Efficacy Evaluation of Apparent Diffusion Coefficient in the Treatment of Uterine Fibroid by Magnetic Resonance Guided Focused Ultrasound Surgery / 中山大学学报(医学科学版)

ObjectiveTo assess the value of apparent diffusion coefficient （ADC） in the treatment of uterine fibroid using magnetic resonance guided focused ultrasound surgery （MRgFUS）. MethodsThe MRI and clinical data of 56 patients with uterine fibroid before， at 3 and 6 months after MRgFUS treatment， at Foshan Hospital of Traditional Chinese Medicine from December 2018 to October 2022， were retrospectively analyzed. The correlation between the ADC value and lesion volume， symptoms severity score （SSS） and uterine fibroid symptoms quality of life questionnaire （UFS-QOL） were analyzed. ANOVA was used to compare the differences in related parameters before and after treatment， and Pearson’s method was performed to analyze data correlation. ResultsThere were significant differences in ADC value ［（1.11±0.13）， （1.84±0.09）， （2.12±0.24），×10-3/（mm2/s）］， lesion volume （102±35.30， 56.70±18.88， 46.93±18.99，cm3）， SSS （36.73±11.74， 21.77±10.21， 17.66±9.30） and UFS-QOL score （59.05±17.48， 76.54±16.50， 82.46±12.37） between before treatment and each time point after treatment （F value was 557.837， 73.589， 53.976 and 37.606， respectively， all P<0.05）. The ADC values were negatively correlated with lesion volume and SSS， and positively correlated with UFS-QOL score， with correlation coefficients of -0.586， -0.630 and 0.592， respectively （all P<0.05）. ConclusionThe ADC value has clinical significance for the treatment of uterine fibroid using MRgFUS.

The effect of small size uterine fibroids on pregnancy outcomes in high-risk pregnancies

Abstract Objective To evaluate the obstetric outcomes of singleton high-risk pregnancies with a small size uterine fibroid. Methods This retrospective cohort study was conducted among 172 high-risk pregnant women who were followed-up by a single surgeon between 2016 and 2019. Pregnant women with preconceptionally diagnosed small size (< 5 cm) single uterine fibroids (n = 25) were compared with pregnant women without uterine fibroids (n = 147) in terms of obstetric outcomes. Results There was no statistically significant difference between the groups in terms of adverse pregnancy outcomes. The size of the fibroids was increased in 60% of the cases, and the growth percentage of the fibroids was 25% during pregnancy. Intrapartum and short-term complication was not observed in women who underwent cesarean myomectomy. Conclusion Small size uterine fibroids seem to have no adverse effect on pregnancy outcomes even in high-risk pregnancies, and cesarean myomectomy may be safelyperformed in properly selected cases.

Comparative study between vaginal natural progesterone and oral dydrogesterone in prevention of red degeneration of uterine fibroid in pregnancy

Background: Uterine leiomyomas are highly prevalent benign monoclonal tumors, arising from the smooth muscle of the myometrium; they occur in up to 50-60% of reproductive age women, causing significant morbidity in up to 30% of women. The most serious complication of uterine fibroids; is red degeneration that causes severe pain, and may lead to preterm labour, miscarriage, fetal and maternal morbidity and mortality. Objective of this study was designed to compare between the effect of vaginal natural MP and oral dydrogesterone in prevention of red degeneration of uterine fibroid during pregnancy.Methods: Patients were recruited from El-Shatby Maternity University Hospital. They were 50 pregnant females, diagnosed having a uterine fibroid more than 3 cm in size then there were divided into two groups, Group A: twenty-five treated by vaginal natural progesterone, Group B: twenty-five treated by oral dydrogesterone. All patients at 14-15 weeks of gestational age underwent complete history taking, clinical examination and ultrasound examination for mean gestational age and assessment of the type and uterine fibroid.Results: Results showed that there were no statistically significant differences as regards age, obstetric history (gravidity and parity), number, Site, grade and size of the fibroid. There was a significant difference between the two studied groups, regarding the acute abdominal pain, it occurred to only 3 cases (12%) in Group A, versus to 16 cases (64%) in Group B. Regarding occurrence of red degeneration, it occurred only to 3 cases (12%) in Group A, while in Group B it occurred to 15 cases (60%).Conclusions: Vaginal natural micronized progesterone is more effective than oral dydrogesterone in prevention of red degeneration of uterine fibroid in pregnancy with fewer complications. Vaginal natural progesterone daily dose of 200 mg is recommended to all pregnant females with uterine fibroids.

