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1.
Obstet Gynecol Surv ; 77(8): 485-494, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35932289

RESUMEN

Importance: Leiomyomata, or fibroids, are a common gynecological problem affecting many women of reproductive age. Historically, myomectomy is offered to women with symptomatic fibroids who desire to preserve fertility. More recently, uterine artery embolization (UAE) has been explored as another fertility-sparing option. Objective: This review aims to provide an in-depth summary of the effects on fertility and reproductive outcomes following myomectomy and UAE for the treatment of symptomatic fibroids. Evidence Acquisition: Articles were obtained from PubMed using search terms myomectomy, uterine artery embolization, and fertility, as well as American Society of Reproductive Medicine practice committee reports. References from identified sources were searched to allow for thorough review. Results: While myomectomy and UAE are both fertility-sparing options for women with fibroids, reproductive outcomes following myomectomy are superior to UAE with higher rates of clinical pregnancy and live births and lower rates of spontaneous abortion, abnormal placentation, preterm labor, and malpresentation. Conclusions: Myomectomy should be offered to women with symptomatic submucosal or cavity-distorting fibroids who have a strong desire for a future pregnancy. For women who are not appropriate surgical candidates, UAE can be offered, although detrimental effects on future fertility should be disclosed. Relevance: A thorough understanding of the efficacy of both myomectomy and UAE, as well as their impact on future fertility, allows for improved counseling when deciding the optimal intervention for women with fibroids who desire future fertility.


Asunto(s)
Leiomioma , Embolización de la Arteria Uterina , Miomectomía Uterina , Neoplasias Uterinas , Femenino , Fertilidad , Humanos , Recién Nacido , Leiomioma/cirugía , Embarazo , Resultado del Tratamiento , Neoplasias Uterinas/cirugía
2.
Medicine (Baltimore) ; 101(31): e29726, 2022 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-35945797

RESUMEN

To evaluate the efficacy and safety of a gonadotropin-releasing hormone (GnRH) agonist for treating large-sized submucosal leiomyoma before hysteroscopic myomectomy. The data were retrospectively collected from patients who underwent a hysteroscopic myomectomy for a submucosal leiomyoma >3.5 cm in size from January 2009 to December 2018. The patients were divided into the GnRH group and the control group according to whether they were pretreated before surgery. A total of 61 patients were included in the study, 31 in the GnRH agonist group and 30 in the control group. At diagnosis, the maximum leiomyoma diameter was similar between the 2 groups (4.67 ± 0.6 cm in the GnRH agonist group vs 3.82 ± 0.6 cm in the control group, P = .061). After pretreatment with the GnRH agonist, the maximum diameter was significantly smaller in the GnRH agonist group compared to the control group (3.82 ± 0.6 vs 4.33 ± 0.8 cm, respectively, P = .004). The leiomyoma volume in the GnRH agonist group decreased by 55.6%, from 41.68 ± 15.7 to 23.19 ± 10.4 cm3, which led to significant differences in leiomyoma volume between the 2 groups (23.19 ± 10.4 cm3 in the GnRH agonist group vs 33.22 ± 24.7 cm3 in the control group, P = .042). The GnRH agonist group showed a shorter operation time (37.7 vs 43.9 minutes, P = .040) and less uterine distention media was used (6800 vs 9373.3 mL, P = .037) compared to the control group. Postoperative complications such as estimated blood loss, remnant leiomyoma, and recurrence were similar between the 2 groups. Treatment with a GnRH agonist before hysteroscopic myomectomy for large submucosal leiomyoma might decrease the volume of the leiomyoma, reduce operation time, and the amount of uterine-distension media used without surgical complications.


Asunto(s)
Leiomioma , Miomectomía Uterina , Neoplasias Uterinas , Femenino , Hormona Liberadora de Gonadotropina , Humanos , Leiomioma/tratamiento farmacológico , Leiomioma/cirugía , Estudios Retrospectivos , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/cirugía
3.
J Exp Clin Cancer Res ; 41(1): 242, 2022 Aug 11.
Artículo en Inglés | MEDLINE | ID: mdl-35953818

