Does big mean evil? Giant, but benign uterine leiomyoma: case report and review of the literature / Será que grande significa maligno? Leiomioma gigante, porém benigno: Relato de caso e revisão de literatura

Abstract Uterine leiomyoma is themost prevalent benign type of gynecological tumor. It affects more than 80% of women worldwide and, within this group, more than 50% may be asymptomatic. However, large fibroid volumes may be associated with symptoms of extrinsic compression, and most of the cases do not present atypical cells. We present the case of a 49-year-old woman who underwent a total abdominal hysterectomy of a 13.5-kg uterine leiomyoma with no malignancies at histopathology and review the literature about giant uterine leiomyomas and their clinical repercussion. We concluded that large volumes do not always pose a threat regarding malignancy; however, future molecular studies are needed to investigate giant uterine fibroids.

Resumo Leiomioma uterino é o tumor benigno ginecológico de maior prevalência. Ele afeta mais de 80% das mulheres no mundo e, deste grupo, mais de 50% podem ser assintomáticas. Contudo, miomas de grande volume podem ser associados com sintomas de compressão extrínseca, e a maioria dos casos não apresentam células atípicas. Nós apresentamos o caso de uma mulher de 49 anos que foi submetida a histerectomia total abdominal de um espécime de 13,5 quilos sem malignidades ao exame histopatológico. Também revisamos a literatura sobre leiomiomas uterinos de grande volume e sua repercussão clínica. Concluímos que grandes volumes nem sempre representam um risco relacionado à malignidade; contudo, estudos moleculares futuros são necessários para investigar leiomiomas uterinos gigantes.

Effects and Mechanism of Xiaozheng Decoction on the Proliferation and Migration of Uterine Leiomyoma Cells in Rat / 中国药房

OBJECTIVE：To study the effects a nd mechanism of X iaozheng decoction on the proliferation and migration of uterine leiomyoma cells in rat. METHODS ：Female SD rats were randomly divided into normal control group ，model group ， chemical medicine positive control group （Mifepristone tablets ，2.25 mg/kg），TCM positive control group （Guizhi fuling capsules ， 200 mg/kg），Xiaozheng decoction low-dose ，medium-dose and high-dose groups （1.4，2.8，5.6 g/kg），with 15 rats in each group. Except for normal control group ，other groups were given intramuscular injection of estrogen and progesterone to induce uterine leiomyomas model. On the second day after modeling ，rats in administration groups were given relevant medicine intragastrically ； normal control group and model group were given constant volume of normal saline intragastrically ，once a day ，for consecutive 4 months. After last administration ，the uterus was removed and its morphology was observed ；the uterine coefficient was calculated. Uterine leiomyoma cells or uterine smooth muscle cells were isolated and cultured. The proliferation rate and migration rate of cells were detected by MTT method and cell scratch test ；flow cytometry was used to detect the cell apoptosis rate ；mRNA expression of HMGB 1 were detected by RT-qPCR. The expression of phosphorylated protein kinase B （p-Akt），nuclear factor κB inhibitor α （IκBα）and phosphorylated transforming growth factor β-activated kinase 1（p-TAK1）were detected by ELISA ；the protein expression of HMGB 1，phospholipid 3 kinase（PI3K），p-Akt in cytoplasm and nuclear factor κB p65（NF-κB p65）in nucleus were detected by Western blot assay. RESULTS ：Compared with normal control g roup，the myometrium of the model group was significantly thickened ，the number of uterine smooth muscle cells were significantly increased and the sizes were 83777930。E-mail：jianghua_ouyang@126.com different，the arrangement of muscle fibers in so me areas was disordered，the uterine coefficient ，and the relative expression of HMGB 1 mRNA and protein were increased significantly （P＜ 0.01）. Compared with model group ，the thickening of uterine myometrium and other symptoms were improved to different extents in Xiaozheng decoction groups and positive control groups ；the uterine coefficient ，cell proliferation rate ，migration rate ，mRNA and protein expression of HMGB 1，the expression of p-Akt and IκBα，protein expression of PI 3K and p-Akt （except for Xiaozheng decoction low-dose group ）in cytoplasm were all decreased significantly （P＜0.05 or P＜0.01）；the cell apoptosis rate ，the expression of p-TAK 1，protein expression of NF-κB p65 in nucleus were all increased significantly （P＜0.05 or P＜0.01）. The effects of Xiaozheng decoction showed a dose-dependent trend. CONCLUSIONS ：Xiaozheng decoction can inhibit the proliferation and migration of uterine leiomyoma cells by down-regulating the expression of HMGB 1，PI3K and p-Akt ，up-regulating the expression of NF-κB p65，so as to promote cell apoptosis.

