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1.
Obstet Gynecol ; 141(2): 375-378, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36649323

RESUMO

BACKGROUND: Uterine artery embolization (UAE) is a minimally invasive procedure for treatment of symptomatic uterine leiomyomas, but long-term complications are under-reported. CASE: This is the case of a healthy 51-year-old woman who had previously undergone UAE for symptomatic uterine leiomyomas. The patient presented with gross hematuria and pelvic pain 10 years later. She was found to have both a vesicouterine and a uteroduodenal fistula. The patient was successfully treated with hysterectomy, excision of the vesicouterine fistula, partial cystectomy, excision of the duodenal fistula, and primary duodenal repair. CONCLUSION: Complex gynecologic fistulas may occur as a long-term complication in symptomatic women with a history of UAE.


Assuntos
Embolização Terapêutica , Fístula , Leiomioma , Embolização da Artéria Uterina , Neoplasias Uterinas , Feminino , Humanos , Pessoa de Meia-Idade , Embolização da Artéria Uterina/efeitos adversos , Embolização da Artéria Uterina/métodos , Neoplasias Uterinas/cirurgia , Leiomioma/cirurgia , Histerectomia , Fístula/terapia , Resultado do Tratamento , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos
2.
Obstet Gynecol ; 141(2): 371-374, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36649332

RESUMO

We used a claims database to identify patients with uterine leiomyomas who underwent hysterectomy between 2011 and 2019. Use of conservative medical and surgical interventions in the 24-month period before hysterectomy was explored. Overall, 59.7% of patients did not receive any conservative intervention before hysterectomy. Individuals who underwent hysterectomy in more recent years and those with endometriosis, abnormal bleeding, greater comorbidity, or prior venous thromboembolism were more likely to receive conservative interventions.


Assuntos
Endometriose , Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Neoplasias Uterinas/cirurgia , Tratamento Conservador , Leiomioma/cirurgia , Histerectomia , Endometriose/cirurgia
3.
BMJ Case Rep ; 16(1)2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36653040

RESUMO

Although rare and unusual occurrences, a ruptured ectopic molar pregnancy (MP) and a ruptured uterine fibroid can lead to significant maternal morbidity and mortality. We present a unique case of these complications developing concurrently-resulting in the haemodynamic compromise of an otherwise healthy young female patient. The patient underwent a diagnostic laparoscopy which converted into a laparotomy, salpingectomy and myomectomy. Comprehensive histopathology confirmed the diagnosis of a ruptured ectopic complete MP and ruptured uterine fibroid. The patient recovered quickly within days. Prompt definitive management, conclusive histopathology and adequate follow-up were the hallmarks of this singular case. These key factors lead to the rare diagnosis of ruptured ectopic MP and uterine fibroid, prevention of adverse outcomes and provision of comprehensive patient care.


Assuntos
Mola Hidatiforme , Leiomioma , Gravidez Ectópica , Miomectomia Uterina , Neoplasias Uterinas , Gravidez , Feminino , Humanos , Gravidez Ectópica/diagnóstico , Leiomioma/complicações , Leiomioma/diagnóstico , Leiomioma/cirurgia , Mola Hidatiforme/complicações , Mola Hidatiforme/diagnóstico , Mola Hidatiforme/cirurgia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia
4.
Int J Hyperthermia ; 40(1): 2155077, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36603842

