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1.
Int J Mol Sci ; 23(17)2022 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-36077127

RESUMO

Uterine fibroids (UFs) are the most common benign tumors of female genital diseases, unlike uterine leiomyosarcoma (LMS), a rare and aggressive uterine cancer. This narrative review aims to discuss the biology and diagnosis of LMS and, at the same time, their differential diagnosis, in order to distinguish the biological and molecular origins. The authors performed a Medline and PubMed search for the years 1990-2022 using a combination of keywords on the topics to highlight the many genes and proteins involved in the pathogenesis of LMS. The mutation of these genes, in addition to the altered expression and functions of their enzymes, are potentially biomarkers of uterine LMS. Thus, the use of this molecular and protein information could favor differential diagnosis and personalized therapy based on the molecular characteristics of LMS tissue, leading to timely diagnoses and potential better outcomes for patients.


Assuntos
Leiomioma , Leiomiossarcoma , Neoplasias Pélvicas , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/diagnóstico , Leiomioma/genética , Leiomioma/patologia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/genética , Leiomiossarcoma/patologia , Neoplasias Uterinas/patologia , Útero/patologia
2.
Expert Opin Drug Metab Toxicol ; 18(7-8): 441-457, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35968602

RESUMO

INTRODUCTION: Uterine fibroids are the most common benign gynecological tumors affecting women of reproductive ages. Although surgery is the definitive treatment choice, several medical approaches have been investigated to control their symptoms. The main issue of currently employed drugs for uterine fibroids is the long-term safety and tolerability profile. Today, new emerging options represent hopeful alternatives that could potentially overcome these limitations. AREAS COVERED: This manuscript aims to give an updated overview of the pharmacodynamic and pharmacokinetic properties of current and new investigational medical drugs for the treatment of symptomatic uterine fibroids. The bibliographic research was conducted by searching alone or combined keywords on the following electronic databases: Medline, PubMed, Embase, Science Citation Index via Web of Science. EXPERT OPINION: The most recent therapeutic strategies for uterine fibroids are represented by gonadotropin-releasing hormone antagonists (GnRH-ants; elagolix and relugolix) and selective progesterone receptor modulators (SPRM; ulipristal acetate). After early promising results, studies on innovative drugs, such as linzagolix (GnRH-ant) and vilaprisan (SPRM) are demanding. In the near future, a deeper knowledge of biological mechanisms at the basis of the genesis and growth of uterine fibroids could pave the way for the development of innovative targeted therapies.


Assuntos
Leiomioma , Neoplasias Uterinas , Ácidos Carboxílicos , Feminino , Hormônio Liberador de Gonadotropina , Humanos , Leiomioma/tratamento farmacológico , Leiomioma/patologia , Pirimidinas , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/patologia
3.
Int J Hyperthermia ; 39(1): 1088-1096, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35995432

RESUMO

OBJECTIVE: Investigate the relationships between endopelvic fascial edema and its influencing factors after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids. METHODS: This retrospective study included 688 women with uterine fibroids treated by USgHIFU; based on post-treatment MRI, the patients were divided into two groups: endopelvic fascial edema group and nonedema group. The specific location of fascial edema of each patient was also recorded. Fascial edema and fibroid features and treatment parameters were set as the dependent and independent variables, respectively, and the correlations were studied using univariate and multivariate analyses. The relationship between the pain-related adverse events and location of fascial edema was analyzed by χ2 and fisher's exact tests. RESULTS: Edema and nonedema groups had 556 and 112 patients, respectively. Among the edema patients, posterior fascial edema incidence was the highest. Multifactorial analysis showed that the energy efficiency factor (EEF), fibroid location, and enhancement type were positively associated with endopelvic fascial edema (p < 0.05), while the distance from dorsal surface of the fibroid to sacrum was negatively correlated (p < 0.001). Patients with anterior, posterior and perirectal, and right lateral fascial edemas were associated with lower abdominal pain, sacrococcygeal pain, and leg numbness/pain, respectively. CONCLUSION: Post-USgHIFU ablation, patients were prone to developing endopelvic fascial edema, and some of them experienced pain-related adverse events. The fibroid location, its types of contrast enhancement, the distance from the dorsal surface of the fibroid to the sacrum, and EEF were the influencing factors resulting in the endopelvic fascial edema after USgHIFU ablation.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Neoplasias Uterinas , Edema/complicações , Edema/diagnóstico por imagem , Feminino , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Leiomioma/cirurgia , Imageamento por Ressonância Magnética/métodos , Dor/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção , Neoplasias Uterinas/cirurgia
4.
BMC Womens Health ; 22(1): 346, 2022 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-35974345

