Características en resonancia magnética de la degeneración de leiomiomas / Characteristics in magnetic resonance of the degeneration of leiomyomas

Resumen La neoplasia ginecológica más frecuente son los leiomiomas uterinos, tumores benignos hormonodependientes que se generan del músculo liso del miometrio. Presentan una alta incidencia en mujeres en edad reproductiva entre la cuarta y quinta década de la vida y suelen disminuir con la menopausia. Generalmente son asintomáticos, pero a menudo se pueden acompañar de dismenorrea, metrorragia o infertilidad. El estudio inicial para su caracterización es la ecografía transvaginal; sin embargo, la resonancia magnética tiene un alto valor diagnóstico, ya que permite una evaluación más específica sobre el tipo, ubicación y número de leiomiomas, así como también permite identificar el tipo de degeneración y diferenciar entre leiomiomas y sus lesiones imitadoras. El objetivo principal de este manuscrito es abordar las principales características en resonancia magnética entre los distintos tipos de degeneración leiomiomatosa, siendo esta una causa de posible dolor abdominal y pélvico agudo.

Abstract The most common gynecological neoplasm is uterine leiomyomas, these are benign hormone-dependent tumors that are generated from the smooth muscle of the myometrium. They have a high incidence in women of reproductive age between the fourth and fifth decades of life and usually decrease with menopause. They are generally asymptomatic, but can often be accompanied by dysmenorrhea, metrorrhagia, or infertility. The initial study for its characterization is transvaginal ultrasound, however, magnetic resonance imaging has a high diagnostic value since it allows a more specific evaluation of the type, location and number of leiomyomas, as well as allowing the identification of the type of degeneration and differentiation. between leiomyomas and their mimic lesions. The main objective of this manuscript is to address the main characteristics in magnetic resonance between the different types of leiomyomatous degeneration, this being a cause of possible acute abdominal and pelvic pain.

Leiomioma uterino gigante en adolescente mexicana de 14 años, un caso raro de sangrado uterino anormal. Reporte de caso / Giant uterine leiomyoma in a 14-year-old Mexican adolescent, a rare case of abnormal uterine bleeding. Case Report

Resumen ANTECEDENTES: Los leiomiomas son neoplasias benignas comunes durante la edad reproductiva. Su aparición en adolescentes es excepcional y un reto diagnóstico en menores de 18 años de edad. El caso aquí reportado se integra a los 26 casos asentados en la bibliografía y se trata del tumor más grande en la paciente más joven hasta ahora comunicado. CASO CLÍNICO: Paciente de 14 años, con inicio de sangrado uterino anormal, aumento del perímetro abdominal y tres semanas con hipermenorrea. El reporte inicial de la química sanguínea informó: anemia severa y el ultrasonido pélvico: un gran tumor anexial sólido. Luego de mejorar las condiciones hemodinámicas de la paciente por medio de transfusiones de concentrados eritrocitarios se practicó una laparotomía exploradora y se extirpó un leiomioma gigante, dependiente del útero. El informe histopatológico fue de: leiomioma de 16 cm de diámetro, con degeneración roja. La paciente cursó sin complicaciones posquirúrgicas y hasta la actualidad no ha experimentado datos de recurrencia ni sangrado uterino anormal. CONCLUSIÓN: La fisiopatología de la miomatosis uterina sigue aún sin comprenderse del todo. El tratamiento quirúrgico a una edad temprana debe tomar en consideración el deseo de embarazo y llevar a cabo un seguimiento estrecho para valorar: la fertilidad, recurrencia, atipia celular y trastornos menstruales.

Abstract BACKGROUND: Leiomyomas are common benign neoplasms during reproductive age. Its appearance in adolescents is exceptional and a diagnostic challenge in children under 18 years of age. The case reported here is one of the 26 cases reported in the bibliography and it is the largest tumor reported in the youngest patient to date. CLINICAL CASE: A 14-year-old patient with onset of abnormal uterine bleeding, increased abdominal circumference and three weeks with hypermenorrhea. Initial blood chemistry report: severe anemia and pelvic ultrasound: a large solid adnexal tumor. After improving the patient's hemodynamic conditions through transfusions of erythrocyte concentrates, an exploratory laparotomy was performed and a giant leiomyoma, dependent on the uterus, was removed. The histopathological report was: leiomyoma of 16 cm in diameter, with red degeneration. The patient had no postoperative complications and to date she has not experienced recurrence or abnormal uterine bleeding. CONCLUSION: The pathophysiology of uterine fibroids remains poorly understood. Surgical treatment at an early age should take into account the desire for pregnancy and carry out a close follow-up to assess: fertility, recurrence, cellular atypia and menstrual disorders.