RESUMO

OBJECTIVES: To compare pregnancy outcomes after high-intensity focused ultrasound ablation (HIFU), myomectomy and uterine artery embolization (UAE) for fertility-sparing patients with uterine fibroids and to investigate the possible mechanism of improving pregnancy by HIFU. MATERIALS AND METHODS: A meta-analysis of 54 studies containing 12,367 patients was conducted to compare the pregnancy outcomes of three fertility-sparing therapies. And a retrospective self-control study of 26 patients with uterine fibroids from May 2019 to December 2020 was performed to assess the blood flow impedance of bilateral uterine arteries before and after HIFU. RESULTS: In the analysis by treatment option, the pregnancy rate after myomectomy was 0.43 (95% CI 0.36-0.49), which was higher than 0.18 (95% CI 0.10-0.26) after HIFU, the latter was significantly higher than that after UAE (ratio 0.08, 95% CI 0.06-0.10). The miscarriage rate after HIFU was 0.08 (95% CI 0.04-0.12), which was similar to 0.15 (95% CI 0.09-0.21) after myomectomy and also similar to 0.16 after UAE (95% CI 0.01-0.30). In the subgroup analysis, women who received ultrasound guided HIFU (USgHIFU) were more likely to have ideal pregnancy outcomes than that after magnetic resonance imaging-guided HIFU. The pulsatility index and resistance index on the right side were significantly higher 3 months after HIFU than before (1.637 ± 0.435 vs. 1.845 ± 0.469; p = 0.033; 0.729 ± 0.141 vs. 0.784 ± 0.081, p = 0.039). CONCLUSIONS: HIFU, especially USgHIFU, may be an alternative fertility-sparing modality for patients with uterine fibroids over 40 years old. HIFU may contribute to improving pregnancy rates by elevating uterine blood flow impedance.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Neoplasias Uterinas , Gravidez , Humanos , Feminino , Adulto , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/patologia , Estudos Retrospectivos , Resultado do Tratamento , Leiomioma/cirurgia , Leiomioma/patologia
5.
Mymensingh Med J ; 32(1): 168-176, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36594317

RESUMO

Uterine fibroids are benign tumor of the uterus that often appear during child bearing ages. Medical treatments are considered the first-line treatment to preserve fertility, avoid or delaying surgery. This randomized control study was carried out in OPD of Obstetrics and Gynecology Department of BSMMU, Dhaka, Bangladesh from May 2018 to March 2019 to evaluate the efficacy and safety of ulipristal acetate (5mg) once daily in reproductive women with three months treatment courses. Total 52 samples with symptomatic uterine fibroids for treatment course-1, among them 36 were needed for treatment course-2 which was slow or non-responding in treatment course-1. Main outcome measures were amenorrhea, controlled bleeding, fibroid volume, anaemia, quality of life. Sixty one percent (61.0%) of patients were achieved amenorrheic during both treatment courses. Ninety percent (90.0%) patients were control of bleeding during both treatment courses. In treatment course-1, reductions from baseline in fibroid volume were 62.70%, whereas in course-2, reductions in fibroid volume were 75.33%. Five percent (5.0%) of patients were discontinuing Ulipristal acetate due to adverse effects. Renal and liver function tests were performed before and after each course of treatment. The level of creatinine, SGPT in the blood for both treatment courses had no statistically significant effects. Ulipristal acetate may be an alternative to surgical treatment, the safety profiles and prolong effects with improvement of symptoms, quality of life after cessation of drugs. Repeated use of drugs reduces the size and also improves the patient's condition.


Assuntos
Leiomioma , Neoplasias Uterinas , Humanos , Feminino , Neoplasias Uterinas/tratamento farmacológico , Qualidade de Vida , Bangladesh , Leiomioma/tratamento farmacológico
6.
Diagn Pathol ; 18(1): 5, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36639698

RESUMO

BACKGROUND: Uterine adenosarcoma is a rare malignant tumor that accounts for 8% of all uterine sarcomas, and less than 0.2% of all uterine malignancies. However, it is frequently misdiagnosed in clinical examinations, including pathological diagnosis, and imaging studies owing to its rare and non-specific nature, which is further compounded by the lack of specific diagnostic markers. CASE PRESENTATION: We report a case of uterine adenosarcoma for which a comprehensive genomic profiling (CGP) test provided a chance to reach the proper diagnosis. The patient, a woman in her 60s with a history of uterine leiomyoma was diagnosed with an intra-abdominal mass post presentation with abdominal distention and loss of appetite. She was suspected to have gastrointestinal stromal tumor (GIST); the laparotomically excised mass was found to comprise uniform spindle-shaped cells that grew in bundles with a herringbone architecture, and occasional myxomatous stroma. Immunostaining revealed no specific findings, and the tumor was diagnosed as a spindle cell tumor/suspicious adult fibrosarcoma. The tumor relapsed during postoperative follow-up, and showed size reduction with chemotherapy, prior to regrowth. CGP was performed to identify a possible treatment, which resulted in detection of a JAZF1-BCORL1 rearrangement. Since the rearrangement has been reported in uterine sarcomas, we reevaluated specimens of the preceding uterine leiomyoma, which revealed the presence of adenosarcoma components in the corpus uteri. Furthermore, both the uterine adenosarcoma and intra-abdominal mass were partially positive for CD10 and BCOR staining. CONCLUSION: These results led to the conclusive identification of the abdominal tumor as a metastasis of the uterine adenosarcoma. The JAZF1-BCORL1 rearrangement is predominantly associated with uterine stromal sarcomas; thus far, ours is the second report of the same in an adenosarcoma. Adenosarcomas are rare and difficult to diagnose, especially in atypical cases with scarce glandular epithelial components. Identification of rearrangements involving BCOR or BCORL1, will encourage BCOR staining analysis, thereby potentially resulting in better diagnostic outcomes. Given that platinum-based chemotherapy was proposed as the treatment choice for this patient post diagnosis with adenosarcoma, CGP also indirectly contributed to the designing of the best-suited treatment protocol.


