affiliation(s)
- Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wen-Ling Lee
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan; Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Chih-Yao Chen
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bor-Chin Sheu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Ming-Shyen Yen
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Infection and Immunity Research, National Yang-Ming University, Taipei, Taiwan.
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Di Donato N, Bertoldo V, Montanari G, Zannoni L, Caprara G, Seracchioli R. Question mark form of uterus: a simple sonographic sign associated with the presence of adenomyosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:126-127. [PMID: 25486912 DOI: 10.1002/uog.14750] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/28/2014] [Accepted: 12/02/2014] [Indexed: 06/04/2023]
Affiliation(s)
- N Di Donato
- Minimally Invasive Gynecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - V Bertoldo
- Minimally Invasive Gynecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - G Montanari
- Minimally Invasive Gynecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - L Zannoni
- Minimally Invasive Gynecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - G Caprara
- Department of Anatomo-Pathology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - R Seracchioli
- Minimally Invasive Gynecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
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Huang X, Huang Q, Chen S, Zhang J, Lin K, Zhang X. Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis. BMC WOMENS HEALTH 2015; 15:24. [PMID: 25783654 PMCID: PMC4359498 DOI: 10.1186/s12905-015-0182-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/24/2015] [Indexed: 11/10/2022]
Abstract
Background Adenomyomectomy has recently been considered the priority option for the treatment of adenomyosis, however, the surgical efficacy and modes are still debated. We aimed to evaluate the efficacy of laparoscopic adenomyomectomy using a double-flap method for the treatment of uterine diffuse adenomyosis when compared with conventional laparoscopic adenomyomectomy. Methods Laparoscopic adenomyomectomy using the conventional method (group A, n = 48) and the double-flap method (group B, n = 46) to treat diffuse uterine adenomyosis, respectively. Visual analog scale (VAS), menstrual amount, serum CA125 levels, and uterine volume were comparatively analyzed in both groups. Results The VAS scores, menstrual amount, serum CA125 levels, and uterine volume at 12 or 24 months after surgery significantly reduced in group B than in group A (P < 0.05); these parameters were statistically decreased in both groups after surgery compared with those obtained before surgery (P < 0.001). Moreover, serum CA125 levels and uterine volume at six months of follow up were significantly lower in group B than in group A (P < 0.01). In addition, blood loss during surgery was similar in groups A and B (P > 0.05), although the operative time was significantly longer in group B than that in group A (P < 0.05). Conclusions Laparoscopic adenomyomectomy using the double-flap method may be an effective technique to treat uterine diffuse adenomyosis.
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Affiliation(s)
- Xiufeng Huang
- The Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, P. R. China,
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Increased dose single-agent gemcitabine in platinum-taxane resistant metastatic ovarian cancer. TUMORI JOURNAL 2015; 101:36-40. [PMID: 25702671 DOI: 10.5301/je.5000209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/20/2022]
Abstract
CONCLUSION In platinum–taxane resistant epithelial ovarian cancer (EOC), we aimed to determine the effectiveness. PATIENTS AND METHODS Between 2004 and 2013, patients afflicted with platinum–taxane resistant EOC and who were administered a 30-minute i.v. infusion of single-agent gemcitabine at a dose of 1,250 mg/m2 on the 1st, 8th and 15th days, every 28 days, were examined retrospectively. RESULTS Twenty-six patients with platinum–taxane resistant EOC were included in the study. The overall survival (OS) was 48 months. The median survival after becoming platinum–taxane resistant was 16 months for the study population. Median time to progression (TTP) and median survival after becoming platinum–taxane resistant for patients who received second-line treatment were 3.3 months and 16 months, respectively; for patients who received third-line treatment with gemcitabine, these were 3.7 months and 19 months, respectively. Administration of gemcitabine as second- and third-line chemotherapy in platinum–taxane resistant EOC, provides similar TTP and OS outcomes (p = 0.4, p = 0.9) with a similar response and toxicity rate. CONCLUSIONS Second- and third-line gemcitabine at a dose of 1,250 mg/m2 on days 1, 8 and 15 every 28 days as a 30-minute i.v. infusion in platinum–taxane resistant EOC is an effective treatment option with a tolerable and manageable toxicity.
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Benaglia L, Cardellicchio L, Leonardi M, Faulisi S, Vercellini P, Paffoni A, Somigliana E, Fedele L. Asymptomatic adenomyosis and embryo implantation in IVF cycles. Reprod Biomed Online 2014; 29:606-11. [DOI: 10.1016/j.rbmo.2014.07.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 11/24/2022]
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Pérez-López FR, Ornat L, Ceausu I, Depypere H, Erel CT, Lambrinoudaki I, Schenck-Gustafsson K, Simoncini T, Tremollieres F, Rees M. EMAS position statement: Management of uterine fibroids. Maturitas 2014; 79:106-16. [DOI: 10.1016/j.maturitas.2014.06.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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