Research Progress on Lichongtang in Treatment of Uterine Leiomyoma / 中国实验方剂学杂志

Uterine leiomyoma （UL）， the most common benign tumor of the reproductive system in women of childbearing age， is characterized by clinical symptoms such as increased menstrual flow， prolonged menstrual period， breast tenderness，backache， lower abdominal pain and mass in the lower abdomen. With the continuous progress of modern society， the age of women's marriage and childbirth is gradually pushed back， which to a certain extent has led to an increase in the probability of modern women suffering from UL. Relevant literature shows that the incidence of UL is about 70%， and 25%-50% of the patients have clinical symptoms， seriously endangering women's physical health. The prevention and treatment of UL by modern medicine is currently limited to two aspects： drug control of estrogen and progesterone levels and surgical removal. Traditional Chinese medicine（TCM）has shown obvious advantages in improving the clinical symptoms of UL patients， with very broad application prospects as it can regulate body's Qi and blood on the basis of syndrome differentiation， treatment and overall concepts. Lichongtang， as a famous TCM prescription for replenishing Qi， activating blood and removing blood stasis， was created by ZHANG Xi-chun， a famous Chinese medicine doctor in the Qing dynasty， and recorded in the Records of Tradition Chinese and Western Medicine in Combination. It is widely used in the field of gynecological diseases in clinical practice. Studies have shown that Lichongtang is effective in treating UL. Clinical observations show that Lichongtang can significantly relieve the clinical symptoms of UL patients such as prolonged menstrual period， dysmenorrhea， waist and abdomen swelling and irregular vaginal bleeding， with the characteristics of stable curative effect， high safety， less side effect and low recurrence rate. The experimental results show that Lichongtang has a comprehensive regulatory effect on UL through inhibiting the proliferation of UL cells and inducing apoptosis， reducing serum estrogen and progesterone level， regulating the apoptosis pathway of tumor cells， and promoting the degradation of extracellular matrix（ECM）. After retrieval in PubMed， CNKI and other databases， the authors made a review by summarizing the theories， clinical efficacy and action mechanisms of Lichongtang in the treatment of UL， in order to provide reference for the follow-up in-depth study of pharmacological mechanism of Lichongtang and its further clinical application and promotion.

Shikonin Affects Uterine Leiomyoma in Rats by Regulating ERK Signaling Pathway / 中国实验方剂学杂志

Objective:To investigate the effect of shikonin on uterine leiomyoma in rats and its molecular mechanism. Method:Sixty female SD rats， of SPF grade and weighing 200-250 g， were randomly divided into the control group， model group， low-， medium-， and high-dose （5， 10， 20 mg·kg^-1） shikonin groups， and mifepristone group. A rat model of uterine leiomyoma was established， and the changes in uterine wet weight， uterine coefficient， and smooth muscle thickness were detected after drug administration for four successive weeks. The pathological changes in uterine tissue were observed by hematoxylin-eosin （HE） staining. The contents of estrogen receptor （ER） and progesterone receptor （PR） in serum and uterus were measured by enzyme-linked immunosorbent assay （ELISA）， and the protein expression levels of ER， PR， phosphorylated extracellular signal-regulated kinase （p-ERK）， and ERK in the uterine tissue were assayed by Western blot. Result:Compared with the control group， the model group exhibited significantly increased uterine wet weight， uterine coefficient， and smooth muscle thickness （<italic>P</italic><0.01）， uterus deformity， focal smooth muscle cell necrosis and hyperplasia， neutrophil infiltration. elevated serum and uterine ER and PR （<italic>P</italic><0.01）， and up-regulated p-ERK protein expression in the uterine tissue （<italic>P</italic><0.01）. Compared with the model group， shikonin at the middle and high doses and mifepristone significantly reduced the uterine wet weight， uterine coefficient， and smooth muscle thickness （<italic>P</italic><0.01）， relieved the pathological changes in uterus，and lowered serum and uterine ER and PR， and down-regulated the p-ERK protein expression in the uterine tissue （<italic>P</italic><0.05）. In addition， the uterine wet weight， smooth muscle thickness， serum ER， and uterine PR and p-ERK protein expression in the low-dose shikonin group were significantly lower than those in the model group （<italic>P</italic><0.05）. Conclusion:Shikonin produces the anti-uterine leiomyoma activity possibly by inhibiting the activation of ERK pathway.

