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1.
Nutrients ; 13(2)2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33670322

RESUMO

Uterine fibroids (UFs) are the most common benign gynecological tumors. It was estimated that fifty percent of women presenting with UFs has symptomatology that negatively influences their quality of life. Pharmacological and/or surgical treatments are frequently required, depending on the woman's desire to preserve fertility, with a high impact on healthcare costs. Generally, the use of currently available pharmacological treatments may lead to side effects. Therefore, there is a growing interest in a natural and safe approach for UFs. In recent years, epidemiological studies reported a vitamin D deficiency in patients with UFs raised interest in the potential biological effects of vitamin D supplementation. In vitro studies proved vitamin D efficacy in inhibiting UFs growth by targeting pathways involved in the regulation of various biological processes, including proliferation, extracellular matrix (ECM) remodeling, DNA repair, signaling and apoptosis. However, clinical studies supported only in part the beneficial effects of vitamin D supplementation in reducing UFs growth and tumor volume. Randomized controlled trials and large population studies are mandatory as the potential clinical benefits are likely to be substantial.


Assuntos
Leiomioma/terapia , Neoplasias Uterinas/terapia , Vitamina D/administração & dosagem , Animais , Apoptose/efeitos dos fármacos , Reparo do DNA/efeitos dos fármacos , Suplementos Nutricionais , Feminino , Humanos , Leiomioma/epidemiologia , Leiomioma/patologia , Transdução de Sinais/efeitos dos fármacos , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/patologia , Vitamina D/farmacologia , Vitamina D/fisiologia , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/epidemiologia
2.
Anaesthesia ; 76 Suppl 4: 46-55, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682092

RESUMO

A number of benign and malignant gynaecological conditions can cause infertility. Advancements in assisted reproductive technologies have facilitated the rapidly evolving subspecialty of fertility preservation. Regardless of clinical indication, women now have the reproductive autonomy to make fully informed decisions regarding their future fertility. In particular, there has been an increasing interest and demand among patients and healthcare professionals for fertility-sparing surgery. Gynaecologists find themselves continually adapting surgical techniques and introducing novel procedures to facilitate this rapidly emerging field and anaesthetists need to manage the consequent physiological demands intra-operatively. Not only is it important to understand the surgical procedures now undertaken, but also the intra-operative management in an ever evolving field. This article reviews the methods of fertility-sparing surgery and also describes important anaesthetic challenges including peri-operative care for women undergoing complex fertility-sparing surgeries such as uterus transplantation.


Assuntos
Anestésicos/administração & dosagem , Útero/cirurgia , Endometriose/patologia , Endometriose/cirurgia , Feminino , Preservação da Fertilidade , Humanos , Leiomioma/patologia , Leiomioma/cirurgia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Útero/transplante
3.
Medicine (Baltimore) ; 100(8): e24911, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663124

RESUMO

RATIONALE: Vaginal leiomyoma is a rare type of leiomyoma that occurs on the wall of vagina. Treatment for vaginal leiomyoma is varied and is based on the location and size of the leiomyoma. PATIENT CONCERNS: In this case, a 24-year-old newly married Chinese woman complained of dyspareunia. The physical examination revealed a solid mass on the anterior wall of vagina. It almost filled up the whole vagina cavity. DIAGNOSIS: Transvaginal ultrasound showed a tumor on the anterior wall of vagina. Pelvic computed tomography (CT) and magnetic resonance imaging (MRI) also confirmed the tumor on vaginal wall. Fine needle aspiration biopsy confirmed fibrous and smooth muscle tissue in the tumor, and immunohistochemical examination found the estrogen receptor (ER) and progesterone receptor (PR) were positive. INTERVENTIONS: 6 courses of gonadotropin-releasing hormone (GnRH) analogue were given before the patient underwent complete surgical resection through vagina. OUTCOME: No postoperative complications occurred, and the patient was discharged from the hospital 3 days after surgery. Follow-up after 3 months revealed negative symptoms of genitourinary system. No sign of recurrence was found. CONCLUSION: In this case, vaginal leiomyoma was diagnosed with help of imagological examinations like ultrasound, CT, and MRI, as well as pathological examination like fine needle aspiration biopsy. Preoperative GnRH analogue treatment can ensure smooth surgical procedure, and reduce blood loss during surgery.


