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1.
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
2.
Drugs ; 82(15): 1549-1556, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36331779

RESUMO

An oral fixed-dose combination of relugolix/estradiol/norethisterone (also known as norethindrone) acetate (Ryeqo®; Myfembree®) has been approved for the management of heavy menstrual bleeding associated with uterine fibroids in the USA and management of moderate to severe symptoms of uterine fibroids in the EU. Relugolix is a gonadotropin releasing hormone (GnRH) receptor antagonist that decreases serum estradiol and progesterone concentrations to postmenopausal levels. The addition of estradiol/norethisterone acetate to relugolix ameliorates relugolix-induced bone loss and hot flush. In the two phase 3 LIBERTY trials, relugolix + estradiol/norethisterone substantially decreased menstrual bleeding and improved a range of other uterine fibroid symptoms in women with uterine fibroids-associated heavy menstrual bleeding. The combination was generally well tolerated, with vasomotor symptoms being the most common adverse reaction. Treatment with this combination for over up to 2 years did not induce a clinically meaningful bone loss in the majority of women. Relugolix/estradiol/norethisterone acetate, with its convenient once-daily administration, is a useful addition to current pharmacological treatment options for premenopausal women with symptomatic uterine fibroids.


Uterine fibroids are a common type of noncancerous tumours that grow in the uterus. In some women, these tumours cause debilitating symptoms, such as heavy menstrual bleeding, pelvic pain and passing of blood clots. Hysterectomy is the only definitive treatment for this condition, but is associated with some disadvantages. Less invasive procedures and medical treatments are now available to treat these symptoms. Recently, a fixed-dose tablet comprising relugolix, estradiol and norethisterone acetate (Ryeqo®; Myfembree®) has been approved to treat symptoms of uterine fibroids. This combination works by suppressing ovarian hormone levels. In clinical trials, relugolix + estradiol/norethisterone substantially reduced menstrual bleeding and improved several other symptoms in women with uterine fibroids-associated heavy menstrual bleeding. The combination was generally well tolerated and had a minimal impact on bone loss, a known adverse effect of such therapies. With its convenient once-daily administration, relugolix/estradiol/norethisterone acetate is a useful addition to current medical treatment options for premenopausal women with symptomatic uterine fibroids.


Assuntos
Leiomioma , Menorragia , Neoplasias Uterinas , Feminino , Humanos , Acetato de Noretindrona , Menorragia/complicações , Menorragia/tratamento farmacológico , Neoplasias Uterinas/complicações , Neoplasias Uterinas/tratamento farmacológico , Leiomioma/tratamento farmacológico , Noretindrona/efeitos adversos , Estradiol/uso terapêutico , Acetatos/uso terapêutico
3.
Eur J Obstet Gynecol Reprod Biol ; 279: 118-121, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36332539

RESUMO

OBJECTIVE: To evaluate the relative rates of malignancy in women with single and multiple polyps presenting to a UK Cancer Centre with postmenopausal bleeding (PMB). STUDY DESIGN: A retrospective review of patients treated at Royal Derby Hospital (RDH) for PMB who underwent outpatient hysteroscopy based on ultrasonographic suspicion of endometrial polyps between May 2014 to December 2019. The main outcome measure was the rates of precancerous and malignant histology for single or multiple polyps. The secondary outcomes assessed the influence of risk factors on the rates of malignancy within the single and multiple polyps groups. RESULTS: The study population was 851 women of which 533 were in the single polyp group and 318 in the multiple polyps group. The multiple polyps group (mean age 65.2 years) was older compared to the single polyp group (mean age 62.1 years), P = 0.0001. Elevated rates of cancer was driven most significantly by endometrioid cancer in the multiple polyps compared to single polyp group, with rates of 50/314 (16 %) and 28/512 (5.5 %) respectively, P=< 0.00001. For rarer histologies there was no significant difference between the proportion of serous, carcinosarcomas and clear cell cancers between those with single compared to multiple polyps (P > 0.05). Significantly more endometrial hyperplasia with atypia (AEH) was found in the multiple polyps compared to single polyp group, with rates of 18/314 (5.7 %) and 15/512 (2.9 %) respectively, P = 0.046. CONCLUSION: Our study found increased rates of endometrioid cancer and its precursor, AEH within the multiple polyps compared to the single polyps groups. Future risk predicting algorithms should consider incorporating single and multiple polyps as part of their risk model.


