RESUMEN
Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an autosomal dominant syndrome wherein affected individuals are at risk for the development of cutaneous leiomyomas, early-onset multiple uterine leiomyomas, and an aggressive subtype of renal cell cancer. HLRCC is caused by germline mutations in the fumarate hydratase (FH) gene, which inactivates the enzyme and alters the function of the tricarboxylic acid/Krebs cycle. This article reviews the hitherto described morphologic features of HLRCC-associated renal cell carcinoma (RCC) and outlines the differential diagnosis and ancillary use of immunohistochemistry and molecular diagnostics for these tumors. The morphologic spectrum of HLRCC-associated RCC is wide and histologic features, including tumor cells with prominent nucleoli, perinucleolar halos, and multiple architectural patterns within the same tumor, which are suggestive of this diagnosis. FH immunohistochemistry in conjunction with genetic counseling and germline FH testing are the important parameters for detection of this entity. These kidney tumors warrant prompt treatment as even smaller sized lesions can demonstrate aggressive behavior and systemic oncologic treatment in metastatic disease should, if possible, be part of a clinical trial. Screening procedures in HLRCC families should preferably be evaluated in large cohorts.
Asunto(s)
Carcinoma de Células Renales/diagnóstico , Neoplasias Renales/diagnóstico , Leiomiomatosis/diagnóstico , Síndromes Neoplásicos Hereditarios/diagnóstico , Neoplasias Cutáneas/diagnóstico , Neoplasias Uterinas/diagnóstico , Diagnóstico Diferencial , Fumarato Hidratasa/genética , Pruebas Genéticas , Humanos , Inmunohistoquímica , Leiomiomatosis/fisiopatología , Síndromes Neoplásicos Hereditarios/fisiopatología , Neoplasias Cutáneas/fisiopatología , Neoplasias Uterinas/fisiopatologíaRESUMEN
BACKGROUND: Diffuse esophageal leiomyomatosis (DEL) is a rare disorder characterized by benign hypertrophy of esophageal smooth muscle cells. No rigorous summary of available evidence on how to best manage these patients exists. OBJECTIVE: To define the clinical features and outcomes of pediatric patients with DEL. MATERIALS AND METHODS: A systematic literature search of the PubMed and Cochrane databases was performed with respect to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (end-of-search date: October 6, 2018). The algorithm: "esophageal leiomyomatosis AND (children OR pediatric*)" was implemented. RESULTS: Thirty-five studies including a total of 58 patients were analyzed. The female:male ratio was 1.45:1. Mean patient age was 8.54 ± 4.67 years. The most common disease manifestations were dysphagia and gastrointestinal symptoms (90.0%, 95% confidence interval [CI]: 78.2-96.1), followed by failure to thrive (57.9%, 95% CI: 36.2-76.9) and pulmonary symptoms (56.4%, 95% CI: 41.0-70.7). Alport syndrome (AS) was seen in 57.7% (95% CI: 44.2-70.1) of the patients. The most commonly implemented procedure was esophagectomy (85.2%; n = 46/54; 95% CI: 73.1-92.6) with gastric transposition (37.8%; n = 17/45; 95% CI: 25.1-52.4). Postoperative complications developed in 33.3% (n = 15/45; 95% CI: 21.3-48) of the patients. All-cause mortality was 7.0% (95% CI: 2.3-17.2) and disease-specific mortality was 3.5% (95% CI: 0.3-12.6). CONCLUSION: DEL is an uncommon condition that typically occurs in the setting of AS. Esophagectomy with gastric transposition is the mainstay of treatment. Although complications develop in one-third of the patients, mortality rates are low.
