Medical Treatment for Uterine Myomas

Resveratrol inhibits human leiomyoma cell proliferation via crosstalk between integrin αvβ3 and IGF-1R

Leiomyomas (myomas) are the most common benign smooth muscle cell tumor of the myometrium. Resveratrol, a stilbene, has been used as an anti-inflammatory and antitumor agent. In the current study, we investigated the inhibitory effect of resveratrol on the proliferation of primary human myoma cell cultures. Resveratrol arrested cell proliferation via integrin αvβ3. It also inhibited integrin αvβ3 expression and protein accumulation. Concurrently, constitutive AKT phosphorylation in myoma cells was inhibited by resveratrol. Expressions of proapoptotic genes, such as cyclooxygenase (COX)-2, p21 and CDKN2, were induced by resveratrol in myoma cells. On the other hand, expressions of proliferative (anti-apoptotic) genes were either inhibited, as in BCL2, or unchanged, as in cyclin D1 and proliferating cell nuclear antigen (PCNA). The accumulation of insulin-like growth factor (IGF)-1 receptor (IGF-1R) was inhibited by resveratrol in primary myoma cells. IGF-1-induced cell proliferation was inhibited by co-incubation with resveratrol. Therefore, growth modulation of myoma cells occurs via mechanisms dependent on cross-talk between integrin αvβ3 and IGF-1R. Our findings suggest that resveratrol can be considered an alternative therapeutic agent for myomas.

Disability benefits as an incentive for hysterectomy: Uterine fibroid patients in Taiwan

Worker compensation insurance in Taiwan ensures that a woman under the age of 45 years who has her uterus removed can receive disability compensation benefits. The present study investigated whether such a compensation policy was related to a woman's inclination to have a hysterectomy. We extracted the records of 16,030 women diagnosed with uterine fibroids (UF) between 2000 and 2010 from the Longitudinal Taiwan Health Insurance Database. Each younger and older age group had a significantly lower hysterectomy rate compared to that of the 44-year-old age group. Moreover, significantly more patients with lower monthly wages had had hysterectomies than those with higher monthly wages. Policy makers should be aware that worker compensation regulations in Taiwan might encourage women with economic need to undergo hysterectomy surgery when approaching the age of 45 years.

Medical treatment for adenomyosis and/or adenomyoma

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.

The association between occupational characteristics and hysterectomies for treating uterine fibroids in Taiwan

This study examined the relationship between the occupational characteristics of women with uterine fibroids (UFs) and the decision to have a hysterectomy. Data from the Longitudinal Taiwan Health Insurance Database (LTHID) from 2000 to 2009 were analyzed to investigate the association between occupation and hysterectomies. Multivariable logistic regression analysis showed that, compared with white-collar UF patients, the odds ratio (OR) for hysterectomy surgery was 1.21 (95% confidence interval (CI) = 1.11-1.32) for blue-collar UF patients. Moreover, non-government employees with UFs also had significantly increased odds of having a hysterectomy compared to government employees with UFs (OR = 1.19, 95% CI = 1.04-1.36). This study provides information regarding the extent to which differences in occupation and decision-making processes might affect the marked variations in the use of hysterectomies for UFs.

Effect of gonadotropin-releasing hormone agonist on ES-2 ovarian cancer cells

OBJECTIVE

Gonadotropin-releasing hormone (GnRH) receptor is found in the ovarian tissue, including epithelial ovarian cancer (EOC), suggesting that GnRH agonists may have direct action on EOC.

MATERIALS AND METHODS

Ovarian clear cell cancer (ES-2) cells were treated with low-dose GnRH agonist with/without low-dose paclitaxel (1 μM D-Lys(6) with/without 0.5 μM or 1.0 μM paclitaxel). Growth and behavior of ES-2 cells were evaluated.

RESULTS

Use of either D-Lys(6) or paclitaxel or a combination of the two did not affect the morphology and growth pattern of ES-2 cells. However, ability of migration and invasion of ES-2 cells was significantly decreased in either use of D-Lys(6) or paclitaxel and more apparent with the combination. Type I GnRH receptor expression of ES-2 was not altered significantly by the combination.

