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1.
JNMA J Nepal Med Assoc ; 59(234): 220-224, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506454

RESUMO

Pregnancy with uterine myoma increases the risk of abortion, fetal malpresentation, placenta previa, postpartum hemorrhage, hysterectomy and risk to neonate and mother. Caesarian myomectomy is a safe and cost-effective procedure especially when performed by an experienced surgeon only in selected cases. Here, we present our experiences of cesarean myomectomy on ten patients presenting to our center in a period of one year. The most common indications were breech presentation and previous cesarean section. The most common site was anterior, except one which was posterior and the common type is intramural. Despite prophylactic measures, two cases had a postpartum hemorrhage of 2000ml and 700ml, respectively and one even received a blood transfusion. No cases of hysterectomy, neonatal morbidity and mortality were noted in these cases. In our experience, cesarean myomectomy in uterine fibroids has been a safe procedure with limited intraoperative and postoperative complications.


Assuntos
Apresentação Pélvica , Miomectomia Uterina , Neoplasias Uterinas , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , Centros de Atenção Terciária , Neoplasias Uterinas/cirurgia
2.
JNMA J Nepal Med Assoc ; 59(234): 200-203, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506473

RESUMO

Uterine adenosarcoma is a rare variant of mixed Mullerian tumors comprised of neoplastic glands with the benign appearance and sarcomatous stroma. The epithelium most often consists of endometrium- like cells, while the sarcomatous component usually shows low-grade homologous uterine sarcoma. These tumors present as a pelvic mass or an enlarged uterus with abnormal vaginal bleeding. Here, we present a case of 61 years old postmenopausal female patient with chief complaints of excessive vaginal bleeding and urine retention.


Assuntos
Adenossarcoma , Tumor Mulleriano Misto , Neoplasias Uterinas , Adenossarcoma/diagnóstico , Adenossarcoma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Hemorragia Uterina/etiologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia
3.
JNMA J Nepal Med Assoc ; 59(237): 504-505, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34508428

RESUMO

Leiomyomas are common benign tumors of the uterus, affecting 20-30% of women of reproductive age group. But vaginal leiomyomas remain an uncommon entity with only about 300 reported cases. The first case was described in 1733. Only a few cases have been reported in Nepal to date. Tumors are thought to arise from Mullerian smooth muscle cells in the sub-epithelium of the vagina. Vaginal leiomyomas are usually situated in the anterior vaginal wall. Here, we report a case of a 48-year old multipara who presented the outpatient department with the ultrasonographic report showing multiple uterine fibroids but was asymptomatic. A physical examination showed a mass in the right vaginal wall. Pervaginal removal of the tumor was performed and subsequent histopathology revealed a vaginal leiomyoma. Removal of the tumor by the vaginal route, wherever possible, with the subsequent histopathological examination, appears to be the optimum management plan.


Assuntos
Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Pessoa de Meia-Idade , Nepal , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia , Vagina/cirurgia
4.
Rev Assoc Med Bras (1992) ; 67(3): 426-430, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468609

RESUMO

OBJECTIVE: To determine if there is a difference between uterine incision techniques (vertical vs. transversal) in terms of clinical results. METHODS: All women with leiomyomas who underwent open abdominal myomectomy (n=61) between March and August 2016 at the Gynecology and Obstetrics Clinic at the Women's Health Research and Training Hospital Zekai Tahir Burak were included, and the clinical results were included and prospectively reviewed. RESULTS: The estimated blood loss during myomectomy increased in the transversal group compared with the vertical group (809.33±483.34 versus 405.32±180.95 mL, p<0.001). The average operation duration was 60 min, and the patients got discharged on the second day after surgery. No intergroup statistical differences were observed in the surgical procedure. CONCLUSIONS: Surgeons should give preference to the most viable incision depending on the size and location of the leiomyoma.