RESUMO

BACKGROUND: The growth of uterine leiomyomas is dependent on the levels of sex steroid hormones, and they usually shrink after menopause. However, there are cases in which leiomyomas continue to grow and/or surgery is required after menopause. In addition to estrogen, progesterone has recently been implicated in leiomyoma enlargement, but its relevance to postmenopausal leiomyoma remains unknown. Therefore, we investigated whether hormone receptor expression is associated with postmenopausal leiomyoma enlargement and characterized pathological findings of postmenopausal leiomyoma, which have not been clarified yet. METHODS: Nine cases that required total hysterectomy for leiomyomas after menopause were examined. Surgeries were conducted because of pelvic pressure, pelvic pain, suspected malignancy, or growing leiomyoma. Six cases of leiomyomas being incidentally found during total hysterectomy for postmenopausal uterine prolapse, and six patients who underwent hysterectomy for leiomyomas before menopause, were examined as controls. We evaluated the expression of estrogen receptor, progesterone receptor B, and progesterone receptor AB by immunohistochemical staining among the cases. We also analyzed the pathological findings of leiomyomas. RESULTS: In postmenopausal leiomyomas, the expression of progesterone receptor was higher than that in the adjacent myometrium. Compared with premenopausal leiomyomas, the expression of progesterone receptor decreased. Postmenopausal leiomyomas that required surgery did not show elevated sex steroid hormone receptor expression, compared with the leiomyomas that did not require surgery. The degeneration frequency of leiomyomas was 92% in the group that underwent surgery for postmenopausal leiomyomas, 65% in the group that underwent surgery for reasons other than the presence of leiomyomas after menopause, and 47% in the group operated for leiomyomas before menopause. CONCLUSIONS: These results suggest that sex steroid hormones are unlikely to be associated with the growth of leiomyomas after menopause. Since leiomyoma degeneration with increased extracellular matrix is likely to occur in postmenopausal women, the degeneration of leiomyomas may be the main mechanism for the growth of postmenopausal leiomyomas.


Assuntos
Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/patologia , Pós-Menopausa , Progesterona , Receptores de Progesterona/metabolismo , Neoplasias Uterinas/patologia
5.
Medicine (Baltimore) ; 101(31): e29650, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35945744

RESUMO

RATIONALE: Extrauterine leiomyoma occasionally occurs in rare locations with unusual growth patterns, especially pelvic retroperitoneal leiomyoma, which brings great challenges for surgeons to make a diagnosis. It is essential to distinguish benign from malignant retroperitoneal neoplasms according to the imaging manifestations. Laparotomy and laparoscopy are the common options for pelvic retroperitoneal neoplasms, while they may cause side effects during operation such as secondary damage. Appropriate surgical techniques should be adopted to ensure the complete excision of neoplasms meanwhile preserve the urination, defecation, and sexual function. PATIENT CONCERNS: A 30-year-old woman was referred to our hospital because of dull pain in the perianal region for 1 month. Laboratory results including tumor markers were all within normal limits. The digital rectal examination revealed a huge and tough mass with smooth mucosa protruding into the rectal cavity from the rear area of rectum. DIAGNOSIS: Imaging examinations were performed. Contrasted computed tomography (CT) of pelvis showed an enhanced retroperitoneal solid mass in the space between sacrum and rectum, and very close to the levator ani muscle. The mass was about 11.0*8.0 cm in size. Computerized tomography angiography (CTA) showed the distal branches of bilateral internal iliac artery went into the mass. Endoscopic ultrasonography (US) showed the mass compressed the rectum, as well as a clear boundary to the rectal wall. A histopathologic examination confirmed the mass was a pelvic retroperitoneal leiomyoma. INTERVENTIONS: The patient underwent an operative resection with da Vinci Si surgical system after routine preoperative preparation. Anorectal motility was weekly monitored postoperation. No additional adjuvant therapy was performed. OUTCOMES: The patient could walk after 1 day and defecate normally on the third day after operation. She was discharged on the seventh postoperative day. No adverse events including pelvic floor hernia or defecation dysfunction occurred in the follow-up period. At 4 weeks follow-up, the patient was pain-free and recovered well. LESSONS: Although imaging examinations were crucial for retroperitoneal neoplasms, histopathological examination remains the "gold standard" for making a definite diagnosis. This case highlights the possibility of retroperitoneal leiomyoma occurring in a woman of reproductive age and the advantages of robotic surgical system in pelvic retroperitoneal surgeries.


Assuntos
Leiomioma , Neoplasias Pélvicas , Neoplasias Retroperitoneais , Robótica , Adulto , Feminino , Humanos , Leiomioma/diagnóstico , Leiomioma/patologia , Leiomioma/cirurgia , Neoplasias Pélvicas/patologia , Pelve/patologia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Espaço Retroperitoneal/patologia , Espaço Retroperitoneal/cirurgia
6.
Ann Palliat Med ; 11(6): 2033-2042, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35817738