Miomectomía durante el embarazo: leiomioma gigante con degeneración / Miomectomy during pregnancy: giant leiomyoma with degeneration

Resumen ANTECEDENTES: Los leiomiomas son los tumores pélvicos más comunes, con múltiples presentaciones clínicas a lo largo de la vida de la mujer. Es inusual que aparezcan durante el embarazo y que ameriten tratamiento quirúrgico, sobre todo por abdomen agudo secundario a degeneración. OBJETIVO: Aportar y exponer el proceso de diagnóstico, tratamiento quirúrgico y desenlace obstétrico en una paciente con un leiomioma gigante con degeneración asociado al embarazo. CASO CLÍNICO: Paciente de 34 años, primigesta, con 22.1 semanas de embarazo. Acudió a Urgencias con abdomen agudo, fiebre y daño ventilatorio secundario a un leiomioma gigante que ocupaba la totalidad del abdomen y comprimía las estructuras abdominales y torácicas. Debido al deterioro clínico se decidió la intervención quirúrgica para extraer los dos miomas: el mayor de 35 x 20 cm y 9150 g. La evolución posoperatoria fue favorable lo mismo que el control prenatal. La finalización del embarazo fue por cesárea electiva a las 38.1 semanas, sin complicaciones maternas ni perinatales. CONCLUSIÓN: La miomectomía durante el embarazo es un procedimiento seguro para disminuir la morbilidad y la mortalidad materna y fetal en casos seleccionados.

Abstract BACKGROUND: Leiomyomas are the most common pelvic tumors, with multiple clinical presentations throughout a woman's life. It is unusual for them to appear during pregnancy and to merit surgical treatment, especially for acute abdomen secondary to degeneration. OBJECTIVE: To provide and expose the process of diagnosis, surgical treatment and obstetric outcome in a patient with a giant leiomyoma with pregnancy-associated degeneration. CLINICAL CASE: A 34-year-old primigravida patient, 22.1 weeks pregnant. She came to the emergency department with acute abdomen, fever and ventilatory impairment secondary to a giant leiomyoma that occupied the entire abdomen and compressed abdominal and thoracic structures. Due to the clinical deterioration, surgery was decided to remove the two fibroids: the larger one measuring 35 x 20 cm and weighing 9150 g. The postoperative evolution was favorable. The postoperative evolution was favorable as well as the prenatal control. The pregnancy was terminated by elective cesarean section at 38.1 weeks, without maternal or perinatal complications. CONCLUSION: Myomectomy during pregnancy is a safe procedure to reduce maternal and fetal morbidity and mortality in selected cases.

Leiomioma como simulador de neoplasia maligna uterina: reporte de un caso / Leiomyoma as a simulator of uterine malignant neoplasms: a case report

RESUMEN El cáncer de mama puede originar de forma muy excepcional metástasis en órganos genitales. Estas suelen presentarse de forma asintomática siendo su diagnóstico generalmente tardío. En el estudio de la enfermedad diseminada la tomografía de emisión de positrones con fluordeoxiglucosa asociada a la tomografía computada (FDG PET/CT) juega un rol importante, sin embargo presenta limitantes al momento de diferenciar entre lesiones secundarias, primarias y neoplasias benignas que pueden tener elevada captación de fluordeoxiglucosa (1). Por lo expuesto anteriormente el diagnóstico de certeza solo puede realizarse mediante el estudio anatomopatológico. El caso presentado a continuación abarca uno de los posibles diagnósticos diferenciales con FDG PET/CT que evidencia un incremento en la captación de fluordeoxiglucosa.