Assuntos
Neoplasias do Endométrio , Pólipos , Lesões Pré-Cancerosas , Neoplasias Uterinas , Gravidez , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Pós-Menopausa , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Pólipos/patologia , Neoplasias Uterinas/patologia , Endométrio/diagnóstico por imagem , Endométrio/patologia , Histeroscopia/efeitos adversos , Hemorragia Uterina/etiologia , Hemorragia Uterina/complicações , Neoplasias do Endométrio/patologia , Estudos Retrospectivos
4.
Sci Rep ; 12(1): 19612, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36385486

RESUMO

Uterine sarcomas have very poor prognoses and are sometimes difficult to distinguish from uterine leiomyomas on preoperative examinations. Herein, we investigated whether deep neural network (DNN) models can improve the accuracy of preoperative MRI-based diagnosis in patients with uterine sarcomas. Fifteen sequences of MRI for patients (uterine sarcoma group: n = 63; uterine leiomyoma: n = 200) were used to train the models. Six radiologists (three specialists, three practitioners) interpreted the same images for validation. The most important individual sequences for diagnosis were axial T2-weighted imaging (T2WI), sagittal T2WI, and diffusion-weighted imaging. These sequences also represented the most accurate combination (accuracy: 91.3%), achieving diagnostic ability comparable to that of specialists (accuracy: 88.3%) and superior to that of practitioners (accuracy: 80.1%). Moreover, radiologists' diagnostic accuracy improved when provided with DNN results (specialists: 89.6%; practitioners: 92.3%). Our DNN models are valuable to improve diagnostic accuracy, especially in filling the gap of clinical skills between interpreters. This method can be a universal model for the use of deep learning in the diagnostic imaging of rare tumors.


Assuntos
Aprendizado Profundo , Leiomioma , Neoplasias Pélvicas , Sarcoma , Neoplasias de Tecidos Moles , Neoplasias Uterinas , Feminino , Humanos , Diagnóstico Diferencial , Sensibilidade e Especificidade , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologia , Leiomioma/patologia , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Neoplasias de Tecidos Moles/diagnóstico
5.
Turk J Ophthalmol ; 52(5): 356-359, 2022 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-36317827

RESUMO

The reported experience with preoperative embolization of solid orbital tumors is scarce. Herein, we present a case of a large and hypervascular orbital solitary fibrous tumor (SFT) in which 500-700 µm tris-acryl gelatin microspheres (TAGM) were used for preoperative embolization. A 41-year-old man presented with severe proptosis, palpable mass, restrictive myopathy, exposure keratopathy, and compressive optic neuropathy in the right orbit. Magnetic resonance imaging showed a 65x35x35 mm, diffusely contrast-enhanced tumor in the superior orbit, extending to the apex, and multiple intratumoral vascular flow voids. A diagnosis of SFT was made by incisional biopsy. Endovascular tumor embolization was performed with 500-700 µm TAGM. Two days later, the tumor was entirely removed with minimal bleeding. No embolization- or surgery-related complications and tumor recurrence or metastasis developed during the 42-month postoperative follow-up.


Assuntos
Leiomioma , Tumores Fibrosos Solitários , Neoplasias Uterinas , Masculino , Feminino , Humanos , Adulto , Leiomioma/irrigação sanguínea , Neoplasias Uterinas/irrigação sanguínea , Resultado do Tratamento , Recidiva Local de Neoplasia , Tumores Fibrosos Solitários/diagnóstico , Tumores Fibrosos Solitários/cirurgia
6.
Rom J Morphol Embryol ; 63(2): 323-334, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36374138

RESUMO

Endometrial polyps (EPs) are a frequent gynecological condition. EPs often arise in the common womanly patients and are appraised to be about 25%. Advancing age, hyperestrogenism, hypertension, and Tamoxifen use are acknowledged as ordinary risk elements for the development of EP. The etiopathogenesis of EP is not accurately elucidated, but certain considerations such as diabetes mellitus, hormonal factors or arterial hypertension are considered to perform a significant contribution. The diagnosis of EPs is essentially by imaging. Transvaginal ultrasound is the primary investigation in EPs. Hysteroscopic resection is now the "gold standard" to treat to treat this disease. Hysterectomy is the definitive treatment for EPs, but it requires a judicious indication and an adequate counseling of the patient. Currently, a certain histological pattern is found in different sequences in EPs. Even if the vast majority EPs are benign, they may reach hyperplastic, with malignant alteration. The purpose of this pictorial review is the integrated approach to this type of abnormal endometrial proliferation from the perspective of natural history, diagnosis, management, morphological aspects, risk of malignancy, recurrence and last but not least, clinical outcome.