RESUMEN

BACKGROUND: Uterine serous cancer (USC) is the most common non-endometrioid subtype of uterine cancer, and is also the most aggressive. Most patients will die of progressively chemotherapy-resistant disease, and the development of new therapies that can target USC remains a major unmet clinical need. This study sought to determine the molecular mechanism by which a novel unfavorable prognostic biomarker ryanodine receptor 1 (RYR1) identified in advanced USC confers their malignant phenotypes, and demonstrated the efficacy of targeting RYR1 by repositioned FDA-approved compounds in USC treatment. METHODS: TCGA USC dataset was analyzed to identify top genes that are associated with patient survival or disease stage, and can be targeted by FDA-approved compounds. The top gene RYR1 was selected and the functional role of RYR1 in USC progression was determined by silencing and over-expressing RYR1 in USC cells in vitro and in vivo. The molecular mechanism and signaling networks associated with the functional role of RYR1 in USC progression were determined by reverse phase protein arrays (RPPA), Western blot, and transcriptomic profiling analyses. The efficacy of the repositioned compound dantrolene on USC progression was determined using both in vitro and in vivo models. RESULTS: High expression level of RYR1 in the tumors is associated with advanced stage of the disease. Inhibition of RYR1 suppressed proliferation, migration and enhanced apoptosis through Ca2+-dependent activation of AKT/CREB/PGC-1α and AKT/HK1/2 signaling pathways, which modulate mitochondrial bioenergetics properties, including oxidative phosphorylation, ATP production, mitochondrial membrane potential, ROS production and TCA metabolites, and glycolytic activities in USC cells. Repositioned compound dantrolene suppressed USC progression and survival in mouse models. CONCLUSIONS: These findings provided insight into the mechanism by which RYR1 modulates the malignant phenotypes of USC and could aid in the development of dantrolene as a repurposed therapeutic agent for the treatment of USC to improve patient survival.


Asunto(s)
Cistadenocarcinoma Seroso , Neoplasias Uterinas , Animales , Cistadenocarcinoma Seroso/patología , Dantroleno/farmacología , Dantroleno/uso terapéutico , Femenino , Humanos , Ratones , Fenotipo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Canal Liberador de Calcio Receptor de Rianodina/genética , Canal Liberador de Calcio Receptor de Rianodina/metabolismo , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/genética , Neoplasias Uterinas/metabolismo
4.
Comput Math Methods Med ; 2022: 5653250, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35799665

RESUMEN

In order to explore the ability of vaginal ultrasound combined with bleeding pattern to predict factors related to abnormal uterine bleeding (AUB), a total of 205 patients with abnormal uterine bleeding were selected as experimental subjects. According to the corresponding diagnostic criteria, patients were divided into the endometrial polyp group (56 cases), endometrial hyperplasia and canceration group (84 cases), and normal cycle endometrial group (65 cases). The efficiency of the method was determined by comparing the prediction efficiency of the single/joint model. The results showed that there were statistically significant differences in the body mass index, dysmenorrhea, endometrial thickness, diabetes, hypertension, and polycystic ovary syndrome among the three groups, P < 0.05. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index of endometrial polyp diagnosis were 86.89%, 88.12%, 83.54%, 90.11%, and 0.74, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and JordAn index in diagnosing endometrial hyperplasia and canceration were 96.71%, 98.40%, 96.54%, 98.24%, and 0.96, respectively. In summary, the body mass index, dysmenorrhea, endometrial thickness, diabetes, hypertension, and polycystic ovary syndrome were related factors, and the combination of vaginal ultrasound and bleeding pattern had a stronger predictive power for abnormal uterine bleeding.


Asunto(s)
Hiperplasia Endometrial , Hipertensión , Síndrome del Ovario Poliquístico , Pólipos , Neoplasias Uterinas , Dismenorrea/complicaciones , Dismenorrea/etiología , Hiperplasia Endometrial/complicaciones , Hiperplasia Endometrial/patología , Endometrio/diagnóstico por imagen , Endometrio/patología , Femenino , Humanos , Hipertensión/complicaciones , Pólipos/complicaciones , Pólipos/diagnóstico por imagen , Sensibilidad y Especificidad , Ultrasonografía , Hemorragia Uterina/complicaciones , Hemorragia Uterina/etiología , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patología
5.
Contrast Media Mol Imaging ; 2022: 4366840, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35800231