Assuntos
Adenossarcoma , Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Adenossarcoma/diagnóstico , Adenossarcoma/genética , Adenossarcoma/patologia , Proteínas Correpressoras , Diagnóstico Diferencial , Proteínas de Ligação a DNA , Genômica , Leiomioma/diagnóstico , Proteínas Repressoras/genética , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia , Idoso
7.
Clin Nucl Med ; 48(2): 199-200, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36607371

RESUMO

ABSTRACT: Subserosal cystic myoma with intense FDG uptake can resemble malignant cystic ovarian tumor and may lead to a false-positive diagnosis. A 49-year-old woman presented with chest pain for 4 months, and the initial chest CT showed multiple bone lesions. 18F-FDG PET/CT revealed not only multiple osteolytic lesions with FDG uptake but also a highly FDG-avid mass abutting the right side of the uterus. Ovarian malignancy with multiple bone metastases was considered initially. Subsequent biopsy confirmed multiple myeloma, and a subserosal uterine myoma was diagnosed by transvaginal sonography.


Assuntos
Neoplasias Ósseas , Leiomioma , Mieloma Múltiplo , Mioma , Neoplasias Ovarianas , Neoplasias Uterinas , Feminino , Humanos , Pessoa de Meia-Idade , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Uterinas/diagnóstico por imagem , Leiomioma/diagnóstico por imagem , Neoplasias Ósseas/secundário , Neoplasias Ovarianas/diagnóstico por imagem
8.
Nutrients ; 15(2)2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36678191

RESUMO

A similar abstract of the interim analysis was previously published in Fertility and Sterility. EPIGALLOCATECHIN GALLATE (EGCG) FOR TREATMENT OF UNEXPLAINED INFERTILITY ASSOCIATED WITH UTERINE FIBROIDS (PRE-FRIEND TRIAL): EARLY SAFETY ASSESSMENT. Uterine fibroids are the most common cause of unexplained infertility in reproductive-aged women. Epigallocatechin gallate (EGCG), a green tea catechin, has demonstrated its ability to shrink uterine fibroids in prior preclinical and clinical studies. Hence, we developed an NICHD Confirm-funded trial to evaluate the use of EGCG for treating women with fibroids and unexplained infertility (FRIEND trial). Prior to embarking on that trial, we here conducted the pre-FRIEND study (NCT04177693) to evaluate the safety of EGCG in premenopausal women. Specifically, our aim was to assess any adverse effects of EGCG alone or in combination with an ovarian stimulator on serum liver function tests (LFTs) and folate level. In this randomized, open-label prospective cohort, participants were recruited from the FRIEND-collaborative clinical sites: Johns Hopkins University, University of Chicago, University of Illinois at Chicago, and Yale University. Thirty-nine women, ages ≥18 to ≤40 years, with/without uterine fibroids, were enrolled and randomized to one of three treatment arms: 800 mg of EGCG daily alone, 800 mg of EGCG daily with clomiphene citrate 100 mg for 5 days, or 800 mg of EGCG daily with Letrozole 5 mg for 5 days. No subject demonstrated signs of drug induced liver injury and no subject showed serum folate level outside the normal range. Hence, our data suggests that a daily dose of 800 mg of EGCG alone or in combination with clomiphene citrate or letrozole (for 5 days) is well-tolerated and is not associated with liver toxicity or folate deficiency in reproductive-aged women.