Assuntos
Neoplasias do Endométrio , Hipertensão , Pólipos , Neoplasias Uterinas , Humanos , Gravidez , Feminino , Histeroscopia/métodos , Pólipos/patologia , Neoplasias Uterinas/patologia , Histerectomia , Hipertensão/patologia , Neoplasias do Endométrio/patologia , Endométrio/patologia
7.
BMC Womens Health ; 22(1): 435, 2022 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-36335369

RESUMO

BACKGROUND: To assess the efficacy of dysdrogesterone in the treatment of chronic endometritis (CE) treated with antibiotic in premenopausal women with endometrial polyps (EPs). METHODS: Routine detection of endometrium was simultaneously conducted to determine whether there was CE by syndecan-1 (CD138), while women underwent hysteroscopic polypectomy in our hospital. Antibiotic was given for the treatment of CE. A total of 235 premenopausal women with CE who underwent hysteroscopic polypectomy were enrolled in the retrospective observational study. In the control group, single antibiotic was given for the treatment of CE form January 2016 to December 2018, and in the treatment group additional dydrogesterone was used from January 2019 to November 2020. Comparison of cure rates of CE with different treatment regimens was performed. RESULTS: The cure rates of CE in dydrogesterone and antibiotic combination group and the single antibiotic group were 85.2% and 74.3%, respectively, with overall cure rate of 80.0% (188/235). The combination group showed better effects regarding the cure rate of CE (P < .05). Multivariate analysis confirmed that the cure rate of CE was not affected by age, body mass index, number of EPs, the status of estrogen receptor and the status of progesterone receptor. Conversely, dydrogesterone and endometrial scratching were beneficial factors for cure rate increase with antibiotic treatment. CONCLUSION: Combination of dydrogesterone and antibiotic was more effective for cure rate of CE than antibiotic alone in premenopausal women after hysteroscopic polypectomy. Endometrial scratching also contributed to the cure rate increase with antibiotic treatment.


Assuntos
Endometrite , Pólipos , Neoplasias Uterinas , Gravidez , Feminino , Humanos , Endometrite/diagnóstico , Didrogesterona/uso terapêutico , Histeroscopia , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Pólipos/tratamento farmacológico , Pólipos/cirurgia , Endométrio/cirurgia , Endométrio/patologia , Neoplasias Uterinas/patologia , Doença Crônica
8.
Medicina (Kaunas) ; 58(11)2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36422166

RESUMO

Leiomyomas are the most common pelvic tumors. Submucosal fibroids are a common cause of abnormal bleeding and infertility. Hysteroscopic myomectomy is the definitive management of symptomatic submucosal fibroids, with high efficacy and safety. Several techniques have been introduced over time and will be covered in depth in this manuscript. Advances in optics, fluid management, electrosurgery, smaller diameter scopes, and tissue removal systems, along with improved training have contributed to improving the safety and efficiency of hysteroscopic myomectomy.


Assuntos
Infertilidade , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Gravidez , Humanos , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/patologia , Histeroscopia/métodos , Leiomioma/cirurgia
9.
Taiwan J Obstet Gynecol ; 61(6): 935-940, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36427995

RESUMO

Uterine smooth muscle tumor of uncertain malignant potential is a subtype of uterine smooth muscle neoplasms. It is characterized by distinct pathologic findings with morphologic features intermediate between those of benign leiomyoma and malignant leiomyosarcoma. Clinically, STUMP is rare and its clinical picture is comparable to that of leiomyoma, with diagnosis typically being made postoperatively. Most patients with STUMP are uneventful after tumor resection. However, a small portion of patients may experience recurrence that may even lead to mortality. Given the uncommon occurrence of STUMP and the low frequency of malignant potential, currently there is still no standard guideline in treating patients with this disease and this can be challenging for physicians. Moreover, because cases are rarely available for study, investigating this tumor is difficult. Thus, matters such as the pathologic diagnostic criteria, strategy of clinical management, identification of prognostic factors, and the pathogenesis of this disease remain to be clarified. We collected and analyzed recently published case series studies of STUMP to obtain up-to-date clinical information. The current status of research in various basic and clinical aspects of this tumor was also reviewed.