RESUMEN

In recent years, with the continuous development and application of minimally invasive methods in China, laparoscopic myomectomy has become the primary method for clinical treatment of uterine fibroids. There is also a high risk of recurrence and reoperation after endoscopic myomectomy. Intraoperative use of ultrasound for auxiliary examination can provide medical staff with spatial information and position information of fibroids and help medical staff to accurately locate the surgical incision. The aim is to investigate the effect of intraoperative ultrasound monitoring on the risk of postoperative recurrence and reoperation in patients undergoing myomectomy. This study retrospectively collected 80 patients who underwent laparoscopic myomectomy in the gynecology department of our hospital from January 2020 to January 2022. According to the different treatment methods, they were divided into a study group and a control group (both n = 40). The control group underwent preoperative ultrasonography and then underwent myomectomy, while the study group underwent both preoperative and intraoperative ultrasonography before undergoing hysterectomy. Myomectomy: all the enrolled patients were followed up by ultrasound after surgery and followed up for 1 year (recheck ultrasound every 3 months). The indicators, postoperative complications, postoperative average diameter of uterine fibroids, postoperative residual rate of uterine fibroids, postoperative recurrence, and reoperation were compared between the two groups. Intraoperative ultrasound monitoring has a significant effect on patients undergoing myomectomy, which can effectively reduce the residual rate of fibroids, completely remove small and deep fibroids, and reduce complications, postoperative recurrence, and reoperation risks. It has good clinical application value.


Asunto(s)
Leiomioma , Miomectomía Uterina , Neoplasias Uterinas , Femenino , Humanos , Leiomioma/diagnóstico por imagen , Leiomioma/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación/efectos adversos , Estudios Retrospectivos , Ultrasonografía , Miomectomía Uterina/efectos adversos , Miomectomía Uterina/métodos
6.
PLoS One ; 17(7): e0271526, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35862371

RESUMEN

OBJECTIVE: This study aimed to determine 5-year progression-free and overall survival in patients with uterine carcinosarcoma, to determine clinical and surgical-pathologic features, to recognize patterns of recurrence and to identify prognostic factors influencing progression-free survival (PFS) and overall survival (OS). DESIGN: This was a single institution, retrospective 10-year review of patients treated at Tygerberg Hospital in South Africa with pathologically confirmed uterine carcinosarcoma. METHODS: A total of 61 patients were studied. Demographic, clinicopathological, treatment and outcome information were obtained. Kaplan-Meier survival analysis and Cox proportional hazards models were used to determine the effects of variables on PFS and OS. RESULTS: Eighteen patients (29%) presented as FIGO stage I disease, 5 patients (8%) as stage II, 16 patients (26%) as stage III and 22 patients (36%) as stage IV disease. Fifty of the 61 patients (82%) had surgery. Five-year PFS and 5-year OS were 17.3% (CI 8.9%-27.9%) and 19.7% (CI 10.6%-30.8%), respectively. Seventeen patients presented with recurrence of which 5 (29.4%) were local and 12 (70.6%) were outside the pelvis. In the univariate analysis, tumour diameter ≥ 100mm (HR 4.57; 95% CI 1.59-13.19; p-value 0.005) was associated with 5-year PFS and in univariate analysis of OS, a positive family history (HR 0.42; 95% CI 0.18-0.99; p-value 0.047), receiving a full staging operation (HR 0.37; 95% CI 0.18-0.78; p-value 0.008) and receiving any other modality of treatment, with or without surgery, (HR 0.48; 95% CI 0.27-0.85; p-value 0.012) were associated with better survival. An abnormal cervical smear (HR 2.4; 95% CI 1.03-5.6; p-value 0.041), late-stage disease (HR 3.48; 95% CI 1.79-6.77; p-value < 0.001), presence of residual tumour (HR 3.66; 95% CI 1.90-7.02; p-value < 0.001), myometrial invasion more than 50% (HR 2.29; 95% CI 1.15-4.57; p-value 0.019), cervical involvement (HR 3.38; 95% CI 1.64-6.97; p-value 0.001) and adnexal involvement (HR 3.21; 95% CI 1.56-6.63; p-value 0.002) were associated with a higher risk of death. In the multivariate analysis, full staging operation was associated with a risk of progression of disease (HR 3.49; 95% CI 1.17-10.41; p-value 0.025). Advanced stage (HR 4.2; 95% CI 2.09-8.44; p-value < 0.001) was associated with a higher risk of death. Any other modality of treatment (HR 0.28; 95% CI 0.15-0.53; p-value < 0.001) and full staging laparotomy (HR 0.27; 95% CI 0.12-0.59; p-value 0.001) was a protective factor for death. CONCLUSIONS: Carcinosarcoma is an aggressive cancer with poorer survival in this specific cohort than has been described in other contemporary cohorts. Biological or genetic factors are a possible explanation for lower overall survival in this population. Although it is also possible that later diagnosis and poor access to health care contribute to poorer survival. Most recurrences occur outside of the pelvis. Full staging surgery (including pelvic lymphadenectomy) and additional use of other modalities (either for radical or palliative intent) improve survival.