ABSTRACT Breast cancer rarely metastasize on pelvic organs and its diagnosis is often delayed due to the asymptomatic nature of this disease. Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) is a useful method for early diagnosis. However, may present a false positive diagnosis from benign lesions that have an increased uptake of glucose. We present a case in which a patient who had breast cancer had an increase glucose uptake in FDG PET/CT from a benign lesion.

Uterine Lipoleiomyoma: a rare variant of benign uterine neoplasm

The lipomatous tumors are very rare benign neoplasms of the uterus. Lipoleiomyoma is a benign tumor which is variant of leiomyoma. It has similar clinical course and presentation like uterine leiomyoma and is typically found in postmenopausal women. Authors report a case of 45 years female presented with a complaint of increased frequency of menstrual cycles and generalized weakness since 5- 6 months. On ultrasonography abdomen - pelvis a single large lobulated hyperechoic mass was noted in the fundal myometrium measuring 5 x 4.6 cm. The finding was suggestive of fibroid uterus. On histopathological examination showed variable proportions of lobules of mature adipocytes and interlacing bundles of benign smooth muscle cells which was diagnostic of lipoleiomyoma. Authors are presenting this case for its rarity, clinical presentation, imaging and histopathological finding with differential diagnosis.

Atypical Leiomyomas of the Uterus: A Clinicopathologic Study of 54 Cases and an Immunohistochemical Analysis of Ki-67 and p53 / Leiomiomas atípicos del útero: un estudio clínico-patológico de 54 casos y un análisis inmunohistoquímico de Ki-67 y p53

ABSTRACT Objective: Uterine atypical leiomyomas (ALs) are extremely rare and occur in an age group almost one decade earlier than that for leiomyosarcomas. According to the literature, extensive clinicopathologic studies on ALs were limited to only two studies (2, 8). Atypical leiomyomas of the uterus are well-defined neoplasms with smooth muscle cells. The aim of this study was to investigate clinicopathologic findings in 54 cases diagnosed with ALs as well as Ki-67 and p53 expressions immunohistochemically. Methods: Fifty-four cases diagnosed between 2000 and 2013 were included. The histological and clinical features of the cases were reviewed, and their medical records were examined. Ki-67 and p53 were performed on all cases immunohistochemically. Results: The average age of the patients was 41.8 years. The average clinical follow-up period was 57 months. Hysterectomy was performed in 31 patients, and myomectomy in 21 patients, while resection of the mass was performed in two patients due to the intraligamentary mass. The average size of the neoplasms was 6.2 cm. Severe cellular atypia was noticed in 25 patients. While the number of mitoses was 1/10 high power field in 30 patients, it was 4/10 high power field in six patients. Ki67 was found to be positive in 50 patients at the rate of 1-5% immunohistochemically, while p53 demonstrated staining at the ratio of 10-15% staining in four patients. Conclusion: The differentiation of ALs from leiomyosarcomas is crucial. The recurrence rate after follow-up is 2%. In our opinion, the patients diagnosed with 'AL with limited experience' before should be correctly diagnosed as AL. We recommend that Ki-67 and p53 can be used as adjuvant markers immunohistochemically in the patients where a problem in differential diagnosis from leiomyosarcoma exists.