Bilateral pyelonephritis due to Escherichia coli infection in a captive jaguar (Panthera onca) / Pielonefrite bilateral por Escherichia coli em uma onça-pintada (Panthera onca)

Extraintestinal pathogenic Escherichia coli (ExPEC) is a highly diverse pathotype of E. coli which colonizes the intestine, and it is considered an important etiological agent associated with bacteremia and other systemic infections, among them urinary tract infection. Retrospective studies evaluating morbidity and mortality of nondomestic felids have demonstrated that urinary tract diseases are among the main causes of death for geriatric animals. Also, mesenchymal neoplasms of the uterus are common in wild felids, and they possess variable morphologic characteristics related to invasiveness and malignancy. This report describes a case of bilateral pyelonephritis due to extraintestinal uropathogenic E. coli infection in a captive jaguar (Panthera onca). The diagnosis was confirmed through pathological, bacterial and immunohistochemical findings. According to molecular analysis, this E. coli strain was classified in the phylogroup F, possessing the following virulence-associated genes: usp, cnf-1, hlyA, papC and sfa. Additionally, this E. coli was highly resistant to beta-lactams and first-generation cephalosporin. This jaguar also presented a uterine leiomyoma with distinct distribution, and severe degenerative articular disease, both of them described as frequently seen lesions in geriatric animals from the Panthera genus.(AU)

Escherichia coli extraintestinal patogênica (ExPEC) é um patotipo altamente diverso de E. coli que coloniza o intestino e é considerada um agente etiológico importante, associado com bacteremia e outras infecções sistêmicas, dentre elas infecções do trato urinário. Estudos retrospectivos avaliando morbidade e mortalidade de felídeos não domésticos demostram que doenças do trato urinário estão entre as principais causas de morte de animais geriátricos. Ainda, neoplasias mesenquimais uterinas são comuns em felídeos de cativeiro e possuem características morfológicas variáveis relacionadas a invasividade e malignidade. Neste relato é descrito um caso de pielonefrite bilateral por E. coli extraintestinal uropatogênica em uma onça-pintada de cativeiro (Panthera onca). O diagnóstico foi confirmado através dos achados patológicos, bacteriológicos e imuno-histoquímicos. A partir da análise molecular, esta cepa de E. coli foi classificada no filogrupo F, possuindo os seguintes genes associados a virulência: usp, cnf-1, hlyA, papC and sfa. Adicionalmente, a bactéria isolada foi altamente resistente a ß-lactâmicos e cefalosporinas de primeira geração. Foi observado ainda um leiomioma uterino com distribuição distinta e doença articular degenerativa severa, ambas descritas na literatura como comumente observadas em animais geriátricos do gênero Panthera.(AU)

Pelvic Desmoid Tumour Imitating Uterine Leiomyoma in a Nigerian Premenopausal Woman

Aim:To describe a rare case of pelvic desmoid tumour simulating as a huge uterine leiomyomacausing a diagnostic dilemma in a premenopausal woman.Case Presentation:This was a 44-year-old, para 2 (2 alive) who was referred to our gynaecology clinic from a secondary health facility onaccount of slowly increasing abdominal swelling of 2yearsduration. There was no nausea, vomiting or diarrhoea. There was associated mild to moderate dull lower abdominal pain that did not radiate to any other part of the body. There was no change in her monthly menstrual flow. Physical examination revealed a pelvic mass about 32weeks pregnancy size and firm. Computed Topography scan showed a huge pedunculated sub-serous uterine fibroid. A huge mass adherent to the anterior surface of the body of the uterus was completely surgically excised at exploratory laparotomy. Histology of the excised tumour revealed a definitive histological diagnosis of pelvic desmoidtumour. The patient was clinically stable and discharged home 10 days post operation and was followed-up on out-patient gynaecology clinic basis.Discussion:Pelvic desmoid is a rare mesenchymal tumour caused by abnormal proliferation of fibroblasts. It is threetimesmore common in women and occurs mostly between 25 and 35 years of age which correspond to the same age peak incidence for uterine fibroids. The tumour can easily be misdiagnosed as uterine leiomyoma and imaging cannot reliably distinguish the two conditions.Conclusion:Pelvic desmoid tumour should be considered as adifferential diagnosis in premenopausal women who present with abdominal swelling. Relevant clinical history, Radiological imaging and Histopathologicalassessment are essential in making prompt accurate diagnosis

