Extracellular matrix metalloproteinase expression in endometrial tissue after arterial embolization of myomas

OBJECTIVES: Arterial embolization of myomas (AEM) is controversial because of the changes that occur in the extracellular matrix (ECM) of the endometrium and its effect on gestational success in infertile patients desiring reproductive capability. Therefore, we performed this study on the expression of genes in the ECM of the endometrium, such as those coding metalloproteinases (MMP), before and 6 months after embolization of the uterine arteries. METHODS: Seven women with leiomyomas were evaluated, and MMP3 and MMP10 levels were measured. The women underwent pelvic nuclear magnetic resonance (NMR), examination, and endometrial biopsy between the 20th and 24th day of the menstrual cycle, and pre- and post-AEM (after 6 months). For data analysis, the Cq comparative method, also known as the 2-ΔΔCT method, was used to calculate the relative quantities of MMP gene expression among the samples collected. RESULTS: There was a significant decrease by 9.52 times in the expression of MMP3 (p=0.007), and a non-significant change in the expression of MMP10 (p=0.22) in post-AEM-treated women than pre-AEM-treated women. CONCLUSIONS: The results suggest that ECM continues to undergo tissue remodeling 6 months after AEM, at least with regard to MMP3 expression, suggesting that AEM affects the ECM for at least 6 months after the procedure.

Rare case: enucleation of multiple fibroids after intraoperative vaginal sonographic detection of the solitary pelvic kidney by patient with Mayer-Rokitansky-Kuster-Hauser syndrome

Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is a congenital anomaly of the genital tract that occurs in about 1 in 4000 women. MRKH syndrome can be associated with renal, skeletal, heart and hearing abnormalities. The frequency of renal/urinary tract abnormalities is 33%. Only a few cases of fibroid development in MRKH syndrome have been described in the literature. The diagnosis and surgery of a fibroid in MRKH syndrome may be complicated in associated kidney abnormality by an atypical kidney position, as in this case: pelvic kidney on one side and renal agenesia on the contralateral side. Authors present the case of a 47-year-old female patient with a known MRKH syndrome and a pelvic kidney on the right side who had presented with an unclear tumour in the right lower abdomen. A completed CT scan revealed the tumour directly next to the pelvic kidney. A malignancy could not be excluded with certainty, so that a laparoscopy in laparotomy readiness was indicated and performed. During surgery, two rudimentary uterine horns were found; on the right side retroperitoneally, below the uterine horn, the tumour was located and directly below it there was a soft tissue alteration, probably the kidney. For safety, a vaginal sonography was performed in between, to clearly identify the only kidney and to avoid damaging it. The tumour could be extirpated laparoscopically without kidney injury. The two uterine horns were removed simultaneously. Histologically the fibroid could be confirmed. In addition, three other fibroids (one on the left side and two on the right side) were detected. Due to the high probability of a simultaneous kidney abnormality in the MRKH syndrome, authors suggest an accurate kidney diagnosis preoperatively. If necessary, in the case of a pelvic kidney and/or renal agenesia, as in this case, an additional intraoperative kidney check should be performed.

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.

To Compare the Efficacy of Ulipristal acetate and Mifepristone in Management of Uterine Fibroids in Symptomatic Patients of Reproductive Age Group

Introduction: Uterine myomas incidence is variable asmost of the patients are asymptomatic but most commonclinical feature which makes women seek their treatment aremenorrhagia and iron deficiency anaemia leading to chronicfatigue. Study aimed to compare the efficacy of UPA andmifepristone in medical management of uterine fibroids insymptomatic patients of reproductive age group.Material and methods: A prospective randomizedobservational study was carried out, in women with single ormultiple uterine leiomyoma. Exclusion criteria: severe anemia,using any hormonal therapy, with suspected carcinomas orwith adnexal masses. 100 patients were randomly allocatedto two subgroups; group A receiving 5 mg UPA and groupB receiving 25 mg Mifepristone daily, for 13 weeks. PBACwas used to assess menstrual blood loss and Likert scorefor other symptoms. Baseline variables: uterine size andvolume, Myoma size and volume, number, hemoglobin, liverfunction tests were noted and reassessed at 1, 3 and 6 months.Endometrial sampling was done initially and at the end tostudy.Results: Mean fibroid volume reduction was 35.23% in groupA and 33.45% after 13 weeks’ treatment in group B. Meanreduction in menorrhagia: 84% in group A and 52.5% in groupB. 91% cases experienced amenorrhoea in group A and 72%in group B.Conclusion: UPA 5mg was better at achieving significantreduction in menorrhagia and achieving amenorrhoeic state ascompared to Mifepristone.