Nonpersistent endocrine disrupting chemicals and reproductive health of women

Uterine Fibroid: Isolation, Culture and Characterization

Present study was carried out to establish uterine fibroid primary culturesystem for screening of natural/synthetic compounds against uterine fibroid. For invitro culture, enzymatic isolation method was used. To characterize, histochemistry (H& E, Masson’s Trichrome and Periodic Acid Schiff) staining and immunocytochemistryusing marker antibodies (Versican) were performed in vitro. Uterine fibroid tissueshowed much intense staining of Masson’s Trichrome and Periodic Acid Schiff stain ascompared to adjacent myometrium tissue. The primary cultured cells showedsignificantly higher proliferation, sub-culture efficiency and expression of Versicanprotein. In conclusion, our results suggest that in vitro cultured uterine fibroid cells mayoffer a suitable alternative model to evaluate natural or synthetic compounds havingantitumor properties for uterine fibroid treatment.

The role of tourniquet in myomectomy: an observational study

Background: Leimymoma is one of the commonest benign tumours encountered in women during the reproductive age. One quarter of these women may be symptomatic. When surgical management is indicated, myomectomy may be considered as the procedure of choice. Myomectomy can be complicated by severe intraoperative haemorrhage. One of the methods to reduce blood loss during myomectomy is the mechanical application of tourniquet.Methods: A prospective observational single arm study was done with 24 women who underwent open myomectomy to determine the utility of tourniquet in reducing blood loss during the procedure.  Women of reproductive age group, having symptomatic fibroid, not responding to medical therapy, not completed their family and with total uterine size not exceeding 20 weeks were included in the study while those with pregnancy, concomitant adenomyosis, cervical or broad ligament fibroid, bleeding diathesis were excluded. The 7-French pediatric feeding tube was used as tourniquet. Our primary end point was intra-operative blood loss. Secondary outcome measures included operative morbidity and blood transfusion rates.Results: It was seen that application of the tourniquet considerably reduced the amount of blood loss and made resection of the myoma much easier. 83.3% patients had a blood loss less than 200ml and the rest between 200ml and 400ml. For majority of the patients (75%) the postoperative change of PCV was between 1 and 2%.Conclusions: The infant feeding tube form of tourniquet is cheap, safe, readily available, effectively reduces blood loss during myomectomy while not adding to the complications due to the operation.

Clinicopathological Study on Uterine Fibroid in a Medical College Hospital

Uterine fibroid are the most common benign pelvic tumor in females. Its occurrence in reproductive age group makes it important. Methods: The present hospital based cross-sectional study was done to find the clinicopathological features of fibroid of uterus at a tertiary care center. Histopathological examination was done to observe the type and morphology of these lesions. Results: Uterine fibroids are commonly seen in females of <40 years age and present with menorrhagia (55.2%) and abdominal pain (27.1%). The most common location was intramural (63.5%) and the most common degeneration was hyaline change (12.5%). Conclusion: Routine histopathological examination of hysterectomy specimen is needed to rule out tumor or infective pathology.