Mioma intraligamentario de gran tamaño en una adolescente / Intra-ligamentary leiomyoma of giant elements in adolescent patient

Resumen ANTECEDENTES: Los leiomiomas uterinos son los tumores benignos ginecológicos más frecuentes en las mujeres en edad reproductiva; por tanto, son extremadamente raros en las adolescentes (menos de 1%) y solo se encuentran reportes de caso en la bibliografía. CASO CLÍNICO: Paciente de 16 años, con tumor suprapúbico de rápido crecimiento, acompañado de dolor abdominal generalizado, enviada a la unidad médica con diagnóstico de miomatosis uterina para descartar su malignidad. El ultrasonido pélvico reportó múltiples lesiones hipoecoicas diseminadas en el miometrio, similares a metástasis. La tomografía abdomino-pélvica informó hepatomegalia, a expensas del lóbulo izquierdo y leiomiomas intramurales de medianos y grandes elementos; los marcadores tumorales se encontraron en límites normales. En la laparotomía se encontró una tumoración interligamentaria izquierda de 25 cm; el estudio histopatológico reportó: leiomioma uterino de patrón histológico convencional. CONCLUSIONES: El cuadro clínico de los leiomiomas en adolescentes representa un reto clínico por la edad, signos, síntomas y necesidad de preservación de la función reproductiva, aspectos decisivos a la hora de decidir el tratamiento.

Abstract BACKGROUND: The uterine leiomyomas are the most common gynecological benign tumors in fertile females; however, they are very rare in adolescents (less than 1%) and there are only a few reports in the literature. CLINICAL CASE: A 16-year-old patient with a fast-growing suprapubic tumor, accompanied by generalized abdominal pain, sent to the hospital with diagnosis of pelvic tumor probable uterine miomatosis, to rule out malignant tumor. Pelvic ultrasound was performed with a report of multiple disseminated hypoechoic lesions in myometrium giving appearance of metastasis, without being the characteristic images of myomas, pelvic abdominal tomography reported hepatomegaly of the left lobe, intramural leiomyomas of medium and large elements, tumor markers within normal limits. The laparotomy was performed, left intraligamentary myoma of giant elements was located; and the histopathological study reported uterine leiomyoma of conventional histological pattern. CONCLUSIONS: The clinical of leiomyomas in adolescent patients represents a challenge for the gynecologist. The age, symptomatology, and preservation of reproductive function are important aspects to decide the therapeutic regimen.

Long-term outcomes of single-port laparoscopic myomectomy using a modified suture technique

OBJECTIVE: To evaluate the long-term outcomes, including the pregnancy outcome and recurrence rate after single-port laparoscopic myomectomy (LM) using a modified suture technique with a Hem-o-lok clip (Choi's LM) and conventional 4-port LM.METHODS: A retrospective study of patients who underwent Choi's LM (n=55) and 4-port LM (n=102) in a single institutional hospital was conducted. Patients with <3 symptomatic myomas sized <10 cm each and operated on by a single surgeon were included. Recurrence was confirmed when a myoma measuring ≥3 cm was detected.RESULTS: The patients in both groups had similar demographic characteristics. Single (76.4% vs. 62.7%) and intramural (52.7% vs. 56.9%) tumors were commonly detected in both groups in the mean diameter (6.8±1.5 cm vs. 7.0±1.6 cm; P=0.40). In Choi's LM, 16 patients (29.1%) needed an additional port; those who were nulliparous and/or had a large leiomyoma more frequently required an additional port (P=0.023 and 0.04, respectively). During a median follow-up period of 69 months, 17 patients (7.1% vs. 14.6%) had recurrence. The size of dominant myomas at recurrence was significantly smaller in patients who underwent Choi's LM (3.4±0.7 cm vs. 5.7±2.4 cm; P=0.004). All 13 patients in both groups who successfully conceived had a full-term delivery. No major complications occurred during pregnancy.CONCLUSION: Although an additional port was frequently used, the long-term outcomes of patients who experienced recurrence and pregnancy after Choi's LM were acceptable. Considering its usability, Choi's LM is feasible for the treatment of uterine leiomyoma.