RESUMEN Objetivo: Los leiomiomas atípicos uterinos (LA) son extremadamente raros y se presentan en un grupo de edad casi una década antes que los leiomiosarcomas. De acuerdo con la literatura, los extensos estudios clínico-patológicos en los LA se limitaron a sólo dos estudios (2, 8). Los leiomiomas atípicos del útero son neoplasmas bien definidos con células de músculo liso. El objetivo de este estudio fue investigar los hallazgos clínico-patológicos en 54 casos diagnosticados con LA, así como las expresiones Ki-67 y p53, de forma inmunohistoquímica. Métodos: Se incluyeron cincuenta y cuatro casos diagnosticados entre 2000 y 2013. Se revisaron las características histológicas y clínicas de los casos y se examinaron sus historias clínicas. Ki-67 y p53 se realizaron en todos los casos de forma inmunohistoquímica. Resultados: La edad promedio de los pacientes fue de 41.8 años. El período promedio de seguimiento clínico fue de 57 meses. Se realizaron histerectomías a 31 pacientes, y miomectomías a 21 pacientes, en tanto que a dos pacientes se les realizó resección de la masa debido a la situación intraligamentosa. El tamaño promedio de los neoplasmas fue de 6.2 cm. Se observó atipia celular severa en 25 pacientes. El número de mitosis fue de 1/10 campos de gran aumento en 30 pacientes, en contraste con el número de mitosis de 4/10 campos de gran aumento en seis pacientes. Se encontró que Ki67 fue positivo en 50 pacientes a razón de 1-5% inmunohistoquímicamente, mientras que p53 mostró tinción a razón de 10-15% de tinción en cuatro pacientes. Conclusión: La diferenciación de LA entre los leiomiosarcomas es crucial. La tasa de recurrencia después del seguimiento es de 2%. En nuestra opinión, los pacientes diagnosticados con 'LA con experiencia limitada ' antes, deben ser diagnosticados correctamente como LA. Recomendamos que Ki-67 y p53 sean usados como marcadores adyuvantes inmunohistoquímicamente en los pacientes con un diagnóstico diferencial de leiomiosarcoma.

Establishment of a rat model for uterine leiomyomas based on Western and traditional Chinese medicine theories

Uterine leiomyomas (ULs) are benign monoclonal tumors that arise from the underlying myometrial tissue in the uterus. Effective therapies are still lacking because of poor understanding of the pathophysiology and epidemiology. Hence, it is urgent to establish efficient animal models to screen novel anti-UL therapies. In this study, for the first time, traditional Chinese medicine and Western medicine were combined to establish an animal model of ULs in rats. In order to evaluate the function and value of the novel model, it was compared with other models. The long-term and short-term rat models for ULs were established using progesterone and diethylstilbestrol. Rats in Qi stagnation and blood stasis group were injected with epinephrine hydrochloride and received chronic unpredictable stress for two weeks. Rats in combining disease with syndrome group (CDWSG) received not only epinephrine hydrochloride injection and chronic unpredictable stress but also progesterone and diethylstilbestrol treatment. We analyzed differences in organ coefficient, uterus size, uterine pathology, concentrations of progesterone, estradiol, progesterone receptor, estrogen receptor, expression of desmin, α-smooth muscle actin, and vimentin among the five groups. The animal model of ULs was successfully constructed by loading the rats with estrogen and progesterone. The rat model of CDWSG was more stable than other groups and the method was the most efficient.

Application of methylene blue staining for precise positioning of small esophageal leiomyoma during video-assisted thoracoscopic surgery via one utility port / 中国胸心血管外科临床杂志

@#Objective    To develop a novel methylene blue staining technique to localize small esophageal leiomyomas ( small esophageal leiomyomas ( and 4 females with an average age of 51 years. We preoperatively injected 0.5–1.0 ml methylene blue in the submucosa adjacent to the tumors under the guidance of gastroscope. Then, we transferred the patients to the operating room. Results    Staining was successful in 9 patients. The unstained tumor was exposed after the blue-stained mediastinal pleura and overlying muscle were incised longitudinally during ideo-assisted thoracoscopic surgery via one utility port. No abnormalities were detected in the esophageal mucosa. No major complications, such as esophageal leakage or esophageal diverticulum occurred. Conclusion    Endoscopic methylene blue staining is safe and feasible for localizing small esophageal leiomyomas during video-assisted thoracoscopic surgery via one utility port. This method will enable enucleation precise and easy.

Treatment of multiple cutaneous leiomyomas with surgery / 中华整形外科杂志

A 43-year-old female presented with multiple, painful, erythematous papules and nodules on the dorsal of the body over the past 17 years. The tumor was painful after cold stimulus and the significant symptoms improved for recent 3 years. Histopathological examinations confirmed the clinical diagnosis of cutaneous leiomyomas. A surgical procedure was one of the therapeutic options in the case of multiple and painful leiomyomas.