Assuntos
Leiomioma , Leiomiossarcoma , Tumor de Músculo Liso , Neoplasias Uterinas , Feminino , Humanos , Tumor de Músculo Liso/diagnóstico , Tumor de Músculo Liso/cirurgia , Neoplasias Uterinas/patologia , Leiomioma/cirurgia , Leiomioma/patologia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Leiomiossarcoma/patologia , Útero/patologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-36323291

RESUMO

Due to the increasing popularity of minipigs as pets, the frequency of presentation to the veterinarian is increasing as well. In addition to routine measures such as claw trimming, vaccination and antiparasitic treatment, diagnostics, and therapy of diseased minipigs are also common activities in the veterinary practice. In recent years, we have noticed more and more pathological changes of the female genital tract of uncastrated minipigs. There are also some case reports available in the international literature in this regard. The following case report describes the diagnostic procedures and ovariohysterectomies of 2 13-year-old female minipigs in detail. In these cases, uterine adenocarcinoma, and uterine carcinoma, respectively, combined with cystic endometrial hyperplasia (CEH) of the endometrium were diagnosed.


Assuntos
Adenocarcinoma , Hiperplasia Endometrial , Doenças dos Suínos , Neoplasias Uterinas , Suínos , Animais , Feminino , Hiperplasia Endometrial/diagnóstico , Hiperplasia Endometrial/cirurgia , Hiperplasia Endometrial/veterinária , Porco Miniatura , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/veterinária , Endométrio/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Adenocarcinoma/veterinária , Doenças dos Suínos/diagnóstico , Doenças dos Suínos/cirurgia , Doenças dos Suínos/patologia
11.
Obstet Gynecol ; 140(6): 920-930, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36357960

RESUMO

OBJECTIVE: In the LIBERTY 1 and LIBERTY 2 placebo-controlled trials, once-daily relugolix combination therapy reduced menstrual blood loss volume and pain in women with heavy menstrual bleeding associated with uterine leiomyomas and was well tolerated, with preservation of bone mineral density (BMD) through 24 weeks. Here we report the long-term efficacy and safety of relugolix combination therapy treatment for up to 52 weeks. METHODS: Women with uterine leiomyoma-associated heavy menstrual bleeding who completed any treatment arm in either the LIBERTY 1 or LIBERTY 2 trial were eligible to enroll in a 28-week long-term extension study. All participants received once-daily relugolix combination therapy (40 mg relugolix, estradiol 1 mg, norethindrone acetate 0.5 mg) in the extension study. The primary efficacy endpoint was the proportion of women who achieved or maintained a menstrual blood loss volume of less than 80 mL and a 50% or greater reduction in menstrual blood loss volume from LIBERTY study baseline to the last 35 days of treatment (defined as responders ). Analyses were conducted for all three randomized treatment groups from pivotal studies. RESULTS: Overall, 477 women enrolled, 476 were treated, and 363 (76.1%) completed 52 weeks. Among patients treated with relugolix combination therapy through 52 weeks (n=163), sustained improvement in heavy menstrual bleeding was observed in 87.7% (responders). The least squares mean menstrual blood loss volume reduction was 89.9%, with 70.6% of patients achieving amenorrhea. At week 52, 59.0% of patients with anemia at baseline had improvements in hemoglobin concentration of greater than 2 g/dL. Distress due to uterine leiomyoma-associated symptoms measured by the BPD (Bleeding and Pelvic Discomfort) scale score was reduced by 51.3 points. Sustained reductions in uterine and uterine leiomyoma volume were observed. Bone mineral density was preserved through week 52. CONCLUSION: Improvements in heavy menstrual bleeding and anemia and reduction of uterine leiomyoma-associated symptom burden were sustained through up to 52 weeks of treatment with relugolix combination therapy in women with uterine leiomyomas. No new safety concerns were identified, and BMD was maintained. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT03049735; NCT03103087; NCT03412890. FUNDING SOURCE: Myovant Sciences GmbH.