Predictors and symptomatic burden of uterine fibroids among women in South-Eastern India: a cross-sectional survey analysis

Background: Uterine fibroid is the most common pelvic tumor in women of reproductive age and are asymptomatic in at least 50% of affected women. Various risk factors are associated with development of uterine fibroids during this reproductive age. The present study established various associated risk factors increases the prevalence of uterine fibroid among reproductive age group and clinical symptoms burden of diagnosed case.Methods: A cross sectional study design was used to collect samples for a period of six months in an OPD basis. Purposive sampling technique was used to select the 362 sample of reproductive age group (15-45 years) women in a tertiary care hospital, Southeastern India. Women diagnosed with uterine fibroid by ultrasonography were included as cases. Symptomatic features and associated risk factors of UF were collected through structure interview schedule.Results: Point prevalence of uterine fibroid among women in reproductive age group during the period of six months was 20%. Majority of them were in the age group of 30-39 years. Demographic factor such as overweight and obesity and consume dairy products daily has increased the prevalence of UF, whereas use of oral contraceptive pills and normal BMI had inverse relationship with UF risk. Most of the cases reported of having menstrual disturbances like heavy bleeding, passes blood clots during menstruation, prolonged period, urinary symptoms and pressure symptoms were considered independent predicting factors for the occurrence of uterine fibroid.Conclusions: Uterine fibroid is more prevalent among women of reproductive age causing various bleeding and renal symptoms that can have negative impact on quality of women’s life.

The value of quantitative perfusion in the prediction of ablation response in MR-HIFU for uterine fibroids / 实用放射学杂志

Objective To investigate the value of whole-tumor histogram analysis of quantitative perfusion in the prediction of ablation response in MR-guided high-intensity focused ultrasound (MR-HIFU)treatment for uterine fibroids.Methods A total of 31 fibroids in 28 eligible patients were treated with MR-HIFU.Four histogram parameters of the quantitative perfusion parameter (Ktrans )were obtained prior to MR-HIFU treatment:mean,median,skewness and kurtosis.T1 contrast-enhanced MRI immediately after MR-HIFU was performed to determine the non-perfused volume (NPV)and acquire non-perfused volume ratio (NPVR).The relationship between NPVR and all fibroid characteristics was determined by Spearman correlation analysis.Results The 3 1 fibroids were divided into high-response group and low-response group according to whether NPVR was higher than 60%.Four histogram metrics of Ktrans showed statistical difference between the two groups.The mean and median of Ktrans ,fibroid maximum diameter and T2 signal intensity type were correlated with NPVR.The Spearman correlation coefficient were －0.60,－0.66,－0.45 and －0.39,respectively (P＜0.05).Conclusion Uterine fibroids with lower whole-tumor Ktrans can achieve higher immediate ablation efficiency in MR-HIFU.Together with its histogram metrics,it might be a valuable indicator for patient selecting.

Recurrence of uterine fibroids / 中国实用妇科与产科杂志

Recurrence of uterine fibroids after myomectomy is common,and the mechanism of recurrence is unknown.The recurrence rate may be related to the number,size and type of fibroids.The treatment for recurrent uterine fibroids is the same as that for primary fibroids.Currently,there is no effective method or drug to prevent recurrence. The risk of recurrence should be assessed at the same time with surgery,and postoperative guidance and follow-up should be done.

Effects of Kuntai capsule on GnRH-a-induced perimenopause symptoms:a prospective randomized controlled study / 中国实用妇科与产科杂志

OBJECTIVE: To evaluate the effect of Kuntai capsule on the gonadotrophin releasing hormone agonist(GnRH-a)-induced perimenopaus symptoms and the sex hormone levels.METHODS: A total of 99 patients with uterine fibroids,adenomyosis or moderate to severe endometriosis who needed the treatment of GnRH-a at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 2015 to March 2016 were collected and randomly divided into research group(Kuntai capsule)and control group(Tibolone). GnRH-a was injected once every 28 days and first injection of GnRH-a was administered on the 2 nd to 4 th day of menstrual period or retraction bleeding after surgery.Kuntai capsule or Tibolone was orally taken beginning from the first GnRH-a injection,and the co-administration of Caltrate D-600 and alfacalcidol was given in both groups.The Kupperman scores,sex hormone levels including folliclestimulating hormone(FSH)and estrogen(E_2),and adverse events were recorded.RESULTS: Kuntai capsule kept the perimenopause symptoms at mild level with the slow increase of Kupperman scores,whose effect was significantly superior to Tibolone(P<0.05)after 8 weeks of treatment,especially in paresthesia,nervousness,and formication.The FSH and E_2 levels in both Kuntai and Tibolone groups were obviously decreased when compared with the pre-treatment(P<0.05),and these hormone levels in Kuntai group were comparable to those in Tibolone group.No adverse events occurred in either group. CONCLUSION: In the short-term treatment of GnRH-a,Kuntai capsule exhibits significant alleviating effects on perimenopause symptoms caused by GnRH-a with high safety and few adverse reactions.