Asunto(s)
Carcinosarcoma , Neoplasias Uterinas , Carcinosarcoma/patología , Carcinosarcoma/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Neoplasias Uterinas/cirugía
7.
Electromagn Biol Med ; 41(3): 343-351, 2022 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-35793396

RESUMEN

Previous studies reported that combined effect of magnetic field (MF) on cytotoxic drugs in human cancer cells. We focused on the effects of 60 Hz MF on drug activity in human uterine sarcoma MES-SA and drug-resistant variant MES-SA/Dx5 cells that overexpressed the membrane protein MDR1(P-glycoprotein), a drug efflux transporter for doxorubicin, daunorubicin, and etoposide, but not cisplatin. The cisplatin with MF caused 60% decrease in cell viability when compared with no MF treatment, cisplatin alone in MES-SA cells. Even in MES-SA/Dx5 cells, MF exposure equally enhanced cisplatin activity. Then, MF enhanced doxorubicin and daunorubicin activity in MES-SA cells and caused 60% decrease in the cell viability compared with these drugs only but had less effect on these drugs in MES-SA/Dx5 cells. Etoposide activity was unaffected by MF exposure in both cell lines, although etoposide is a MDR1 substrate as with doxorubicin and daunorubicin. Thus, MF had no direct impact on MDR1 in the cell membrane. However, the differences in doxorubicin and daunorubicin activity between MES-SA and MES-SA/Dx5 data revealed that the presence of MDR1 in abundance prevented the enhancing effects of MF on doxorubicin and daunorubicin activity. These results suggested that MF may act in the opposite direction of MDR1, affect the drug influx transporters for doxorubicin and daunorubicin, and facilitate anticancer drug uptake into the cells.


Asunto(s)
Antineoplásicos , Sarcoma , Neoplasias Uterinas , Antineoplásicos/farmacología , Línea Celular , Línea Celular Tumoral , Daunorrubicina/farmacología , Daunorrubicina/uso terapéutico , Doxorrubicina/farmacología , Doxorrubicina/uso terapéutico , Resistencia a Múltiples Medicamentos , Etopósido/farmacología , Etopósido/uso terapéutico , Femenino , Humanos , Campos Magnéticos , Sarcoma/tratamiento farmacológico , Sarcoma/metabolismo , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/metabolismo
8.
Medicine (Baltimore) ; 101(30): e29934, 2022 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-35905248

RESUMEN

BACKGROUND: This study aimed to systematically review the existing literature on epithelioid trophoblastic tumors (ETTs), the rarest type of gestational trophoblastic neoplasia. METHODS: A systematic review according to PRISMA guidelines was performed, using ScienceDirect, Web of Science, and Scopus databases. The only filter used was the English language. Eligibility/inclusion criteria: retrospective observational studies (case reports, case series) including full case description of epithelioid trophoblastic tumor lesions. RESULTS: Seventy studies were assessed for synthesis, including 147 cases. 66.7% of patients with ETT presented with irregular vaginal bleeding. Pretreatment ß-hCG levels ranged up to 1000 mIU/mL in 58.5% patients. Of most patients, 42.2% had stage I disease, 10.9% stage II, 25.2% stage III, and 21.8% of patients had stage IV. The most common sites of metastatic disease were the lungs, followed by the liver and brain. After treatment, complete remission was achieved in 75.5% of patients, partial remission in 10.2% of patients, and 14.3% of patients died. On univariate and multivariate analyses, stage IV disease was an independent prognostic factor for overall and disease-free survival. CONCLUSIONS: Hysterectomy and metastatic lesion resection are essential for controlling ETT. Investigational studies on molecules like EGFR, VEGF, PD-1, CD105, and LPCAT1 are potential therapeutic targets for metastatic ETT.


Asunto(s)
Enfermedad Trofoblástica Gestacional , Neoplasias Trofoblásticas , Neoplasias Uterinas , Femenino , Enfermedad Trofoblástica Gestacional/diagnóstico , Enfermedad Trofoblástica Gestacional/patología , Enfermedad Trofoblástica Gestacional/terapia , Humanos , Histerectomía , Embarazo , Neoplasias Trofoblásticas/patología , Neoplasias Uterinas/patología
9.
Curr Opin Obstet Gynecol ; 34(4): 262-269, 2022 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-35895970

RESUMEN

PURPOSE OF REVIEW: This article provides a clinical review of radiofrequency ablation (RFA) for the treatment of uterine leiomyomas. RECENT FINDINGS: RFA is an effective and durable treatment for fibroids with sustained improvements in fibroid volume, bleeding, and patient reported outcomes with low reintervention rates. Although fertility data is limited, it is overall positive and may represent a uterine conserving and fertility preserving treatment modality. SUMMARY: RFA is a safe and effective uterine preserving treatment option for symptomatic leiomyomas.