Sistema intrauterino liberador de levonorgestrel en el tratamiento del sangrado uterino anormal secundario a miomatosis uterina / Levonorgestrel-releasing intrauterine system in the treatment of abnormal uterine bleeding secondary to uterine leiomyomas

Resumen ANTECEDENTES: el sangrado uterino anormal por miomatosis intramural de pequeños elementos es una indicación frecuente de histerectomía; el tratamiento hormonal puede disminuir la necesidad de esta cirugía. OBJETIVO: evaluar si con el sistema liberador de levonorgestrel disminuye el sangrado uterino anormal por miomatosis intramural de pequeños elementos. MATERIALES Y MÉTODOS: ensayo clínico fase II de un solo brazo al que se incluyeron mujeres de 35 a 45 años de edad, con diagnóstico de sangrado uterino anormal por miomatosis intramural de pequeños elementos, con útero menor a 12 cm (eje longitudinal por ultrasonido) y biopsia de endometrio sin enfermedad maligna; a todas se les colocó el sistema liberador de levonorgestrel. Se evaluó: el sangrado con la escala PBACs (Pictorial Blood Assessment Chart score), el dolor pélvico con escala de EVA, la recuperación hematológica (hemoglobina sérica), volumen uterino (mm3) y recuperación de la actividad física y sexual antes de la colocación del sistema liberador de levonorgestrel y a los 3, 6 y 9 meses posteriores. RESULTADOS: se estudiaron 20 pacientes, de éstas 3 con histerectomía antes de cumplir los tres meses de seguimiento. A los tres meses 76.4% (IC 95%: 55.9-97) redujeron el sangrado en más de 50% del basal, a los seis meses todas habían reducido más de 50% el sangrado y a los nueve meses, nueve eran amenorreicas, el resto con reducción promedio de 90%. El dolor se redujo y permitió recuperar la actividad física y sexual en 90% de los casos. Las concentraciones de hemoglobina se incrementaron, en promedio, 0.8 g/dL, y no hubo reducción clínicamente significativa del tamaño uterino. CONCLUSIONES: el sistema liberador de levonorgestrel disminuyó de manera muy significativa el sangrado uterino anormal por miomatosis intramural de pequeños elementos a partir de los tres meses de tratamiento.

Abstract BACKGROUND: abnormal uterine bleeding due to small intramural leiomyomas is a frequent indication of hysterectomy; hormone treatment may decrease the need for this surgery. OBJECTIVE: to evaluate if using the levonorgestreal-releasing system decreases abnormal uterine bleeding caused by small intramural leiomyomas. MATERIALS AND METHODS: a phase II single arm clinical trial that included women from 35 to 45 years with a diagnosis of abnormal uterine bleeding caused by small intramural leiomyomas in less than 12 cm uteri (longitudinal axis on ultrasound) and endometrial biopsy with no malignant disease; all the women had the levonorgestrel-releasing system placed. We evaluated: bleeding with the PBAC scale (Pictorial Blood Assessment Chart score), pelvic pain with the EVA scale, hematological recovery (serum hemoglobin), uterine volume (mm3) and recovery of physical and sexual activity before placement of the levonorgestrel-releasing system 3, 6 and 9 months later. RESULTS: 20 patients were studied, 3 of these had a hysterectomy before the three month follow up period. After three months 76.4% % (IC 95%: 55.9-97) decreased bleeding more than 50% compared to baseline, after six months, all had decreased bleeding more than 50% and at nine months, nine had amenorrhea and the rest had an average reduction of 90%. Pain decreased and allowed them to recover physical and sexual activity in 90% of cases. Concentrations of hemoglobin increased an average of 0.8 g/dL and there was no clinically significant reduction of the uterine size. CONCLUSIONS: the levonorgestrel-releasing system significantly decreased abnormal uterine bleeding caused by small intramural leiomyomas after three months of treatment.