Assuntos
Catequina , Infertilidade , Leiomioma , Humanos , Feminino , Adulto , Catequina/farmacologia , Letrozol , Estudos Prospectivos , Fígado , Leiomioma/tratamento farmacológico , Clomifeno , Ácido Fólico , Chá
9.
Am J Case Rep ; 24: e938390, 2023 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-36642936

RESUMO

BACKGROUND Reproductive health affects long-term quality of life, including in the elderly. Uterine inversion is common in postpartum women in developing countries and menopausal women are also at risk. CASE REPORT A 65-year-old menopausal woman had 3 children and a history of uterine tumors and curettage. She had received a different diagnosis - a cervical tumor - exactly 3 years ago. She was admitted to a referral hospital for lower abdominal pain, difficulty in defecating, and a mass in the genitals when straining, accompanied by blood clots. There was a 20×20 cm mass protruding from the vagina, and the uterine fundus of the uterus was not palpable. The patient was diagnosed with chronic uterine inversion due to submucous leiomyoma. Management requires the collaboration of multidisciplinary professionals in hospitals. These patients receive therapy to improve their general condition, transfusions, antibiotics, and a hysterectomy plan. The results of the Urogynecology Division showed that a 20×15 cm mass came out of the vagina, with a large necrotic area. The patient was first managed by Spinelli procedure to correct the uterine inversion, followed by an abdominal hysterectomy. Histopathology revealed the final diagnosis as a benign mesenchymal lesion, leiomyoma with myxoid degeneration. CONCLUSIONS Timely diagnosis and management by a multidisciplinary team can help reduce morbidity and mortality in patients with submucosal uterine leiomyoma leading to chronic uterine inversion.


Assuntos
Leiomioma , Inversão Uterina , Neoplasias Uterinas , Criança , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Inversão Uterina/diagnóstico , Inversão Uterina/etiologia , Inversão Uterina/cirurgia , Pós-Menopausa , Qualidade de Vida , Leiomioma/cirurgia , Leiomioma/diagnóstico , Neoplasias Uterinas/patologia , Doença Crônica
11.
Eur J Obstet Gynecol Reprod Biol ; 281: 23-28, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36527825

RESUMO

OBJECTIVE: To assess the efficacy of Uterine Myoma Position-based Radiofrequency Ablation (UMP-b RFA) at 36 months. An analysis of a new uterine fibroid ablation technique that allows personalized access of delivering radiofrequency energy (transvaginal, hysteroscopic or laparoscopic) based on myoma localization. STUDY DESIGN: Prospective observational cohort study in a community-based secondary care medical center enrolled 61 premenopausal women with 112 symptomatic uterine myomas. 112 fibroids were ablated in 5 ways with single or combined accesses: 82 Vaginal Ultrasound (VU)-guided RFA, 19 Laparoscopic (L)-RFA, 5 Hysteroscopic (H)-RFA, 5 VU+H-RFA, and 1 VU+L-RFA. The primary endpoint of this study was to evaluate the 3-year clinical outcome of UMP-b RFA. The secondary endpoint was the possible identification of predictors of its success. The outcomes evaluated at 12, 24, and 36 months after UMP-b RFA were myoma size, type of symptomatology suffered, quality of life based on the "Uterine Fibroid Symptom and Quality of Life" questionnaire, and interviews on the degree of satisfaction with this surgery. The reintervention and complication rates were also recorded and analyzed. RESULTS: Fibroids volume and diameter were significantly reduced by -90.2 % / -55.7 % at 36 months post-intervention (p < 0.001) and the reduction of Symptom Severity scores was -71.8 % three years after UMP-b RA (p < 0.001). The overall improvement in the quality of life was demonstrated by an increase in the Quality-of-Life score of + 26.0 % at the third follow-up (p < 0.001). 88.5 % of the patients interviewed would have the surgery done again if they went back in time. The reintervention rate was 10/61 (16.4 %): 3 hysterectomies, 3 myomectomies, 3 operative hysteroscopies and 1 VU-RFA reoperation. In this group of unsuccessful surgeries, the mean diameter of the dominant myomas was found to be greater than that of the successes (5.3 vs 4.4 cm.). Out of the 61 cases, no major complications occurred, and the 2 minor complications observed were self-limiting. CONCLUSION: Uterine Myoma Position-based Radiofrequency Ablation is a safe, effective, and minimally invasive solution for the treatment of symptomatic fibroids. Indeed, these clinical outcome data at 36 months shows how UMP-b RFA can treat the symptomatology of uterine fibromatosis. Hysterectomies or myomectomies were successfully avoided in more than 80 % of women bearing myomas with an average diameter of less than 5 cm.


