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1.
N Engl J Med ; 383(5): 440-451, 2020 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-32726530

RESUMO

BACKGROUND: Uterine fibroids, the most common type of tumor among women of reproductive age, are associated with heavy menstrual bleeding, abdominal discomfort, subfertility, and a reduced quality of life. For women who wish to preserve their uterus and who have not had a response to medical treatment, myomectomy and uterine-artery embolization are therapeutic options. METHODS: We conducted a multicenter, randomized, open-label trial to evaluate myomectomy, as compared with uterine-artery embolization, in women who had symptomatic uterine fibroids and did not want to undergo hysterectomy. Procedural options included open abdominal, laparoscopic, or hysteroscopic myomectomy. The primary outcome was fibroid-related quality of life, as assessed by the score on the health-related quality-of-life domain of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire (scores range from 0 to 100, with higher scores indicating a better quality of life) at 2 years; adjustment was made for the baseline score. RESULTS: A total of 254 women, recruited at 29 hospitals in the United Kingdom, were randomly assigned: 127 to the myomectomy group (of whom 105 underwent myomectomy) and 127 to the uterine-artery embolization group (of whom 98 underwent embolization). Data on the primary outcome were available for 206 women (81%). In the intention-to-treat analysis, the mean (±SD) score on the health-related quality-of-life domain of the UFS-QOL questionnaire at 2 years was 84.6±21.5 in the myomectomy group and 80.0±22.0 in the uterine-artery embolization group (mean adjusted difference with complete case analysis, 8.0 points; 95% confidence interval [CI], 1.8 to 14.1; P = 0.01; mean adjusted difference with missing responses imputed, 6.5 points; 95% CI, 1.1 to 11.9). Perioperative and postoperative complications from all initial procedures, irrespective of adherence to the assigned procedure, occurred in 29% of the women in the myomectomy group and in 24% of the women in the uterine-artery embolization group. CONCLUSIONS: Among women with symptomatic uterine fibroids, those who underwent myomectomy had a better fibroid-related quality of life at 2 years than those who underwent uterine-artery embolization. (Funded by the National Institute for Health Research Health Technology Assessment program; FEMME Current Controlled Trials number, ISRCTN70772394.).


Assuntos
Leiomioma/cirurgia , Qualidade de Vida , Embolização da Artéria Uterina , Miomectomia Uterina , Neoplasias Uterinas/cirurgia , Adulto , Feminino , Humanos , Histeroscopia , Análise de Intenção de Tratamento , Complicações Intraoperatórias , Laparoscopia , Leiomioma/terapia , Tempo de Internação , Menorragia , Pessoa de Meia-Idade , Reserva Ovariana , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Embolização da Artéria Uterina/efeitos adversos , Miomectomia Uterina/efeitos adversos , Miomectomia Uterina/métodos , Neoplasias Uterinas/terapia , Útero/cirurgia
2.
Medicine (Baltimore) ; 99(26): e20491, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590732

RESUMO

BACKGROUND: Atypical polypoid adenomyoma (APA) is a rare uterine tumor typically found in fertile age and associated with infertility. Among young nullipara women, conservative treatment is proposed despite the high recurrence rate and the association with endometrial cancer.Our aim was to assess the risk of recurrence with different conservative treatments in fertile ages and the prevalence of malignant or pre-malignant associated lesions to better address an adequate patient counselling when treatment modalities are discussed. METHODS: This study is a systematic review and meta-analysis of case reports and case series about APA management and follow-up. A literature search was carried from Medline and Scopus for studies published from January 1, 1980 to December 31, 2018. RESULTS: We included 46 observational studies and 296 cases in fertile women. The prevalence of APA relapse was 44% (CI.95 33-57%) and was lower in cases treated with operative hysteroscopy (22%; CI.95 11-39%) than in cases treated with blind curettage and polypectomy (38%; CI.95 15-67%). The prevalence of the concomitant or during the follow-up diagnosis of endometrial carcinoma was 16% (CI.95 9-29%). The risk of cancer development during follow-up was significantly less in cases treated with histeroscopy (10.56% new cumulative diagnosis at 5 years follow up; CI.95 0-23.7%) than blind curettage and polypectomy (35.5% new cumulative diagnosis at 5 years; CI.95 11.65-52.92%; P < .05). Medical treatment with medroxyprogesterone acetate after surgery does not reduce APA recurrence. Pregnancy was observed in 79% cases in which the desire was expressed. CONCLUSION: This review suggests that conservative treatment performed by operative hysteroscopy is the optimal choice because it lowers the risk of recurrence, improves the accuracy of concomitant carcinoma or hyperplasia diagnosis, and leaves the possibility of future pregnancies.