Asunto(s)
Enfermedades del Esófago/fisiopatología , Leiomiomatosis/fisiopatología , Adolescente , Niño , Preescolar , Trastornos de Deglución/etiología , Enfermedades del Esófago/diagnóstico , Enfermedades del Esófago/mortalidad , Enfermedades del Esófago/cirugía , Esofagectomía/estadística & datos numéricos , Femenino , Humanos , Lactante , Leiomiomatosis/diagnóstico , Leiomiomatosis/mortalidad , Leiomiomatosis/cirugía , MasculinoRESUMEN
RATIONALE: Intravascular leiomyomatosis (IVL) is a rare nonmalignant tumor that can be fatal if untreated. PATIENT CONCERNS: A 49-year-old nulliparous Asian woman who underwent hysterectomy and left salpingo-oophorectomy for multiple uterine leiomyomas 18 months prior presented complaining of intermittent palpitation and chest tightness for approximately 1 month. Echocardiography revealed a large mobile tumor mass extending from the inferior vena cava (IVC) to the right atrium that partially obstructed IVC flow and tricuspid inflow. Thoracicabdominopelvic computed tomography revealed a left adnexal tumor (4.8â×â2.5âcm) causing intravascular obstruction extending from the left internal iliac vein to the IVC, right atrium, and right ventricle. DIAGNOSIS: IVL with right heart involvement INTERVENTIONS:: Under cardiopulmonary bypass, a one-stage surgery combining sternotomy and laparotomy was performed. The tumor was approached and extracted via sternotomy, and tumor detachment and removal of residual tumors was accomplished via laparotomy. OUTCOMES: A firm, smooth, and regularly shape tumor 15.5â×â5.5â×â2.5 in size was completely removed and histopathologically confirmed as IVL. The patient tolerated the surgical procedure well and no postoperative complication was noted. LESSONS: We describe a one-stage surgical approach to completely remove an IVL extending to the right ventricle.
Asunto(s)
Atrios Cardíacos , Neoplasias Cardíacas , Ventrículos Cardíacos , Laparotomía/métodos , Leiomiomatosis , Esternotomía/métodos , Neoplasias Uterinas , Neoplasias Vasculares , Procedimientos Quirúrgicos Vasculares/métodos , Vena Cava Inferior , Puente Cardiopulmonar/métodos , Disección/métodos , Ecocardiografía/métodos , Femenino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/fisiopatología , Neoplasias Cardíacas/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Humanos , Histerectomía/métodos , Leiomiomatosis/patología , Leiomiomatosis/fisiopatología , Leiomiomatosis/cirugía , Persona de Mediana Edad , Invasividad Neoplásica , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugía , Neoplasias Vasculares/patología , Neoplasias Vasculares/fisiopatología , Neoplasias Vasculares/cirugía , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/patología , Vena Cava Inferior/fisiología , Vena Cava Inferior/cirugíaRESUMEN
OBJECTIVES: The aim of this study was to evaluate the pharmacoeconomic profile in Italy of preoperative treatment with ulipristal acetate at the dose of 5â¯mg/day for 13 weeks in comparison with placebo prior to surgical management of symptomatic uterine fibroids. STUDY DESIGN: The pharmacoeconomic analysis was based on the calculation of incremental cost-effectiveness ratio (ICER). Effectiveness data were derived from the randomized-controlled trial PEARL-1, whilst costs data were retrieved from the published literature. A Markov model was employed to simulate the pattern of costs and two univariate sensitivity analyses tested the robustness of the results. RESULTS: In comparison with placebo, ulipristal acetate 5â¯mg for presurgical therapy was estimated to be associated with an incremental cost of 351 per patient. Costs per patient were 3836 for ulipristal acetate vs 3485 for placebo. The incremental effectiveness was 0.01931 QALYs per patient (around 7 quality-adjusted days per patient). Hence, the cost effectiveness ratio was calculated to be 18,177 per QALY gained. CONCLUSIONS: Preoperative use of ulipristal acetate 5â¯mg in patients with uterine fibroids has a favourable pharmacoeconomic profile.