Navigating through the maze of caesarean myomectomy: generating evidence

Management of myomas during pregnancy and labor is a contested subject so far. Currently no recommended national or international guidelines are in place resulting in conflicted opinion and management variation across the globe. Many obstetricians still discourage its practice due to fear of uncontrolled haemorrhage which may lead to unwanted hysterectomy in a reproductive age. However, some researchers have challenged the conventional perspective and argue that caesarean myomectomy (CM) is a safe procedure. The aim of this study is to examine all aspects of CM with an evaluative lens and to weigh its risk-benefit ratio.  For this purpose, we conducted a literature review of studies, including those from low-resource countries indexed in scientific databases like PubMed, Google Scholar and Scopus. Most recent articles that reported benefits, complications and different techniques to safely perform caesarean myomectomy with proven benefit for the patient were examined thoroughly so that solid evidence on pros and cons of caesarean myomectomy could be generated. There is a dire need to conduct large sample size studies or randomized controlled trials for the risk-benefit evaluation of CM and to produce evidence-based clinical conclusion.

Mioma uterino mimetizando neoplasia do trato genital com miomectomia anteparto bem sucedida: relato de caso / Uterine leiomyoma mimicking a tumor of the genital tract with successful antepartum miomectomy: case report

JUSTIFICATIVA E OBJETIVOS: Os miomas são tumores benignos, estrogênio-dependentes, atingindo suas dimensões máximas durante o menacme e são encontrados em até 4% das gestações.A miomectomia na gravidez é discutível, intervir ou não depende da possível lesão à gestação. O objetivo deste estudo foi apresentar um caso de mioma subseroso que simulou neoplasia em primigesta com miomectomia anteparto bem sucedida. RELATO DO CASO: Nulípara, 38 anos, encaminhada à Oncologia Ginecológica por distensão abdominal progressiva, protusão umbilical e amenorreia há três meses e desconforto respiratório.O abdômen demonstrava massa endurecida, fixa, ocupando região pélvica e abdominal até apêndice xifoide. Trazia ultrassonografia (US) transvaginal relatando útero aumentado de volume (2305 cc), textura difusamente heterogênea com múltiplos nódulos sólidos; colo uterino e canal cervical normais; ovários não visualizados e presença de ascite. Solicitou-se fração Beta da gonadotrofina coriônica humana (BetaHCG), marcadores tumorais e ressonância magnética nuclear (RMN) para investigação etiológica. Os resultados demonstraram BetaHCG: 57684 mUI/mL; CA125: 161,1 U/mL; CA:19,9:0,8 U/mL; alfafetoproteína: 2,56 KUI/mL; US: feto vivo pesando 580 g e 22 semanas. RMN mostrava imagem compatível com útero gravídico e placenta corporal. Na parede uterina existia a presença de mioma intramural. A paciente foi submetida à laparotomia exploradora onde foi observada presença de massa pediculada única de aproximadamente 30 cm com pedículo vascular de 5 cm. O exame perioperatório revelou lesão benigna, provável leiomioma. O exame anatomopatológico revelou leiomioma, pesando 7925 g e dimensões de 27 x 24 x 12 cm, negativo para células neoplásicas. Após a miomectomia, a gestação evoluiu sem qualquer intercorrência, com parto a termo por cesariana. CONCLUSÃO: A miomectomia pode ser um procedimento seguro durante a gravidez, se indicada.