Assuntos
Leiomioma , Menorragia , Neoplasias Uterinas , Humanos , Feminino , Menorragia/tratamento farmacológico , Menorragia/etiologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/tratamento farmacológico , Leiomioma/complicações , Leiomioma/tratamento farmacológico , Pirimidinonas
12.
Obstet Gynecol ; 140(6): 1042-1048, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36357982

RESUMO

OBJECTIVE: To estimate the age-specific incidence of uterine leiomyomas identified by transvaginal ultrasonography among participants in SELF (Study of Environment, Lifestyle & Fibroids). METHODS: SELF is a longitudinal cohort study of individuals aged 23-35 years who self-identified as Black. Participants were recruited from the Detroit, Michigan, area and underwent up to five transvaginal ultrasonograms over a period of up to 10 years to identify uterine leiomyomas. We randomly imputed incidence dates between the last ultrasonogram date in which no leiomyomas were detected and the date of the ultrasonogram in which leiomyomas were first detected. We used Poisson regression to estimate age-specific incidence rates per 1,000 person-years with 95% CIs. The rates were then compared with those of the BWHS (Black Women's Health Study) and the NHS II (Nurses' Health Study II)-two prospective cohort studies based on self-reported leiomyoma diagnoses. RESULTS: In this cohort, 1,693 participants completed a baseline interview and ultrasonogram. We excluded 385 (22.7%) participants with leiomyomas detected during baseline, seven participants whose ultrasonograms were poor quality, and 60 participants with only a baseline ultrasonogram. Among the remaining 1,241 participants, the overall incidence rate was 53.9 cases per 1,000 person-years (95% CI 48.6-59.6). The age-specific incidence rates (cases/1,000 person-years) were: younger than 30 years: 49.7, 95% CI 40.9-59.9; 30-34 years: 55.2, 95% CI 47.0-64.3; and 35-39 years: 58.2, 95% CI 47.3-70.9. Among participants aged younger than 30 years, the incidence rate in SELF was more than double that of the BWHS or the NHS II. CONCLUSION: The high age-specific leiomyoma incidence rates in this prospective ultrasound-based study indicate that many young Black individuals with leiomyomas go undiagnosed. These data suggest that individuals could benefit from ultrasound screening when they experience symptoms compatible with leiomyomas (eg, heavy menstrual bleeding, anemia, pelvic pain).


Assuntos
Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Incidência , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/epidemiologia , Estudos Prospectivos , Estudos Longitudinais , Leiomioma/diagnóstico por imagem , Leiomioma/epidemiologia , Estudos de Coortes , Ultrassonografia , Fatores Etários
13.
Int J Gynecol Cancer ; 32(11): 1402-1409, 2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36343971

RESUMO

OBJECTIVES: To evaluate differences in survival and recurrence patterns in stage I-IV uterine carcinosarcoma patients treated with surgery followed by adjuvant chemotherapy alone, radiation alone, or a combination of both chemotherapy and radiation therapy. METHODS: A multicenter retrospective analysis of patients with surgically staged carcinosarcoma receiving adjuvant therapy from January 2000 to December 2019 was conducted. Inclusion criteria were patients with carcinosarcoma who had received primary surgical treatment, followed by adjuvant therapy with chemotherapy alone, radiation therapy alone, or a combination of chemoradiation. Patients were excluded for incomplete surgical staging data, adjuvant brachytherapy alone, adjuvant chemotherapy and brachytherapy without external beam radiation therapy, receipt of neoadjuvant chemotherapy and/or pre-operative pelvic radiation, and death due to non-cancer causes. Sites of recurrence were analyzed by adjuvant treatment modality using Pearson's χ2 test. Progression-free and overall survival were calculated using Kaplan-Meier estimates. Multivariate analysis was performed using Cox proportional hazards model. RESULTS: Of 176 evaluable patients, 27% (n=47) had stage I, 14% (n=24) stage II, 37% (n=66) stage III, and 22% (n=39) stage IV disease. Among them, 33% (n=59) received chemotherapy alone, 17% (n=29) received radiation therapy alone, and 50% (n=88) received chemoradiation. Patients with stage I disease recurred less frequently (64%) versus stage II (83%), stage III (85%), and stage IV (90%) (p<0.001). Stage I disease demonstrated improved progression-free and overall survival relative to all other stages (p<0.01). Across all stages, patients receiving chemoradiation experienced superior progression-free (p=0.01) and overall survival (p=0.05) versus single modality therapy. However, when analyzed in a stage-specific manor, stage III disease derived the greatest survival benefit from chemoradiation versus all other stages (p<0.01). On multivariant analysis, only stage and receipt of chemoradiation were independent predictors of survival. CONCLUSION: Stage I disease demonstrated improved survival compared with other stages regardless of adjuvant treatment modality. Chemoradiation was associated with improved survival and better distant and local disease control for all stages of disease. Patients with stage III disease derived the most benefit from chemoradiation.