Assuntos
Laparoscopia , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Hemorragia , Humanos , Histerectomia , Leiomioma/cirurgia , Gravidez , Miomectomia Uterina/efeitos adversos , Neoplasias Uterinas/cirurgia
5.
Zhonghua Bing Li Xue Za Zhi ; 50(9): 1008-1013, 2021 Sep 08.
Artigo em Chinês | MEDLINE | ID: mdl-34496490

RESUMO

Objective: To investigate the clinicpathological, immunohistochemical and molecular genetic features of malignant mixed mesodermal tumor (MMMT) in the female reproductive system. Methods: To analyze its histopathological characteristics, we performed a retrospective review of the MMMT cases diagnosed at PLA General Hospital, Beijing, China during 2005-2019 using its surgical and pathological databases. EnVision immunohistochemical staining was used to detect the expression of ER, PR, p16, p53 and MMR proteins. Results: Fifty cases were conformed to the diagnosis, including 29 cases originated in the uterus, 16 cases in ovary, 4 cases of synchronous occurrence in uterus and ovary, 1 case in cervix. The tumor was histologically composed of two components, namely carcinoma and sarcoma ones, with clear borderline or blend mutually. The proportion of cancer component in the whole tumor ranged from 5%-90%. The proportion of carcinoma was more than 50% in 76% of the cases, and less than 50% in 24% of cases, including 2 cases with<10% of carcinoma. In the cases of primary uterine MMMT, the main carcinoma type was high grade endometrioid carcinoma (55%, 16/29). In ovarian MMMT, the main carcinoma type was serous carcinoma (12/16), while that of cervical MMMT was squamous cell carcinoma. The others were clear cell carcinoma or the undifferentiated carcinoma. There was one carcinoma type in most cases, only 7 cases had two carcinoma types. Homologous sarcomas, including stromal sarcoma, leiomyosarcoma and high-grade spindle cell sarcomas, were more commonly found in uterine MMMT (72.4%, 21/29). While heterogenic sarcomas, including chondrosarcoma, osteosarcoma and rhabdomyosarcoma, were more commonly noted in ovarian MMMT (12/16) than MMMT of other sites. There were 10 cases that consisted of two types of sarcomas. The synchronous MMMT of uterus and ovary had similar morphology and the types of carcinoma and sarcoma. The tumor cells that spread or metastasized to lymph node, omentum, intestinal wall or skin were all carcinoma cells, and were morphologically consistent with the original tumors. Immunohistochemically, ER and PR were both negative (23/25 in uterine, 8/10 in ovarian tumors). p16 was strongly positive (11/11 in uterine tumors, and 6/6 in ovarian tumors), with similar expression patterns in the carcinoma and sarcoma components. p53 showed mutant-type staining (64%, 21/33) and expressed synchronously in carcinoma and sarcoma components. p53 mutation was found in 35% cases of endometrial carcinoma and 46.7% cases of non-endometrial carcinoma. p53 mutation was also found in only 31.8% cases of heterogenic sarcomas, but in 50% of non-heterogenic sarcomas. Twenty-eight cases (28/33, 85%) presented intact mismatch repair proteins, while 5 cases (5/33, 15%) presented deficient mismatch repair proteins. Conclusions: MMMT in female reproductive system is a rare high-grade biphasic tumor with complex and diverse morphology. The immunohistochemical features are characterized by negative ER/PR and strongly positive p16, mostly mutant p53 and proficient mismatch repair proteins. The patients with a high FIGO stage have worse prognosis.