Assuntos
Leiomioma/patologia , Neoplasias Vaginais/patologia , Antineoplásicos Hormonais/uso terapêutico , Biópsia por Agulha Fina , Terapia Combinada , Feminino , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/terapia , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Neoplasias Vaginais/diagnóstico por imagem , Neoplasias Vaginais/terapia , Adulto Jovem
4.
AJR Am J Roentgenol ; 216(4): 967-974, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33594913

RESUMO

OBJECTIVE. The purpose of this article was to evaluate MRI features of uterine leiomyomas that predict volumetric response after uterine artery embolization (UAE). MATERIALS AND METHODS. This retrospective study included 75 patients with 212 uterine leiomyomas who were successfully treated between August 2013 and December 2018. To predict uterine volumetric response, age, number of lesions, and baseline uterine volume were assessed. To predict leiomyoma volumetric response, a multivariate regression analysis was performed to evaluate six predictive factors: location, baseline leiomyoma volume, signal intensity on T1-weighted and T2-weighted MRI, heterogeneity of signal intensity on T2-weighted MRI, and vascularity on subtraction imaging (SI). A five-variable predictive ROC model was developed to evaluate the diagnostic accuracy of the signal intensity ratio on T2-weighted MRI, enhancement ratio, heterogeneity ratio on T2-weighted MRI, location, and baseline leiomyoma volume in predicting at least 40% leiomyoma volumetric response. RESULTS. Age, number of leiomyomas, and baseline uterine volume were not predictive of uterine volumetric response. A submucosal location was the best predictive factor of leiomyoma volumetric response, and it showed 32.2% more leiomyoma volumetric response compared with a nonsubmucosal location (p < .001). Hyperintensity on T2-weighted MRI was the second best predictive factor of leiomyoma volumetric response, and it showed 16.9% more volumetric response compared with hypointense leiomyomas (p = .013). A small baseline leiomyoma volume (< 58 cm3) was associated with 10.2% more leiomyoma volumetric response compared with larger leiomyomas (p = .01). Leiomyomas that were hyperintense on SI showed 7.9% more leiomyoma volumetric response compared with those that were hypointense (p = .014). The five-variable ROC model showed high diagnostic accuracy with an AUC of 0.85, sensitivity of 82%, and specificity of 71%. CONCLUSION. A submucosal location, hyperintensity on T2-weighted MRI, small baseline leiomyoma volume (< 58 cm3), and hyperintense leiomyoma on subtraction imaging are the main independent favorable predictors of leiomyoma volumetric response after UAE. An accurate predictive ROC model was developed that may help in selecting patients suitable for UAE. Quantitative assessment of heterogeneity on T2-weighted MRI showed promising results as a predictor of volumetric response, and further research in this area using texture analysis and radiomics is suggested.


Assuntos
Leiomioma/terapia , Imagem por Ressonância Magnética , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Adulto , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologia , Útero/diagnóstico por imagem , Útero/patologia , Adulto Jovem
5.
Int J Mol Sci ; 22(4)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33557274

RESUMO

Uterine smooth muscle tumors of uncertain malignant potential (STUMPs) represent a heterogeneous group of tumors that cannot be histologically diagnosed as unequivocally benign or malignant. For this reason, many authors are working to obtain a better definition of diagnostic and prognostic criteria. In this work, we analyzed the genomic and epigenomic profile of uterine smooth muscle tumors (USMTs) in order to find similarities and differences between STUMPs, leiomyosarcomas (LMSs) and leiomyomas (LMs), and possibly identify prognostic factors in this group of tumors. Array-CGH data on 23 USMTs demonstrated the presence of a more similar genomic profile between STUMPs and LMSs. Some genes, such as PRKDC and PUM2, with a potential prognostic value, were never previously associated with STUMP. The methylation data appears to be very promising, especially with regards to the divergent profile found in the sample that relapsed, characterized by an overall CGI hypomethylation. Finally, the Gene Ontology analysis highlighted some cancer genes that could play a pivotal role in the unexpected aggressive behavior that can be found in some of these tumors. These genes could prove to be prognostic markers in the future.