Assuntos
Leiomioma , Mioma , Ablação por Radiofrequência , Neoplasias Uterinas , Humanos , Feminino , Neoplasias Uterinas/cirurgia , Seguimentos , Estudos Prospectivos , Qualidade de Vida , Leiomioma/cirurgia , Ablação por Radiofrequência/métodos , Uridina Monofosfato , Resultado do Tratamento
12.
Int J Gynaecol Obstet ; 160(2): 492-501, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36511801

RESUMO

OBJECTIVE: To determine treatment options (myomectomy vs. uterine artery embolization (UAE)) for women wishing to avoid hysterectomy. METHODS: A multicenter randomized controlled trial was conducted on 254 women and data were collected on fibroid-specific quality of life (UFS-QOL), loss of menstrual blood, and pregnancy. RESULTS: At 4 years, the mean difference in the UFS-QOL was 5.0 points (95% confidence interval (CI) -1.4 to 11.5; P = 0.13) in favor of myomectomy. This was not statistically significant as it was at 2 years. There were no differences in bleeding scores, rates of amenorrhea, or heavy bleeding. Of those who were still menstruating, the majority reported regular or fairly regular periods: 36 of 48 (75%) in the UAE group and 30 of 39 (77%) in the myomectomy group. Twelve women after UAE and six women after myomectomy became pregnant (4 years) with seven and five live births, respectively (hazard ratio 0.48, 95% CI 0.18-1.28). There was no difference between the levels of hormones associated with the uterine reserve in each group. CONCLUSION: Leiomyoma are common in reproductive-aged women, causing heavy menses and subfertility. Among women with uterine fibroids, myomectomy resulted in better fibroid-related quality of life at 4 years, compared with UAE but the treatments decreased menstrual bleeding equally. There was also no significant difference in the impact of treatment on ovarian reserve.


Assuntos
Leiomioma , Menorragia , Embolização da Artéria Uterina , Miomectomia Uterina , Neoplasias Uterinas , Gravidez , Feminino , Humanos , Adulto , Embolização da Artéria Uterina/métodos , Qualidade de Vida , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/complicações , Menorragia/cirurgia , Leiomioma/cirurgia , Leiomioma/complicações , Histerectomia , Resultado do Tratamento
13.
Genes Chromosomes Cancer ; 62(1): 27-38, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35822448

RESUMO

Uterine leiomyomas, or fibroids, are very common smooth muscle tumors that arise from the myometrium. They can be divided into distinct molecular subtypes. We have previously shown that 3'RNA-sequencing is highly effective in classifying archival formalin-fixed paraffin-embedded (FFPE) leiomyomas according to the underlying mutation. In this study, we performed 3'RNA-sequencing with 111 FFPE leiomyomas previously classified as negative for driver alterations in mediator complex subunit 12 (MED12), high mobility group AT-hook 2 (HMGA2), and fumarate hydratase (FH) by Sanger sequencing and immunohistochemistry. This revealed 43 tumors that displayed expression features typically seen in HMGA2-positive tumors, including overexpression of PLAG1. We explored 12 such leiomyomas by whole-genome sequencing to identify their underlying genomic drivers and to evaluate the feasibility of detecting chromosomal driver alterations from FFPE material. Four tumors with significant HMGA2 overexpression at the protein-level served as controls. We identified chromosomal rearrangements targeting either HMGA2, HMGA1, or PLAG1 in all 16 tumors, demonstrating that it is possible to detect chromosomal driver alterations in archival leiomyoma specimens as old as 18 years. Furthermore, two tumors displayed biallelic loss of DEPDC5 and one tumor harbored a COL4A5-COL4A6 deletion. These observations suggest that instead of only HMGA2-positive leiomyomas, a distinct leiomyoma subtype is characterized by rearrangements targeting either HMGA2, HMGA1, or PLAG1. The results indicate that the frequency of HMGA2-positive leiomyomas may be higher than estimated in previous studies where immunohistochemistry has been used. This study also demonstrates the feasibility of detecting chromosomal driver alterations from archival FFPE material.