RESUMO

BACKGROUND: Uterine leiomyoma is one of the most common benign tumors in females. High-intensity focused ultrasound (HIFU) has been widely used in the therapy of uterine leiomyomas. However, HIFU method has a prolonged duration of operation and poor patient tolerance, which need improvement. This study sought to explore the efficacy and safety of add-on use of oxytocin in uterine leiomyomas patients who received HIFU and ultrasound-guided percutaneous anhydrous ethanol injection. METHODS: This is a randomized controlled trial. A total of 60 patients with uterine leiomyomas were included and randomly divided into study group and control group. The patients in the control group were treated with HIFU and ultrasound-guided percutaneous anhydrous ethanol injection, while the study group received oxytocin injection in addition to the treatment measures of the control group. The efficacy and safety of the treatments were assessed by using the volume ablation rate of the tumor and the Society of Interventional Radiology (SIR) Practice Guidelines, respectively. RESULTS: Finally, all of the 60 patients (30 in the study group and 30 in the control group) completed the treatments. There were no statistically significant differences between the 2 groups in terms of leiomyoma volume ablation rate (94.48%±2.07% vs. 94.91%±2.53%, P=0.36), crumb gray time (150.70±57.51 vs. 165.77±77.13 s, P=0.37), total treatment energy (556,835.0±202,583 vs. 512,610.0±158,004 J, P=0.19), and total treatment time (116.70±28.61 vs. 107.40±23.22 mins, P=0.14). The pain score of the oxytocin group was significantly greater than that in the control group (4.53±1.55 vs. 3.60±1.19, P=0.008). At 3 months and 1-year post-therapy, no statistically significant differences were observed in the residual necrotic leiomyoma volume between the 2 groups. CONCLUSIONS: The add-on use of oxytocin in uterine leiomyomas patients undergoing HIFU and ultrasound-guided intratumoral ethanol injection could not improve treatment effect. TRIAL REGISTRATION: Chinese Clinical Trial Registry identifier: ChiCTR2200058584.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Neoplasias Uterinas , Etanol/uso terapêutico , Feminino , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Leiomioma/patologia , Leiomioma/cirurgia , Imageamento por Ressonância Magnética/métodos , Ocitocina , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/patologia
7.
Zhonghua Fu Chan Ke Za Zhi ; 57(6): 435-441, 2022 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-35775251

RESUMO

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.


Assuntos
Fumarato Hidratase , Leiomioma , Neoplasias Uterinas , Adulto , Desmina/metabolismo , Feminino , Fumarato Hidratase/deficiência , Fumarato Hidratase/metabolismo , Humanos , Antígeno Ki-67/metabolismo , Leiomioma/enzimologia , Leiomioma/patologia , Leiomioma/cirurgia , Erros Inatos do Metabolismo/enzimologia , Pessoa de Meia-Idade , Hipotonia Muscular/enzimologia , Transtornos Psicomotores/enzimologia , Estudos Retrospectivos , Proteína Supressora de Tumor p53 , Neoplasias Uterinas/diagnóstico
8.
J Paediatr Child Health ; 58(8): 1313-1316, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35730111

RESUMO

Inflammatory fibroid polyp (IFP) is a rare, usually solitary and intraluminal polypoid benign tumour that can affect any part of the gastrointestinal (GI) tract. Its aetiology is unknown and clinical presentation depends on the site of involvement. We present the case of a 12-month-old girl with IFP and review all reported cases of IFP in children and adolescents <18 years. A 12-month-old girl presented with rectal bleeding. The patient underwent colonoscopy which revealed an anus polyp. Surgical resection was performed and histopathological examination of the specimen showed features of IFP. A literature review of 20 cases (including ours) between 1966 and January 2022 is also presented. To our knowledge, this is the youngest reported patient with IFP and the first in the anal area.


Assuntos
Neoplasias Gastrointestinais , Leiomioma , Pólipos , Adolescente , Canal Anal/patologia , Criança , Colonoscopia , Feminino , Humanos , Lactente , Leiomioma/patologia , Pólipos/diagnóstico , Pólipos/patologia , Pólipos/cirurgia
9.
Abdom Radiol (NY) ; 47(8): 2747-2759, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35668195

RESUMO

PURPOSE: This study aimed to summarize the computed tomography (CT) findings of PMME and differentiate it from esophageal SCC and leiomyoma using CT analysis. METHODS: This was a retrospective study including 23 patients with PMME, 69 patients with SCC, and 21 patients with leiomyoma in our hospital. Qualitative CT morphological characteristics of each lesion included the location, tumor range, ulcer, enhanced pattern, and so on. For quantitative CT analysis, thickness, length and area of tumor, size of largest lymph node, number of metastatic lymph node, and CT value of tumor in plain, arterial, and delayed phases were measured. The associated factors for differentiating PMME from SCC and leiomyoma were examined with univariate and multivariate analysis. Receive operating characteristic curve (ROC) was used to determine the performance of CT models in discriminating PMME from SCC and leiomyoma. RESULTS: The thickness, mean CT value in arterial phase, and range of tumor were the independent factors for diagnosing PMME from SCC. These parameters were used to establish a diagnostic CT model with area under the ROC (AUC) of 0.969, and accuracy of 90.2%. In pathology, interstitial vessels in PMME were more abundant than that of SCC, and the stromal fibrosis was more obvious in SCC. PMME commonly exhibited intraluminal expansively growth pattern and SCC often showed infiltrative pattern. The postcontrast attenuation difference in maximum CT attenuation value between plain and arterial phases was the independent factor for diagnosing PMME from leiomyoma. This parameter was applied to differentiate PMME from leiomyoma with AUC of 0.929 and accuracy of 86.4%. CONCLUSION: The qualitative and quantitative CT analysis had excellent performance for differentiating PMME from SCC and esophageal leiomyoma.