Assuntos
Adenomioma/terapia , Recidiva Local de Neoplasia/patologia , Neoplasias Uterinas/terapia , Adenomioma/patologia , Antineoplásicos Hormonais/uso terapêutico , Quimioterapia Adjuvante , Tratamento Conservador , Curetagem , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histeroscopia , Acetato de Medroxiprogesterona/uso terapêutico , Neoplasias Primárias Múltiplas , Gravidez , Taxa de Gravidez , Neoplasias Uterinas/patologia
3.
Medicine (Baltimore) ; 99(18): e20016, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358379

RESUMO

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


Assuntos
Terapia por Acupuntura/métodos , Medicamentos de Ervas Chinesas/uso terapêutico , Leiomioma/terapia , Neoplasias Uterinas/terapia , Adolescente , Adulto , China , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Leiomioma/tratamento farmacológico , Leiomioma/patologia , Ciclo Menstrual , Pessoa de Meia-Idade , Qualidade de Vida , Projetos de Pesquisa , Índice de Gravidade de Doença , Método Simples-Cego , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/patologia , Adulto Jovem
4.
Am J Obstet Gynecol ; 223(1): 75.e1-75.e5, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32199924

RESUMO

Uterine fibroid tumors are the most common benign pelvic tumors in women, with complications that include heavy menstrual bleeding, pelvic pain, reproductive complications, and bulk-related symptoms. Although the majority of uterine fibroid tumors are asymptomatic, those women who experience symptoms can experience substantial burdens on quality of life and daily functioning. Comparative effectiveness reviews of available medical, surgical, and radiologic treatments have found that a lack of high-quality data to inform treatment decisions is, in part, due to the use of heterogeneous outcomes and instruments in clinical studies. With multiple new interventions emerging, this call-to-action encourages the development and use of a core outcome set that will capture the most relevant, patient-important outcomes in late-phase and after-marketing therapeutic trials for uterine fibroid tumors. The core outcome set should be developed by a diverse, multistakeholder group comprised of key healthcare decision-makers. Development and uptake of a core outcome set ensures that a consistent, collaboratively vetted set of outcomes will be accessible across different studies and promotes transparency for innovators who seek to anticipate the evidence needs of patients, providers, payers, regulators, and other stakeholders.


Assuntos
Pesquisa Biomédica , Leiomioma/terapia , Neoplasias Uterinas/terapia , Feminino , Humanos , Resultado do Tratamento
5.
Can Assoc Radiol J ; 71(1): 75-80, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32062997

RESUMO

PURPOSE: Uterine artery embolization (UAE) is an effective treatment for the management of symptomatic uterine fibroids. We aim to evaluate the efficacy of superior hypogastric nerve block (SHNB) in reducing narcotic analgesia use for postprocedural pain after UAE. METHODS: A retrospective review of 88 consecutive patients with symptomatic fibroids who underwent UAE between August 2015 and August 2018 was performed. A total of 44 patients had intraprocedural SHNB and 44 patients had no SHNB. They were placed on a morphine patient-controlled anesthesia (PCA) pump after the procedure and were admitted for overnight observation. The total amount of PCA narcotic analgesia received was recorded for each patient. Additional factors including fibroid size, fibroid location, and patient age were evaluated to determine the predictors of narcotic use reduction after SHNB. RESULTS: The mean amount of postprocedural morphine use was 51.7 mg in patients who did not receive an SHNB versus 35.9 mg in patients who did receive an SHNB (P = .008), resulting in a 47.2% reduction in narcotic analgesia use in the SHNB cohort. A significant reduction in morphine use with SHNB was associated with fibroid size greater than 5 cm (P = .009), intramural fibroid location (P = .04), and patients 45 years or younger (P = .006). CONCLUSION: The use of SHNB could significantly reduce the amount of narcotic analgesia required for pain control after UAE with larger intramural fibroids and younger patients as predictors of increased efficacy.