The influence of uterus position on HIFU ablation effect of uterine fibroids / 介入放射学杂志

Objective To compare high-intensity focused ultrasound (HIFU) ablation effect on uterine fibroids between patients with different uterus positions. Methods The clinical data of 372 patients with symptomatic uterine fibroids, who were treated with HIFU at authors' hospital, were retrospectively analyzed. According to the position of the uterus, the patients were divided into anteverted group, mid-position group and retroverted group. Single factor analysis of variance was used to compare the baseline data of fibroids and HIFU ablation results between each other among the three groups. Results Successful HIFU treatment was accomplished in all patients. The average age of the patients was (39±6) years. Single factor analysis of variance indicated that no statistically significant difference in baseline data of fibroids existed between each other among the three groups (P>0.05) . The one cm3 sonication time and energy efficiency factor (EEF) in the anteverted group were significantly smaller than those in the retroverted group, the differences were statistically significant (P =0.007 and P =0.017 respectively) . Conclusion Uterine fibroids within an anteverted uterus are more likely to be ablated by HIFU.

Comparison on gravidity of post-operative patients between uterine fibroid ablation of high intensity focused ultrasound and laparoscopic myomectomy / 中国医学装备

Objective: To compare the effects between uterine fibroid ablation of high intensity focused ultrasound (HIFU) and laparoscopic myomectomy for gravidity of postoperative patients. Methods: 120 patients with uterine fibroid were divided into ultrasound ablation group (60 cases) and laparoscopy group (60 cases) as random number table. And the patients of ultrasound ablation group were treated by using HIFU and the patients of laparoscopy group received the treatment of laparoscopic myomectomy. The operative situation, curative effect and post-operative situation of gravidity of the two groups were compared and researched. Results: The effective rate of laparoscopy group was significantly higher than that of ultrasound ablation group (x2=3.56, P<0.05), while operation time, bleeding volume and postoperative recovery time of laparoscopy group were significantly higher than that of ultrasound ablation group, respectively (t=1.560, t=1.975, t=1.896, P<0.05). On the other hand, the postoperative gravidity rate of ultrasound ablation group was significantly higher than that of laparoscopy group (x2=3.65, P<0.05). Conclusion:Although the effective rate of HIFU for ablation of uterine fibroids is lower than that of laparoscopic myomectomy, its recovery time is shorter and its postoperative gravidity rate is higher than that of laparoscopic myomectomy. Therefore, it has popularized worthy in clinical practice.

The clinical application of microbubble contrast agent in high intensity focused ultrasound treatment for uterine fibroids / 介入放射学杂志