Assuntos
Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia , Proteína HMGA1a/genética , Leiomioma/genética , Leiomioma/patologia , Proteína HMGA2/genética , Proteína HMGA2/metabolismo , Fumarato Hidratase/genética , Aberrações Cromossômicas , Mutação , Fatores de Transcrição/genética , RNA , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo
14.
J Gynecol Obstet Hum Reprod ; 52(1): 102517, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36481492

RESUMO

BACKGROUND: Uterine leiomyoma (UL) is the most common benign tumor of the reproductive period and become a major health problem. The present umbrella review assessed the environmental risk factors associated with UL based on meta-analyses studies. MATERIALS AND METHODS: We searched three Major databases until February 2022. The meta-analyses that had focused on evaluating the environmental risk factors associated with the UL were included. The summary effect estimates, 95% CI, heterogeneity I², 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis were applied. We used A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) for assessing the quality of the meta-analyses. RESULT: The risk factor of chronic psychological stress (OR 1.24, 95% CI: 1.15, 1.34) and obesity (OR 1.19, 95% CI: 1.09, 1.29) was graded as suggestive evidence (class III). The current alcohol intake (OR 1.33, 95% CI: 1.01, 1.76) was graded as the risk factor with weak evidence (class IV). Current oral contraceptive (OCP) use (RR 0.43, 95% CI: 0.25, 0.73) (class IV), and former smokers (OR 0.93, 95% CI: 0.88, 0.99) (class IV) were as the protective factors. CONCLUSION: The current alcohol intake, chronic psychological stress, and obesity were risk factors for the UL, but current OCP use and former smokers were the protective factors.


Assuntos
Leiomioma , Humanos , Leiomioma/epidemiologia , Leiomioma/etiologia , Fatores de Risco , Obesidade/complicações , Obesidade/epidemiologia
15.
Rev. esp. enferm. dig ; 115(1): 37-38, 2023. ilus
Artigo em Inglês | IBECS | ID: ibc-ADZ-504

RESUMO

An endoscopic full-thickness resection with FTRD system (Ovesco Endoscopy, Tübingen, Germany) was performed in a 69-year-old man with a granular laterally spreading tumor (G-LST) with non-lifting sign in the ascending colon. Histology showed a low-grade dysplasia tubulovillous adenoma, R0 resection. At surveillance colonoscopy after 12 months, the clip was found with a polypoid tissue with regular mucosal surface pattern trapped inside. Since the length of time the clip was left in place ensured proper healing and in order to avoid any recurrence of adenoma in the area, the polypoid lesion and the clip were resected en bloc. The histological study revealed a polypoid formation with muscular tissue surrounded by healthy mucosa, suggesting a leiomyoma. Immunohistochemical actine staining confirmed the presence of muscularis mucosae and the muscularis propria inside the polypoid lesion, due to a full-thickness clip entrapment of the colon wall, with the development a leiomyoma-like clip artifact. The presence of foreign bodies such as clips at the resection site may produce artifacts leading to confusion in the diagnosis as in this case in which it has been able to produce an abnormal growth of the muscularis propria. The detection of a clip artifact leiomyoma has not yet been reported and highlights the importance of transmitting correct information about the case and the technique to the pathologist in order to achieve a correct diagnosis (AU)


Assuntos
Humanos , Masculino , Idoso , Leiomioma/diagnóstico , Adenoma/diagnóstico , Neoplasias do Colo/diagnóstico , Diagnóstico Diferencial , Imuno-Histoquímica , Colonoscopia
16.
Eur J Obstet Gynecol Reprod Biol ; 280: 179-183, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36512958