Asunto(s)
Anticonceptivos Hormonales Orales/uso terapéutico , Leiomioma/tratamiento farmacológico , Leiomiomatosis/tratamiento farmacológico , Modelos Económicos , Norpregnadienos/uso terapéutico , Cuidados Preoperatorios , Neoplasias Uterinas/tratamiento farmacológico , Adulto , Estudios de Cohortes , Terapia Combinada/efectos adversos , Terapia Combinada/economía , Anticonceptivos Hormonales Orales/efectos adversos , Anticonceptivos Hormonales Orales/economía , Análisis Costo-Beneficio , Femenino , Costos de la Atención en Salud , Humanos , Histerectomía/efectos adversos , Histerectomía/economía , Italia , Leiomioma/economía , Leiomioma/fisiopatología , Leiomioma/cirugía , Leiomiomatosis/economía , Leiomiomatosis/fisiopatología , Leiomiomatosis/cirugía , Norpregnadienos/efectos adversos , Norpregnadienos/economía , Cuidados Preoperatorios/efectos adversos , Cuidados Preoperatorios/economía , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Carga Tumoral/efectos de los fármacos , Embolización de la Arteria Uterina/efectos adversos , Embolización de la Arteria Uterina/economía , Hemorragia Uterina/economía , Hemorragia Uterina/etiología , Hemorragia Uterina/prevención & control , Hemorragia Uterina/terapia , Miomectomía Uterina/efectos adversos , Miomectomía Uterina/economía , Neoplasias Uterinas/economía , Neoplasias Uterinas/fisiopatología , Neoplasias Uterinas/cirugíaRESUMEN
OBJECTIVES: To determine the proportion and the characteristics of patients who did or did not respond after 3 months of ulipristal acetate (UPA) therapy. STUDY DESIGN: In this retrospective cohort study conducted in the University Hospital of Bordeaux (France) and University Medical Center Ljubljana (Slovenia), symptomatic non-menopausal patients with fibroids that qualified for surgery were pretreated by 3 months of oral UPA 5â¯mg/day. Clinical success was defined by normalization of the bleeding score, and/or regression of pelvic pain, and/or abdominal distension. Imaging success was defined by reduction in fibroid volumeâ¯≥â¯25%. RESULTS: The clinical and imaging success rates were 54/66 (82%) and 39/66 (59%) respectively. The absence of previous pregnancy (pâ¯=â¯0.004) and the size of the dominant fibroidâ¯≥â¯80â¯mm (pâ¯=â¯0.004) were independent factors associated with clinical failure. Age <35 years (pâ¯=â¯0.02) was the only independent factor associated with imaging failure. CONCLUSION: Young women developing fibroids and/or women with large fibroids may be resistant to ulipristal acetate therapy.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Anticonceptivos Hormonales Orales/uso terapéutico , Leiomioma/tratamiento farmacológico , Leiomiomatosis/tratamiento farmacológico , Norpregnadienos/uso terapéutico , Neoplasias Uterinas/tratamiento farmacológico , Adulto , Estudios de Cohortes , Resistencia a Medicamentos , Femenino , Francia , Hospitales Universitarios , Humanos , Leiomioma/diagnóstico por imagen , Leiomioma/patología , Leiomioma/fisiopatología , Leiomiomatosis/diagnóstico por imagen , Leiomiomatosis/patología , Leiomiomatosis/fisiopatología , Imagen por Resonancia Magnética , Menorragia/etiología , Menorragia/prevención & control , Dolor Pélvico/etiología , Dolor Pélvico/prevención & control , Estudios Retrospectivos , Eslovenia , Carga Tumoral/efectos de los fármacos , Ultrasonografía , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/patología , Neoplasias Uterinas/fisiopatología , Adulto JovenAsunto(s)
Leiomioma/terapia , Leiomiomatosis/terapia , Neoplasias Uterinas/terapia , Costo de Enfermedad , Femenino , Humanos , Infertilidad Femenina/etiología , Infertilidad Femenina/prevención & control , Leiomioma/etiología , Leiomioma/inmunología , Leiomioma/fisiopatología , Leiomiomatosis/etiología , Leiomiomatosis/inmunología , Leiomiomatosis/fisiopatología , Calidad de Vida , Neoplasias Uterinas/etiología , Neoplasias Uterinas/inmunología , Neoplasias Uterinas/fisiopatologíaAsunto(s)
Medicina Basada en la Evidencia , Leiomioma/terapia , Leiomiomatosis/terapia , Neoplasias Uterinas/terapia , Terapia Combinada/efectos adversos , Terapia Combinada/economía , Costo de Enfermedad , Femenino , Predisposición Genética a la Enfermedad , Variación Genética , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud , Humanos , Infertilidad Femenina/etiología , Infertilidad Femenina/prevención & control , Leiomioma/economía , Leiomioma/genética , Leiomioma/fisiopatología , Leiomiomatosis/economía , Leiomiomatosis/genética , Leiomiomatosis/fisiopatología , Guías de Práctica Clínica como Asunto , Calidad de Vida , Neoplasias Uterinas/economía , Neoplasias Uterinas/genética , Neoplasias Uterinas/fisiopatologíaAsunto(s)