Objective To investigate the clinical utility of SonoVue,a microbubble-enhancing contrast agent,in the treatment of uterine fibroids carrying different signal intensities on T2WI with high-intensity focused ultrasound (HIFU).Methods Based on the preoperative MRI signal intensity on T2WI,a total of 64 patients with uterine fibroids,who were scheduled to receive HIFU,were divided into low-intensity group (n =24),iso-intensity group (n =22) and high-intensity group (n =18).MRI check-up examination was performed one day after HIFU treatment to evaluate the ablation effect.The parameters related to HIFU,including therapeutic power,irradiation time and therapeutic dose,and the indexes related to therapeutic effect,including volume ablation rate (non-perfusion volume ratio,NPVR),energy-efficiency factor,treatment time,were recorded,and the results were compared between each other among the three groups.Results In the low-intensity group,iso-intensity group and high-intensity group,the volume ablation rates were (84.83±18.49)％,(8.72±17.76)％ and (71.11±23.87)％ respectively,the energy-efficiency factors were (6.87±7.77) J/mm3 (7.99±6.58) J/mm3 and (12.93±9.38) J/mm3 respectively,the treatment time were (102.12±54.45) min,(153.86±66.04) min and (141.50±69.56) min respectively.Single factor analysis indicated that statistically significant differences in volume ablation rate,energy-efficiency factor and treatment time existed between each other among the three groups.Among the total 64 patients,3 patients developed lower abdominal pain (6/64,9.4％),3 patients complained of general aches with numb (3/64,4.7％),and no severe complications,such as skin burn in treatment area,etc.,occurred in all patients.Conclusion The curative effect of SonoVue combined with HIFU for low-intensity and iso-intensity uterine fibroids is better than that for high-intensity uterine fibroids;the treatment time for low-intensity uterine fibroids is shorter than that for iso-intensity and high-intensity uterine fibroids.SonoVue is a safe and effective synergist for HIFU treatment.

Clincal Value of Ultrasound-guided Transvaginal Radiofrequency Ablation for the Treatment of Symptomatic Uterine Fibroid / 现代生物医学进展

Objective:To investigate the safety and efficacy of ultrasound-guided transvaginal radiofrequency ablation in the treat ment of symptomatic uterine fibroid.Methods:39 patients with symptomatic uterine fibroid underwent transvaginal radiofrequency ablation therapy were selected Before treatment,the fibroid size and volume were measured using ultrasound.The fibroid-related symptom severity and quality of life were scored using uterine fibroid symptom and quality of life survey.The fibroid volume reduction rate,improvement in clinical symptom and quality of life,and ovarian function of patients were observed before treatment and at three,six,nine and 12 months after treatment.Results:The average operation time of radiofrequency ablation was 25 minutes.There was no clear intraand postoperative complication.Preoperative fibroid volume was 65.2± 49.3cm3,which was reduced to 32.2± 27.6 cm3,21.2± 18.2 cm3,15.3± 12.1 cm3 and 10.3± 9.8 cm3 at 3,6,9 and 12 months after treatment,respectively(P＜0.05).The symptom severity score (SSS) was 60.23± 13.2 before treatment,and gradually decreased to 42.2± 11.4,21.1± 10.2,15.4± 10.3 and 12.2± 9.7 at 3,6,9 and 12 months after treatment(P＜0.05).The quality of life (QOL) score gradually increased from 58.24± 16.24 before treatment to 70.3± 20.3,81.4± 8.6,86.3± 7.6 and 88.2± 9.1 at 3,6,9 and 12 months after treatment (P＜0.05).The levels of follicle stimulating hormone,luteinizing hormone and estradiol at 3,6,9 and 12 months after treatment showed no difference compared with these before treatment (P＞0.05).Conclusions:Ultrasound-guided transvaginal radiofrequency therapy was a minimally invasive,safe,and effective therapy for symptomatic uterine fibroid.

Clinical application of high-intensity focused ultrasound ablation for uterine fibroids

HIFU (high-intensity focused ultrasound) ablation is an emerging therapeutic modality that induces thermal coagulative necrosis of biological tissues by focusing high-energy ultrasound waves onto one small spot. This technique is at various stages of clinical applications in several organs. However, it has increasingly been used in the treatment of symptomatic uterine fibroids, a common condition affecting women. Since its first clinical use for symptomatic uterine fibroids, this technique has been recognized for safety, satisfactory therapeutic efficacy in symptom control, uterus-preserving ability, radiation-free nature, and because of the fact that it does not require hospitalization. Owing to its numerous benefits, HIFU ablation is currently one of the major therapeutic options for symptomatic uterine fibroids. In this review, several aspects ranging from the physical principle of HIFU to the long-term outcomes are summarized from the perspective of the clinical application for uterine fibroids.