RESUMO

OBJECTIVE: To assess the utilization and cost of intraoperative cell salvage (ICS) in minimally invasive myomectomy. STUDY DESIGN: Retrospective cohort study of patients who underwent minimally invasive myomectomy at a quaternary care academic hospital. Patients were classified into: ICS setup vs no ICS setup, ICS setup with reinfusion vs ICS setup without reinfusion. RESULTS: Of 382 patients who underwent minimally invasive myomectomy, 67 (17.5 %) had ICS setup, 30 (44.8 %) of those patients reinfused. Median volume of reinfusion per patient was 300 mL (range 125-1000 mL). Patients who ultimately underwent ICS reinfusion, compared to those with ICS setup only, had significantly larger mean maximum fibroid size (9.8 cm vs 8.0 cm, p = 0.02), higher median total specimen weight (367 vs 304 g, p = 0.03), higher median estimated blood loss (575 vs 300 mL, p < 0.0001), longer mean operative time (261 vs 215 min, p = 0.04). No perioperative complications were associated with ICS. Higher costs are associated with universal use or complete lack of ICS; lowest cost is associated with ICS setup only for those ultimately reinfused. CONCLUSION: ICS might reduce requirements for allogeneic blood transfusions in patients undergoing minimally invasive myomectomy, and may contribute to cost savings. Uterine and maximum fibroid sizes are possible preoperative indicators for patients who require cell salvage reinfusion.


Assuntos
Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Humanos , Estudos Retrospectivos , Leiomioma/cirurgia , Útero , Transfusão de Sangue , Neoplasias Uterinas/cirurgia
17.
Int J Hyperthermia ; 40(1): 2154575, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36535925

RESUMO

INTRODUCTION: Uterine fibroids are the most common benign tumors in healthy women. High Intensity Focused Ultrasound (HIFU) is a modern, noninvasive thermal ablation method for treating uterine fibroids. There is increasing evidence that ultrasound guided HIFU (US-HIFU) has no adverse impact on ovarian reserve but little data exists on magnetic resonance guided HIFU (MR-HIFU). There are different options to estimate ovarian reserve, perhaps the most reliable being the measurement of serum Anti-Müllerian hormone (AMH). MATERIAL AND METHODS: Seventy-four (74) premenopausal women with serum AMH 0.1 ug/L or over, aged 24-48 and with fibroids or adenomyosis treated with MR-HIFU were enrolled in our study. AMH levels were analyzed before and 3 months after the MR-HIFU treatment. Correlations between AMH level changes and position of fibroids, fibroid volume, non-perfused volume ratio, and treatment energies were studied. RESULTS: The median AMH level before the HIFU treatment was 1.20 (range: 0.1-7.75 ug/L) and after the treatment 1.23 (range: 0.1-8.51 ug/L). No significant change was detected (p = .90). The patients were divided in three subgroups depending on the baseline AMH levels. The changes were not significant in any of the subgroups. Neither did the location of the treated fibroid affect the change of AMH levels nor the total energy used during treatment. CONCLUSIONS: MR-HIFU does not compromise the ovarian reserve. Neither the location of the treated fibroid nor the total energy used during MR-HIFU had any effect on the change of AMH levels.


Assuntos
Adenomiose , Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Reserva Ovariana , Neoplasias Uterinas , Humanos , Feminino , Neoplasias Uterinas/cirurgia , Adenomiose/terapia , Resultado do Tratamento , Leiomioma/cirurgia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética
18.
Int J Hyperthermia ; 40(1): 2154576, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36535945

RESUMO

OBJECTIVE: This study compared the feasibility and efficacy of transabdominal ultrasound (TAU) and combined transabdominal and transvaginal ultrasound (TA/TV US)-guided percutaneous microwave ablation (PMWA) for uterine myoma (UM). METHOD: This study enrolled 73 patients with UM who underwent PMWA via the transabdominal ultrasound-guided (TA group) or the combined transabdominal and transvaginal ultrasound-guided (TA/TV group) approaches. The intraoperative supplementary ablation rates, postoperative immediate ablation rates, lesion reduction rates and other indicators three months postoperatively were compared between the groups. The display of the needle tip, endometrium, uterine serosa, rectum and myoma feeding vessels under the guidance of TAU, transvaginal ultrasound (TVU) and TA/TV US were evaluated in the TA/TV group. RESULTS: In the TA/TV group, the real-time position of the needle tip and the endometrium complete display rate of the same lesions with TVU guidance were significantly higher than those using TAU. TA/TV US guidance significantly improved the complete display rate of each indicator. The intraoperative supplementary ablation rate in the TA/TV group was lower than that in the TA group. Similarly, the postoperative immediate ablation and volume reduction rates of the lesions three months postoperatively were higher than those in the TA group, especially for lesions with a maximum diameter ≥6 cm. CONCLUSION: TA/TV US is an effective monitoring method that can be used to improve imaging display. Its use is recommended in patients with obesity, poor transabdominal ultrasound image quality and large myoma volumes.