Assuntos
Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Leiomioma , Melanoma , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/diagnóstico por imagem , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Melanoma/patologia , Estudos Retrospectivos , Neoplasias Cutâneas , Tomografia Computadorizada por Raios X/métodos
10.
Int J Hyperthermia ; 39(1): 772-779, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35654459

RESUMO

OBJECTIVE: To investigate the value of the image indexes of B-mode and power Doppler sonography in predicting the therapeutic efficacy of high intensity focused ultrasound (HIFU) ablation for uterine fibroids. MATERIALS AND METHODS: Two hundred and three patients with a solitary uterine fibroid were enrolled in this study. Every patient underwent transvaginal sonography (TVS) and magnetic resonance imaging (MRI) before HIFU. The patients were divided into hypointense, isointense and hyperintense fibroid groups based on T2 weighted MR imaging characteristics, and ultrasonic image indexes of the fibroids in different groups were compared. Multiple linear regression analysis was used to evaluate the correlation between ultrasonic image indexes and energy efficiency factor (EEF), non-perfused volume (NPV) ratio of uterine fibroids. RESULTS: Among them, 72 patients had a hypointense fibroid, 70 had an isointense fibroid and 61 had a hyperintense fibroid. Significant differences were observed in the ultrasound imaging gray scale value difference between the myometrium and uterine fibroids (GSmyo-fib), the ultrasound imaging gray scale value ratio of fibroids over the myometrium (GSfib/myo), and the ratio of power Doppler pixel area to fibroid area (PDPA/FA) among the three groups (p < 0.05). Linear regression analysis showed that the PDPA/FA and the location of fibroids were the factors affecting the NPV ratio, a model for predicting the NPV ratio was established. CONCLUSIONS: A model with the PDPA/FA for NPV ratio could be used to predict the therapeutic efficacy of HIFU for fibroids.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Neoplasias Uterinas , Feminino , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Leiomioma/cirurgia , Resultado do Tratamento , Ultrassonografia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
11.
Int J Hyperthermia ; 39(1): 835-846, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35764325

RESUMO

Objectives: To develop and apply magnetic resonance imaging (MRI) parameter-based machine learning (ML) models to predict non-perfused volume (NPV) reduction and residual regrowth of uterine fibroids after high-intensity focused ultrasound (HIFU) ablation.Methods: MRI data of 573 uterine fibroids in 410 women who underwent HIFU ablation from the Chongqing Haifu Hospital (training set, N = 405) and the First Affiliated Hospital of Chongqing Medical University (testing set, N = 168) were retrospectively analyzed. Fourteen MRI parameters were screened for important predictors using the Boruta algorithm. Multiple ML models were constructed to predict NPV reduction and residual fibroid regrowth in a median of 203.0 (interquartile range: 122.5-367.5) days. Furthermore, optimal models were used to plot prognostic prediction curves.Results: Fourteen features, including postoperative NPV, indicated predictive ability for NPV reduction. Based on the 10-fold cross-validation, the best average performance of multilayer perceptron achieved with R2 was 0.907. In the testing set, the best model was linear regression (R2 =0.851). Ten features, including the maximum thickness of residual fibroids, revealed predictive power for residual fibroid regrowth. Random forest model achieved the best performance with an average area under the curve (AUC) of 0.904 (95% confidence interval (CI), 0.869-0.939), which was maintained in the testing set with an AUC of 0.891 (95% CI, 0.850-0.929).Conclusions: ML models based on MRI parameters can be used for prognostic prediction of uterine fibroids after HIFU ablation. They can potentially serve as a new method for learning more about ablated fibroids.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Neoplasias Uterinas , Feminino , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Leiomioma/cirurgia , Aprendizado de Máquina , Imageamento por Ressonância Magnética , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
12.
BMC Pregnancy Childbirth ; 22(1): 522, 2022 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-35764945