Meta-analysis of the Efficacy of Gongliuqing Capsules Combined with Mifepristone in the Treatment of Uterine Leiomyoma / 中国药房

OBJECTIVE：To systematically evaluate therapeutic efficacy of Gongliuqing capsules combined with mifepristone in the treatment of uterine leiomyoma ，in order to provide evidence-based reference for clinical medication. METHODS ：Retrieved from Cochrane Library ，PubMed，Embase，CJFD，VIP，CBM and Wanfang database ，randomized controlled trials （RCTs）about Gongliuqing capsules combined with mifepristone （trial group ）versus mifepristone alone （control group ）in the treatment of uterine leiomyoma were collected. After literature screening and data extraction ，the quality of included literatures was evaluated with modified Jadad scale. Meta-analysis was conducted by using Stata 14.0 software，and trial sequential analysis （TSA）was performed by using TSA 0.9 software. RESULTS ：A total of 12 RCTs were included ，involving 1 210 patients. The results of Meta- analysis showed that the total response rate of trial group [RR ＝1.12，95％CI（1.00，1.26），P＜0.05] was significantly higher than that of control group ；maximum uterine leiomyoma volume after treatment [SMD ＝－1.08，95％CI（－1.21，－0.95），P＜0.05]，uterine volume after treatment [SMD ＝－0.80，95％CI（－1.14，－0.45）， P＜0.05]，follicle stimulating hormone （FSH）level [SMD ＝ － 0.28，95％ CI（－ 0.45，－ 0.19），P＜0.05]，luteinizing hormone（LH）level [SMD ＝－0.44，95％CI（－0.52，－0.12）， 020-38076311。E-mail：867203217@qq.com P＜0.05]，E2 level [SMD ＝－2.69，95％CI（－3.08，－1.49）， P＜0.05] and progesterone （P）level [SMD ＝－1.27，95％CI（－1.69，－0.71），P＜0.05] of trial group were significantly lower or better than those of control group. Results of subgroup analysis showed that except for the level of FSH in 5 and 10 mg mifepristone groups （P＞0.05），maximum uterine leiomyoma volume after treatment ，uterine volume after treatment ，the levels of FSH，LH，E2 and P in trial group were significantly lower than control group. The results of TSA showed that there were definite evidences for total response rate of Gongliuqing capsules combined with mifepristone being better in the treatment of hysteromyoma. CONCLUSIONS ：Total response rate of Gongliuqing capsules combined with mifepristone in the treatment of hysteromyoma is better than mifepristone alone ，which can effectively decrease the volume of maximum uterine leiomyoma volume and uterine vilume ，and reduce the level of serum hormone.

Correlational Analysis of Interleukin 6, Adiponectin and Lipid Indices in Women with Uterine Fibroids