Assuntos
Leiomioma/terapia , Morfina/uso terapêutico , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Adulto , Analgesia Controlada pelo Paciente , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos
6.
Acta Radiol ; 61(9): 1287-1296, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31955609

RESUMO

BACKGROUND: Uterine fibroid embolization (UFE) is an effective treatment for uterine leiomyomata. Optimizing the choice of embolic agents is imperative to achieve better patient outcomes with maximum resource utilization. PURPOSE: To evaluate the efficacy and cost-effectiveness of trisacryl gelatin microspheres (TAGM) versus combined TAGM and gelatin sponge (GS) embolization in the treatment of symptomatic uterine leiomyomata. MATERIAL AND METHODS: Between July 2007 and December 2010, 106 consecutive patients underwent UFE with TAGM. Between January 2011 and December 2016, 123 consecutive patients underwent UFE with a combination of TAGM/GS. The primary outcomes were successful infarction rate (≥90% infarction) of the dominant leiomyoma and percentage reduction in uterine and dominant leiomyoma volume on MRI at six months. Secondary outcomes included adverse event rates, pain scores, and change in clinical symptoms at six months. The embolic agents utilized per procedure were recorded and a cost-effectiveness analysis was performed. RESULTS: Baseline characteristics of both groups were similar. Successful infarction was achieved in 93.2% of the TAGM group and 94.6% of the TAGM/GS group (P = 0.52). Reduction in uterine volume (TAGM 40.7%, TAGM/GS 44.4%, P = 0.16) and dominant leiomyoma volume (TAGM 47.6%, TAGM/GS 50.1%, P = 0.29) at six months was similar. No significant difference was observed in symptom improvement at six months (P = 0.8). The mean number of TAGM vials utilized and cost per procedure was 6.3 and $1688.40 for TAGM embolization and 3.6 and $979.50 for TAGM/GS embolization, respectively. CONCLUSION: Primary and secondary outcomes were comparable when performing UFE with TAGM versus combined TAGM/GS. The combined use of TAGM/GS reduced the mean cost of embolic agents by 42%.


Assuntos
Resinas Acrílicas/uso terapêutico , Gelatina/uso terapêutico , Leiomioma/terapia , Embolização da Artéria Uterina/métodos , Neoplasias Uterinas/terapia , Adulto , Meios de Contraste , Análise Custo-Benefício , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Imagem por Ressonância Magnética , Meglumina/análogos & derivados , Compostos Organometálicos , Medição da Dor , Estudos Retrospectivos , Neoplasias Uterinas/diagnóstico por imagem
7.
J Vasc Interv Radiol ; 31(3): 388-392, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31983594

RESUMO

In a single-arm, nonrandomized, retrospective case-control study, 39 patients (mean age, 44 y) who underwent elective outpatient uterine artery embolization with the use of superior hypogastric nerve block (SNHB) for pain control over a period of 3 years were identified. Technical success of SNHB was 87%. Of the 34 patients who received SNHB, 97% did not need a patient-controlled analgesia pump. The median opioid requirement for the 17 patients who needed opioid agents was 7.5 morphine milligram equivalents (interquartile range [IQR], 10). The median length of stay was 2.2 hours (IQR, 1.7 h). SHNB offers a safe and effective intervention that significantly reduces pain and the need for opiate agents and allows same-day discharge after uterine artery embolization.


Assuntos
Plexo Hipogástrico , Leiomioma/terapia , Tempo de Internação , Bloqueio Nervoso , Dor/prevenção & controle , Alta do Paciente , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Adulto , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Bloqueio Nervoso/efeitos adversos , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Embolização da Artéria Uterina/efeitos adversos , Neoplasias Uterinas/diagnóstico por imagem
8.
Gynecol Obstet Invest ; 85(2): 178-183, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940645

RESUMO

INTRODUCTION: Nowadays, the resection of submucosal myomas is usually performed by hysteroscopy. No previous study has investigated the use of preoperative hormonal therapy before outpatient hysteroscopic myomectomy. OBJECTIVE: To compare the usefulness of 3-month preoperative treatment with ulipristal acetate (UPA) before outpatient hysteroscopic myomectomy in patients with FIGO (International Federation of Gynecology and Obstetrics) type 0-1 myomas. STUDY DESIGN: This prospective patient preference study included women requiring hysteroscopic resection of single FIGO type 0-1 myoma with the largest diameter <2 cm. Patients underwent either preoperative treatment with UPA (5 mg/day) for 3 months or direct surgery. Outpatient myomectomy was performed using the bipolar electrosurgical Versapoint system (Ethicon Gynecare, USA). The primary objective of the study was to compare the rate of complete resections in the 2 study groups. The secondary objective of the study was to compare the operative time and the volume of fluid infused/absorbed. The tertiary objective of the study was to assess the surgical appearance of the myomas in patients treated with UPA. RESULTS: The study included 38 women treated with UPA and 45 women who underwent direct surgery. UPA treatment significantly decreased the volume of uterine myomas (p < 0.001). The percentage of complete resection was higher in patients treated with UPA (89.5%) than in those who underwent direct surgery (68.9%; p = 0.046). Preoperative UPA treatment decreased the operative time (p < 0.001) and the volume of fluid infused (p = 0.016), but it did not significantly affect the volume of fluid absorbed (p = 0.874). The texture of the myoma was not significantly affected by UPA treatment (p = 0.142). CONCLUSIONS: Three-month UPA treatment improves the chance of single-step complete outpatient hysteroscopic resection of single FIGO type 0-1 myoma. Future randomized studies with a larger sample size should confirm these preliminary findings.