Assuntos
Biomarcadores Tumorais/genética , Epigenômica , Regulação Neoplásica da Expressão Gênica , Leiomioma/patologia , Leiomiossarcoma/patologia , Tumor de Músculo Liso/patologia , Neoplasias Uterinas/patologia , Adulto , Idoso , Estudos de Casos e Controles , Metilação de DNA , Feminino , Seguimentos , Genômica , Humanos , Leiomioma/genética , Leiomiossarcoma/genética , Masculino , Pessoa de Meia-Idade , Prognóstico , Tumor de Músculo Liso/genética , Neoplasias Uterinas/genética
6.
APMIS ; 129(4): 165-169, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33445214

RESUMO

We aimed to assess whether the presence of atypical mitotic figures (AMF) in smooth muscle tumors of uncertain malignant potential (STUMP) of the uterus and uterine adnexa is associated with increased risk of recurrence, and the association of AMF with the Stanford criteria, that is, significant cytologic atypia, mitotic index ≥ 10/10HPF, and coagulative tumor cell necrosis (CTCN). A systematic review was performed to identify all studies reporting the presence of AMF and oncologic outcomes in STUMP series. Fisher's exact test was used to assess the association of AMF with the three Stanford parameters. Kaplan-Meier and Cox regression survival analyses with hazard ratio (HR) calculation were performed to assess the association between AMF and STUMP recurrence. A p-value < 0.05 was considered significant. Five studies with 80 STUMPs were included, out of which 23.8% had AMF. AMF were significantly associated with the presence of significant atypia (p = 0.023), but not with the presence of a mitotic index ≥ 10/10HPF (p = 0.769), CTCN (p = 1), or more than one Stanford parameter (p = 0.171). AMF was not significantly associated with the risk of STUMP recurrence at both univariate (HR = 0.366; p = 0.188) and multivariate analyses (HR = 0.528; p = 0.463). In STUMP of the uterus and uterine adnexa, AMF are more common in the case of significant cytologic atypia, but do not seem to increase the risk of recurrence. Further studies are necessary in this regard.


Assuntos
Leiomioma/patologia , Neoplasias Uterinas/patologia , Doenças dos Anexos/patologia , Feminino , Humanos , Mitose , Prognóstico
7.
Clin Nucl Med ; 46(1): e6-e7, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32604103

RESUMO

Rectal leiomyoma is an exceedingly rare benign lesion. We here report a case with extraluminal leiomyoma of the middle and lower parts of the rectum showing aberrant hypermetabolism on F-FDG PET/CT in a 54-year-old man.


Assuntos
Fluordesoxiglucose F18 , Leiomioma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retais/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Leiomioma/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/patologia
8.
Cancer Sci ; 112(5): 2046-2059, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33338329

RESUMO

Uterine leiomyosarcoma (LMS) is a rare but deadly disease. Due to poor understanding of the molecular and genetic causes of the disease, the diagnosis of LMS has been based primarily on histology. Nuclear atypia is one of hallmarks in LMS, however, it also occurs in 2 clinically benign variants, including smooth muscle tumors with fumarate hydratase alteration (SMT-FH) and leiomyoma with bizarre nuclei (LM-BN). In addition to nuclear atypia, many well recognized biomarkers used for LMS are also frequently overexpressed in LM-BN, and the histogenesis and molecular natures for LM-BN and LMS remain largely unknown. To characterize the molecular profiling of LMS, SMT-FH, and LM-BN, we performed integrated comprehensive genomic profiling including whole-genome sequencing (WGS) and RNA sequencing and genomic microarray analyses to assess genome-wide copy number alterations (CNAs) and immunohistochemistry (IHC) in all 3 tumor types. We found that both LM-BN and LMS showed genomic instability and harbored extensive CNAs throughout the whole genome. By contrast, the SMT-FH presented its characteristic 1q43-44 deletions in all cases tested, with minimal CNAs in the rest of genomic regions. Further analyses revealed that LMS and LM-BN groups showed similar patterns of CNAs that are tended to cluster together and separated from the SMT-FH group. The integrated molecular profiling enabled the detection of novel and traditional biomarkers and showed excellent discrimination between LM-BN and LMS. Our study suggests that LM-BN, despite having similar nuclear atypia to SMT-FH, showed similar genomic instability but distinct genomic alterations with its malignant counterpart of LMS. The integrated molecular profiling is of clinical importance in characterizing these rare uterine smooth muscle tumors.


Assuntos
Leiomioma/genética , Leiomioma/patologia , Leiomiossarcoma/genética , Leiomiossarcoma/patologia , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia , Adulto , Biomarcadores Tumorais , Núcleo Celular/patologia , Feminino , Fumarato Hidratase/genética , Deleção de Genes , Dosagem de Genes , Perfilação da Expressão Gênica , Humanos , Pessoa de Meia-Idade , Músculo Liso , Necrose , Análise de Componente Principal , Análise de Sequência de RNA/métodos , Análise Serial de Tecidos/métodos
10.
Wiad Lek ; 73(9 cz. 2): 2004-2009, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148849