Background:Uterine fibroids are the most common benign, monoclonal tumours affecting women of reproductive age.Aim:This study investigated the association between interleukin-6 (IL-6), adiponectin(ADP) and lipid indices in women with uterine fibroids.Subjects and Methods:Sixty (60) participants were recruited for this study. They comprised thirty (30) subjects who had ultrasonographic evidence of uterine fibroids and thirty (30) subjects who hadno ultrasonographic evidence of uterine fibroids. Subjects were recruited from the Gynaecology out-patient clinic of LAUTECH Teaching Hospital Ogbomoso, Nigeria. Anthropometric measurements were performed using standard method. About 5mL of venous blood was collected from each study participant and was dispensed into a plain bottle. Serum was obtained after clotting and centrifugation and was aliquoted into a small vial which was stored at -20°C until time of analysis. Interleukin-6 (IL-6), adiponectin (ADP), total cholesterol (TC), triglycerides (TG) and high density lipoprotein (HDL) were determined using enzyme linked immunosorbent assay (ELISA) and colorimetric method as appropriate. Low density lipoprotein (LDL) was estimated using Friedewald’s equation. Data analysis was done using Student’s t-test for comparison of variables and Pearson’s correlation was used to determine the relationship between variables. P–value less than 0.05 was considered significant.Results:Women with uterine fibroids had significantly elevated body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) when compared with the controls (P<0.05). The mean values of TC, TG, LDL and IL-6 were significantly elevated in women with uterine fibroids when compared with the control subjects (P<0.05). Women with uterine fibroids had significantly reduced levels of ADP when compared with controls (P<0.05) and there was no significant difference in the levels of HDL when both case and control subjects were compared (P>0.05). Interleukin-6 had a significant positive correlation with BMI, WC, WHR, TC, TG and LDL. Interleukin-6 also had a significant negative correlation with HDL and ADP.Conclusion:This study demonstrated a significant direct relationship between IL-6 anddyslipidemia in women with uterine fibroids. Also, we observed a noteworthy inverse relationship between IL-6 and adiponectin in women with uterine leiomyomas, thus emphasizing the low grade chronic inflammatory state, associated with uterine leiomyomas

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.

Caso de pseudo-Meigs, signo guía de afección ginecológica subyacente / Case of Pseudo-Meigs, Guide Sign of Underlying Gynecological Condition

Introducción: El síndrome de Meigs consiste en la asociación de tumor benigno de ovario tipo fibroma con ascitis e hidrotórax, que se resuelven tras la extirpación del tumor. El síndrome de pseudo-Meigs secundario al leiomioma uterino es una entidad rara. Presentación de caso: Mujer de 68 años que presentó una historia de un mes con sensación de opresión torácica y disnea. La radiografía de tórax reveló derrame pleural derecho. En la tomografía axial computarizada de abdomen y región pelviana se aprecia ascitis y un gran mioma uterino subseroso. Se sometió a una histerectomía abdominal total con salpingo-ooforectomía bilateral. Conclusiones: La ascitis y el derrame pleural desaparecieron rápidamente en el postoperatorio. Tras 20 meses de seguimiento, no hay recidiva de la enfermedad(AU)

Introduction: Meigs syndrome consists of the association of a benign tumor of the ovary "fibroma type" with ascites and hydrothorax, which resolve after the tumor is removed. The pseudo-Meigs syndrome secondary to uterine leiomyoma is a rare entity. Case report: A 68-year-old woman refered having a month with a sensation of chest tightness and dyspnea. Chest X-ray revealed right pleural effusion. Computed axial tomography of the abdomen and pelvic region shows ascites and a large subserous uterine myoma. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Conclusions: Ascites and pleural effusion disappeared rapidly in the postoperative period. After 20 months of follow-up, there is no recurrence(AU)

Transcriptional profiling of uterine leiomyoma rats treated by a traditional herb pair, Curcumae rhizoma and Sparganii rhizoma

The aim of this study was to elucidate the concise effects of a traditional herb pair, Curcumae rhizoma-Sparganii rhizoma (CRSR), on uterine leiomyoma (UL) by analyzing transcriptional profiling. The UL rat model was made by intramuscular injection of progesterone and gavage administration of diethylstilbestrol. From 11 weeks of the establishment of the model, rats of the UL+CRSR group were gavaged daily with CRSR (6.67 g/kg). The serum concentrations of progesterone (P) and estradiol (E2) were determined by radioimmunoassay, the uterine index was measured by caliper measurement, and the pathological status was observed by hematoxylin and eosin stain. Gene expression profiling was checked by NimbleGen Rat Gene Expression Microarrays. The results indicated that the uterine mass of UL+CRSR rats was significantly shrunk and serum P and E2 levels significantly reduced compared to UL animals and nearly to the level of normal rats. Results of microarrays displayed the extensive inhibition of CRSR upon the expression of proliferation and deposition of extracellular matrix (ECM)-related genes, and significantly regulated a wide range of metabolism disorders. Furthermore, CRSR extensively regulated key pathways of the UL process, such as MAPK, PPAR, Notch, and TGF-β/Smad. Regulation of the crucial pathways for the UL process and ECM metabolism may be the underlying mechanisms of CRSR treatment. Further studies will provide clear clues for effectively treating UL with CRSR.