Assuntos
Contraceptivos Hormonais/administração & dosagem , Histeroscopia/métodos , Leiomioma/terapia , Norpregnadienos/administração & dosagem , Cuidados Pré-Operatórios/métodos , Miomectomia Uterina/métodos , Neoplasias Uterinas/terapia , Adulto , Procedimentos Cirúrgicos Ambulatórios/métodos , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Duração da Cirurgia , Preferência do Paciente , Gravidez , Cuidados Pré-Operatórios/psicologia , Estudos Prospectivos , Resultado do Tratamento
9.
Int J Gynaecol Obstet ; 149(1): 3-9, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31960950

RESUMO

Uterine leiomyomas are one of the most common and yet understudied diseases in women. These tumors, commonly known as fibroids, affect women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African ancestry during their lifetime. This disease has a profound impact on health care delivery and costs worldwide. Though most women with fibroids are asymptomatic, approximately 30% of them will present with severe symptoms which can include abnormal uterine bleeding, anemia, pelvic pain and pressure, back pain, urinary frequency, constipation, or infertility, and will require intervention. Furthermore, fibroids have been associated with poor obstetrical outcomes. The current options for symptomatic fibroid treatment include expectant, medical, and surgical management, and interventional radiology procedures. This article reviews the recent progress and available management strategies for uterine fibroids and highlights areas where further research is needed to find new therapeutic targets and better personalize treatments.


Assuntos
Leiomioma/terapia , Neoplasias Uterinas/terapia , Feminino , Humanos , Leiomioma/epidemiologia , Leiomioma/patologia , Dor Pélvica/etiologia , Hemorragia Uterina/etiologia , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/patologia
10.
Acta Obstet Gynecol Scand ; 99(1): 89-98, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31468503

RESUMO

INTRODUCTION: Laparoscopic myomectomy can be difficult when fibroids are large and numerous. This may result in extensive intraoperative bleeding and the need for a conversion to a laparotomy. Medical pretreatment prior to surgery might reduce these risks by decreasing fibroid size and vascularization of the fibroid. We compared pretreatment with ulipristal acetate (UPA) vs gonadotropin-releasing hormone agonists (GnRHa) prior to laparoscopic myomectomy on several intra- and postoperative outcomes. MATERIAL AND METHODS: We performed a non-inferiority double-blind randomized controlled trial in nine hospitals in the Netherlands. Women were randomized between daily oral UPA for 12 weeks and single placebo injection or single intramuscular injection with leuprolide acetate and daily placebo tablets for 12 weeks. The primary outcome was intraoperative blood loss. Secondary outcomes were reduction of fibroid volume, suturing time, total surgery time and surgical ease. RESULTS: Thirty women received UPA and 25 women leuprolide acetate. Non-inferiority of UPA regarding intraoperative blood loss was not demonstrated. When pretreated with UPA, median intraoperative blood loss was statistically significantly higher (525 mL [348-1025] vs 280 mL[100-500]; P = 0.011) and suturing time of the first fibroid was statistically significantly longer (40 minutes [28-48] vs 22 minutes [14-33]; P = 0.003) compared with GnRHa. Pretreatment with UPA showed smaller reduction in fibroid volume preoperatively compared with GnRHa (-7.2% [-35.5 to 54.1] vs -38.4% [-71.5 to -19.3]; P = 0.001). Laparoscopic myomectomies in women pretreated with UPA were subjectively judged more difficult than in women pretreated with GnRHa. CONCLUSIONS: Non-inferiority of UPA in terms of intraoperative blood loss could not be established, possibly due to the preliminary termination of the study. Pretreatment with GnRHa was more favorable than UPA in terms of fibroid volume reduction, intraoperative blood loss, hemoglobin drop directly postoperatively, suturing time of the first fibroid and several subjective surgical ease parameters.