RESUMO

OBJECTIVE: The aim: To conduct a comparative analysis of the results of ultrasound and hysteroscopic examinations with further histopathological findings and the clinical and anamnestic features of patients with hyperproliferative pathology in order to determine the etiopathogenetic mechanisms of the development of endometrial pathological processes. PATIENTS AND METHODS: Materials and methods: We studied 119 medical records of patients of the Gynecological Department of Minipal Non-Commercial Enterprise "Ternopil Municipal City Hospital No. 2", who applied for medical assistance because of benign endometrial hyperplasia in the reproductive age with a verified diagnosis of "uterine polyp" during 2017-2018. The control group consisted of 30 patients of the same age group, with menstrual disorders with no signs of hyperplastic processes of endometrium. With the consent of the patients, they were treated with diagnostic hysteroscopy in order to study evacuated material from the uterus. The results of the histological study confirmed the absence of signs of hyperplastic processes of endometrium. The results of diagnostic methods were evaluated by comparing the material's histological data with the results of ultrasound and hysteroresectoscopy. RESULTS: Results: Taking into account the results of our research, women with hyperplastic processes of endometrium have the risk of the pathology of the nervous system is in 2.71 times higher (OR=2.71, CI-0.88: 8.33), cardiovascular pathology-in 2.04 (OR=2.04, CI-0.57:7.34), vascular diseases of the lower extremities-in 1.81 times (OR=1.81, CI-0.21:15.32) compared with the control group. While the risk of pathology of the urinary system and organs of vision is only-OR=0.48, CI-0.11:2.03 and OR=0.75, CI-0.08:7.48, respectively. Analyzing the results of the study using ultrasound examination, it was found that endometrial polyposis in combination with uterine leiomyoma was not detected in 3 women (15%), while all the results of hysteroscopy were confirmed by histopathological studies. When the endometrial hyperplastic processes were combined with adenomyosis- according to ultrasound examination a false positive result was obtained in 2 patients (13.3%), and in a hysteroscopic study we determined -1 false positive result. In patients the diagnosis of "endometrial polyp" according to the results of hysteroscopy was not confirmed in 2 women (2 false positive results 2.99%) and in 5 cases of ultrasound examination (5 false negative results 7.46%). The use of ultrasound examinations in patients with endometrial hyperplastic changes, according to our data, made it possible to identify pathology in 88.39% of cases, while the information content of the hysteroscopy was 98.21% (p<0.001). CONCLUSION: Conclusions: Thus, the results of the subjective examination of patients in the gynecological department: complaints, anamnestic data on gynecological and extragenital pathology should be used to identify etiopathogenetic factors and the formation of risk groups for the occurrence of hyperplastic processes of endometrium. Women with cervical erosion, uterine myoma and episodes of herpetic rash on the mucous membranes in past medical history have a higher likelihood of hyperplastic processes of endometrium. The vast majority of patients (63.87%) with polyps of the body of the uterus have a combined hyperproliferative pathology, which requires an individual approach to planning the scope of diagnostic examination and the choice of treatment method. Visualization of endometrium with hysteroscopy is more informative than ultrasound for diagnosing hyperproliferative processes, including uterine polyps. Hysteroscopic polypectomy has a high level of both clinical and economic benefits as well as diagnostic value in patients with hyperplastic processes of endometrium.


Assuntos
Leiomioma , Pólipos , Doenças Uterinas , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Histeroscopia , Leiomioma/patologia , Pólipos/diagnóstico por imagem , Pólipos/patologia , Gravidez , Doenças Uterinas/diagnóstico por imagem
11.
J Cancer Res Ther ; 16(4): 884-887, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32930135

RESUMO

Objective: Paraoxonase 1 (PON1) plays a defensive role against oxidative stress by destroying oxidized lipids. Q192R single nucleotide polymorphism of PON1 gene alters the enzyme's activity. Several investigations reported a link between Q192R and an increased risk of developing tumors including uterine leiomyomas. We assessed the antioxidant effects of Q192R on myoma which fluctuate in frequency between populations. Study Design: The cohort consisted of 68 unrelated uterine leiomyoma patients and 93 healthy controls that were randomly selected from women with no ultrasonographic evidence of myoma. Materials and Methods: Genotyping was performed using tetra-primer amplification refractory mutation system-polymerase chain reaction. Chi-square test was selected to evaluate differences between the groups. Results: To analyze the correlation between PON1 Q192R and leiomyoma risk, the AA genotype was given as a reference genotype then the two other genotypes were compared with the reference. A significantly (P < 0.05) increased risk of myoma was observed with both Q192R homozygote GG and heterozygote AG genotypes. The odds ratio (OR) of AG genotype was calculated 1.8 (confidence interval [CI]: 0.94-3.62). A higher OR was seen with GG genotype (OR: 2.8; 95% CI: 0.98-8.18). Conclusion: Oxidative stress has been suspected of having a link with tumor development, and the role of endogenous-free radical scavenger is taken into consideration. Increased protein oxidative stress status and reduced antioxidant capacity have been observed in leiomyomas patients. Our study indicates that the low-antioxidant PON1 R192 allele correlates to leiomyoma development.