Assuntos
Carcinoma Endometrioide , Neoplasias do Endométrio , Sarcoma do Estroma Endometrial , Neoplasias Uterinas , Carcinoma Endometrioide/cirurgia , Feminino , Humanos , Estudos Retrospectivos , Neoplasias Uterinas/cirurgia
7.
Int J Hyperthermia ; 38(1): 1341-1348, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34486914

RESUMO

OBJECTIVE: To assess the long-term outcomes and the factors affecting local recurrence of uterine fibroids after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation. MATERIALS AND METHODS: 629 patients with a solitary uterine fibroid smaller than 10 cm in diameter treated with USgHIFU at our institutes between January 2011 and December 2016 were retrospectively analyzed. The patients were requested to take pre-HIFU and one day post-HIFU MRI. The patients were asked to return to the hospital every 3 months until January 2020, for imaging evaluation and to check on improvement in symptoms. RESULTS: Five hundred and thirty-six patients completed follow-up according to our protocol. The median follow-up time was 69 (interquartile range: 48 to 89) months. Among them, local recurrence was detected in 110 patients. 18 (16.4%) patients required additional treatment between 12 and 24 months after USgHIFU treatment, 59 (53.6%) patients required additional treatment 24 months after USgHIFU. Therefore, in total, 77 patients required additional treatment, of which 32 received USgHIFU and 45 underwent myomectomy. The median non-perfused volume (NPV) ratio in patients with recurrence was 73%, compared to 89% among patients without recurrence. Multivariate analysis showed that NPV ratio, maximum fibroid diameter and fibroid enhancement type were the independent factors affecting the recurrence of fibroids after USgHIFU treatment. CONCLUSIONS: Achievement of NPV ratio higher than 70% has led to acceptable re-intervention rate during the follow-up period after USgHIFU. NPV ratio, maximum fibroid diameter, and fibroid enhancement type were the independent factors affecting the recurrence of fibroids after USgHIFU treatment.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
8.
Artigo em Inglês | MEDLINE | ID: mdl-34444270

RESUMO

Cotyledonoidleiomyoma is an unusual uterine myoma due to some ultrasound features that mimic a malignant lesion facilitating the choice of radical surgery. This study aims to summarize the ultrasound and the magnetic resonance imaging aspects of this atypical lesion, and also discuss surgical treatment and pathological exam. It included all English case reports or case series until August 2021 found through PubMed, Google Scholar, and Scopus. A total of 94 cotyledonoid leiomyomas were reported, with a median tumor size of 12 cm. The typical ultrasound image is characterized by a large solid heterogeneous mass, with high vascularity, no shadowing, and indistinct margins within the myometrium. Magnetic resonance imaging shows the presence of merging isointense nodules to the myometrium in T1-weighted images, hyperintense in T2-weighted images, and contrast agent enhancement. Surgical treatment consists of hysterectomy (75 cases, 80%) or myomectomy (19 cases, 20%), without evidence of recurrence if complete. The placenta-like appearance observed during surgery supports this rare fibroid hypothesis. The intraoperative frozen section can be considered. Microscopically, no atypical cells, signs of mitotic activity or cell necrosis are found. To conclude, some preoperative and intraoperative aspects of this lesion are distinctive and may lead surgeons to opt for conservative surgery.


Assuntos
Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Imageamento por Ressonância Magnética , Miométrio , Recidiva Local de Neoplasia , Gravidez , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
9.
Am J Case Rep ; 22: e931386, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34381010

RESUMO

BACKGROUND Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor originating in the uterus or in the uterine vessels. It is characterized by continuous intraluminal growth that may extend through iliac veins and inferior vena cava (IVC) to right chambers of the heart and pulmonary vasculature, leading to life-threatening complications. This case report describes an uncommon cause of non-thrombotic pulmonary embolism in young woman caused by extensive IVL. CASE REPORT A 39-year-old woman was admitted after multiple syncopal episodes. She was initially found to have a bilateral pulmonary embolism and large right atrial mass believed to be a thrombus. After an unsuccessful attempt to remove the thrombus with AngioVac (AngioDynamics, Latham, NY), subsequent sternotomy revealed a large pedunculated mass extending to the infra-hepatic IVC. Further abdominal imaging showed multiple uterine masses, with the largest about 17 cm, infiltrating the parauterine vessels and extending through the right iliac vein and inferior vena cava up to the right atrium. Pathology examination of the atrial mass revealed benign leiomyoma consistent with further pathology findings after hysterectomy. The pulmonary embolism was believed to be caused by tumor tissue, and anticoagulation was abandoned. Pulmonary nodule raised a suspicion of benign pulmonary metastases, but, fortunately, remained stable during follow-up and the patient had a successful recovery. CONCLUSIONS Available information about IVL is scarce. This tumor, although benign and rare, should be included in the differential diagnosis of cardiac tumors and non-thrombotic pulmonary emboli in women with predisposing risk factors, as potential complications are life-threatening.


