Leiomyomatosis peritonealis disseminata positive for progesterone receptor.

BACKGROUND: Leiomyomatosis peritonealis disseminata (LPD) is a rare condition that occurs in reproductive-age women. The pathogenesis of LPD is considered to be related to female sex hormones. CASE REPORT: A 30-year-old woman who had undergone an ovariectomy due to calcified thecoma at 24 years of age and had delivered a baby boy at 29 years of age showed abnormal abdominal-pelvic masses in a computed tomography scan. The peritoneal nodules were resected and histologically diagnosed as LPD. Smooth muscle cells in LPD lesions expressed progesterone receptor, while estrogen receptor and luteinizing hormone/chorionic gonadotropin receptor were negative. CONCLUSIONS: LPD should be considered when multiple nodules mimicking dissemination of malignancies are found in the abdominal cavity. In the present case, progesterone may have been involved in the pathogenesis of LPD.

Alterations in RCAS1 serum concentration levels during menstrual cycle in patients with uterine leiomyoma and lack of analogical changes in adenomyosis.

INTRODUCTION: The selective suppression phenomenon of the cytotoxic immune response occurs in the endometrium at the beginning of decidualization. This process seems to be associated with an increase in the endometrial expression of proteins such as RCAS1 that are involved in the suppression of immune cell activity. The aim of the present study was to evaluate alterations in the RCAS1 blood serum concentration levels in women with uterine leiomyoma over the course of the different menstrual cycle phases and to compare these levels with those found in patients suffering from adenomyosis. MATERIAL AND METHODS: The sRCAS1 blood serum concentration level was determined for 87 patients, including 38 patients with both adenomyosis and uterine leiomyoma, and 49 suffering from leiomyomatosis alone. RESULTS: Fluctuations in sRCAS1 blood serum concentration levels correlating with the menstrual cycle phases were demonstrated in patients suffering from uterine leiomyoma alone. The highest level of sRCAS1 concentration was found during the secretory cycle phase and the lowest during the proliferative cycle phase. However, no such fluctuations correlating with menstrual cycle phases were observed in patients suffering from both adenomyosis and leiomyoma. In fact, the level of sRCAS1 blood serum concentration in patients with adenomyosis remained almost constant. Patients with adenomyosis and leiomyoma were characterized by statistically significantly higher blood serum sRCAS1 levels during the proliferative cycle phase in comparison with the sRCAS1 blood serum levels in patients with leiomyoma alone. CONCLUSION: The lack of alterations in the sRCAS1 blood serum concentration levels observed in patients with adenomyosis may favor the development of the condition.

The effect of anastrazole on symptomatic uterine leiomyomata.

OBJECTIVE: To evaluate the effect of anastrazole on symptomatic uterine leiomyomata. METHODS: This was a prospective intervention study carried out in a university department of obstetrics and gynecology. Forty-one premenopausal women eligible for hysterectomy with 45 uterine leiomyomata were enrolled and treated with anastrazole 1 mg daily for three cycles of 28 days each. The effect of treatment was evaluated on leiomyoma and uterine volumes, endometrial thickness, gonadotrophins, estradiol and hematocrit levels, menstrual pattern, severity of leiomyoma-related symptoms, and adverse effects. The effects of leiomyoma location, size, and age of participants on tumor volume changes were evaluated. RESULTS: Thirty-five women with 39 leiomyomata finished the study. Anastrazole resulted in a mean 55.7% reduction of leiomyoma volumes (163 mL to 72 mL, P<.001), a 29.9% reduction in total uterine volumes (278 mL to 195 mL, P<.001), and an 11.3% increase of the hematocrit levels (33.4% to 37.2%, P<.001) at the end of the treatment. Leiomyoma location had no significant effect on volume decrease. Leiomyoma volume decreased in women aged older than 40 years (P=.002), whereas no difference was found in women younger than 40. The size of large (greater than 50 mm) leiomyomata decreased significantly (P=.004). Less difference was observed in small (50 mm or less) leiomyomata (P=.031). No differences were detected in hormonal status. Anastrazole improved leiomyoma-related symptomatology and caused no serious adverse effects. CONCLUSION: In premenopausal women, anastrazole reduces the size of uterine leiomyomata, improves symptomatology, and is generally well tolerated. LEVEL OF EVIDENCE: III.