Assuntos
Arildialquilfosfatase/genética , Leiomioma/genética , Neoplasias Uterinas/genética , Adulto , Arildialquilfosfatase/metabolismo , Estudos de Casos e Controles , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Leiomioma/enzimologia , Leiomioma/patologia , Polimorfismo de Nucleotídeo Único , Neoplasias Uterinas/enzimologia , Neoplasias Uterinas/patologia
12.
Clin Imaging ; 67: 250-254, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32890909

RESUMO

We present a compelling case of a 45-year-old female with a history of endometriosis and leiomyomas, who presented to her gynecologist with chronic pelvic pain complaints. Both a transvaginal ultrasound (US) and an MRI (magnetic resonance imaging) were ordered. The US demonstrated multiple uterine lesions, likely fibroids, and an endometrioma within the right ovary. The MRI of the pelvis with and without gadolinium identified a mass within the right ovary with homogenous intermediate T2-signal, restricted diffusion, and delayed enhancement relative to the myometrium. Several irregular-shaped lesions were also noted within the external myometrium, anterior pelvic wall, and the peritoneum, which were intermediate signal on T2-weighted images, restricted diffusion, and an enhancement pattern similar to the myometrium. The patient underwent a right adnexectomy. The histopathology findings were consistent with a low-grade endometrial stromal sarcoma (low grade-ESS) arising from the endometrial stroma of the right ovary. A debulking surgery confirmed the involvement of external myometrium, anterior pelvic wall, and the peritoneum secondary to a low-grade ESS without the endometrial cavity's involvement. The underlying hypothesis is that the endometriosis stroma from extra-uterine structures such as the right ovary, pelvic and anterior peritoneum, and external myometrium may have subsequently resulted in a low-grade ESS. Low-grade extra-uterine ESS without endometrial involvement is a rare entity. Based on our literature search, this is one of the few reports covering the radiological features of low-grade extra-uterine ESS arising outside the uterus with a concomitant deep infiltrating endometriosis, but without the involvement of the endometrial cavity.


Assuntos
Neoplasias do Endométrio/diagnóstico por imagem , Endometriose/diagnóstico por imagem , Sarcoma do Estroma Endometrial/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Feminino , Humanos , Leiomioma/patologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Miométrio/patologia , Dor Pélvica , Sarcoma do Estroma Endometrial/patologia , Sarcoma do Estroma Endometrial/cirurgia , Ultrassonografia
14.
Life Sci ; 257: 118101, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32679146

RESUMO

AIMS: Uterine leiomyoma (UM) is the most common benign gynecological tumor and the leading indication for hysterectomy. Our study explored the roles of TRIM9 in leiomyoma formation and investigated the underlying molecular mechanisms. MATERIAL AND METHODS: The relationship between TRIM9 expression and fibroids formation was deciphered from the GEO database after bioinformatics analysis and identified by qPCR in human leiomyoma tissues. Both TRIM9 mRNA and protein expression were further detected in primary cultured uterine leiomyoma cells (UMC). The tumorigenesis potentials of TRIM9 in cell proliferation, cell cycle, cell apoptosis; cyclin D1, survivin and cleaved-caspase 3 protein expressions in primary UMC with TRIM9 overexpression (UMC-oeTRIM9); and uterine smooth muscle cells (SMC) with TRIM9 knockdown (SMC-siTRIM9) were evaluated in vitro. NF-κB p65 and its phosphorylation were further examined by western blotting, and rescue experiments on cell proliferation, cell cycle and cell apoptosis were conducted. KEY FINDINGS: TRIM9 showed higher expression in UM tissue and UMC compared with normal myometrium. The overexpression of TRIM9 in UMC notably promoted UM growth via enhancement of cell proliferation, reduction of cell apoptosis, and regulation of cyclin D1, survivin, cleaved-caspase 3, and nuclear NF-κB expression, which were reversed in SMC-siTRIM9 and PDTC (an NF-κB inhibitor) intervention in UMC-oeTRIM9. SIGNIFICANCE: To our knowledge, this was the first study demonstrating the roles of TRIM9 in cell growth progression of UM development. TRIM9 may be a potential therapeutic target for UM, by promoting leiomyoma cell proliferation and reducing cell apoptosis via activation of the NF-κB pathway.