Uterine leiomyoma and related issues of fertility and pregnancy safety / 中国实用妇科与产科杂志

Uterine leiomyoma is a common benign tumour in women of childbearing age,with an incidence of 25%-30%.Uterine myoma can cause infertility,as well as abortion,premature delivery,placental abruption and postpartum hemorrhage and other adverse pregnancy outcomes,which increases the cesarean section rate.The influence of uterine leiomyoma on fertility is closely related to its location and size.The treatment should be individualized,considering the size,location and fertility of the myoma.

Establishment of a rat xenograft model of human uterine leiomyoma / 中国实验动物学报

Objective To establish a rat xenograft model of human uterine leiomyoma using immunosuppressive a-gent and provide a useful tool for the study on uterine leiomyoma. Methods Intragastric administration with immunosup-pressive agent mycophenolate mofetil(MMF)(40 mg/kg)was given to rats for two weeks before the surgery until the end of the experiment. 20 SPF female Wistar rats were randomly divided into 4 groups after abdominal transplantation of human leiomyoma tissues:group A received femoston containing 0.4 mg/kg estradiol and 2 mg/kg dydrogesterone, group B re-ceived estadiol 0.4 mg/kg,group C received dydrogesterone 2 mg/kg,and group D served as the control group, received distilled water 1 mL/200 g. All rat received the corresponding drugs once per day for 2 days. Samples were taken at 4 weeks after the surgery to observe the pathology of the tumor tissues. Results The modeling success rates were 90% in the group A,40 % in the group B,and 0% in the groups C and D. Conclusions Rat xenograft model of human leiomyoma can be successfully established using an immunosuppressive agent femostone with a high modeling success rate and low cost. It can be used as a new animal model for the study of transplanted leiomyoma.

Expressions of p16INK4a protein in cervical lesion tissues of Mongolian patients and their significances / 吉林大学学报(医学版)

Objective:To detect the expressions of p16INK4a protein in the cervical lesion tissues of the Mongolian patients, and to explore the relationship between its expression and the occurrence and development of cervical cancer in the Mongolian patients.Methods:A total of 100 cases of paraffin sections of cervical cancer, cervical intraepithelial neoplasia(CIN),chronic cervicitis and uterine leiomyoma were divided into 25 cases of cervical cancer, 35 cases of CIN, 20 cases of chronic cervicitis, and 20 cases of uterine leiomyoma groups. The expressions of p16INK4a protein in different cervical tissues were detected by immunohistochemical SP method.Results:The positive rates of p16INK4a protern in cervical cancer, CIN, chronic cervicitis and uterine leiomyoma tissnes were 100.0%, 74.3%, 25.0%,and 10.0%, respectively.The results of K-W H rank sum test for multiple sample comparisons showed that the positive expression rate of p16INK4a protein in cervical cancer tissue was significantly higher than those in CIN, chronic cervicitis and uterine leiomyoma tissues(P<0.05).Conclusion:p16INK4a protein can be used as a indicator to screen the Mongolian patients with early cervical cancer.

Clinicopathological study of 6 cases of benign metastasizing leiomyoma / 临床与实验病理学杂志

Purpose To investigate the clinicopathological characteristics,diagnosis and differential diagnosis of benign metastasizing leiomyoma (BML).Methods The clinicopathological data in 6 patients with BML were collected.All cases of BLM were investigated by HE and immunohistochemistry of EnVision method.Results All cases were female,with age of 33 -65 years,and had undergone myomectomy.5 cases had lung metastasis,including abdominal wall metastasis and spinal metastasis in each of the 1 cases,and another case had inguinal metastasis.Morphology showed that the tumor cells were spindle without obvious atypia,nuclear mitoses and necrosis,some cases were cellular.Immunohistochemical staining showed that the tumor cells were positive for SMA,SM-MHC,desmin,ER,PR,vimentin,while negative for S-100,CD117,CD34.Ki-67 label index were less than 5％.3 patients were alive with tumor and 3 patients were alive without tumor in the follow up of 18,28,40,31,36,80 months.Conclusion BML often occurs in female patients that undergone uterine myomectomy.The lung is the most common site of metastasis,often accompanied by other sites.The disease progresses slowly,and most patients have a longer survival time.