Comparative study of different dosages of goserelin in size reduction of myomatous uteri.

STUDY OBJECTIVE: To compare uterine size reduction obtained with three monthly subcutaneous injections of 3.6 mg of goserelin versus a single subcutaneous injection of 10.8 mg. DESIGN: Prospective, randomized clinical trial (Canadian Task Force classification I). SETTING: Department of Gynecology and Obstetrics at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. PATIENTS: Forty-five premenopausal women with uterine leiomyomas and uterine size greater than 600 cm(3) randomized to one of two groups. INTERVENTION: Group A: 23 women received three monthly subcutaneous 3.6-mg doses of goserelin. Group B: 22 women received a single subcutaneous injection of 10.8 mg of goserelin. Follicle-stimulating hormone (FSH), estradiol, and hemoglobin levels were measured monthly. After 3 months, uterine size was determined by transvaginal and/or abdominal ultrasound. MEASUREMENTS AND MAIN RESULTS: In group A, mean reduction of uterine size was 43% (426 cm(3)) at the end of treatment. In Group B, mean reduction of uterine size was 54% (494 cm(3)). Serum levels of FSH and estradiol were in postmenopausal range during treatment. Hemoglobin level improvement was equivalent in both groups. CONCLUSION: Use of single injection of 10.8 mg of goserelin promoted significantly greater reduction in uterine size than three monthly 3.6-mg injections in patients with voluminous uterine leiomyomas.

Review of readmissions due to complications from uterine fibroid embolization.

AIM: To determine the frequency, nature and outcome of complications resulting in readmission to hospital following uterine artery embolization (UAE). MATERIAL AND METHODS: A retrospective review of the medical notes and available imaging of 42 consecutive patients who had undergone elective uterine artery embolization for the treatment of fibroid disease was performed. RESULTS: The mean age of the patients was 42 years (range 31--54 years) and seven patients (17%) were readmitted to hospital. The median time to readmission was 3 weeks (range 1-29 weeks). All seven patients were admitted with signs and symptoms of infection. In four patients an organism was isolated from high vaginal swabs, and in one patient the midstream urine sample was confirmed as the source of infection. In the other two patients no definite source of infection was identified. All patients were treated with intravenous antibiotics. Six of the seven patients responded to treatment. The remaining patient required hysterectomy for uncontrolled uterine sepsis. CONCLUSION: Readmission following UAE is common and arises secondary to infection. Infection can occur several months after the procedure.

Postmenopausal intravenous leiomyomatosis with high levels of estradiol and estrogen receptor.

BACKGROUND: Intravenous leiomyomatosis is a rare variant of leiomyoma. CASE: The patient was a 49-year-old gravida 3, para 3 woman with menopause at age 46. She presented with a history of syncope. Vaginal examination revealed an enlarged and elastic-soft mass of the uterus. A pelvic ultrasound, computed tomography scan, and magnetic resonance imaging showed a heterogeneous, irregularly shaped 8- to 10-cm tumor. In addition, the inferior vena cava was almost completely occluded. Cardiac ultrasound demonstrated a mobile mass in the right atrium. The serum estradiol was 208 pg/mL (normal 0-59). Intravenous leiomyomatosis with cardiac extension was diagnosed preoperatively. A resection of the intracardiac and intracaval mass and a subtotal hysterectomy with bilateral salpingo-oophorectomy were performed. The uterine tumor weighed 600 g, and the cordlike intravascular tumor extending from the internal iliac vein into the right ventricle was 40 cm long and weighed 60 g. Pathologic examination confirmed intravenous leiomyomatosis with no evidence of atypia. The level of estrogen receptor in the tissue was 140 fmol/mg protein. The postoperative course was uneventful, and she has been in good health for 17 months after the operation. CONCLUSION: We report a case of intravenous leiomyomatosis extending into the right ventricle treated with a one-stage operation. It is possible that a high concentration of serum estradiol and high level of tissue estrogen receptor are related to the intravenous leiomyomatosis.

Serum levels of the tumour-associated trypsin inhibitor in patients with endometriosis.