CONCLUSION

GnRH agonist might modify the ES-2 ovarian cancer cells, and its role might be independent, additional or synergistic, suggesting the potential role of the use of GnRH agonist in the management of clear cell type of the ovarian cancer. However, the results of this study were derived using ES-2 ovarian cancer cells, and might not be valid in other cell types of ovarian cancers.

Expression profiling of protein tyrosine kinases and their ligand activators in leiomyoma uteri

The aim of this study is to compare the expression patterns of tyrosine kinases and their ligand activators between matched myometrium and leiomyoma tissues. Total RNA extracted from 42 pairs of matched leiomyomal and adjacent myometrial tissues were hybridized to a set of 840 customized oligonucleotide microarrays to compare the expression profiles of 244 selected human genes including 90 tyrosine kinases and 103 ligands. Among the 244 genes surveyed, 38 were found to exhibit differential expression between pairs of myometrium and leiomyoma tissues. Clustering analysis of the expression ratios of these 38 genes from 42 pairs of samples led to the subdivision of fibroid samples into three groups, based in principle on the expression ratios of two peptide ligands, CYR61 and EFNA4. Real-time quantitative RT-PCR measurements of an additional 32 pairs of samples further confirmed the three subgroups. The altered expression of ligand activators between myometrium and leiomyoma suggest that tyrosine kinases regulated by CYR61 and EFNA4 may be exploited as therapeutic targets to develop non-surgical treatments of symptomatic leiomyomas.

Intramyometrial ectopic pregnancy in an ICSI patient following uterine artery embolization

Myometrial pregnancy represents a rare subtype of ectopic pregnancy. A history of uterine artery embolization (UAE) because of symptomatic uterine fibroids, and assisted reproductive treatment may predispose to this unusual implantation site. A 40-year-old woman with a history of uterine fibroids underwent a transfer of two embryos after intracytoplasmic sperm injection treatment. The combined findings on transvaginal ultrasound scan, pelvic magnetic resonance imaging scan, suction curettage, diagnostic hysteroscopy and laparoscopy were compatible with a diagnosis of ectopic pregnancy within the myometrium, at the site of a necrotized intramyometrial fibroid following UAE. Treatment with systemic methotrexate resulted in successful resolution of this ectopic pregnancy. In conclusion, this study reports a pregnancy within a previously necrotized fibroid. Findings suggest that in patients with a history of UAE for the treatment of uterine fibroids and who subsequently undergo assisted reproductive treatment, the risk of an ectopic pregnancy within the myometrium has to be considered.

Comparing uterine fibroids treated by myomectomy through traditional laparotomy and 2 modified approaches: ultraminilaparotomy and laparoscopically assisted ultraminilaparotomy

OBJECTIVE

We sought to compare myomectomy performed by laparotomy (LT), and 2 other modified approaches: ultraminilaparotomy (UMLT) and laparoscopically assisted UMLT for uterine fibroids with a size <8 cm and the number <5.

STUDY DESIGN

A cohort study, including 79 (35.3%) women in the LT group, 71 (31.7%) in the UMLT group, and 74 (33.0%) in the laparoscopically assisted UMLT group, was conducted. The outcome was measured by comparing surgical parameters, immediate postoperative recovery, and therapeutic outcomes.

RESULTS

The median follow-up was 52 months with similar recurrence rates in the 3 groups. The modified approaches had advantages not only in the surgical parameters, but also in postoperative recovery, compared to LT (all P < .05).

CONCLUSION

UMLT and laparoscopically assisted UMLT can be used successfully in place of LT in the management of uterine fibroids.

Levonorgestrel-releasing intrauterine device insertion ameliorates leiomyoma-dependent menorrhagia among women of reproductive age without a significant regression in the uterine and leiomyoma volumes

Levonorgestrel- (LNG) releasing intrauterine device (IUD) insertion revealed significant reduction in visual bleeding scores and spotting with an increase in amenorrhea and uterine pulsatility index scores. LNG-IUD can be considered as a simple and effective alternative to surgical treatment in the management of leiomyoma-dependent menorrhagia of reproductive-age women.