Assuntos
Apoptose , Proliferação de Células , Leiomioma/patologia , NF-kappa B/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Transdução de Sinais , Proteínas com Motivo Tripartido/metabolismo , Ubiquitina-Proteína Ligases/metabolismo , Neoplasias Uterinas/patologia , Western Blotting , Feminino , Citometria de Fluxo , Regulação Neoplásica da Expressão Gênica , Humanos , Leiomioma/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Neoplasias Uterinas/metabolismo
15.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(2): 51-57, abr.-jun. 2020. graf, ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-191314

RESUMO

Los miomas uterinos son una de las patologías ginecológicas más comunes encontrándose hasta en el 70% de las mujeres de raza caucásica y en el 80% de las mujeres de raza negra1,2. En los últimos años, la angiogénesis y la vascularización se han convertido en pieza fundamental de estudio del crecimiento de los tumores. En el caso de los miomas uterinos se ha descubierto que existen diferencias en la vascularización cuando se compara con el tejido uterino adyacente. La patogenia de los miomas es multifactorial existiendo varias vías que intervienen en el crecimiento de los mismos como la vía estrogénica, la progestagénica y la de los factores de crecimiento3. Otra de las vías qué influyen en su desarrollo es la vía de la vitamina D. Niveles inadecuados de dicha vitamina pueden favorecer el crecimiento de los mismos. En nuestro trabajo hemos analizado cómo influye la terapia con vitamina D en el volumen de los miomas y en su vascularización mediante el análisis sérico de VEGF y ecografía 3 DPW


Uterine fibroids are one of the most common gynaecological disorders, being found in 70% of Caucasian women and 80% of Afro-Caribbean women 1,2. In recent years, angiogenesis and vascularisation have become a key part of study of tumour growth. Differences in vascularisation have been discovered in uterine fibroids when compared to adjacent uterine tissue. The pathogenesis of uterine fibroids is multifactorial. Several pathways are involved in their growth have been described, such as the oestrogen pathway, the gestagen pathway, and the pathway of the growth factors. Another of the pathways that influences their development is the vitamin D pathway, as inadequate levels of this vitamin may favour the growth of uterine fibroids3. In this work, an analysis is made on how vitamin D therapy influences the volume and vascularity of uterine fibroids, using serum VEGF levels and 3DPW Ultrasound


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Leiomioma/diagnóstico por imagem , Leiomioma/terapia , Projetos Piloto , Vitamina D/administração & dosagem , Neovascularização Patológica/diagnóstico por imagem , Fatores de Crescimento Endotelial/sangue , Leiomioma/patologia , Neovascularização Patológica/sangue , Neovascularização Patológica/patologia , Ultrassonografia Pré-Natal/métodos , Leiomioma/classificação
16.
BMC Womens Health ; 20(1): 89, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32357868

RESUMO

BACKGROUND: Extrauterine leiomyomata is an uncommon lesion that can lead to several problems of differential diagnosis, especially when localized in the external genitalia. There are few reports in the English literature and a novel association with Alport's syndrome has been investigated since the 1980s. CASE PRESENTATION: Here, we describe the case of a premenopausal woman who presented with an indolent swelling of the right interlabial fossa that resulted in a Bartholin cyst. In addition to this cyst, a benign leiomyoma of the right side of the clitoris was also found and removed. Our patient refused any further examination, although she was informed that genetic counselling could be organized to rule out an association with Alport's syndrome. CONCLUSIONS: Extrauterine leiomyomata localized in the external genitalia is an uncommon lesion arising from smooth muscle cells around vascular epithelium or erectile tissue. Since an association between extrauterine leiomyomata and Alport's syndrome has been described, genetic testing can be proposed to these patients. Upper intestinal tract symptoms such as dysphagia should prompt a gastroenterological evaluation as an association with an esophageal leiomyomatosis has been described.