A comparative study on the fertility of uterine artery embolization and myomectomy for leiomyoma / Монголын Анагаах Ухаан

Objective@#To compare the nature of pregnancy and deliveryin women with leiomyoma who were treated with uterine artery embolization to the outcomes in women who were treated with abdominal myomectomy. @*Material and Methods@#A prospective, clinical study was conducted in 2010-2013 at “Urguu” Maternity Hospital, Ulaanbaatar. 94 women meeting the criteria were selected for the study. Post-treatment, the patients were reviewed for a period of two years. Uterine artery embolization was performed using polyvinyl alcohol particles (300-500 µm in diameter).@*Results@#The percentage of conception in UAE group was 25.5% and 31.9% in myomectomy group (p=0.494); complication of pregnancy was 50.0% and 57.1% respectively (p=0.729); complication of delivery was 33.3% and 0.0% respectively (p=0.047). 88.9% and 90.0% (p=0.596) had Caesarean delivery. 16 (84.2%) women had uncomplicated and 3 (15.8%) women had complicated delivery due to placenta praevia, placenta acreta and uterine hypotonia. These cases all belonged to UAE group. @*Conclusion@#Pregnancy rates in women with leiomyoma who were treated by uterine artery embolization, compared with pregnancies after abdominal myomectomy, were similar.(p=0.494) In this study, there was the rate of Cesarean delivery above 80 percent in both group. There were no differences in newborn weights and Apgar scores.

Delayed intestinal perforation and vertebral osteomyelitis after high-intensity focused ultrasound treatment for uterine leiomyoma

High-intensity focused ultrasound (HIFU) is a non-invasive uterine fibroid treatment option for patients who want to preserve fertility. However, according to several reports regarding ablation of solid tumors by HIFU, there are rare complications in patients with uterine leiomyomas, and overall data are still insufficient. Here, we report rare and major complications of HIFU, such as delayed intestinal perforation, uterine perforation with recto-uterine fistula, and osteomyelitis 29 days after the HIFU procedure to treat multiple myomas. Thus, we present a very serious case resulting from HIFU treatment of uterine fibroids and a review of the literature.

Pelvic Intravenous Leiomyomatosis - Case Report / Leiomiomatose intravenosa pélvica - caso clínico

Abstract Introduction Intravenous leiomyomatosis is a benign and rare condition that can result in cardiac events with fatal outcomes when left untreated. Intravenous leiomyomatosis is probably underestimated because the diagnosis is easily missed. We present a case of an intravenous leiomyomatosis without extra-pelvic involvement, with a brief review of this pathology. Case Report 46-year-old woman submitted to hysterectomy and bilateral adnexectomy because of a pelvic mass detected in ultrasound. During the surgery, intravenous leiomyomatosis diagnosis was suspected. Pathological analysis confirmed this suspicion. Further imaging exams were performed without detecting any anomalies related to this condition. The patient remained with no evidence of disease after one year of follow-up. Conclusion Intravenous leiomyomatosis is a rare condition that can lead to serious complications. Early diagnosis followed by an appropriate treatment is very important to patient outcome, and underdiagnoses can be counteracted if the gynecologist is aware of this entity.

Resumo Introdução A leiomiomatose intravenosa é uma condição benigna, rara, que pode resultar em eventos cardíacos, podendo ser fatal quando não tratada. Esta patologia está provavelmente subestimada, uma vez que facilmente não é diagnosticada. Neste artigo, apresentamos um caso de leiomiomatose intravenosa sem envolvimento extrapélvico, com uma breve revisão da patologia. Relato de Caso Mulher de 46 anos de idade, submetida a histerectomia e anexectomia bilateral após detecção ecográfica de massa pélvica. Durante a cirurgia, houve a suspeita de leiomiomatose intravenosa, e o exame anátomo-patológico confirmou o diagnóstico. A paciente foi submetida a outros exames de imagem, não sendo detectada qualquer anomalia relacionada com a patologia. Após um ano de followup, a paciente manteve-se sem evidência de doença. Conclusão A leiomiomatose intravenosa é uma condição rara que pode levar a complicações graves. O diagnóstico precoce e o tratamento adequado são muito importantes para o prognóstico da paciente, e os subdiagnósticos podem ser evitados se o ginecologista estiver ciente dessa entidade.