OBJECTIVE: To show that in patients with endometriosis a 6 kD polypeptide, the tumour-associated trypsin inhibitor (TATI), can occur at elevated concentrations in serum. DESIGN: In a prospective study TATI serum levels were assessed prior to surgery in 368 consecutive patients suffering from benign gynaecological diseases (e.g. pelvic pain, infertility, elective sterilisation, uterine fibroids and pelvic masses) with (n = 71) and without (n = 297) endometriosis, who underwent laparoscopy or laparotomy for diagnosis and/or treatment. RESULTS: The TATI serum levels of patients suffering from endometriosis were significantly different from those in the control group and showed a positive correlation with the stage of endometriosis. The sensitivity of TATI was 0.34 with a specificity of 0.85 for all cases of endometriosis, with an increase of sensitivity (0.67) and slight decrease of specificity (0.82), considering only a group of Stage III/IV patients. Excluding patients with benign ovarian cysts, the specificity of TATI was 0.91 and 0.85, respectively. The combination of TATI and CA125 showed an increase of sensitivity to 0.59 for all cases of endometriosis and 0.89 for patients with Stage III/IV endometriosis. CONCLUSIONS: The sensitivity of TATI as a screening method for endometriosis is too low, but considering its high specificity, TATI in combination with CA125 could provide an additional diagnostic tool in diagnosis and follow up of patients with endometriosis.

[The possibility of using sulprostone during laparoscopic myomectomy in uterine fibromyomatosis. Preliminary studies]. / Possibilità d'impiego del sulprostone in corso di laparomiomectomia nella fibromiomatosi uterina. Indagini preliminari.

The authors considered sulprostone effects, PGE2 synthetic derivative, on the hematic loss during laparomyomectomy. This drug is been used by intravenous way during the operation in 84 patients affected with uterine myomatosis. The effectiveness and tolerance of the drug is thus evident in the reduction of the hematic intraoperative loss.

Influence of the ovary on parameters of LH secretion during the recovery from buserelin-induced desensitization.

This study examined the effect of the ovary on LH pulsatility and on the secretory performance of gonadotrophs during the phase of recovery after treatment with buserelin, a GnRH analogue. We included 12 patients, who received buserelin (1.2 mg/day, intranasally for 3 months) as a reductive therapy for uterine leiomyomatosis prior to hysterectomy. Six patients were oophorectomized and the other 6 patients had their ovaries preserved. LH was measured in samples taken basally up to 36 days after suppression of buserelin. LH pulsatility was studied on day 9 along a 24-h cycle, and the response of the hormone to a double-stimulus GnRH test on days 0, 9, 20, and 34. The concentration of LH reached normal premenopausal levels after an average of 2 weeks in women with ovaries but increased until 4-5 weeks in oophorectomized patients. The pulsatility of LH on day 9 was similar for both groups, but parameters related to LH amplitude or to baseline secretory activity of gonadotrophs were higher in the oophorectomized women. The response of LH to the GnRH tests was also significantly higher in the oophorectomized group from day 9. The conclusions are as follows. (1) At the early stage of recovery from desensitization, as represented by day 9, LH pulsatility was not substantially influenced by the presence or absence of the ovary. (2) There was an increase in parameters related to the amplitude of the LH bursts in the oophorectomized women. Although a higher amplitude of the endogenous GnRH pulses cannot be discarded, most probably that difference is due to a higher sensitivity at a pituitary level, as reflected by the GnRH stimulation tests.

[Anomalous uterine bleeding in the perimenopause: fibromatosis, hyperplastic endometriopathy and GnRH analogs]. / Sanguinamento uterino anomalo in perimenopausa: fibromatosi, endometriopatia iperplastica ed analoghi del GnRH.

In the light of recent reports, the authors used GnRH analogues to treat 18 perimenopausal women with anomalous uterine bleeding, fibromatosis and endometrial hyperplasia. The aim of the study was to avoid the recurrence of anomalous bleeding, reduce hyperplastic endometriopathy and, having attained stable amenorrhea, avoid resorting to traditional surgical treatment. At the end of the study 9 women had reached the pre-established objective, 4 recommended regular menstruation, 2 reported an episode of metrorrhagia due to endometrial atrophy, and a further 2 suffered a recurrence of the initial problem and underwent hystero-annexiectomy. One patient interrupted the therapy due to the onset of arterial hypertension.