Asunto(s)
Ablación por Catéter , Leiomioma , Ablación por Radiofrecuencia , Neoplasias Uterinas , Ablación por Catéter/métodos , Femenino , Humanos , Leiomioma/cirugía , Ablación por Radiofrecuencia/métodos , Resultado del Tratamiento , Neoplasias Uterinas/cirugía
11.
Int J Hyperthermia ; 39(1): 946-951, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35853723

RESUMEN

OBJECTIVE: To investigate the tolerance and efficacy of HIFU ablation for uterine fibroids with a non-perfused volume ratio (NPVR) ≥ 90%. METHODS: A prospective cohort study of 2411 patients from 20 clinical centers was available. Contrast-enhanced MRI was used to assess the non-perfused volume ratio (NPVR). The International Society of Interventional Radiotherapy (SIR) complication grading system was used as the tolerance index. Uterine Fibroids-related Symptoms-Quality of Life (UFS-QoL) was used to evaluate the efficacy. RESULTS: A total of 1352 patients underwent USgHIFU ablation treatment enrolled, NPVR was median 91.9% (IQR, 81.4%,100.0%). There was 761 case (56.3%) in the NPVR ≥ 90% group in which 17.5% case experienced SIR-B abdominal pain, 591 cases (43.7%) in NPVR < 90% group in which 9.3% case had SIR-B abdominal pain. There were statistically differences in the improvement degree of UFS at 12 months among the four subgroups (NPVR < 70%, 70%-80%, 80%-90%, 90%-100%) (all p < 0.05). CONCLUSIONS: Patients with NPVR ≥ 90% had a higher incidence of SIR-B lower abdominal pain. NPVR was positively correlated with the degree of symptom relief at 12 months, and NPVR ≥ 90% was more likely to obtain better clinical symptom relief.


Asunto(s)
Ultrasonido Enfocado de Alta Intensidad de Ablación , Leiomioma , Neoplasias Uterinas , Dolor Abdominal/terapia , Estudios de Casos y Controles , Femenino , Humanos , Leiomioma/diagnóstico por imagen , Leiomioma/cirugía , Imagen por Resonancia Magnética , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento , Neoplasias Uterinas/cirugía
13.
Front Immunol ; 13: 915246, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35874683

RESUMEN

Cytokines and cytokine receptors are important mediators in immunity and cancer development. Interleukin 22 (IL22) is one of the most important cytokines which has protumor effect. Given that common and specific roles of cytokines/receptors in multiple cancers, we conducted a pan-cancer study to investigate the role of IL22RA1 in cancer using The Cancer Genome Atlas (TCGA) database. Notably, we found IL22RA1 transcript was upregulated in 11 cancer types compared with their corresponding control. The mRNA expression level of IL22RA1 was highest in the pancreas among tumor tissues. The higher expression of IL22RA1 was associated with worse overall survival rate in patients. A total of 30 IL22RA1-correlated genes (e.g. IL17D, IL22RA2, IL20RB, IL10RA, IL10RB, TSLP and TYK2) are involved in the JAK/STAT pathway which promotes tumor progression. The upregulation of IL22RA1 in tumors was correlated with immune cell infiltration level. Higher expression of IL22RA2, IL20RB, IL10RA, IL10RB, TSLP, TYK2, STAT1 and STAT3 was associated with decreased overall survival rate in patients. IL22RA1 mutation was observed more in uterine cancer and melanoma compared with the other cancer types. Deactivation of IL22RA1 induced a lot of changes in gene expression. IL22RA1 mutants had upregulated DNA damage/repair genes in uterine cancer, whereas downregulated genes in the FoxO signaling pathway. In melanoma, mutation of IL22RA1 can upregulate the HIF signaling pathway but downregulate metabolic pathways. Our study suggests that IL22RA1/JAK/STAT signaling can be an important target for cancer treatment.