Assuntos
Neoplasias Cardíacas , Leiomiomatose , Embolia Pulmonar , Neoplasias Uterinas , Neoplasias Vasculares , Adulto , Feminino , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Humanos , Leiomiomatose/complicações , Leiomiomatose/cirurgia , Embolia Pulmonar/etiologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/cirurgia , Neoplasias Vasculares/complicações , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/diagnóstico por imagem
12.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404659

RESUMO

A 37-year-old nulliparous woman with abnormal uterine bleeding and a uterine mass suggestive of a leiomyoma not responding to medical therapy was submitted to two hysteroscopies with histological analysis. The first one showed a 'leiomyoma' and the second a 'uterine smooth muscle tumour of uncertain malignant potential/epithelioid leiomyosarcoma, with positivity for hormonal receptors'. The patient was submitted to a total hysterectomy with bilateral salpingo-oophorectomy, and the microscopic examination of the tumour revealed a 'uterine tumour resembling ovarian sex-cord tumours'. According to the literature, most cases are diagnosed in postmenopausal women and have a favourable prognosis. These rare tumours have uncertain malignant potential and have no established treatment protocol, but it appears that a fertility-sparing approach is possible once they are well diagnosed.


Assuntos
Leiomioma , Leiomiossarcoma , Tumor de Músculo Liso , Neoplasias Uterinas , Adulto , Feminino , Humanos , Histerectomia , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/cirurgia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
13.
Int J Hyperthermia ; 38(1): 1126-1132, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34325610

RESUMO

BACKGROUND: High-intensity focused ultrasound (HIFU) is a promising and non-invasive therapy for symptomatic uterine fibroids. Currently, the main image-guided methods for HIFU include magnetic resonance-guided (MR-HIFU) and ultrasound-guided (US-HIFU). However, there are few comparative studies on the therapeutic efficacy and safety of MR-HIFU and US-HIFU in treating symptomatic uterine fibroids with a volume <300 cm3. OBJECTIVE: We performed this meta-analysis to evaluate the efficacy and safety of MR-HIFU and US-HIFU in treating symptomatic uterine fibroids with a volume <300 cm3. METHODS: We searched relevant literature in PubMed, EMBASE, Cochrane Library CNKI from inception until 2021. The mean value, the proportion, and their 95% confidence intervals (CIs) were measured by random-effects models. Publication bias was assessed using funnel plots. RESULTS: 48 studies met our inclusion criteria-28 describing MR-HIFU and 20 describing US-HIFU. The mean non-perfused volume rate (NPVR) was 81.07% in the US-HIFU group and 58.92% in the MR-HIFU group, respectively. The mean volume reduction rates at month-3, month-6, and month-12 were 42.42, 58.72, and 65.55% in the US-HIFU group, while 34.79, 37.39, and 36.44% in the MR-HIFU group. The incidence of post-operative abdominal pain and abnormal vaginal discharge in the US-HIFU group was lower than that of MRI-HIFU. However, post-operative skin burn and sciatic nerve pain were more common in the US-HIFU group compared with MRI-HIFU. The one-year reintervention rate after MR-HIFU was 13.4%, which was higher than 5.2% in the US-HIFU group. CONCLUSION: US-HIFU may show better efficiency and safety than MR-HIFU in treating symptomatic fibroids with a volume <300 cm3.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Imageamento por Ressonância Magnética , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
14.
J Coll Physicians Surg Pak ; 31(8): 926-931, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34320709