Leiomioma/terapia , Leiomiomatosis/terapia , Modelos Genéticos , Modelos Inmunológicos , Terapias en Investigación , Neoplasias Uterinas/terapia , Terapia Combinada/tendencias , Costo de Enfermedad , Femenino , Humanos , Leiomioma/genética , Leiomioma/inmunología , Leiomioma/fisiopatología , Leiomiomatosis/genética , Leiomiomatosis/inmunología , Leiomiomatosis/fisiopatología , Terapias en Investigación/tendencias , Neoplasias Uterinas/genética , Neoplasias Uterinas/inmunología , Neoplasias Uterinas/fisiopatologíaAsunto(s)
Drogas en Investigación/uso terapéutico , Medicina Basada en la Evidencia , Leiomioma/tratamiento farmacológico , Leiomiomatosis/tratamiento farmacológico , Neoplasias Uterinas/tratamiento farmacológico , Terapia Combinada/efectos adversos , Terapia Combinada/tendencias , Costo de Enfermedad , Aprobación de Drogas , Drogas en Investigación/efectos adversos , Femenino , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Hormona Liberadora de Gonadotropina/metabolismo , Antagonistas de Hormonas/efectos adversos , Antagonistas de Hormonas/uso terapéutico , Humanos , Leiomioma/metabolismo , Leiomioma/fisiopatología , Leiomioma/terapia , Leiomiomatosis/metabolismo , Leiomiomatosis/fisiopatología , Leiomiomatosis/terapia , Menorragia/etiología , Menorragia/prevención & control , Calidad de Vida , Receptores de Progesterona/antagonistas & inhibidores , Receptores de Progesterona/metabolismo , Estados Unidos , United States Food and Drug Administration , Neoplasias Uterinas/metabolismo , Neoplasias Uterinas/fisiopatología , Neoplasias Uterinas/terapiaAsunto(s)
Aborto Espontáneo/etiología , Medicina Basada en la Evidencia , Infertilidad/etiología , Leiomioma/fisiopatología , Leiomiomatosis/fisiopatología , Neoplasias Uterinas/fisiopatología , Aborto Espontáneo/prevención & control , Terapia Combinada/efectos adversos , Terapia Combinada/tendencias , Femenino , Preservación de la Fertilidad/efectos adversos , Preservación de la Fertilidad/tendencias , Humanos , Infertilidad/prevención & control , Infertilidad/terapia , Leiomioma/cirugía , Leiomioma/terapia , Leiomiomatosis/cirugía , Leiomiomatosis/terapia , Guías de Práctica Clínica como Asunto , Técnicas Reproductivas Asistidas , Miomectomía Uterina/efectos adversos , Neoplasias Uterinas/cirugía , Neoplasias Uterinas/terapiaAsunto(s)
Preservación de la Fertilidad , Infertilidad Femenina/prevención & control , Leiomioma/cirugía , Leiomiomatosis/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Neoplasias Uterinas/cirugía , Terapia Combinada/efectos adversos , Terapia Combinada/tendencias , Femenino , Preservación de la Fertilidad/efectos adversos , Preservación de la Fertilidad/instrumentación , Preservación de la Fertilidad/tendencias , Humanos , Infertilidad Femenina/etiología , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/prevención & control , Laparoscopía/efectos adversos , Laparoscopía/instrumentación , Laparoscopía/tendencias , Leiomioma/diagnóstico por imagen , Leiomioma/patología , Leiomioma/fisiopatología , Leiomiomatosis/diagnóstico por imagen , Leiomiomatosis/patología , Leiomiomatosis/fisiopatología , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/tendencias , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/efectos adversos , Cuidados Preoperatorios/tendencias , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/tendencias , Carga Tumoral , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/patología , Neoplasias Uterinas/fisiopatologíaRESUMEN
Intravenous leiomyomatosis is a life-threatening leiomyoma that grows into the extrauterine venous system. A high recurrence rate has been reported in reproductive-age women who undergo only tumor excision to preserve fertility. Precise diagnosis of tumor extension is essential to achieve complete resection. A 24-year-old woman presented with hypermenorrhea. Contrast-enhanced MRI showed an intramural myoma with worm-like extension into the right parametrium. F-FES PET/MRI accurately depicted the extension with strong FES activity into the right uterine vein, whereas F-FDG PET/MRI excluded the possibility of malignancy. These modalities can be a novel strategy to manage such cases of intractable intravenous leiomyomatosis.