Asunto(s)
Melanoma , Neoplasias Uterinas , Citocinas/metabolismo , Femenino , Humanos , Quinasas Janus/metabolismo , Receptores de Interleucina/metabolismo , Factores de Transcripción STAT/metabolismo , Transducción de Señal
14.
Menopause ; 29(8): 952-956, 2022 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-35881941

RESUMEN

OBJECTIVE: To analyze the clinical and pathological features of asymptomatic postmenopausal women with an incidentally detected increase in endometrial thickness (ET) by transvaginal ultrasound examination and discuss the cutoff value of ET for the timely discovery of endometrial malignancy. METHODS: This was a retrospective study of postmenopausal women with asymptomatic thickened endometrium (greater than or equal to 5 mm) screened by transvaginal ultrasound who were referred to the gynecology department at Xuanwu Hospital between January 2018 and March 2021. Data on participant demographics, clinical characteristics, and histopathology outcomes were collected. We stratified the participants into the benign group and malignant group according to pathology results and assessed differences between the two groups. A receiver operating characteristic curve was used to identify the cutoff value of ET for predicting endometrial malignancy in postmenopausal women with asymptomatic thickened endometrium. RESULTS: A total of 163 eligible cases were included in the analysis. The results showed that only ET was significantly different between the two groups. The median ET was significantly higher in the malignant group than in the benign group (1.20 vs 0.80, P = 0.023). The optimal cutoff value of ET was 10 mmwith the maximum AUC (0.881, 95% CI 0.810-0.952, P = 0.024), and the sensitivity and specificity for the diagnosis of endometrial malignancy were 100%and 80%, respectively. Among the 47 women with ET ≥ 10mm, the prevalence of endometrial malignancy was 6.3%, which was significantly higher than that among women with ET < 10mm ( P = 0.023). CONCLUSION: For postmenopausal women with asymptomatic endometrial thickening, the prevalence of endometrial malignancy is significantly higher when ET is ≥ 10 mm. If ET is ≥ 10mm, further histopathological testing should be recommended to exclude endometrial malignancy. Further large-sample and prospective studies are needed to determine the predictive value of ET.


Asunto(s)
Neoplasias Endometriales , Enfermedades Uterinas , Neoplasias Uterinas , Neoplasias Endometriales/epidemiología , Endometrio/diagnóstico por imagen , Endometrio/patología , Femenino , Humanos , Posmenopausia , Estudios Retrospectivos , Ultrasonografía , Hemorragia Uterina , Neoplasias Uterinas/diagnóstico
15.
Cells ; 11(14)2022 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-35883603

RESUMEN

Uterine leiomyosarcoma (uLMS) is the most common type of uterine sarcoma associated with poor prognosis, high rates of recurrence, and metastasis. There is currently limited information about uLMS molecular mechanisms of origin and development. Bromodomain (BRD)-containing proteins are involved in many biological processes, most notably epigenetic regulation of transcription, and BRD protein dysfunction has been linked to many diseases including tumorigenesis. However, the role of BRD proteins in the pathogenesis of uLMS is unknown. Here, we show for the first time that BRD9 is aberrantly overexpressed in uLMS tissues compared to adjacent myometrium. BRD9 expression is also upregulated in uLMS cell lines compared to benign uterine fibroid and myometrium cell lines. Inhibition of BRD9 using the specific inhibitor (TP-472) suppressed uLMS cell proliferation via inducing apoptosis and cell cycle arrest. To further characterize the mechanistic basis for TP-472 inhibition of uLMS cell growth, we performed a comparative RNA-seq analysis of vehicle-treated and TP-472-treated uLMS cells (n = 4 each). Bioinformatics analysis revealed that TP-472 treatment distinctly altered the uLMS cell transcriptome. Gene set enrichment analysis identified critical pathways altered by BRD9 inhibition, including interferon-alpha response, KRAS signaling, MYC targets, TNF-a signaling via NFkB, and MTORC1 signaling. Parsimonious gene correlation network analysis identified nine enriched modules, including cell cycle and apoptosis modules. Moreover, the ENCODE Histone Modifications gene set and TargetScan microRNA analysis in Enrichr suggested that TP-472-induced BRD9 inhibition may alter the uLMS cell transcriptome by reprograming the oncogenic epigenome and inducing miRNA-mediated gene regulation. Therefore, BRD9 constitutes a specific vulnerability in malignant uLMS, and targeting non-BET BRD proteins in uLMS may provide a promising and novel strategy for treating patients with this aggressive uterine cancer.