RESUMO

OBJECTIVE: To evaluate the efficacy of adjuvant chemotherapy (ACTx) in completely resected uterine leiomyosarcoma (ULMS) in terms of survival outcomes. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey from February 2009 to November 2019. METHODOLOGY: Patients older than 18 years, who underwent complete surgical resection with a diagnosis of non-metastatic ULMS were evaluated retrospectively. The patients were divided into two groups: patients who received ACTx (group I) and patients who received only surgical treatment (group II). Both groups were compared in terms of main patient and tumour characteristics, relapse rates, relapse-free survival (RFS) and overall survival (OS). RESULTS: Forty-five patients with a median age of 52.1 years (IQR, 45.8-58.2) were included in the study. Group I consisted of 26 (57.8%) patients and group II consisted of 19 (42.2%) patients. Median RFS was 43.8 months (95% CI, 7.4-80.2) and the median OS was 81.3 months (95% CI, 39.4-123.1) for all patients (N = 45). Median RFS was 27.1 months (95% CI, 6.8-47.4) in group I (n = 26) and 43.8 months (95% CI, 11.8-75.8) in group II (n = 19) (p = 0.985). Median OS was 85.6 months (95% CI, 38.3-132.9) in group I (n = 26) and 81.2 months (95% CI, 62.1-100.4) in group II (n = 19) (p = 0.699).  Conclusion: There was no survival benefit of ACTx in completely resected ULMSs, in accordance with the literature data. There is a need for prospective randomised clinical trials evaluating the role of ACTx in ULMSs. Key Words: Uterine leiomyosarcoma, Complete resection, Adjuvant chemotherapy, Relapse, RFS, OS.


Assuntos
Leiomiossarcoma , Neoplasias Uterinas , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioterapia Adjuvante , Feminino , Humanos , Leiomiossarcoma/tratamento farmacológico , Leiomiossarcoma/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Turquia/epidemiologia , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/cirurgia
15.
J Med Case Rep ; 15(1): 356, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34238340

RESUMO

BACKGROUND: Uterine artery embolization in the treatment of uterine leiomyoma has been rarely associated with dislodgement and expulsion of infarcted uterine fibroids through the vagina, peritoneum, or bowel wall, predominantly occurring within 6 months of uterine artery embolization. CASE PRESENTATION: We present the case of a 54-year-old African American woman who underwent uterine artery embolization 11 years prior and developed mechanical small bowel obstruction from the migration of fibroid through a uteroenteric fistula with ultimate impaction within the distal small bowel lumen. Small bowel resection and hysterectomy were curative. CONCLUSIONS: Uteroenteric fistula with small bowel obstruction due to fibroid expulsion may present as a delayed finding after uterine artery embolization and requires heightened awareness.


Assuntos
Embolização Terapêutica , Obstrução Intestinal , Leiomioma , Embolização da Artéria Uterina , Doenças Uterinas , Neoplasias Uterinas , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Leiomioma/complicações , Leiomioma/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento , Neoplasias Uterinas/complicações , Neoplasias Uterinas/cirurgia
16.
J Med Case Rep ; 15(1): 344, 2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34253260

RESUMO

BACKGROUND: Fibroids of the uterus are the most common benign pelvic tumors in women worldwide. Their diagnosis is usually not missed because of the widespread and well-established use of ultrasound in gynecological clinics. Hence, the development of an unusually large myoma is a rare event, particularly in first-world countries such as Germany. It is even more uncommon that a myoma is misdiagnosed as a dietary failure. CASE PRESENTATION: Herein, we report the case of a Caucasian woman with a giant fibroid that reached a size of over 50 cm, growing slowly over the past 15 years, and was misdiagnosed as abdominal fat due to weight gain. We aim to discuss the factors that lead to the growth of such a huge tumoral mass, including misdiagnosis and treatment, and the psychological impact. Through this case, we intend to increase the awareness among general physicians and gynecologists. Although menstrual disorders incorporate several pathologies, adequate assessment remains the primary responsibility of health care providers. A literature review revealed approximately 60 cases of giant uterine fibroids. CONCLUSION: The use of clinical and diagnostic devices, especially ultrasound, in this case, is indispensable. In conclusion, the growth of a giant fibroid can have disastrous effects on a woman's health, including surgical trauma and psychological issues.