RESUMO

BACKGROUND: Type 3 fibroids are a special subtype of intramural fibroids that are likely to affect the pregnancy outcomes of assisted reproductive techniques. Hysteroscopic resection is a treatment for type 3 fibroids, but there has few study of its efficacy to date. In this study we evaluated the effect of hysteroscopic resection of type 3 fibroids on the pregnancy outcomes in infertile women. METHODS: This retrospective case-control study was conducted from January 1, 2014 to June 30, 2021. Patients who underwent IVF-ICSI in our unit were divided into a type 3 fibroid group and a hysteroscopic myomectomy group. The inclusion criteria for the type 3 fibroid group and the hysteroscopic myomectomy group were as follows: 1) age ≤ 40 years; 2) fibroid diameter or total fibroid diameter > 2.0 cm. The following exclusion criteria were used: 1) oocyte donor treatment cycles and 2) presence of chromosomal abnormalities; 3) history of other uterine surgery; 4) presence of intracavitary lesions, including submucosal fibroids; 5) single fibroid > 5.0 cm; 6) cervical fibroids; 7) unclear ultrasound description of fibroids; 8) preimplantation genetic testing was performed and 9) congenital or acquired uterine malformations. The control group in our study was selected from patients who were treated with IVF only because of fallopian tube factors. According to the age of the type 3 fibroid group and hysteroscopic myomectomy group, random sampling was carried out in the patients between 25 and 47 years of age to determine a control group. The outcomes measured included the average transfer times to live birth, cumulative clinical pregnancy rate, and cumulative live birth rate. RESULTS: A total of 302 cycles were enrolled in our study, including 125 cycles with type 3 fibroids, 122 cycles with hysteroscopic myomectomy, and 139 cycles of control patients. The average transfer times to live birth were significantly higher in the type 3 fibroid group than in the other two groups. The frequency of cumulative live births in the type 3 fibroid group was significantly lower than that in the control group. Compared with the control group, the hysteroscopic myomectomy patients had no statistically significant differences in the cumulative clinical pregnancy rate and cumulative live birth rate. CONCLUSIONS: Type 3 fibroids significantly reduced the cumulative live birth rate of IVF patients. Ultrasound-guided hysteroscopic myomectomy can be used as a treatment for type 3 fibroids and could improve the pregnancy outcomes in infertile women.


Assuntos
Infertilidade Feminina , Leiomioma , Estudos de Casos e Controles , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Leiomioma/complicações , Leiomioma/patologia , Leiomioma/cirurgia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
13.
Spinal Cord Ser Cases ; 8(1): 51, 2022 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-35534465

RESUMO

INTRODUCTION: Chronic irritation caused by urinary catheter may predispose to metaplastic changes in the bladder and very rarely, nephrogenic metaplasia. CASE PRESENTATION: A 53-year-old lady with T-2 paraplegia and urethral catheter drainage for 27 years presented with haematuria. MRI of pelvis, performed seven years ago, showed a 10 cm intramural fibroid within the anterior aspect of the uterine body which was pushing the collapsed urinary bladder containing the Foley catheter to the left. The patient decided to avoid surgery to remove the fibroid at that time. Ultrasound scan of the urinary bladder done now, revealed a polypoidal lesion in the left superolateral wall. Superficial enhancing lesion with no invasion of the bladder wall was seen in the CT urography. Cystoscopy showed extensive catheter reaction, and in the centre, a slightly more papillary area, which was resected. Histology revealed inflamed bladder mucosa showing tubular and papillary structures lined by cuboidal epithelial cells; the features were of nephrogenic metaplasia. The tubular and papillary structures were lined by cells showing positive immunohistochemical staining for CK7 and PAX8. DISCUSSION: Catheter reaction and nephrogenic metaplasia was found in the left superolateral wall of the bladder where the large uterine fibroid was pushing the balloon of the catheter against the bladder wall for more than seven years. The patient decided to undergo surgery to remove the large fibroid and thereby prevent further pressure effects upon the urinary bladder.


Assuntos
Leiomioma , Traumatismos da Medula Espinal , Feminino , Humanos , Leiomioma/patologia , Metaplasia/patologia , Pessoa de Meia-Idade , Paraplegia , Traumatismos da Medula Espinal/patologia , Bexiga Urinária/patologia
14.
Am J Surg Pathol ; 46(9): 1298-1308, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35575789

RESUMO

With the widespread application of next-generation sequencing, the genetic landscape of uterine mesenchymal neoplasms has been evolving rapidly to include several recently identified fusion genes. Although chromosomal rearrangements involving the 10q22 and 17q21.31 loci have been reported in occasional uterine leiomyomas decades ago, the corresponding KAT6B::KANSL1 fusion has been only recently identified in 2 uterine tumors diagnosed as leiomyoma and leiomyosarcoma. We herein describe 13 uterine stromal neoplasms carrying a KAT6B::KANSL1 (n=11) and KAT6A::KANSL1 (n=2) fusion. Patient ages ranged from 33 to 81 years (median, 49 y). Tumor size was 2.6 to 23.5 cm (median, 8.2 cm). Nine tumors were myometrium-centered, and 3 had an intracavitary component. Original diagnoses were mostly low-grade endometrial stromal sarcoma (LG-ESS; 10 cases) with atypical features (limited CD10 expression, sex cord-like features, pericytic vasculature, and frequent myxoid changes). Treatment was hysterectomy±bilateral salpingo-oophorectomy (10), myomectomy (1), and curettage (2). Five patients were disease-free at 6 to 34 months, 3 (27%) died of disease at 2 to 47 months, and 3 were alive with disease at 2, 17, and 17 years. Histologically, most tumors showed variable overlap with LG-ESS, but they were generally well-circumscribed lacking the extensive permeative and angioinvasive growth typical of LG-ESS. They were composed of monotonous medium-sized oval and spindle cells arranged into diffuse sheets with prominent spiral-type arterioles and frequent pericytoma-like vascular pattern. Variable myxoid stromal changes were frequent. Mitotic activity ranged from 1 to >20 in 10 HPFs. Immunohistochemistry showed variable expression of CD10 (12/13), estrogen receptor (8/11), progesterone receptor (8/11), smooth muscle actin (9/11), desmin (4/12), h-caldesmon (2/10), calretinin (3/8), inhibin (1/7), WT1 (4/7), cyclin D1 (5/11; diffuse in only 1 case), and pankeratin (5/10). This series characterizes a KAT6B/A::KANSL1 fusion-positive uterine stromal neoplasm within the morphologic spectrum of LG-ESS but with atypical features. The relationship of these neoplasms to genuine LG-ESS remains unclear. This molecular subtype of uterine endometrial stromal sarcoma has the potential for an unfavorable clinical course despite the absence of widely invasive growth; nevertheless, analysis of more cases is necessary to delineate the phenotypic spectrum and biological potential of this tumor.