Asunto(s)
Leiomioma , Leiomiosarcoma , MicroARNs , Factores de Transcripción , Neoplasias Uterinas , Carcinogénesis/genética , Epigénesis Genética , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Leiomiosarcoma/patología , MicroARNs/genética , Factores de Transcripción/metabolismo , Neoplasias Uterinas/patología
16.
BMJ Case Rep ; 15(7)2022 Jul 14.
Artículo en Inglés | MEDLINE | ID: mdl-35835485

RESUMEN

Benign metastasising leiomyoma (BML) is a rare tumour characterised by extrauterine metastasis of histologically benign leiomyomas. We present a case of BML with pulmonary involvement. A 49-year-old woman presented with large pelviabdominal masses complicated by gross abdominal and lower limb swelling 6 years following open myomectomy. Preoperative CT imaging showed pelviabdominal masses and multiple bilateral pulmonary nodules. Initial impression was that of a stage 4 gynaecological malignancy. Palliative total hysterectomy bilateral salpingo-oophorectomy was performed. Histopathology confirmed benign uterine leiomyomas. Biopsy of pulmonary nodules showed benign leiomyomas, strongly positive for oestrogen and progesterone receptors. Definitive diagnosis of BML was made on histopathology and immunohistochemistry. The patient declined letrozole treatment as she had just undergone bilateral oophorectomy. She opted for conservative monitoring of her lung nodules. CT imaging 7 months postsurgery showed disease regression. She will require long-term surveillance scans to detect disease progression.


Asunto(s)
Leiomioma , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Neoplasias Uterinas , Femenino , Humanos , Leiomioma/diagnóstico por imagen , Leiomioma/cirugía , Neoplasias Pulmonares/patología , Persona de Mediana Edad , Enfermedades Raras , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugía
17.
Int J Mol Sci ; 23(15)2022 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-35897637

RESUMEN

According to recent studies and observations in clinical practice, uterine fibroids increase the risk of preterm birth. There are several theories on the pathogenesis of preterm birth in the presence of fibroids. One theory proclaims that fibroid necrosis leads to preterm birth, though pathophysiological mechanisms have not been described. Necrotic tissue secretes specific cytokines and proteins and we suggest these to be comparable to the inflammatory response leading to spontaneous preterm birth. We hypothesize that fibroid necrosis could induce preterm parturition through a similar inflammatory response. This new hypothesis generates novel perspectives for future research and the development of preventative strategies for preterm birth. Moreover, we emphasize the importance of the recognition of fibroids and especially fibroid necrosis by clinicians during pregnancy.


Asunto(s)
Leiomioma , Nacimiento Prematuro , Neoplasias Uterinas , Femenino , Humanos , Recién Nacido , Inflamación/complicaciones , Leiomioma/etiología , Necrosis , Embarazo , Nacimiento Prematuro/etiología , Neoplasias Uterinas/etiología , Neoplasias Uterinas/patología
18.
J Coll Physicians Surg Pak ; 32(7): 920-923, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35795944

RESUMEN

OBJECTIVE: To assess the safety and efficacy of barbed suture laparoscopic myomectomy for large posterior myoma compared to conventional suture. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Gynecology, Affiliated Women and Children's Hospital of Ningbo University, Ningbo, Zhejiang, China between July 2019 and June 2020. METHODOLOGY: All cases of laparoscopic myomectomy for large posterior myoma (≥8cm in the largest diametre) were retrospectively reviewed. The surgical technique was identical except the selection of suture material. A comparison between the barbed suture and conventional suture was performed in terms of clinical characteristics and surgical outcomes such as total operative time, suture time, intraoperative blood loss, and changes in hemoglobin concentration. RESULTS: A total of 48 eligible cases, 24 cases with barbed sutures and 24 cases with conventional sutures were included in the final analysis. Patients' clinical characteristics such as age, body mass index, number, and size of myomas were similar between the two groups. In patients with barbed sutures, the time for suturing, the total operative time, intraoperative blood loss, and the changes in hemoglobin concentration were significantly lower than in conventional sutures (all p<0.05). No significant differences in time for enucleation, time for morcellation, and postoperative complications were found between the two groups. Two patients with conventional sutures received postoperative emergent uterine artery embolization and three patients received a blood transfusion. CONCLUSIONS: The use of barbed sutures could reduce the difficulty and enhance safety in laparoscopic myomectomy for large posterior myoma. KEY WORDS: Barbed suture, Laparoscopy, Myomectomy, Posterior.