Assuntos
Glândulas Vestibulares Maiores/cirurgia , Clitóris/cirurgia , Leiomioma/cirurgia , Adulto , Clitóris/patologia , Feminino , Humanos , Leiomioma/patologia , Masculino
17.
Medicine (Baltimore) ; 99(18): e20016, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358379

RESUMO

INTRODUCTION: Uterine fibroids are a common benign genital tumor disease in gynecological diseases. It is mainly a change in physical function caused by the growth of smooth muscle cells in the factor uterus. Modern medicine's treatment of this disease is based on the dependence of uterine fibroids on sex hormones. Treatment with antiprogestin and estrogen drugs can reduce the volume of fibroids or slow the rate of increase in volume, thereby achieving the goal of alleviating clinical symptoms. In order to meet the needs of the majority of women of childbearing age and to maintain fertility, acupuncture treatment of uterine fibroids has a broad prospect for development. METHODS/DESIGN: This study plans to select 60 cases that meet the corresponding selection criteria. According to the random principle, they will be divided into intervention group and control group, with 30 cases in each group. The general information, fibroid size, and TCM syndrome scores of the two groups of patients will be compared before treatment. In terms of treatment, the intervention group will be given acupuncture combined therapy; the control group will be given Chinese patent medicine. The treatment cycles in both groups will be three menstrual cycles. After the treatment is completed, the data of the relevant curative effect indicators are analyzed by using SPSS software to draw conclusions. DISCUSSION: We aim to provide higher evidence-based medical evidence for acupuncture treatment of uterine fibroids. TRIAL REGISTRATION: ClinicalTrials.gov, ChiCTR2000030438, Registered on March 01, 2020.


Assuntos
Terapia por Acupuntura/métodos , Medicamentos de Ervas Chinesas/uso terapêutico , Leiomioma/terapia , Neoplasias Uterinas/terapia , Adolescente , Adulto , China , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Leiomioma/tratamento farmacológico , Leiomioma/patologia , Ciclo Menstrual , Pessoa de Meia-Idade , Qualidade de Vida , Projetos de Pesquisa , Índice de Gravidade de Doença , Método Simples-Cego , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/patologia , Adulto Jovem
18.
Obstet Gynecol ; 135(6): 1313-1326, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459423

RESUMO

OBJECTIVE: To investigate the safety and efficacy of elagolix, an oral gonadotropin-releasing hormone antagonist, with hormonal add-back therapy for up to 12 months in women with heavy menstrual bleeding associated with uterine leiomyomas. METHODS: Elaris UF-EXTEND was a phase 3 extension study that evaluated an additional 6 months (up to 12 months total) of elagolix 300 mg twice daily with hormonal add-back therapy (estradiol 1 mg and norethindrone acetate 0.5 mg once daily) in women who completed an initial 6 months of the same treatment in one of two preceding phase 3 studies. The primary endpoint was the percentage of women with both less than 80 mL menstrual blood loss during final month and a 50% or greater reduction in menstrual blood loss from baseline to final month. Safety evaluations included adverse events and bone mineral density changes. The planned sample size of UF-EXTEND was based on estimated rollover and discontinuation rates in the two preceding studies. RESULTS: From September 2016 to March 2019, 433 women were enrolled in UF-EXTEND. Of these women, 218 received up to 12 months of elagolix with add-back therapy; the mean±SD age of this group was 42.4±5.4 years and 67.3% were black. The percentage of women who met the primary endpoint in this elagolix with add-back group was 87.9% (95% CI [83.4-92.3]). The most frequently reported adverse events with up to 12 months of elagolix plus add-back therapy were hot flush (6.9%), night sweats (3.2%), headache (5.5%), and nausea (4.1%). Mean percent decreases in bone mineral density from baseline to extension month 6 were significantly less with elagolix plus add-back therapy than with elagolix alone {between-group difference in lumbar spine: -3.3 (95% CI [-4.1 to -2.5])}. CONCLUSION: Up to 12 months of elagolix with add-back therapy provided sustained reduction in menstrual blood loss in women with uterine leiomyomas, with the addition of add-back therapy attenuating the hypoestrogenic effects of elagolix alone. No new or unexpected safety concerns were associated with an additional 6 months of elagolix with addback therapy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02925494. FUNDING SOURCE: AbbVie Inc funded this study.