Miomatosis uterina: implicaciones en salud reproductiva / Uterine myomatosis: Implications on reproductive health

Resumen OBJETIVO: dar a conocer a los ginecoobstetras un documento donde pueda consultarse, a la luz de los estudios más recientes y con la mejor evidencia en la fisiopatología, prevalencia y significado clínico de los miomas uterinos, así como la mejor evidencia posible acerca de las diversas modalidades de tratamiento. METDOLOGÍA: estudio retrospectivo efectuado por los miembros del Comité de expertos de la Asociación Mexicana de Medicina de la Reproducción, empleando los artículos publicados entre los años 2000 a 2016 en Pubmed y que en el resumen contuvieran los MeSH: leiomyomatosis uterus, leiomyoma, leiomyomatosis uterine, leiomyomatosis uterine in pregnancy. La calidad de la evidencia y la formulación de las recomendaciones se realizaron con la metodología establecida por el sistema GRADE. RESULTADOS: se incluyeron 97 artículos en los que se encontró que la prevalencia en mujeres en edad reproductiva es variable, según la edad (20 a 80%). En la mayoría el diagnóstico se establece entre los 35 y 54 años. Para el tratamiento existen varias opciones con distintos porcentajes de eficacia. CONCLUSIONES: queda de manifiesto la evidencia de la eficacia de varios medicamentos indicados para el control de los síntomas y para mejorar la calidad de vida de las pacientes. En la comparación entre acetato de leuprolide y acetato de ulipristal no se encontraron que originaran síntomas vasomotores, ni disminuyeran la masa ósea. En relación con el último se vislumbra la posibilidad de evitar la cirugía, aunque aún se requiere más investigación a este respecto.

Abstract OBJECTIVE: To make known to the gynecological obstetricians a document where they can be consulted, in the light of the most recent studies and with the best evidence on the pathophysiology, prevalence and clinical significance of uterine fibroids, as well as the best possible evidence about the various treatment modalities. METDOLOGY: A retrospective study carried out by the members of the Committee of experts of the Mexican Association of Reproductive Medicine, using the articles published between 2000 and 2016 in Pubmed and that in the abstract contained MeSH: leiomyomatosis uterus, leiomyoma, Leiomyomatosis uterine, leiomyomatosis uterine in pregnancy. The quality of the evidence and the formulation of the recommendations were made using the methodology established by the GRADE system. RESULTS: 97 articles were included in which the prevalence was found to be variable, according to age (20 to 80%) in women of reproductive age. In most, the diagnosis is established between 35 and 54 years. There are several treatment options with different percentages of effectiveness. CONCLUSIONS: Evidence of the efficacy of several medications indicated for the control of symptoms and to improve the quality of life of the patients is evident. In the comparison between leuprolide acetate and ulipristal acetate, they were not found to cause vasomotor symptoms or to decrease bone mass. Regarding the latter, the possibility of avoiding surgery is envisaged, although more research is still needed in this regard.

The Exploration and Analysis to the Clinical Experience of Professor LU Qibin in Diagnosing and Treating Gynecological Tumor / 浙江中医药大学学报

[Objective]This paper mainly introduces the academic thoughts and clinical experience of professor LU Qibin in diagnosing and treating gynecological tumor. [Methods]To elaborate Professor LU 's experience in the diagnosis and treatment of gynecological tumor, the author analyses the etiology, pathogenesis, syndrome differentiation as well as the rule of choosing the medical herbs and formulas.A clinical case was reported for better demonstration. [Results]In the perspective of Professor LU, the basic pathogenesis of gynecological tumor is"vital Qi deficiency while pathogenic Qi prevailing ,blood stasis induce tumor"and the pathological factors include blood stasis, phlegm wet, and Qi stagnation that deposit in the lower abdomen, stay in Chong Meridian, Ren Meridian and uterus, result in gynecological tumor gradually. The therapeutic princ for a period of timele is"strengthening health, dispersing blood stasis and eliminating lump".Professor LU uses"Xiaozheng Tang"to treat gynecological tumor such as uterine leiomyomas. As the case reported,the uterine leiomyomas decreased when patient was treated by "Xiaozheng Tang".[Conclusion]It has obtained satisfactory therapeatic result in the treatment of gynecological tumor with "Xiaozheng Tang" according to the rule of "strengthening the body resistance, dispersing blood stasis and eliminating lump".

Current Medical Therapy for Uterine Leiomyomas / 고신대학교의과대학학술지

Uterine leiomyomas are benign tumors arising from the myometrium and largely prevalent in the woman's reproductive years. The majority of women with leiomyomas either remain asymptomatic or develop symptoms gradually over time. When patients are symptomatic, the nature of their complaints is often attributable to the number, size, and/or location of their fibroids. Depending on a patient's symptomatology and reproductive plans, treatment options include expectant management, medical management (hormonal and non-hormonal), or surgical management (myomectomy or hysterectomy).