Asunto(s)
Estradiol/análogos & derivados , Leiomiomatosis/diagnóstico por imagen , Leiomiomatosis/cirugía , Imagen por Resonancia Magnética , Imagen Multimodal , Tomografía de Emisión de Positrones , Reproducción , Femenino , Humanos , Leiomiomatosis/fisiopatología , Adulto JovenAsunto(s)
Neoplasias Esofágicas/fisiopatología , Esófago/fisiopatología , Leiomiomatosis/fisiopatología , Peristaltismo , Adolescente , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/patología , Esófago/diagnóstico por imagen , Femenino , Humanos , Leiomiomatosis/diagnóstico por imagen , Leiomiomatosis/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
Intracardiac leiomyomatosis is a rare complication that occurs when a uterine leiomyoma (fibroid) undergoes vascular invasion and propagates within the inferior vena cava to reach the right atrium. This article describes a case of intracardiac leiomyomatosis in a middle-aged woman, exploring the presentation, diagnosis and surgical management of this condition. In this case the presenting complaints were syncope and atrial fibrillation, illustrating the importance of performing a transthoracic echocardiogram in patients presenting with their first episode of atrial fibrillation. Clinicians should consider intracardiac leiomyomatosis when evaluating women with right heart masses, especially those with a history of uterine leiomyomas.
Asunto(s)
Fibrilación Atrial , Ecocardiografía , Neoplasias Cardíacas , Leiomiomatosis , Síncope , Neoplasias Uterinas , Fibrilación Atrial/etiología , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/cirugía , Femenino , Neoplasias Cardíacas/fisiopatología , Neoplasias Cardíacas/secundario , Neoplasias Cardíacas/cirugía , Humanos , Leiomiomatosis/fisiopatología , Leiomiomatosis/cirugía , Persona de Mediana Edad , Síncope/etiología , Síncope/fisiopatología , Síncope/cirugía , Neoplasias Uterinas/fisiopatología , Neoplasias Uterinas/cirugíaRESUMEN
OBJECTIVES: To characterize and describe treatment with Ulipristal acetate (UPA) in a pre-operative setting and to evaluate the safety, effectiveness, and Health Related Quality of Life (HRQoL) outcomes in a population treated according to standard clinical practice in the EU. STUDY DESIGN: Multi-centre, prospective, non-interventional study (PREMYA) of patients diagnosed with moderate to severe symptoms of uterine fibroids and undergoing a pre-operative treatment with UPA (Esmya®) at 73 clinical practice sites within the EU. Patients were followed during UPA treatment and for 12 months after treatment discontinuation for a total of 15 months follow-up. Data was collected every 3 months in accordance with standard care visits. RESULTS: A total of 1568 women were enrolled, of whom 1473 were found to be eligible for data analysis. Only 38.8% of patients underwent surgery, of which the majority were of a conservative/minimally invasive nature. Physicians' assessments of patients' overall symptomatic change, as measured on the Clinical Global Impression-Improvement (CGI-I) scale, indicated that 60% of patients were much improved or very much improved at 3 months. Pain and quality of life after treatment cessation remain lower than baseline during the entire period of follow-up CONCLUSIONS: The majority of patients do not undergo surgery immediately after treatment cessation. Quality of life and pain are highly improved by Esmya® treatment.