Assuntos
Leiomioma , Mioma , Neoplasias Uterinas , Feminino , Humanos , Micro-Ondas , Leiomioma/cirurgia , Ultrassonografia , Ultrassonografia de Intervenção , Neoplasias Uterinas/cirurgia
19.
Dig Dis ; 40(4): 427-435, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34619683

RESUMO

BACKGROUND: Endoscopic ultrasonography (EUS) is crucial to diagnose and evaluate gastrointestinal mesenchymal tumors (GIMTs). However, EUS-guided biopsy does not always differentiate gastrointestinal stromal tumors (GISTs) from leiomyomas. We evaluated the ability of a convolutional neural network (CNN) to differentiate GISTs from leiomyomas using EUS images. The conventional EUS features of GISTs were also compared with leiomyomas. PATIENTS AND METHODS: Patients who underwent EUS for evaluation of upper GIMTs between 2010 and 2020 were retrospectively reviewed, and 145 patients (73 women and 72 men; mean age 54.8 ± 13.5 years) with GISTs (n = 109) or leiomyomas (n = 36), confirmed by immunohistochemistry, were included. A total of 978 images collected from 100 patients were used to train and test the CNN system, and 384 images from 45 patients were used for validation. EUS images were also evaluated by an EUS expert for comparison with the CNN system. RESULTS: The sensitivity, specificity, and accuracy of the CNN system for diagnosis of GIST were 92.0%, 64.3%, and 86.98% for the validation dataset, respectively. In contrast, the sensitivity, specificity, and accuracy of the EUS expert interpretations were 60.5%, 74.3%, and 63.0%, respectively. Concerning EUS features, only higher echogenicity was an independent and significant factor for differentiating GISTs from leiomyomas (p < 0.05). CONCLUSIONS: The CNN system could diagnose GIMTs with higher accuracy than an EUS expert and could be helpful in differentiating GISTs from leiomyomas. A higher echogenicity may also aid in differentiation.


Assuntos
Neoplasias Gastrointestinais , Tumores do Estroma Gastrointestinal , Leiomioma , Adulto , Idoso , Endossonografia , Feminino , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/patologia , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Masculino , Pessoa de Meia-Idade , Redes Neurais de Computação , Estudos Retrospectivos
20.
Reprod Sci ; 29(10): 2786-2809, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-34480321

RESUMO

Newer minimally invasive techniques provide treatment options for symptomatic uterine fibroids while allowing uterus preservation. The objective of this review was to analyze the efficacy of uterine-preserving, minimally invasive treatment modalities in reducing fibroid-related bleeding. A comprehensive search was conducted of PubMed, Embase, PsycINFO, ClinicalTrials.gov, Scopus, and Cochrane Library databases from inception to July 2020. English-language publications that evaluated premenopausal women with fibroid-related bleeding symptoms before and after treatment were considered. Randomized controlled trials were assessed for bias with the established Cochrane Risk of Bias Tool 2.0 and observational studies were assessed for quality under the New Castle-Ottawa Scale guidelines. Eighty-four studies were included in the review, including 10 randomized controlled trials and 74 observational studies. Six studies on myomectomy demonstrated overall bleeding symptom improvement in up to 95.9% of patients, though there was no significant difference between mode of myomectomy. Forty-one studies on uterine artery embolization reported significant reduction of fibroid-related bleeding, with symptomatic improvement in 79 to 98.5% of patients. Three studies suggested that embolization may be superior to myomectomy in reducing fibroid-related bleeding. Six studies reported that laparoscopic uterine artery occlusion combined with myomectomy led to greater reduction of bleeding than myomectomy alone. Fifteen studies demonstrated significantly reduced bleeding severity after radiofrequency ablation (RFA). Additional research is needed to establish the superiority of these modalities over one another. Long-term evidence is limited in current literature for magnetic resonance-guided focused ultrasound surgery, cryomyolysis, microwave ablation, and laser ablation.


Assuntos
Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/complicações , Leiomioma/cirurgia , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/cirurgia , Útero/irrigação sanguínea
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