Assuntos
Neoplasias do Endométrio , Tumores do Estroma Endometrial , Histona Acetiltransferases/genética , Leiomioma , Proteínas Nucleares/genética , Sarcoma do Estroma Endometrial , Neoplasias Uterinas , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Neoplasias do Endométrio/patologia , Tumores do Estroma Endometrial/genética , Feminino , Humanos , Leiomioma/patologia , Pessoa de Meia-Idade , Neprilisina/análise , Sarcoma do Estroma Endometrial/química , Sarcoma do Estroma Endometrial/genética , Sarcoma do Estroma Endometrial/cirurgia , Neoplasias de Tecidos Moles , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia
15.
J Minim Invasive Gynecol ; 29(7): 818-819, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35490939

RESUMO

STUDY OBJECTIVE: To demonstrate tips and tricks for the successful use of single-site laparoscopic surgery for pedunculated myomectomy during pregnancy. DESIGN: Stepwise demonstration with narrated video footage. SETTING: An academic tertiary care hospital affiliated with Baylor College of Medicine. Our patient is a 39-year-old pregnant G1P0010 with a symptomatic 12-cm degenerating pedunculated myoma refractory to conservative pain management. INTERVENTIONS: Recent literature has indicated that most laparotomic myomectomies performed during pregnancy showed overall positive pregnancy outcomes and low complications. This indicates that myomectomy in pregnancy is safe and can be used in cases unresponsive to conservative management [1]. However, cases in literature discussing the single-site techniques for laparoscopic myomectomy during pregnancy have been sparse [2]. Four case series were reviewed; a total of 62 pregnant patients underwent laparoendoscopic single-site surgery without any complications [3-6]. Using laparoscopy in myomectomy compared with laparotomy during pregnancy permits decreased postoperative pain, quicker recovery, and lowered risk of postoperative complications [5,7,8]. Single-site laparoscopic surgery also aids in improved patient cosmesis and can be used for the myoma removal. Literature has demonstrated that single-site laparoscopy is safe and feasible during all stages of pregnancy [3,4]. Nevertheless, this approach may be challenging for inexperienced surgeons owing to the lack of triangulation and crowding of instruments in single-site laparoscopy [5]. At 21 weeks and 3 days pregnancy, our patient underwent single-incision laparoscopic surgery myomectomy. A 2.5-cm skin incision was made at the umbilicus to the abdominal cavity, and a GelPOINT Mini was inserted. Through the laparoscope, we can observe that a 12-cm pedunculated myoma was protruding from the right uterine fundus on a 4-cm stalk. A 0-Vicryl suture was tied around the base of the stalk. The stalk was then cauterized with bipolar energy and transected with the harmonic scalpel, completely detaching the myoma. Subsequently, an Endo Catch bag was placed around the myoma and brought up to the umbilical incision. Using a scalpel, bag-contained morcellation was completed within 22 minutes and the contents removed. As a result, the estimated blood loss was 50 cc and the total operative time was 123 minutes. The extended operating time was caused by slow movements to avoid disrupting the fetus. She had an unremarkable postoperative course, no medications were needed for pain management, and she was discharged home on postoperative day 2. At 38 weeks, she successfully delivered with elective cesarean delivery with no complications. Histopathology showed fragments of leiomyoma with diffuse necrosis. Tips and tricks: 1. Single-site entry technique uses the open Hasson technique, which reduces the risk of injury to the pregnant uterus and dilated surrounding vessels. 2. Through a 2.5-cm incision, the surgeon placed a suture in the myoma stalk because other hemostasis agents such as vasopressin are contraindicated in pregnancy. 3. Owing to difficulties related to single-site surgery, the surgeon should possess extensive expertise in single-site surgery. 4. Manipulation of the uterus should be minimized to reduce the disturbance of the pregnant uterus. 5. V-loc suture allows for faster and simplified uterine incision closure. 6. If the surgeon encounters excessive difficulty during the surgery, a 5-mm accessory port can be placed. 7. During tissue extraction, gentle traction should be used to reduce provoking the pregnant uterus. 8. When transecting the myoma stalk, it is important to leave a stump of more than 1 cm to increase suturing ease and prevent accidental suturing of the uterus. CONCLUSION: Single-incision laparoscopic surgery myomectomy for pedunculated myoma may be a practical technique in women refractive to conservative management. When performed by an experienced surgeon, the patient may benefit from faster specimen removal and recovery.