BACKGROUND AND OBJECTIVES: Leiomyomas are benign estrogen-dependent tumors, that occur in up to 4% of pregnancies with maximum dimensions during the reproductive period. Although myomectomy during pregnancy is still controversial, the decision whether to intervene or not depends mainly on the location of the fibroid and the surgeon's experience. We report here the case of a massive, symptomatic leiomyoma successfully managed by antepartum myomectomy. CASE REPORT: A 38-year-old, nulliparous patient was referred to the Gynecological Oncology outpatient clinic complaining of progressive abdominal distension, umbilical protrusion, 3-months amenorrhea and respiratory distress. On physical examination, her abdomen showed a hardened, fixed mass, occupying the whole pelvic and abdominal region up to the xiphoid appendix. A previous transvaginal ultrasound showed an enlarged uterus (2305 cc), a diffusely heterogeneous texture with multiple solid nodules, cervix and cervical channel without alterations; ovaries not visualized and presence of ascites. We requested Human chorionic gonadotropin (BetaHCG), tumor markers and Nuclear magnetic resonance (NMR) for the etiology investigation. The tests showed QHCG: BetaHCG:57684 mUI/mL; CA125: 161.1 U/mL; CA:19.9: 0.8 U/mL; alpha-fetoprotein: 2.56 KUI/mL; Ultrasonogram: single live fetus,weight 580 g, estimated gestational age 22w. NMR showed image consistent with gravid uterus and corporal placenta. The presence of an intramural leiomyoma in the uterine wall was observed. The patient was submitted to an exploratory laparotomy that showed the presence of a single pediculated mass of approximately 30 cm with a 5 cm vascular pediculus.(...)

Clinical effects of a renew radiofrequency ablation on uterine myomas and disemboweling them from uterine after RFA / 中国医师杂志

Objective To assess the effects on volume of uterine and the dominant fibroid by a re-new radiofrequency ablation ( RFA ) on uterine myomas and disemboweling them from uterine after RFA . Methods Three hundred and eight -three patients were treated by RFA and followed up at 1, 3, 6 and 12 months,165 of them by usual RFA , 163 by improved RFA.To them which myomas diameters were >5cm, 55 cases were added by disemboweling the myomas out of the body after one month of improved RFA .But 66 were not disemboweled.The pre-and postoperative uterine and myoma volumes were measured by 3D ul-trasonography .Results The volume of uterine and the dominant fibroid were reduced in usual and im-proved RFA groups , especially in improved group ,but the difference was no significantly ( P >0.05 ) .In the groups of which myomas diameters were >5cm , the median reduction rates of uterine and myoma vol-ume was more significantly in disemboweling group than un -disemboweling one after 3 and 6 months ( P 0.05),and in disemboweling and un -disemboweling groups ( P >0.05).But the obvious effective rates have significant difference in disemboweling (81.82%)and un-dis-embowelin(41.94%)group ( P <0.01).Conclusion Disemboweling myomas from uterine after RFA can increase the clinical effects significantly .

A cornual ectopic pregnancy case: diagnosis, etiology and its management.

This is a report of a case of cornual ectopic pregnancy, with transvaginal ultrasonography done for early detection, screening, β-hCG measuring, also discussed was the role of methotrexate therapy prior to operative procedure with conservative management. Multiple intramural myomas (22 myomas) in this case were strongly believed as the etiology of the cornual pregnancy.

Transvaginal radiofrequency myolysis for conservative management of uterine myomas / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of transvaginal radiofrequency myolysis of uterine myomas. METHODS: 67 women who had undergone transvaginal radiofrequency myolysis of uterine myomas at Eulji university hospital between May 2005 and March 2006 were participated in this study. Pre-procedural transabdominal and transvaginal ultrasonographic evaluation was done for measurement of the size, numbers, location, and volume of the myomas. 1 month, 3 months, and 6 months after the procedure the numbers and size of the myomas were measured by the same examiner. And also improvement of menorrhagia, dysmenorrhea, abnormal vaginal bleeding, and any symptoms like urinary frequency and pelvic pain that were caused by compression of the myomas were observed on every visit. RESULTS: The average age of the patients were 42.2 years. The average number of myomas were 1.18, the average of the maximal diameter was 5.52 cm, and the average volume was 89.9 cm3. The average procedure time was 15.1 minutes, and the average procedure frequency was 1.4 times. 1 month, 3 moths, and 6 months after the procedure the average maximal diameter of the myomas were decreased by 14.2%, 22.8%, and 29.8% respectively and the average volume decreased by 34.9%, 52.5%, and 63.6% respectively. 8 women who had no early symptoms and who were postmenopaused were excluded and from the other 59 women, 45 women and 37 women had been confirmed of their symptoms after 3 months and 6 months of the procedure respectively. 86.7%, 82.8% of the group had improvement of dysmenorrhea, and 65.2%, 60% had improvement of menorrhagia after 3 months and 6 months of procedure respectively. The group which had both symptoms, 85% and 81.2% had improvement. There were post-procedural complications of lower abdominal pain in 7 women, vaginal bleeding in 1 woman and in 1 case the patient was transferred to the department of internal medicine due to post-procedural fever and abdominal discomfort. No other major complications were found. CONCLUSION: Transvaginal radiofrequency myolysis had benefits in conserving the uterus, and was less invasive and had great effect on the reduction of size of the myomas and improving the symptoms. So this method could be a effective alternative treatment for uterine myomas.