Assuntos
Contraceptivos Hormonais/uso terapêutico , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Laparoscopia , Leiomioma/terapia , Norpregnadienos/uso terapêutico , Miomectomia Uterina , Neoplasias Uterinas/terapia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Método Duplo-Cego , Feminino , Humanos , Países Baixos , Duração da Cirurgia , Suturas
11.
Eur J Radiol ; 122: 108670, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31778966

RESUMO

PURPOSE: To examine non-contrast enhanced MRI value to evaluate necrotic area and ablation rate of uterine fibroids after high-intensity focused ultrasound (HIFU) thermal ablation. METHOD: In total, 508 patients with 598 fibroids who underwent HIFU treatment were enrolled. Contrast-enhanced MRI (CE-MRI) with diffusion-weighted imaging (DWI)were performed before treatment and within two days post-treatment. DWI signal performance of post-operative fibroids was observed; apparent diffusion coefficient (ADC) and DWI signal values pre- and post-operation were measured. The volume of post-operative DWI signal change area and post-contrast enhanced fibroid necrosis area were compared. RESULTS: Average ADC and DWI signal values before HIFU treatment were higher than those post-operation; the difference was statistically significant before and after ablation (P < 0.05). After HIFU, 78.09 % (467 / 598) of DWI showed complete regular or irregular high-signal rings and 21.91 % (131 / 598) showed incomplete high-signal rings. No significant difference was noted between the complete high-signal ring volume on DWI and the non-enhanced volume (P > 0.05); however, this difference was statistically significant compared with the incomplete high-signal ring volume on DWI (P < 0.05). Two doctors had good agreements on evaluating the morphology of high-signal rings (κ > 0.75, P < 0.05). CONCLUSIONS: Combined with pre-operative T2WI and post-operative DWI, non-contrast enhanced MRI can effectively evaluate ablation rate for most patients with uterine fibroids.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Leiomioma/terapia , Neoplasias Uterinas/terapia , Adulto , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Resultado do Tratamento
12.
Br J Radiol ; 93(1105): 20190551, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31573326

RESUMO

Females with symptomatic leiomyomas (fibroids) wishing to maintain fertility are faced with difficult treatment choices. These include uterine fibroid embolization (UFE), myomectomy, hormonal therapy, MRI high intensity focused ultrasound, and myolysis. This review focuses on UFE, one of the most commonly accepted minimally invasive procedural choices among patients with symptomatic fibroids wishing to retain the option of becoming pregnant in the future, and makes comparisons to myomectomy which has historically been the surgical choice for fertility-preserving fibroid treatment. Pubmed and Google Scholar searches using keywords such as: uterine artery embolization, uterine fibroid embolization, pregnancy, complications, infertility were performed between Jan 1, 2019 and May 10, 2019. Publications were chosen based on their inclusion of information pertaining to fertility or pregnancy after UFE without being limited to single case reports.Randomized controlled trials comparing myomectomy and UFE are limited due to study size and confounding variables, but through registry data and familiarity with referring clinicians, UFE has gained wide acceptance. Healthy pregnancies following UFE have been sporadically reported but the actual fertility rate after UFE remains uncertain. Conversely, low birth weight, miscarriage and prematurity have been associated with UFE. Despite inherent risks of possible fertility issues after UFE, the procedure remains an option for females with clinically symptomatic fibroids who desire pregnancy. However, additional research regarding rates of conception and obstetrical risks of infertility following UFE is necessary.


Assuntos
Leiomioma/terapia , Complicações Neoplásicas na Gravidez/terapia , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Feminino , Humanos , Infertilidade Feminina/etiologia , Seleção de Pacientes , Gravidez , Resultado da Gravidez , Embolização da Artéria Uterina/efeitos adversos
13.
Medicine (Baltimore) ; 98(47): e18119, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764852

RESUMO

RATIONALE: Uterine adenosarcoma (UA) with sarcomatous overgrowth (ASSO) is a rare and aggressive disease. Herein, wereported the case of a young patient with advanced uterine ASSO. PATIENTS CONCERNS: A 29-year-old woman with the diagnoses of endometrial polyp and adenomyosis underwent hysteroscopic endometrial polypectomy for the giant endometrial polyp. Postoperative regular ultrasound scan indicated thickened endometriumand an ill-defined mass with continuous enlargement in the myometrium of the posterior wall of the uterus, which was considered as an adenomyoma. Two years after hysteroscopy, she was re-admitted due to lower abdominal distension and large pelvic mass. At that time, she had taken oral short-acting contraceptives for 2.5 years. DIAGNOSES: Magnetic resonance imaging (MRI) of the pelvis revealed an irregular mass with the size of 12*56*107 mm in the right annex area, without distinct border with the rectum, moreover, an uneven intrauterine echo that has no obvious boundary with uterine wall. Right ovarian cancer and adenomyoma were initially considered. INTERVENTIONS: The patient received transperitoneal retroperitoneal pelvic combined with total viscera resection, including uterus, bilateral appendages and rectum, omentectomy, appendectomy, lymphadenectomy, and ileostomy. Postoperative pathology confirmed ASSO in the uterine cavity and muscular layer, the whole cervical duct and the right adnexal. She underwent 2 systemic chemotherapy sessions after the surgery. The chemotherapy regimen was ifosfamide 2.5 g day 1 to 3, with liposomal doxorubicin 40 mg day 1. OUTCOMES: The final diagnosis was uterine ASSO, International Federation of Gynecology and Obstetrics stage IVa. The patient has been following-up so far, with no progression. LESSONS: Review of the case indicated that history of long-term oral short-acting contraceptives and giant endometrial polyps may be the high-risk factors for UA. For patients with high-risk factors, the follow-up ultrasound scan should be more frequently conducted. Moreover, 3D-ultrasound, MRI and outpatient hysteroscopy are recommended for routine screening. Placement of levonorgestrel-releasing intra-uterine system after hysteroscopy may be an effective intervention for patients with a high risk of giant polyps. Cluster of Differentiation 10, Estrogen receptor, Progesterone receptor, and nuclear antigen may be predictors for prognosis and selection of individualized treatment program.