Asunto(s)
Hormona Liberadora de Gonadotropina/agonistas , Leiomioma/tratamiento farmacológico , Leiomiomatosis/tratamiento farmacológico , Norpregnadienos/uso terapéutico , Calidad de Vida , Enfermedades Uterinas/tratamiento farmacológico , Neoplasias Uterinas/tratamiento farmacológico , Dolor Abdominal/etiología , Dolor Abdominal/prevención & control , Adulto , Estudios de Cohortes , Anticonceptivos/efectos adversos , Anticonceptivos/uso terapéutico , Unión Europea , Femenino , Estudios de Seguimiento , Humanos , Histerectomía/efectos adversos , Leiomioma/fisiopatología , Leiomioma/cirugía , Leiomiomatosis/fisiopatología , Leiomiomatosis/cirugía , Persona de Mediana Edad , Norpregnadienos/efectos adversos , Tratamientos Conservadores del Órgano/efectos adversos , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Enfermedades Uterinas/fisiopatología , Enfermedades Uterinas/cirugía , Hemorragia Uterina/etiología , Hemorragia Uterina/prevención & control , Miomectomía Uterina/efectos adversos , Neoplasias Uterinas/fisiopatología , Neoplasias Uterinas/cirugíaAsunto(s)
Hemoperitoneo/etiología , Leiomiomatosis/fisiopatología , Terapia Combinada , Drenaje , Femenino , Hemoperitoneo/complicaciones , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/terapia , Humanos , Histerectomía , Leiomiomatosis/complicaciones , Leiomiomatosis/diagnóstico por imagen , Leiomiomatosis/terapia , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Rotura Espontánea/fisiopatología , Salpingooforectomía , Índice de Severidad de la Enfermedad , Adherencias Tisulares/complicaciones , Adherencias Tisulares/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Histerectomía/métodos , Leiomioma/patología , Leiomiomatosis , Síndromes Neoplásicos Hereditarios , Neoplasias Cutáneas/patología , Neoplasias Uterinas , Adulto , Biopsia/métodos , Diagnóstico Diferencial , Femenino , Humanos , Leiomiomatosis/diagnóstico , Leiomiomatosis/patología , Leiomiomatosis/fisiopatología , Síndromes Neoplásicos Hereditarios/diagnóstico , Síndromes Neoplásicos Hereditarios/patología , Síndromes Neoplásicos Hereditarios/fisiopatología , Piel/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/fisiopatología , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patología , Neoplasias Uterinas/fisiopatología , Neoplasias Uterinas/cirugíaRESUMEN
AIM: The aim of our study was to explore the effects on symptoms and female sexual function of the medical management with gonadotropin-releasing hormone agonist (GnRHa) in women of more than 45 years old compared to surgical management. METHODS: Women with symptomatic uterine fibroids were enrolled to participate to the present open-label study. We offered two different treatment options: medical with GnRHa for 6 months (group A) or hysterectomy (group B). The patients were reviewed in follow-up for 24 months. The impact of medical or surgical therapy on sexual life was evaluated. RESULTS: No significant differences were found in population characteristics between the two groups. GnRHa treatment was efficient in reducing symptoms in 88% of patients but 22% of patients needed adjunctive cycles of medical therapy. After 24 months, 16% of the patients did not complete the study. The failure percentage of the medical treatment was 12%. No severe side-effects were recorded, and eight patients had reached menopause. No significant differences were observed in the Female Sexual Function Index score in each domain between the medical and surgical groups, with total scores of 18.94 ± 10.16 and 22.00 ± 8.86, respectively (mean ± standard deviation), and the prevalence of dysfunction was 12% and 22%, respectively, similar to the general population of the same age. CONCLUSION: We found that medical therapy with GnRHa is a satisfactory alternative to surgery for fibroids in women of more than 45 years old.