Assuntos
Leiomioma , Neoplasias Uterinas , Feminino , Alemanha , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Ultrassonografia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
17.
Eur J Radiol ; 141: 109801, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34116454

RESUMO

PURPOSE: Myomectomy is currently the gold standard for the treatment of uterine fibroids in women who desire pregnancy. However, this surgical fibroid removal has a long convalescence. Promising alternatives may be non-invasive High Intensity Focused Ultrasound (HIFU) under either MRI (MR-HIFU) or ultrasound guidance (USgHIFU). In this systematic review, an overview is provided of reproductive outcomes after these two relatively new ablation techniques. METHOD: A systematic literature search was performed to identify studies reporting reproductive outcomes after HIFU treatment of fibroids. Only peer reviewed, full papers were included. Outcomes included pregnancy-, live-birth- miscarriage and caesarian section rate, time to conceive, reported complications, and possible prognostic factors. RESULTS: In total 21 studies were included. Fourteen studies reported 124 pregnancies after MR-HIFU. Two placenta previas and no uterus ruptures were reported. Pregnancy rates were only retrospectively collected and ranged between 7% and 36%. Miscarriage rate in the oldest and largest prospective registry was 39%. After USgHIFU 366 pregnancies were reported with one fetal intrauterine death, six placenta previas and no uterus ruptures. The only prospective study reported a pregnancy rate of 47% and a miscarriage rate of 11%. Possible prognostic factors like age were not available in most studies. CONCLUSIONS: Based on the heterogeneous data currently available, reproductive outcomes after HIFU appear non-inferior to outcomes after the current standard of care. However, a (randomized) controlled trial comparing reproductive outcomes after HIFU and standard care is necessary to provide sufficient evidence on the preferred fibroid treatment for women with a pregnancy wish.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Gravidez , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
18.
BMJ Case Rep ; 14(6)2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34155019

RESUMO

Gestational trophoblastic disease occurs in 1-3:1000 gestations worldwide. Up to one-fifth of complete hydatidiform moles undergo malignant transformation, with 2%-4% manifesting as metastatic disease. Of these, a third present with vaginal metastases, which can cause bleeding and discharge. We describe the case of a 49-year-old primiparous woman presenting with syncope and intense bleeding from an anterior vaginal lesion, 3 weeks after uterine evacuation for a presumed spontaneous abortion. A vaginal metastatic nodule was suspected; haemostasis was achieved with vaginal packing, precluding the need for surgical intervention. The patient was ultimately diagnosed with invasive mole with vaginal and lung metastases (stage III high-risk gestational trophoblastic neoplasia (GTN)) and started on multiple-agent chemotherapy. Two months later the lesion had regressed completely, and remission was reached 2 weeks later. Clinicians should consider the possibility of metastatic GTN with vaginal involvement whenever heavy vaginal bleeding follows a recent history of failed pregnancy.