Assuntos
Laparoscopia , Leiomioma , Mioma , Miomectomia Uterina , Neoplasias Uterinas , Adulto , Feminino , Humanos , Laparoscopia/métodos , Leiomioma/patologia , Leiomioma/cirurgia , Mioma/cirurgia , Gravidez , Miomectomia Uterina/métodos , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
16.
Sci Rep ; 12(1): 8912, 2022 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-35618793

RESUMO

Somatic mutations in Mediator complex subunit 12 (MED12m) have been reported as a biomarker of uterine fibroids (UFs). However, the role of MED12m is still unclear in the pathogenesis of UFs. Therefore, we investigated the differences in DNA methylome, transcriptome, and histological features between MED12m-positive and -negative UFs. DNA methylomes and transcriptomes were obtained from MED12m-positive and -negative UFs and myometrium, and hierarchically clustered. Differentially expressed genes in comparison with the myometrium and co-expressed genes detected by weighted gene co-expression network analysis were subjected to gene ontology enrichment analyses. The amounts of collagen fibers and the number of blood vessels and smooth muscle cells were histologically evaluated. Hierarchical clustering based on DNA methylation clearly separated the myometrium, MED12m-positive, and MED12m-negative UFs. MED12m-positive UFs had the increased activities of extracellular matrix formation, whereas MED12m-negative UFs had the increased angiogenic activities and smooth muscle cell proliferation. The MED12m-positive and -negative UFs had different DNA methylation, gene expression, and histological features. The MED12m-positive UFs form the tumor with a rich extracellular matrix and poor blood vessels and smooth muscle cells compared to the MED12m-negative UFs, suggesting MED12 mutations affect the tissue composition of UFs.


Assuntos
Epigenoma , Leiomioma , Feminino , Humanos , Leiomioma/patologia , Complexo Mediador/genética , Complexo Mediador/metabolismo , Mutação , Miométrio/metabolismo , Fatores de Transcrição/metabolismo , Transcriptoma
17.
J Pathol ; 257(5): 663-673, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35472162

RESUMO

Uterine leiomyomas (ULs) are the most common benign tumors in women of reproductive age. Despite the high prevalence, tumor pathology remains unclear, which hampers the development of safe and effective treatments. Epigenetic mechanisms appear to be involved in UL development, particularly via DNA methylation that regulates gene expression. We aimed to determine the relationship between DNA methylation and gene expression in UL compared with adjacent myometrium (MM) to identify molecular mechanisms involved in UL formation that are under epigenetic control. Our results showed a different DNA methylation profile between UL and MM, leading to hypermethylation of UL, and a different global transcriptome profile. Integration of DNA methylation and whole-transcriptome RNA-sequencing data identified 93 genes regulated by methylation, with 22 hypomethylated/upregulated and 71 hypermethylated/downregulated. Functional enrichment analysis showed dysregulated biological processes and molecular functions involved in metabolism and cell physiology, response to extracellular signals, invasion, and proliferation, as well as pathways related to uterine biology and cancer. Cellular components such as cell membranes, vesicles, extracellular matrix, and cell junctions were dysregulated in UL. In addition, we found hypomethylation/upregulation of oncogenes (PRL, ATP8B4, CEMIP, ZPMS2-AS1, RIMS2, TFAP2C) and hypermethylation/downregulation of tumor suppressor genes (EFEMP1, FBLN2, ARHGAP10, HTATIP2), which are related to proliferation, invasion, altered metabolism, deposition of extracellular matrix, and Wnt/ß-catenin pathway dysregulation. This confirms that key processes of UL development are under DNA methylation control. Finally, inhibition of DNA methyltransferases by 5-aza-2'-deoxycitidine increased the expression of hypermethylated/downregulated genes in UL cells in vitro. In conclusion, gene regulation by DNA methylation is implicated in UL pathogenesis, and reversion of this methylation could offer a therapeutic option for UL. © 2022 The Pathological Society of Great Britain and Ireland.


Assuntos
Leiomioma , Neoplasias Uterinas , Acetiltransferases/genética , Acetiltransferases/metabolismo , Proliferação de Células/genética , Metilação de DNA , Epigenoma , Matriz Extracelular/patologia , Proteínas da Matriz Extracelular/metabolismo , Feminino , Humanos , Leiomioma/genética , Leiomioma/metabolismo , Leiomioma/patologia , Fatores de Transcrição/genética , Transcriptoma , Neoplasias Uterinas/genética , Neoplasias Uterinas/metabolismo , Neoplasias Uterinas/patologia
18.
J Gynecol Obstet Hum Reprod ; 51(5): 102365, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35405417

RESUMO

Uterine leiomyomas are the most common benign pelvic tumor in females. Pedunculated submucous FIGO type 0 leiomyomas may eventually protrude through the cervical canal and prolapse into the vagina taking the name of "nascent" leiomyomas. Vaginal myomectomy is the main treatment for isolated prolapsed myoma and is successful in more than 95% of cases. We propose a hybrid technique that consists of a transvaginal myomectomy followed by an operative hysteroscopy with cervical torsion to complete the removal of the leiomyoma's pedicle. Our case demonstrates an uneventful removal of a large nascent leiomyoma using a hybrid technique for complete resection of the leiomyoma limiting the risk of recurrence.