Assuntos
Carcinossarcoma , Neoplasias Uterinas , Feminino , Humanos , Estudos Retrospectivos , Histerectomia , Estadiamento de Neoplasias , Neoplasias Uterinas/radioterapia , Neoplasias Uterinas/tratamento farmacológico , Carcinossarcoma/patologia , Quimioterapia Adjuvante , Radioterapia Adjuvante , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
15.
Turk J Med Sci ; 52(3): 762-769, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36326312

RESUMO

BACKGROUND: In this single-center study, we aimed to analyze texture features of primary uterine lesions on 18F-FDG PET/CT to predict lymph node metastases. METHODS: Totally, 157 (mean age: 62 ± 10.2 years) patients were included in the analysis. Histopathological examination results were considered as the standard reference for nodal involvement. On 18F-FDG PET/CT images, only the primary tumor was segmented. SUVmax, SUVmean, SUVpeak, MTV, and TLG of primary uterine lesions were calculated for analyses. For texture analysis first, second, and higher-order texture features were calculated. RESULTS: Mean diameter of primary uterine lesions was calculated as 35± 18.1 mm. Lymph node metastases were detected in 19% of patients in histopathological examination of surgical materials. While 26 patients had pelvic lymph node metastases, 19 patients had additional paraaortic lymph node metastases. On radiomics analysis for 20 features, a significant difference was found between patients with and without lymph node metastasis. With using data mining methods GLZLM ZLNU, EntropyGLCM, Entropyhisto, GLRLM LRHGE, GLZLM HGZE, GLZLM SZHGE, GLRLM HGRE, GLRLM SRHGE were found significant radiomics features to predict lymph node metastasis with a diagnostic accuracy of 0.8. DISCUSSION: The radiomics analysis of intratumoral heterogeneity is a promising method for improving triage of the patients for lymph node dissection in endometrial carcinoma.


Assuntos
Neoplasias do Endométrio , Neoplasias Uterinas , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos Radiofarmacêuticos , Tomografia por Emissão de Pósitrons/métodos , Neoplasias do Endométrio/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Neoplasias Uterinas/patologia , Estudos Retrospectivos
16.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-49195

RESUMO

O mapa apresenta uma visão geral das evidências sobre os efeitos clínicos das terapias complementares e integrativas para o câncer do útero e do colo do útero. A partir da caracterização de centenas de estudos na série de mapas de evidências das Medicinas Tradicionais, Complementares e Integrativas (MTCI/PICS), foram selecionados e incluídos neste mapa de evidências 26 estudos de revisão, dos quais 18 revisões sistemáticas, 7 revisões sistemáticas e metanálises, e 1 metanálise. Com base na ferramenta AMSTAR2, foi avaliado o nível de confiança para a evidência reportada nestes estudos, resultando em 7 revisões de nível alto, 16 revisões de nível baixo e 28 revisões de nível criticamente baixo. Principais Achados: ● As revisões avaliaram o efeito de 28 tipos de intervenções distribuídos em 3 grupos: Fitoterapia e Plantas Medicinais; Terapias não-Farmacológicas; Suplementos / Produtos Naturais. ● As intervenções foram associadas a 33 desfechos de saúde distribuídos em 5 grupos: Curso da doença; Sintomas relacionados ao Câncer; Indicadores Metabólicos e Fisiológicos; Bem-Estar, Vitalidade e Qualidade de Vida; Saúde Mental.