Assuntos
Adenossarcoma/patologia , Neoplasias Uterinas/patologia , Adenossarcoma/terapia , Adulto , Feminino , Humanos , Invasividade Neoplásica , Sarcoma/patologia , Neoplasias Uterinas/terapia
14.
Int J Mol Sci ; 20(21)2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31689961

RESUMO

Dysfunction of p53 is observed in the many malignant tumors. In cervical cancer, p53 is inactivated by degradation through the complex with human papilloma virus (HPV) oncoprotein E6 and E6-associated protein (E6AP), an E3 ubiquitin protein ligase. In endometrial cancer, overexpression of p53 in immunohistochemistry is a significant prognostic factor. A discrepancy between p53 overexpression and TP53 mutations is observed in endometrioid endometrial cancer, indicating that the accumulation of p53 protein can be explained by not only gene mutations but also dysregulation of the factors such as ERß and MDM2. Furthermore, the double-positive expression of immunoreactive estrogen receptor (ER) ß and p53 proteins is closely associated with the incidence of metastasis and/or recurrence. High-grade serous ovarian carcinoma (HGSC) arises from secretary cells in the fallopian tube. The secretary cell outgrowth (SCOUT) with TP53 mutations progresses to HGSC via the p53 signature, serous intraepithelial lesion (STIL), and serous intraepithelial carcinoma (STIC), indicating that TP53 mutation is associated with carcinogenesis of HGSC. Clinical application targeting p53 has been approved for some malignant tumors. Gene therapy by the adenovirus-mediated p53 gene transfer system is performed for head and neck cancer. A clinical phase III trial using MDM2/X inhibitors, idasanutlin (RG7388) combined with cytarabine, is being performed involving relapse/refractory acute myeloid leukemia patients. The use of adenoviruses as live vectors which encode wild-type p53 has given promising results in cervical cancer patients.


Assuntos
Biomarcadores Tumorais/genética , Carcinoma/genética , Neoplasias Ovarianas/genética , Proteína Supressora de Tumor p53/genética , Neoplasias Uterinas/genética , Biomarcadores Tumorais/metabolismo , Carcinoma/patologia , Carcinoma/terapia , Feminino , Terapia Genética/métodos , Humanos , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Proteína Supressora de Tumor p53/metabolismo , Neoplasias Uterinas/patologia , Neoplasias Uterinas/terapia
15.
Bratisl Lek Listy ; 120(10): 734-738, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31663347

RESUMO

OBJECTIVES: Authors evaluate the impact of intraprocedural complications on successful technical realisation and long-term clinical outcome of the uterine fibroid embolisation. BACKGROUND: The uterine artery embolisation (UAE) has become an accepted treatment method for uterine fibroids. In general, the unilateral embolisation is considered to be insufficient due to poor clinical effect. METHODS: Overall, 165 uterine artery embolisations were analysed (retrospectively-prospectively) in 163 female patients. Intraprocedural complications and their impact on the possibility to perform bilateral embolisationwere evaluated. In patients with unscheduled unilateral embolisation, short-term as well as long-term clinical effects were observed with mean follow-up period of 41 months. RESULTS: The bilateral uterine artery embolisation was possible in 95.7 % (95 %, CI 91.3-99.4 %) procedures. The unilateral embolisation was reported in 7 procedures (4.3 %, CI 1.2-8.3 %) and reasons were following: resistant arterial spasm in 4 patients (2.5 %, CI 0.7 %-5.3 %) and impossible catheterisation due to unfavourable anatomic situation in 3 patients (1.8 %, CI 0.3-4.1 %). Other complications, such as dissection and perforation, did not affect the successful technical realisation. The long-term clinical effect of unscheduled unilateral embolisation was reported in 5 patients. CONCLUSION: The results of our series of unscheduled unilateral uterine fibroid embolisation had high long-term clinical success rate. In way of unscheduled unilateral embolisation, we recommend MRI follow-up and reintervention only in way of persistence or recurrence of symptoms with concurrent MRI finding of residual fibroids(Tab. 5, Fig. 3, Ref. 12).