Evaluation Of Diffusion-Weighted Imaging And Apparent Diffusion Coefficient Mapping Using Different B-Values For Magnetic Resonanceguided Focused Ultrasound Surgery: A Preliminary Study For Uterine Fibroid And Adenomyoma

The study was taken to assess the feasibility of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping using different b-values for magnetic resonance-guided focused ultrasound (MRgFUS) treatment of uterine fibroid and adenomyoma. The contrast-enhanced T1-weighted image (cT1WI) as well as DWIs and ADC maps of different b-values (i.e. 200, 600 and 800 s/mm2) were obtained from nine fibroid and five adenomyoma patients, immediately after, and 12 months after MRgFUS treatment. The image contrast score, non-perfused volume (NPV) and NPV ratio obtained were compared to determine the feasibility of DWI and ADC mapping for MRgFUS treatment outcome evaluation. Our finding showed thatimmediately after MRgFUS treatment, the DWI acquired using 200 s/mm2 b-value gave the highest image contrast score among all other b-values. The NPV calculated from DWI of 200 s/mm2 showed the best correlation (R2 = 0.938) with post-contrast NPV. At 12 months follow-up, there was no specific b-value considered as significantly superior to others in terms of image contrast. However, the NPVs and NPV ratios obtained from all DWIs and ADC maps of different b-values were in good agreement with the post-contrast NPV and NPV ratio. We observed that the DWI, particularly obtained with a low b-value (i.e. 200 s/mm2), is feasible for delineation and quantitative volumetric evaluation of the ablated region immediately after the MRgFUS treatment. At 12 months follow-up, both DWIs and ADC maps are feasible for NPV and NPV ratio calculation.

Diagnóstico ultrasonográfico de las masas pélvicas ginecológicas / Ultrasonographic Diagnosis of Gynecologic Pelvic Masses

Introducción: el ultrasonido constituye el examen diagnóstico ideal para el estudio de los tumores ginecológicos. Es un método efectivo, fácil de realizar, económico y no invasivo. Objetivo: caracterizar las masas pélvicas ginecológicas analizadas por ultrasonido. Métodos: se realizó un estudio observacional descriptivo transversal en el Hospital Universitario Ginecobstétrico Provincial Ana Betancourt de Mora desde enero hasta diciembre de 2013. El universo estuvo constituido por 312 féminas. El tamaño de la muestra fue de 151 pacientes seleccionadas al azar. Los datos se obtuvieron del libro de registro del salón de operaciones ginecológicas. La información se obtuvo de las historias clínicas. Se confeccionó una hoja de vaciamiento que se convirtió en el registro definitivo de la investigación y se determinaron estadísticas descriptivas. Resultados: la mayoría de las masas ginecológicas fueron fibroma uterino. Dentro de los hallazgos imagenológicos la mayoría de las masas tenían localización uterina, mostraron una tumoración única, fueron hipoecogénicos. Los diagnósticos clínicos y ultrasonográficos coincidieron por Anatomía Patológica. Conclusiones: el ultrasonido es de gran utilidad en el diagnóstico de las masas pélvicas(AU)

Introduction: Ultrasound is the ideal diagnostic test for the study of gynecologic tumors. It is an effective method, easy to perform, economical and non-invasive. Objective: Characterize gynecological pelvic masses by ultrasound. Methods: Atraverse descriptive observational study was carried out from January to December 2013; at the Provincial Obtetrics-Gynecology University Hospital. The study universe consisted of 312 women, 151 patients was the size of the sample, selected at random. The data were obtained from the registration book of the gynecological surgery room and from the clinical histories. A data sheet that became the definitive record of the investigation was constructed. Descriptive statistical was determined. Results: Most of the gynecological masses were uterine fibromas. Most of the masses, within the imaging discoveries, had uterine localization. They showed a unique tumor, they were hypoecogenic and clinical and ultrasonographic diagnosis pathologically agreed. Conclusions: ultrasound is useful in the diagnosis of pelvic masses(AU)

Miomectomía en gestante de 14 semanas: a propósito de un caso / Myomectomy in a 14-week pregnant woman: about a case