Assuntos
Doença Trofoblástica Gestacional , Mola Hidatiforme Invasiva , Mola Hidatiforme , Neoplasias Uterinas , Feminino , Humanos , Mola Hidatiforme/complicações , Mola Hidatiforme/diagnóstico por imagem , Pessoa de Meia-Idade , Gravidez , Neoplasias Uterinas/complicações , Neoplasias Uterinas/cirurgia
19.
Wiad Lek ; 74(5): 1152-1157, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34090282

RESUMO

OBJECTIVE: The aim: Optimizing the interdisciplinary approaches in the diagnosis and monitoring the dynamics of uterine leiomyoma treatment by high-intensity focused ultrasound ablation. PATIENTS AND METHODS: Materials and methods: In the course of scientific research we conducted a survey 72 women of reproductive age were diagnosed with leiomyoma. All patients underwent bimanual gynecological examination, ultrasound and MRI to determine the condition of the pelvic organs, assess the structure, location, number of myomas, as well as assess the possible acoustic pathway of high-intensity focused ultrasound. During monitoring, dynamic contrasting was used to determine the zone of node necrosis. Methods of control in the postoperative period: ultrasound, MRI of the pelvic organs using paramagnetic, were performed after 1, 3, 6 months. Ultrasound ablation of uterine fibroids was performed using the JC extracorporeal treatment system (Chongqing HAIFU (HIFU) Technology Co. Ltd., China) with a built-in ultrasound system (Italy). Controlling the direct result was based on gray scale changes during real-time ultrasound examination on the monitor of the JC device. Since HIFU is a non-invasive method of treatment, in the future, the diagnosis was limited to using the ultrasound and MRI paramagnetic. Indicators such as: uterine body size were considered as indicators that characterize the effectiveness of treatment; specific volume of myoma; regression of uterine body size; regression of the myoma; regression of the node, calculated on its specific volume, because one patient could have several nodes. RESULTS: Results: Analyzing the obtained results, it should be noted that for a month the average volume of leiomatous hives that were exposed to HIFU, almost did not change and was 122 cm³, while three months after treatment it was - 98 cm. The nodes underwent a significant reduction 6 months after the treatment, their volume averaged 61 cm³. The dynamics analysis results of uterine body volume reduction, which is no less important expected result, showed the following: in the first month after the intervention the uterine volume almost did not change and, compared to the average size before treatment 342cm³, was 300cm³. In three months after treatment, the body volume of the uterus decreased to 264 cm³, and in six months - to 200 cm³. When assessing the node 6 months after the procedure, it was found that during this period there was a significant reduction in the volume of leiomyoma, which was positively correlated with the clinical manifestations of the disease. CONCLUSION: Conclusions: An interdisciplinary approach with the widespread introduction of modern organ-preserving techniques is an important direction in maintaining the reproductive health of women with uterine leiomyoma. Positive dynamics of leiomatous node volume regression depends on its location, volume and MR type. The terms 1 and 3 months after ultrasound ablation are insufficient for objective radiological evaluation of the treatment outcome, but are important for the choice of further tactics in observing and treating the uterine leiomyoma.


Assuntos
Saúde Reprodutiva , Neoplasias Uterinas , China , Feminino , Humanos , Itália , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
20.
J Coll Physicians Surg Pak ; 30(6): 719-721, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34102788

RESUMO

Atypical polypoid adenomyoma (APAM) is a rare polypoidal benign tumor of uterus, which usually presents with irregular vaginal bleeding in women of reproductive age. It has the potential of malignant transformation but does not metastasise. It may coexist with endometrial hyperplasia and adenocarcinoma; and so, is usually misdiagnosed. It is composed of atypical endometrial glands along with bundles of smooth muscle fibres. It has a high incidence of recurrence. We describe a case of APAM, which was managed at a tertiary care hospital. A 25-year woman with irregular vaginal bleeding and abdominal mass had total abdominal hysterectomy (TAH) on suspicion of endometrial sarcoma.  Histopathology specimen revealed APAM. On follow-up so far, she is in stable condition and asymptomatic. Key Words: Atypical polypoid adenomyosis, Adenosarcoma, Endometrial carcinoma.


Assuntos
Adenomioma , Hiperplasia Endometrial , Neoplasias do Endométrio , Neoplasias Uterinas , Adenomioma/diagnóstico por imagem , Adenomioma/cirurgia , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia
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