Assuntos
Neoplasias do Colo do Útero , Neoplasias Uterinas , Terapias Complementares
18.
Comput Math Methods Med ; 2022: 4018803, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36238468

RESUMO

Background: Uterine fibroids are most common in women aged 30-50 and are the most common benign gynecological tumors. Relevant data suggest that about 25% of patients with uterine fibroids are at childbearing age. Uterine fibroids not only cause the discomfort symptoms, and affect the pregnancy, but also have certain malignant transformation risk, thus needed to be treated positively and promptly. Aim: This study is aimed at exploring the effect of laparoscopic myomectomy and comprehensive rehabilitation nursing on patients with uterine fibroids. Methods: The clinical data of 110 cases of uterine fibroids admitted to our hospital from August 2019 to December 2021 were analyzed retrospectively, and they were divided into two groups according to postoperative rehabilitation strategies. Both groups were treated with laparoscopic myomectomy. The A group was treated with routine rehabilitation strategy, while the B group was treated with comprehensive rehabilitation nursing strategy. The differences in operation-related indicators, stress factors, inflammatory factors, nutritional indicators, knowledge mastery, occurrence of adverse symptoms and pain scores, negative emotion scores, nursing satisfaction, and simplified comfort status scale (GCQ) scores between the two groups under nursing strategies were compared. Results: The postoperative exhaust time (13.14 ± 2.03) h, bed time (9.86 ± 1.94) h, postoperative hospital stay (4.37 ± 1.31) d, and total hospital stay (6.78 ± 1.69) d in the B group were shorter than those in the A group, and the hospitalization expenses (0.74 ± 0.25) million were less than those in the A group (P < 0.05). Before operation, stress factors, inflammatory factors, and nutritional indexes were compared between the two groups (P > 0.05). On the 3rd day after operation, tumor necrosis factor-α (TNF-α), cortisol (Cor), norepinephrine (NE), and interleukin-1ß (IL-1ß) in the two groups showed a significantly upward trend compared with those before operation, and albumin and transferrin were significantly fell compared with those before operation. However, the values of stress factor and inflammatory factor in the B group were significantly lower than those in the A group, and the values after the decrease of nutritional index were significantly higher than those in the A group (P < 0.05). The pain scores at 24 h, 48 h, and 72 h after operation in the B group were significantly lower than those in the A group (P < 0.05). Negative emotions, nursing satisfaction, and GCQ scores were compared between the two groups before intervention (P > 0.05). After the intervention, the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the two groups were significantly lower than those before the intervention, and the scores of nursing satisfaction and GCQ were higher than those before the intervention. The values of negative emotions in the B group after the decline were significantly lower than those in the A group, while the values of nursing satisfaction and GCQ after the increase were higher than those in the A group (P < 0.05). The excellent and good rate of knowledge acquisition in the B group was 94.55% (52/55), which was significantly higher than 78.18% (43/55) in the A group (P < 0.05). The incidence of adverse symptoms in the B group was 9.09% (5/55), which was lower than 21.82% (12/55) in the A group, while the difference was not statistically significant (P > 0.05). Conclusion: Laparoscopic myomectomy combined with comprehensive rehabilitation nursing can reduce the postoperative stress state of patients with uterine fibroids, improve patient satisfaction, reduce adverse emotions, and promote rehabilitation.


Assuntos
Laparoscopia , Leiomioma , Enfermagem em Reabilitação , Miomectomia Uterina , Neoplasias Uterinas , Albuminas , Feminino , Humanos , Hidrocortisona , Interleucina-1beta , Leiomioma/cirurgia , Norepinefrina , Dor/cirurgia , Gravidez , Estudos Retrospectivos , Transferrinas , Fator de Necrose Tumoral alfa , Neoplasias Uterinas/cirurgia
19.
BMC Cancer ; 22(1): 1050, 2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36207687