Laparoscopic Uterine Artery Occlusion Combined with Ascendant Myomectomy for Multiple Uterine Myomas / 中国微创外科杂志

Objective To evaluate the middle-term effect of laparoscopic uterine artery occlusion combined with ascendant myomectomy (LUAO-M) for multiple uterine myomas. Methods The uterine artery was isolated and occluded with Kleppinger bipolar forceps (Sabre 2400,ASPEN LABS USA) or PK forceps (Gyrus Medical Limited Inc UK) under a laparoscope. Then dissection was performed on the surface of pseudo capsule with Kleppinger unipolar needle (Sabre 2400,ASPEN LABS USA) or PK needle (Gyrus Medical Limited Inc UK),and the target myoma was stripped out of the tumor bed with the Separate-Scoop device. Afterwards,repair of the incision was carried out in one layer with interrupted single stitch by Absorbable VICRYL suture (Johnson VICRYL ETHICON USA). Results The mean operation time was (102?36) min and mean blood loss was (88.7?58.4) ml. The mean hospital stay after the operation was (7.9?0.2) d,and febrile morbidity was 5.1% (5/98). Complications included two cases of subcutaneous emphysema and one case of ileus;no other severe complications occurred. Of the patients,98 cases were followed-up for 21 to 52 months (mean,36.3 months),during the period they were visited by a mean of 3.6 times,which showed a correction rate of menstruation abnormality of 95.9% (4/98),rate of uterine volume reduction of 57.7%,and rate of recurrent myoma of 3.1% (3/98). Conclusion LUAO-M shows a good clinical outcome and middle-term effect for multiple uterine myomas.

Evaluation of the Effect of Kampo(herbal) Medicine to Diminish Climacteric Symptoms Induced by the GnRH Agonist / 日本東洋医学雑誌

In the hormonal treatment of uterine myomas, which are estrogen dependent, GnRH agonist (GnRHa) therapy has become widespread. However, GnRHa therapy causes uncomfortable or harmful side effects such as climacteric symptoms. The aim of this study is to evaluate the effect of Kampo (herbal) medicine to diminish climacteric symptoms induced by the GnRHa. Twenty-six patients with symptomatic uterine myoma were recruited, and informed consent was obtained from all subjects. Leuprolide acetate depot 3.75mg (LA) as GnRHa was given with subcutaneous injection every four weeks for six months. After LA therapy was initiated, Toki-shakuyaku-san, Kami-shoyo-san, or Keishi-bukuryo-gan was given from the second month of treatment. Climacteric symptoms were evaluated with Simplified Menopausal Index, which was improved for Japanese women. In the present study, we found all three Kampo medicines were useful. In particular, Kami-shoyo-san was useful for climacteric symptoms induced by LA. Also, LA therapy combined with Keishi-bukuryo-gan had beneficial effects in uterine myomas. However, the precise mechanism by which results were achieved remains unclear. Therefore, further research may be necessary to evaluate the ability of Kampo medicines to diminish climacteric symptoms induced by GnRHa.

Effect of laparoscopic surgery on the balance of Th1/Th2 cells in patients with uterine myomas / 中国免疫学杂志

Objective:To investigate the influences of laparoscopic surgery on Th1/Th2 balance in patients with uterine myomas.Methods:In a prospective study,the number of the Th subsets,Th1/Th2 ratio,the serum level of IL-18 and IL-10 in 20 patients submitted to laparoscopic operation and 20 patients undergoing conventional open operation were evaluated preoperatively as well as 2,24,48 h postoperatively.Results:The level of Th1 cell,IL-18,and the Th1/Th2 ratio decreased significantly (laparoscopic group: P