Asunto(s)
Fármacos para la Fertilidad Femenina/uso terapéutico , Hormona Liberadora de Gonadotropina/agonistas , Leiomiomatosis/tratamiento farmacológico , Tratamientos Conservadores del Órgano , Neoplasias Uterinas/tratamiento farmacológico , Útero/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Femenino , Fármacos para la Fertilidad Femenina/administración & dosificación , Fármacos para la Fertilidad Femenina/efectos adversos , Estudios de Seguimiento , Humanos , Histerectomía/efectos adversos , Incidencia , Italia/epidemiología , Leiomioma/tratamiento farmacológico , Leiomioma/patología , Leiomioma/fisiopatología , Leiomiomatosis/patología , Leiomiomatosis/fisiopatología , Leiomiomatosis/cirugía , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/efectos adversos , Premenopausia , Estudios Retrospectivos , Conducta Sexual/efectos de los fármacos , Disfunciones Sexuales Fisiológicas/epidemiología , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/prevención & control , Carga Tumoral/efectos de los fármacos , Neoplasias Uterinas/patología , Neoplasias Uterinas/fisiopatología , Neoplasias Uterinas/cirugía , Útero/patología , Útero/cirugíaRESUMEN
The myoma pseudocapsule (MP) is a fibro-vascular network rich of neurotransmitters, as a neurovascular bundle, surrounding fibroid and separating myoma from myometrium. We investigated the distribution of the opioid neuropeptides, as enkephalin (ENK) and oxytocin (OXT), in the nerve fibers within MP and their possible influence in human reproduction in 57 women. An histological and immunofluorescent staining of OXT and ENK was performed on nerve fibers of MP samples from the fundus, corpus and isthmian-cervical regions, with a successive morphometric quantification of OXT and ENK. None of the nerve fibers in the uterine fundus and corpus MPs contained ENK and the nerve fibers in the isthmian-cervical region demonstrated an ENK value of up to 94 ± 0.7 CU. A comparatively lower number of OXT-positive nerve fibers were found in the fundal MP (6.3 ± 0.8 CU). OXT-positive nerve fibers with OXT were marginally increased in corporal MP (15.0 ± 1.4 CU) and were substantially higher in the isthmian-cervical region MP (72.1 ± 5.1 CU) (p < 0.01). The distribution of OXY neurofibers showed a slight into the uterine corpus, while are highly present into the cervico-isthmic area, with influence on reproductive system and sexual disorders manifesting after surgical procedures on the cervix.
Asunto(s)
Cuello del Útero/patología , Encefalinas/metabolismo , Leiomiomatosis/metabolismo , Fibras Nerviosas/metabolismo , Oxitocina/metabolismo , Neoplasias Uterinas/metabolismo , Útero/metabolismo , Adulto , Cuello del Útero/cirugía , Femenino , Humanos , Histerectomía , Inmunohistoquímica , Leiomiomatosis/patología , Leiomiomatosis/fisiopatología , Leiomiomatosis/cirugía , Menorragia/etiología , Menorragia/prevención & control , Proteínas de Neoplasias/metabolismo , Neovascularización Patológica/metabolismo , Neovascularización Patológica/patología , Neovascularización Patológica/fisiopatología , Neovascularización Patológica/cirugía , Fibras Nerviosas/patología , Dolor Pélvico/etiología , Dolor Pélvico/prevención & control , Neoplasias Uterinas/patología , Neoplasias Uterinas/fisiopatología , Neoplasias Uterinas/cirugía , Útero/irrigación sanguínea , Útero/inervación , Útero/patologíaRESUMEN
Uterine leiomyomas are the most common benign gynecologic condition. The prevalence is three times more common among women of African ethnicity. Disparity in this disease is evidenced by earlier age of onset, greater severity of symptoms, and different response to treatment. Although the pathogenesis of disease development is not completely known, growing evidence focuses on investigating the molecular mechanisms in disease development and the influence of ethnicity. Variation in the expression levels or function of estrogen and progesterone receptors, polymorphism of genes involved in estrogen synthesis and/or metabolism (COMT, CYP17), retinoic acid nuclear receptors (retinoid acid receptor-α, retinoid X receptor-α), and aberrant expression of micro-RNAs (miRNAs) are some of the molecular mechanisms that may be involved. Nutritional factors, such as vitamin D deficiency, might also contribute to the higher incidence in dark skinned populations who are also commonly suffer from hypovitaminosis D. Culture and environmental difference might have a role in disease development. Further analysis and better understanding of these mechanisms will provide insight into the molecular basis of racial disparities in leiomyoma formation and will help to develop new innovations in leiomyoma treatment.