ANTECEDENTES: La prevalencia de los miomas uterinos en la gestación es de 0,3 a 2,6% de los cuales un 10% se complican durante el embarazo. El manejo quirúrgico de los miomas en la gestación se reserva solo para los casos complicados. CASO CLÍNICO: Paciente de 36 años, primigesta, que consulta a las 11 semanas de gestación por cuadro de distensión abdominal, edema en extremidades inferiores y sangrado vaginal escaso. El examen físico y la ecografía evidencia un mioma de 23 cm de diámetro y saco gestacional con embrión vivo a nivel de hipocondrio izquierdo. En controles posteriores la paciente empeora clínicamente debido al crecimiento del mioma, presentado dolor abdominal intenso, aumento de edemas en ambas extremidades inferiores. Los estudios de imagen informan ectasia pielocalicial bilateral y compresión de venas ilíacas. Ante los hallazgos y clínica se realiza miomectomía sin incidencias a las 14 semanas de gestación. El postoperatorio y controles posteriores son normales y se programa cesárea a las 37 semanas de gestación. DISCUSIÓN: La miomectomía en la gestación conlleva riesgos de hemorragia y aborto. Se reserva para casos puntuales que no respondan al manejo expectante. La recomendación actual y la experiencia indican que se debe realizar en el segundo trimestre de gestación. CONCLUSIÓN: La miomectomía en la gestación es una técnica que se debe plantear en casos seleccionados y que presenta pocas complicaciones.

BACKGROUND: The prevalence of uterine fibroids in pregnancy is 0.3 to 2.6%, 10% of which complicate during pregnancy. The surgical management of fibroids in pregnant women is reserved for complicated cases. CASE REPORT: The patient is 36 years old, first pregnancy, consulting at 11 weeks of gestation with bloating, edema in the lower extremities and mild vaginal bleeding. Physical examination and ultrasound evidence a 23 cm diameter fibroid and gestational sac with live embryo in the left upper abdominal quadrant. In subsequent tests the patient worsens clinically due to fibroid growth, presenting intense abdominal pain, increased edema in both lower extremities. Imaging studies report pyelocalyceal bilateral ectasia and compression of iliac veins. Given these findings and symptoms a myomectomy is performed without incidents at 14 weeks of gestation. Postoperative and subsequent tests are normal and caesarean section is preformed at 37 weeks of gestation. DISCUSSION: myomectomy in pregnancy carries risks of bleeding and abortion. It is reserved for cases that do not respond to expectant management. The current recommendation and experience indicate that it has to be performed in the second trimester. CONCLUSION: Myomectomy in pregnancy is a technique that should be considered in selected cases and has few complications.

Pseudo Meig's Syndrome: An Unusual Presentation.

Aim: To describe the radiological findings in a case of pseudo Meig’s syndrome with rare association of pericardial effusion. Presentation of Case: We report a case of pseudo Meig's syndrome who also had pericardial effusion. The patient had sonography and MR imaging of the abdomen which showed uterine fibroid associated with bilateral pleural effusion, ascites and pericardial effusion. Subsequently, the patient underwent hysterectomy with bilateral salpingectomy following which ascites, pleural effusion and pericardial effusion resolved. Histopathological examination confirmed uterine leiomyoma with degenerative changes. Discussion: Pseudo-Meig's syndrome is a condition which describes the association of any ovarian tumor (benign or malignant) other than ovarian fibroma or any pelvic tumor with pleural effusion and ascites. Association of pericardial effusion along with this condition has been rarely reported. Most common tumors associated with this entity described in previous literature include leiomyoma of uterus and broad ligament, germ cell tumors etc. It becomes highly important to identify this condition as it is a curable condition mimicking malignancy and can avoid unnecessary interventions. Conclusion: Pseudo-Meig’s syndrome associated with pericardial effusion is a rarely reported entity which can mimic malignant condition and hence it is important to consider it as a possibility in patients who present with pericardial effusion of unknown cause.