Assuntos
Embolização Terapêutica , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Complicações Intraoperatórias , Leiomioma/terapia , Neoplasias Uterinas/terapia , Feminino , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do Tratamento
16.
Isr Med Assoc J ; 21(10): 653-657, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599505

RESUMO

BACKGROUND: Complete hydatidiform mole and a co-existing normal fetus (CHMCF) is associated with a high complication rate. A possible association with assisted conception might increase the prevalence of CHMCF. OBJECTIVES: To study the potential association between assisted conception and the risks of CHMCF. METHODS: Case series at a single university hospital from 2008 to 2018 are presented and contrasted with data from a comprehensive literature review (1998-2018). Cases were identified from the institutional database that matched the sonographic criteria for CHMCF. A literature review showed comparable cases. RESULTS: None of the three pregnancies presented in this article resulted in a viable fetus, all were aborted. One of the three patients needed chemotherapy due to gestational trophoblastic neoplasia (GTN). A literature search identified 248 reported cases in which 22 fetuses (9%) reached term, 88/248 (35%) progressed to GTN, and 25/120 (21%) were conceived following assisted conception. From 2008 until 2018 at our medical facility, there were 3144 twin pregnancies of which 1667 (53%) were conceived using assisted conception. In our cohort, there was no statistical trend for assisted conception as an etiological factor for CHMCF. CONCLUSIONS: No association between assisted conception and the risk for CHMCF was established at our hospital, although approximately one-quarter of all reported CHMCF pregnancies are attributed to assisted conception technology. However, these data are not always reported, making it difficult to draw definitive conclusions.


Assuntos
Mola Hidatiforme/patologia , Gravidez de Gêmeos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Neoplasias Uterinas/patologia , Aborto Eugênico , Aborto Induzido , Adulto , Feminino , Humanos , Mola Hidatiforme/terapia , Doença Iatrogênica , Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Ultrassonografia Pré-Natal/métodos , Neoplasias Uterinas/terapia
17.
Arch Gynecol Obstet ; 300(5): 1383-1389, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31584132

RESUMO

PURPOSE: Uterine adenosarcomas (UAs) account for 5-8% of cases of uterine sarcomas. Treatment includes total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). Fertility preservation is an emerging concept in gynaecology oncology and is particularly relevant in UA, where cases are diagnosed as young as 15-year-old. This manuscript demonstrates a case of UA which was treated conservatively, achieved successful livebirths and underwent completion hysterectomy after two decades of follow-up. METHOD: This was a retrospective case note review. RESULTS: An 18-year-old nulliparous woman presented with abnormal vaginal bleeding. Ultrasound identified an endometrial polyp, which was histologically diagnosed as low-grade adenosarcoma. She was advised to undergo TAH and BSO, but instead decided to preserve her fertility and opted for conservative management. She was monitored with pelvic ultrasound, hysteroscopy and endometrial biopsy bi-annually, with annual pelvic magnetic resonance imaging for 10 years which was uneventful. 11 years post-operatively she conceived following in-vitro fertilization (IVF) but suffered a miscarriage at 16 weeks likely due to cervical incompetence. She subsequently conceived with twins. She delivered spontaneously preterm at 28 weeks. Both children are alive and well. After 20 years of follow-up, she underwent a laparoscopic hysterectomy with no evidence of recurrence. She remains disease free. CONCLUSION: Whilst radical completion surgery should be advised in UA, this case, in addition to all published conservatively managed cases of UA, demonstrates that conservative management is possible in appropriately selected women. Intensive monitoring post-operatively is essential owing to the risk of recurrence; however, this may pose deleterious side effects which require consideration.