Assuntos
Estradiol/administração & dosagem , Hidrocarbonetos Fluorados/administração & dosagem , Leiomioma/tratamento farmacológico , Menorragia/tratamento farmacológico , Noretindrona/administração & dosagem , Pirimidinas/administração & dosagem , Neoplasias Uterinas/tratamento farmacológico , Adulto , Densidade Óssea/efeitos dos fármacos , Método Duplo-Cego , Quimioterapia Combinada , Estradiol/efeitos adversos , Feminino , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Cefaleia/etiologia , Fogachos/etiologia , Humanos , Hidrocarbonetos Fluorados/efeitos adversos , Leiomioma/complicações , Leiomioma/patologia , Menorragia/sangue , Menorragia/etiologia , Pessoa de Meia-Idade , Náusea/etiologia , Noretindrona/efeitos adversos , Pirimidinas/efeitos adversos , Qualidade de Vida , Neoplasias Uterinas/complicações , Neoplasias Uterinas/patologia
19.
Ann R Coll Surg Engl ; 102(6): e141-e144, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326731

RESUMO

Deep vein thrombosis is a common clinical condition, with well-known risk factors. An unusual case of venous leiomyoma manifesting as a deep vein thrombosis in the left femoral vein of a 55-year-old man was managed successfully at our institution with anticoagulation, en-bloc excision and reconstruction of the femoral vein with spiral vein graft.


Assuntos
Veia Femoral/transplante , Leiomioma/diagnóstico , Neoplasias Vasculares/diagnóstico , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Veia Femoral/diagnóstico por imagem , Veia Femoral/patologia , Humanos , Canal Inguinal , Leiomioma/complicações , Leiomioma/patologia , Leiomioma/cirurgia , Masculino , Pessoa de Meia-Idade , Músculo Liso Vascular/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Enxerto Vascular/métodos , Neoplasias Vasculares/complicações , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgia , Trombose Venosa/etiologia
20.
Medicine (Baltimore) ; 99(15): e19728, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282731

RESUMO

BACKGROUND: The aim of this study was to present several cases of benign and malignant nipple lesions and contribute to diagnosis and differential diagnosis. METHODS: A retrospective study was conducted on 13 patients. All of the patients were evaluated by ultrasonography, and 11 of them had pathological results. We analyzed the clinical and sonographic features. RESULTS: There were 3 malignant lesions, 7 benign lesions, and 3 congenital nipple dysplasia, listed as follows:Malignant lesions (n = 3, 23%): Paget's disease (PD, n = 3, 23%). All of the patients with PD showed unilateral nipple erosion, discharge, and pain. The ultrasound showed abundant blood flow (n = 3, 23%); 2 patients (n = 2, 15%) had microcalcifications.Benign lesions (n = 7, 54%): Adenoma of the nipple (n = 2, 15%). One patient (n = 1, 8%) had nipple erosion and discharge. Two patients (n = 2, 15%) had a palpable nodule in the nipple. The ultrasound of both patients (n = 2, 15%) showed regular-shaped, clear border nodule with abundant blood flow (n = 2, 15%).Leiomyoma of the nipple (n = 1, 8%): This male patient was characterized by unilateral nipple enlargement and pain. The ultrasound showed a regular nodule with absent blood flow.Plasma cell mastitis (n = 2, 15%): Two patients showed unilateral nipple inversion and pain. One patient (n = 1, 8%) showed swollen and redness. The 2 patients showed a lesion in the gland around the nipple present as an irregular shape and unclear boundary hypoechoic mass.Nipple wart (n = 2, 15%): Two patients showed a unilateral soft exogenous neoplasm. Both of the patients showed a hypoechoic wart; the echo was similar to the nipple, the border was clear, and had no blood flow in the wart.Nipple Dysplasia (n = 3, 23%): Accessory nipple (n = 3, 23%). Two patients (n = 2, 15%) had accessory nipples in the subcoastal area, 1 patient (n = 1, 8%) in the areolar. All of the patients' sonographic features were the same as the nipple.The positive predict value (PPV) of the clinical symptoms: Erosion and discharge are both 75% (P < 0.05). The PPV of the US manifestations: irregular shape, indictinct margin, abundant blood flow, microcalcification, thicken skin in diagnosing malignant lesions are 60%,60%,60%,100%,100%, respectively (P < 0.05). CONCLUSIONS: The characteristic sonographic features together with clinical symptoms contribute to the diagnosis of nipple lesions.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamilos/irrigação sanguínea , Mamilos/diagnóstico por imagem , Ultrassonografia/métodos , Adenoma/patologia , Adulto , Neoplasias da Mama/patologia , Calcinose/patologia , Diagnóstico Diferencial , Feminino , Doença da Mama Fibrocística/patologia , Humanos , Leiomioma/patologia , Masculino , Mastite , Pessoa de Meia-Idade , Mamilos/patologia , Doença de Paget Mamária/patologia , Dor/diagnóstico , Plasmócitos/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Ultrassonografia/tendências , Verrugas
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