Assuntos
Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/patologia , Leiomioma/cirurgia , Prolapso , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia , Vagina
19.
Curr Oncol ; 29(4): 2350-2363, 2022 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-35448164

RESUMO

BACKGROUND/AIM: Patients with uterine sarcoma comprise 2-5% of all patients with uterine malignancies; however, the morbidity of uterine sarcoma is low compared with that of other gynecological cancers. For many cases, malignant uterine tumors are diagnosed during follow-up of benign uterine leiomyoma. Of the uterine sarcomas, rhabdomyosarcoma is considered a mixed tumor containing components of epithelial cells and mesenchymal cells. Therefore, the onset of primary uterine rhabdomyosarcoma during follow-up of uterine leiomyoma is extremely rare. Rhabdomyosarcoma is a relatively common malignant tumor in children, but rhabdomyosarcoma in adults is extremely rare, accounting for approximately 3% of all patients with soft tissue sarcoma. Rhabdomyosarcoma in children is highly sensitive to chemotherapy and radiation therapy; however, the response to chemotherapy and radiation therapy in adult rhabdomyosarcoma is low and survival in adult rhabdomyosarcoma with metastatic lesions to other organs is approximately 14 months. We experienced a case of pleomorphic rhabdomyosarcoma during the follow-up of a uterine leiomyoma. MATERIALS AND METHODS: We examined the oncological properties of uterine rhabdomyosarcoma in adults using molecular pathological techniques on tissue excised from patients with uterine leiomyoma. RESULT: A differential diagnosis was made for this case by molecular pathology, which included candidate biomarkers for uterine smooth muscle tumors. The oncological nature of uterine rhabdomyosarcoma was found to be similar to the oncological properties of uterine leiomyosarcoma. However, in uterine rhabdomyosarcoma, LMP2/ß1i-positive cells were clearly observed. CONCLUSION: It is expected that establishing a diagnostic and treatment method targeting characteristics of mesenchymal tumor cells will lead to the treatment of malignant tumors with a low risk of recurrence and metastasis.


Assuntos
Leiomioma , Rabdomiossarcoma , Sarcoma , Neoplasias de Tecidos Moles , Neoplasias Uterinas , Adulto , Algoritmos , Biomarcadores , Criança , Feminino , Humanos , Leiomioma/diagnóstico , Leiomioma/patologia , Rabdomiossarcoma/diagnóstico , Rabdomiossarcoma/patologia , Rabdomiossarcoma/terapia , Sarcoma/patologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia , Neoplasias Uterinas/terapia
20.
Reprod Sci ; 29(6): 1921-1929, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35414045

RESUMO

Uterine leiomyoma is the most common benign gynecological tumor in women of reproductive age. It has been diagnosed approximately in 5 to 69% of women and was symptomatic in 30% of them. The underlying pathobiology of uterine leiomyoma is not well understood yet, but it can be defined as an estrogen-dependent tumor. Thus, this meta-analysis aimed to investigate ESR1rs9340799 (XbaI, A351G), ESR1rs2234693 (Pvull, T397C), and COMT rs4680 (Val158Met) polymorphisms, which affect estrogen functioning and metabolism, in association with UL risk. According to PRISMA protocol, systematic searching of databases resulted 24 included studies. Pooled odds ratios (ORs) with 95% confidence intervals (CI) were used to evaluate associations of the three targeted polymorphisms with uterine leiomyoma risk in dominant model of inheritance. Meta-analysis included 4969 women diagnosed with uterine leiomyoma and 4934 controls. ESR1 (XbaI, A351G) polymorphism showed no significant association with uterine myeloma risk (OR = 1.19, 95% CI 0.98-1.45, P = 0.07). ESR1 (Pvull, T397C) was associated with a higher risk of uterine leiomyoma, but only in Asian (OR = 1.78, 95% CI 1.30-2.45, P = 0.0004) and COMT (Val158Met) according to our data is significantly associated with a lower risk of leiomyoma (OR = 0.83, 95% CI 0.71-0.97, P = 0.02). Our updated meta-analysis provided statistical evidence for the protective role of COMT (Val158Met) in association with the susceptibility to uterine leiomyoma and the possible role of ESR1 (Pvull, T397C) as a risk factor of this tumor.


Assuntos
Leiomioma , Neoplasias Uterinas , Estudos de Casos e Controles , Catecol O-Metiltransferase/genética , Estrogênios , Feminino , Predisposição Genética para Doença , Humanos , Leiomioma/genética , Leiomioma/patologia , Polimorfismo de Nucleotídeo Único , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia
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