Assuntos
Adenossarcoma/terapia , Tratamento Conservador/métodos , Neoplasias Uterinas/terapia , Adolescente , Feminino , Seguimentos , Humanos , Estudos Retrospectivos , Fatores de Tempo
18.
In Vivo ; 33(5): 1621-1624, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471414

RESUMO

BACKGROUND/AIM: Uterine sarcoma is an aggressive tumor associated with poor survival, compared to endometrioid carcinoma. Postoperative local radiotherapy and chemotherapy are controversial. PATIENTS AND METHODS: We report a retrospective analysis of 14 patients with uterine homologous type carcinosarcoma (9 patients) or leiomyosarcoma (5 patients), treated with postoperative 3D-conformal accelerated hypofractionated radiotherapy (2.7 Gy/fraction for 14 fractions followed by one fraction of 6-8 Gy dose to the vagina). Chemotherapy with cisplatin (50 mg/m2) and liposomal doxorubicin (20 mg/m2), was also administered bi-weekly for two cycles before and for three cycles during radiotherapy. RESULTS: Chemotherapy induced only grade 1 neutropenia or anemia in 4/14 (28.5%) and 5/14 (35.7%) of patients, respectively. Two patients (2/14, 14.2%) interrupted their radiotherapy for one and two weeks, respectively, due to grade II persistent diarrhea. Within a median of 58 months (range=8-137 months) of follow-up, none of the patients presented with loco-regional relapse. Two patients developed distant metastasis. CONCLUSION: Concurrent hypofractionated and accelerated chemo-radiotherapy (chemo-HypoAR) is feasible and provides excellent survival figures.


Assuntos
Quimiorradioterapia , Sarcoma/terapia , Neoplasias Uterinas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Terapia Combinada , Gerenciamento Clínico , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Hipofracionamento da Dose de Radiação , Sarcoma/diagnóstico , Sarcoma/mortalidade , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/mortalidade
19.
Gynecol Oncol ; 155(2): 365-373, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31500893

RESUMO

Uterine clear cell cancer (UCCC) is a rare but aggressive disease. Due to its rarity, large, prospective studies focused on UCCC are exceedingly difficult therefore available data are generally from small, retrospective studies. There is also pertinent information from subsection analysis of larger studies that include UCCC and other histotypes. In 2009, the clinical practice committee of the Society of Gynecologic Oncology (SGO) published a review on UCCC aimed at guiding management. Since that publication, there have been developments which are relevant to UCCC, these include availability of data from landmark trials regarding adjuvant therapy, increasing utilization of sentinel lymph node approach and availability of immunotherapy as a treatment option. This SGO review is updated with all relevant, published information since 2009 considered clinically important for management of UCCC. In addition, it follows the new SGO's style for this type of publication which includes utilization of the question and answer format.


Assuntos
Adenocarcinoma de Células Claras/terapia , Neoplasias Uterinas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Braquiterapia/métodos , Quimiorradioterapia Adjuvante , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Humanos , Imunoterapia/métodos , Recidiva Local de Neoplasia/terapia , Guias de Prática Clínica como Assunto , Radioterapia Adjuvante , Estudos Retrospectivos
20.
Cardiovasc Intervent Radiol ; 42(12): 1663-1677, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520113

RESUMO

BACKGROUND: Uterine fibroid embolisation (UFE) is an effective treatment for fibroids. There are varying analgesia protocols published to control procedure associated pain. We aimed to assess what protocols are most effective in controlling post-procedural pain. MATERIALS AND METHODS: A systematic review of the Embase and Medline databases was conducted according to PRISMA guidelines. Studies regarding analgesia protocols post-uterine fibroid embolisation with Visual Analogue Scale or Numerical Rating Scale pain scores were included. The mean maximal pain scores of patients post-procedure were evaluated. ANOVA and t tests were performed. RESULTS: We identified 26 studies (total 3353 patients), with a mean procedural success rate of > 87%. We stratified protocols into four groups. Mean pain scores were: opioids ± NSAIDs ± acetaminophen (4.84, SD = 1.56); opioids ± NSAIDs ± acetaminophen + nerve block (4.7, SD = 1.37); opioids ± NSAIDs ± acetaminophen + intrauterine artery drug administration (4.09, SD = 0.60); and opioids ± NSAIDs ± acetaminophen + other (5.30, SD = 1.13) without significant difference between groups (p = 0.71). Similarly, there was no difference (p = 0.057) between groups for time to discharge or side effects. CONCLUSIONS: There is no evidence to suggest that there is any superiority of one protocol above another in the published literature. Appropriate use of opioids ± NSAIDs ± acetaminophen alone appears to be sufficient to control pain post-UFE. However, due to large heterogeneity of the literature no firm conclusions can be reached, and further research is warranted. LEVEL OF EVIDENCE: Level 1, Systematic review.


Assuntos
Analgesia/métodos , Embolização Terapêutica/métodos , Leiomioma/terapia , Manejo da Dor/métodos , Dor/tratamento farmacológico , Neoplasias Uterinas/terapia , Acetaminofen/uso terapêutico , Adulto , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Protocolos Clínicos , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Bloqueio Nervoso/métodos , Dor/etiologia , Resultado do Tratamento
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