RESUMO

BACKGROUND: Uterine sarcomas are rare and aggressive gynaecologic malignancies, characterized by a relatively high recurrence rate and poor prognosis. The aim of this study was to investigate the clinicopathological features and explore the prognostic factors of these malignancies. METHODS: This was a single-institution, retrospective study. We reviewed the medical records of 155 patients with pathologically confirmed uterine sarcomas including uterine leiomyosarcoma (ULMS), low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), undifferentiated uterine sarcoma (UUS) and adenosarcoma (AS) between 2006 and 2022. A total of 112 patients who underwent surgery between January 2006 and April 2019 were included in the survival analysis. The current study recorded the clinicopathological, treatment and outcome data to determine clinical characteristics and survival. RESULTS: The most common histopathological type was ULMS (63/155, 40.64%), followed by LG-ESS (56/155, 36.13%) and HG-ESS (16/155, 10.32%). The mean age at diagnosis of all patients was 49.27±48.50 years and 32.90% (51/155) of patients were postmenopausal. Fifteen patients underwent fast-frozen sectioning, 63(54.78%) were diagnosed with malignancy, 29(25.22%) were highly suspected of malignancy that needed further clarification and 23(14.84%) were diagnosed with benign disease. A total of 124(80%) patients underwent total hysterectomy (TH) and salpingo-oophorectomy. Multivariate analyses showed that histological type and tumour size were independent prognostic factors both for overall survival (OS) (p<0.001 and P=0.017, respectively) and progression-free survival (PFS) (p<0.001 and P=0.018, respectively). Tumour stage was only significantly associated with PFS (P=0.002). Elevated preoperative NLR, PLR and postmenopausal status were significantly correlated with shorter PFS and OS in univariate analysis, but no statistically significant difference was found in multivariate analysis. CONCLUSIONS: In patients with uterine sarcoma, in comparison to LMS and LG-ESS, UUS and HG-ESS tend to present as more aggressive tumour with poorer outcomes. Furthermore, larger tumour (>7.5 cm) were an important predictor of shorter PFS and OS.


Assuntos
Neoplasias do Endométrio , Tumores do Estroma Endometrial , Leiomiossarcoma , Neoplasias Pélvicas , Sarcoma do Estroma Endometrial , Sarcoma , Neoplasias de Tecidos Moles , Neoplasias Uterinas , Neoplasias do Endométrio/patologia , Feminino , Humanos , Leiomiossarcoma/patologia , Prognóstico , Estudos Retrospectivos , Sarcoma/diagnóstico , Sarcoma/cirurgia , Sarcoma do Estroma Endometrial/diagnóstico , Sarcoma do Estroma Endometrial/cirurgia , Neoplasias Uterinas/patologia
20.
Medicine (Baltimore) ; 101(39): e30665, 2022 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-36181050

RESUMO

RATIONALE: Lipoleiomyoma is a rare neoplasm of the uterus. It is considered a variant of uterine myomas. Its reported incidence varies from 0.03% to 0.2%. Lipoleiomyoma consists of variable proportions of mature lipocytes and smooth muscle cells. These tumors generally occur in asymptomatic obese perimenopausal or postmenopausal women. About 90.7% of lipoleiomyomas arise from the uterine corpus, with only 6.5% arising from the cervix. When it occurs in the cervix, it is difficult to diagnose and treat it. We report an uncommon case of pelviscopic resection of uterine cervical lipoleiomyoma showing continuous growth after menopause. PATIENT CONCERNS: A 55-year-old postmenopausal woman was diagnosed with 40 mm-sized uterine myoma 4 years ago. The size of the mass increased to 58 mm in the last year. DIAGNOSES: An ultrasound scan revealed a 58 × 34-mm-sized round hyperechogenic and barely vascularity mass that appeared to have originated on the left side of the uterine cervix. Final pathologic findings showed lipoleiomyoma. INTERVENTIONS: After admission to the hospital, we performed pelviscopic removal of uterine lipoleiomyoma and both tubes. Microscopic examination revealed a significant amount of fat cells between muscle cells. OUTCOMES: Surgeries were successful. The patient had been followed up regularly for three years after surgery. She did not experience any complications. She remained disease-free. LESSONS: Although lipoleiomyomas mainly occur in postmenopausal women, they can also occur in the uterine cervix. They can increase in size after menopause. They can be removed laparoscopically. If a hyperechoic mass occurred in the uterus after menopause that keeps growing without symptoms, a differential diagnosis of lipoleiomyomas must be performed.


Assuntos
Leiomioma , Lipoma , Neoplasias do Colo do Útero , Neoplasias Uterinas , Colo do Útero/patologia , Feminino , Humanos , Leiomioma/patologia , Lipoma/cirurgia , Pessoa de Meia-Idade , Pós-Menopausa , Neoplasias do Colo do Útero/patologia , Neoplasias Uterinas/patologia
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