PI3K/Akt/mTOR signaling & its regulator tumour suppressor genes PTEN & LKB1 in human uterine leiomyomas.

Background & objectives: Despite their high occurrence and associated significant level of morbidity manifesting as spectrum of clinical symptoms, the pathogenesis of uterine leiomyomas (ULs) remains unclear. We investigated expression profile of tumour suppressor genes PTEN (phosphatase and tensin homolog deleted on chromosome ten) and LKB1 (liver kinase B1), and key signaling components of P13K (phosphatidylinositol 3-kinase)/Akt (protein kinase B)/mTOR (mammalian target of rapamycin) pathway in leiomyomas and adjacent normal myometrium in women of reproductive age, to explore the possibility of targeting this pathway for future therapeutic implications. Methods: Real time PCR (qPCR) was used to quantify relative gene expression levels of PTEN, Akt1, Akt2, mTOR, LKB1 and VEGFA (vascular endothelial growth factor A) in leiomyoma as compared to adjacent normal myometrium. Immunohistochemistry was subsequently performed to analyze expression of PTEN, phospho-Akt, phospho-mTOR, phospho-S6, LKB1 and VEGFA in leiomyoma and adjacent normal myometrium. Results: Significant upregulation of PTEN (2.52 fold; P=0.03) and LKB1 (3.93 fold; P=0.01), and downregulation of VEGFA (2.95 fold; P=0.01) genes were observed in leiomyoma as compared to normal myometrium. Transcript levels of Akt1, Akt2 and mTOR did not vary significantly between leiomyoma and myometrium. An increased immunoexpression of PTEN (P=0.015) and LKB1 (P<0.001) and decreased expression of VEGFA (P=0.01) was observed in leiomyoma as compared to myometrium. Immunostaining for activated (phosphorylated) Akt, mTOR and S6 was absent or low in majority of leiomyoma and myometrium. Interpretation & conclusions: Upregulation of PTEN and LKB1 in concert with negative or low levels of activated Akt, mTOR and S6 indicates that PI3K/Akt/mTOR pathway may not play a significant role in pathogenesis of leiomyoma.

The value of apparent diffusion coefficient map with low b-value to monitor the therapy of high-intensity focused ultrasonic for uterine fibroids / 实用放射学杂志

Objective To assess the value of apparent diffusion coefficient (ADC)map with low b-value to monitor the ablated tissue after high-intensity focused ultrasonic (HIFU)treatment for uterine fibroids.Methods 25 patients with 34 uterine fibroids were treated with HIFU.All patients underwent the routine MRI scans (including pre-and post-contrast scanning)and monoexponential model DWI with b values of 150,600 and 1 000 s/mm2 before the surgery and within 24 hours after the surgery.The mean ADC values with different b-values of the ablated and non-ablated tissues between pre-and post-treatment were analyzed by one-way ANOVA test.The consistency of the ablation area between ADC maps with different b-values and contrast enhancement MRI were evaluated. Results With the b-value of 150 s/mm2 ,the mean ADC value of the ablated tissue was (1.48±0.27)×10-3 mm2/s,which was less significantly than that of pre-treatment (2.06±0.21)×10-3 mm2/s and non-ablated tissue (1.98±0.23)×10-3 mm2/s (P0.05).A fine consistency of the ADC map with the low b-value (150 s/mm2 )was found with non-perfusion volume on contrast-enhanced T1 WI,which was superior to that with high b-values (600 s/mm2 and 1 000 s/mm2 )(P<0.05).Conclusion ADC map with low b-value (150 s/mm2 )can be used to evaluate the blood-supply changes and ablated volume of uterine fibroids indirectly,which helps to assess the treatment effect of HIFU.

Laparoscopic Myomectomy in a Tertiary Care Centre in Douala, Cameroon.