Asunto(s)
Laparoscopía , Mioma , Miomectomía Uterina , Neoplasias Uterinas , Pérdida de Sangre Quirúrgica , Niño , Femenino , Hemoglobinas , Humanos , Laparoscopía/métodos , Mioma/etiología , Mioma/cirugía , Estudios Retrospectivos , Técnicas de Sutura , Suturas , Miomectomía Uterina/efectos adversos , Miomectomía Uterina/métodos , Neoplasias Uterinas/cirugía
19.
Folia Med (Plovdiv) ; 64(2): 341-347, 2022 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-35851791

RESUMEN

Uterine angiolipoleiomyomas are rare, benign mixed mesenchymal lesions. A manifestation in the gynecological region is quite uncommon, with few cases described in the literature so far. We present an interesting case of a 59-year-old woman diagnosed with uterine angiolipoleiomyoma, and the results of the conducted systematic review of the literature. The patient presented with a pelvic mass masquerading as a leiomyoma on the ultrasound and postmenopausal vaginal bleeding. At laparotomy, a large uterus was noticed and the histopathology set the diagnosis of angiolipoleiomyoma. Immunohistochemistry revealed negativity for Melan-A and HMB-45 melanoma-specific antibodies and positivity for Van Gieson and orcein histochemical stains.


Asunto(s)
Leiomioma , Neoplasias Uterinas , Femenino , Humanos , Inmunohistoquímica , Leiomioma/diagnóstico por imagen , Leiomioma/cirugía , Persona de Mediana Edad , Ultrasonografía , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/cirugía , Útero/patología
20.
Zhonghua Fu Chan Ke Za Zhi ; 57(6): 435-441, 2022 Jun 25.
Artículo en Chino | MEDLINE | ID: mdl-35775251

RESUMEN

Objective: To investigate the clinicopathological features of fumarate hydratase (FH) deficiency uterine leiomyoma. Methods: The data of 38 patients with FH deficiency uterine leiomyoma were screened and analyzed. The expressions of FH, S-(2-succino)-cysteine (2SC), desmin, p16, p53, CD10 and cell proliferation associated nuclear antigen (Ki-67) proteins were detected by immunohistochemistry, and their clinicopathological features were analyzed retrospectively. Results: (1) Clinical features: the median age of the patients was (42.5±7.4) years old. Twenty-one cases (55%) of them were myomas found in physical examination, and the median maximum diameter of the tumor was 6.0 cm (range: 5.0-7.5 cm); myomectomy was performed in 23 cases (61%), total hysterectomy with or without bilateral appendages in 15 cases (39%); laparoscopic surgery in 27 cases (71%), open surgery in 11 cases (29%); none of the patients had renal cell carcinoma. (2) Histological features: atypical nuclear cells were distributed locally or diffusely, eosinophilic nucleoli and intranuclear inclusion bodies could be seen, glass like globules could be seen in the cytoplasm, nuclear division was 0-4/10 high power field (HPF), and antler like blood vessels and pulmonary edema-like changes could be seen in the stroma. Among 38 patients with FH deficiency uterine leiomyoma, FH was negative in 37 cases (97%), and positive in 1 case (3%); 2SC, desmin, p16, p53, CD10 and Ki-67 showed focal positive expression in 38 cases (100%), including 35 cases (92%) with Ki-67 index<10% and 3 cases (8%) with Ki-67 index ≥10%. (3) Follow-up: 4 cases (11%) recurred, and there was no death. There were significant differences in age, family history, distribution of atypical nuclei and mitosis number between recurrent group and non-recurrent group (all P<0.05). Conclusions: FH deficiency uterine leiomyoma is a rare tumor, which needs pathological examination,immunohistochemical examination and clinical history. Patients younger than 43 years old, with family history, histologically atypical diffuse nuclear distribution and mitotic number ≥3/10 HPF should be alert to the risk of recurrence.


Asunto(s)
Fumarato Hidratasa , Leiomioma , Neoplasias Uterinas , Adulto , Desmina/metabolismo , Femenino , Fumarato Hidratasa/deficiencia , Fumarato Hidratasa/metabolismo , Humanos , Antígeno Ki-67/metabolismo , Leiomioma/enzimología , Leiomioma/patología , Leiomioma/cirugía , Errores Innatos del Metabolismo/enzimología , Persona de Mediana Edad , Hipotonía Muscular/enzimología , Trastornos Psicomotores/enzimología , Estudios Retrospectivos , Proteína p53 Supresora de Tumor , Neoplasias Uterinas/diagnóstico
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