Objective: To assess the feasibility and outcome of laparoscopic myomectomy with single or double-layer closure of myoma bed for management of myomas at a tertiary care centre in Douala, Cameroon. Materials and Methods: Thirty patients with large or moderate-size myomas were managed laparoscopically from September 1996 to September 2008. The indications for surgery included subfertility, heavy menstrual bleeding, abdominal mass and lower abdominal pain. Pre‑operative evaluation included history, clinical examination and sonographic mapping. Myomas were enucleated and retrieved laparoscopically by morcellation. Myoma beds were sutured in a single or double layer by endoscopic intra-corporeal suturing depending on the depth of the fibroids. Results: Among our patients, 14 (46.7%) presented with subfertility, 8 (26.7%) with heavy menstrual flow and 6 (20%) with abdominal mass. Two (6.7%) presented with lower abdominal pain. The average maximum diameter of myoma was about 8.5 cm. The mean duration of surgery was 123.2±90 min and blood loss was minimal. The mean post-operative stay in hospital was averagely 3.03 days. There were no intra-operative complications recorded among our series and hospital stay was uneventful. Conclusion: With proper single layer closure of the myoma bed, laparoscopic myomectomy is feasible for moderate and even large myomas not more than three fibroids, and has excellent outcomes.

Contemporary treatment guidelines for managing вenign uterine tumors / Монголын Анагаах Ухаан

Uterine leiomyomas are common (20-50%) in women of reproductive age. It is a benign tumor and it ranks second place among genital organ disorders in women.To date, abdominal laparotomy and laparoscopic surgical treatment (myomectomy and hysterectomy) are widely used to manage symptomatic leiomyomas.Although, hysterectomy is considered to be a radical method to manage uterine leiomyomas, women who have had hysterectomy are left totally infertile and they also are at risk to develop post-surgical and post-anesthetic complications. The advantage of myomectomy is to preserve women’s fertility and menstrual function but, the probability of recurrence of leiomyoma is 15-30% [1, 2]. Furthermore, depending on the location, size and number of fibroids, duration of surgery lingers, volume of blood loss is high and the risk to develop post surgical adhesions are high too.In recent, more than a decade period, effective and minimally invasive new, non-surgical methods to manage uterine leiomyomas have been introduced in many countries around the world. These methods have short recovery period and are advantageous to women to preserve their reproductive organ and fertility. They include: uterine artery embolization, uterine artery occlusion via transvaginal route and MRI– guided focused ultrasound surgery of uterine fibroids. Antiprogesterone-low-dose mifepristone for uterine leiomyomas are being introduced as well.In our country, managing leiomyomas surgically is still occupying high rate among surgical treatments. Further, to prevent and reduce complications of surgical treatment and to preserve organ, it is essential and imperative to introduce some of the above- mentioned contemporary non-surgical methods.

Vaginal Leiomyoma: Unusual Case Presentation.

Vaginal leiomyomas are rare to exist as a primary tumor of vagina. Approximately 300 cases have been reported in world literature. They usually arise from anterior vaginal wall and are firm to hard in consistency with varied clinical presentations. Here, we report a case of vaginal leiomyoma presenting as mass per vagina, diagnosed postoperatively with the help of histopathological and immunohistochemical studies.

Multiple benign metastasizing leiomyomas in the pelvic and para-aortic lymph nodes: A case report / 대한산부인과학회지

Benign metastasizing leiomyoma (BML) is a rare entity, defined as a muscle tumor in association with one or more smooth muscle tumor of the uterus and without evidence of any extra uterine primary site. The lung is the most common site of involvement,(2) and the etiology of BML remains unknown. We experienced a case of BML arising in pelvic and para-aortic lymph nodes and report with a brief review of literature.

A Case of Reed's Syndrome(Familial Leiomyomatosis Cutis Et Uteri) / 대한피부과학회지

Reed's syndrome is a rare, autosomal dominant disease with incomplete penetrance that is characterized by uterine and cutaneous leiomyomas. We report a case of Reed's syndrome in a 50-year-old woman. The patient underwent removal of the uterine leiomyoma at the age of 36. Following this the patient noticed development of multiple, cutaneous nodules on both arms at the age of 45. These nodules progressively increased in both number and size, while appearing in other sites. The histopathologic finding of an isolated, single skin lesion showed typical leiomyoma arising from arrector pilorum muscle. Familial history revealed that her father had been affected with similar cutaneous lesions.