Benign Uterine Tumors Research Articles

Giant lipoleiomyoma of the uterine corpus

Lipoleiomyoma is a rare and easily recognized, benign uterine fatty tumor, composed of an admixture of mature adipocytes and smooth-muscle cells. They may associate with metabolic disorders and rarely reach giant size. We report a case of symptomatic giant lipoleiomyoma of the uterine corpus that may be associated with diabetes mellitus and hypothyroidism. Lipoleiomyoma must be thought in the differential diagnosis of the giant uterine tumors and should be removed when diagnosed, because malignancy cannot otherwise be excluded. Also the peculiar features of this giant neoplasm, histogenesis, concomitant metabolic disorders and the diagnostic methods are discussed.

Uterine Tumor Resembling an Ovarian Sex Cord Tumor Associated With Metastasis

Uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are very rare, usually benign uterine tumors, and are probably derived from uterine mesenchymal stem cells. In this case report, a unique case of a malignant UTROSCT is described. Four years after a diagnosis of UTROSCT of the uterine corpus, the patient developed obstructive ileus due to a large infiltrating tumor within the small bowel with the same morphology and expression pattern as the previously diagnosed UTROSCT. In addition, 2 benign gastrointestinal stromal tumors were detected in the same patient. This case indicates that although the majority of UTROSCT are benign tumors, some of them might undergo malignant transformation and have a metastatic potency.

Transcriptional analysis of steroid hormone receptors in smooth muscle uterine leiomyoma tumors of postmenopausal patients

Smooth muscle tumors are histologically separated into benign leiomyomas and malignant leiomyosarcomas. Uterine leiomyomas represent benign clonal tumors often arising within the smooth muscle tissue of the human uterus. Uterine leiomyomas develop after the start of the menstrual cycle, become symptomatic during middle age, and in most postmenopausal patients tumor regression occurs. Rarely, leiomyomas progress to leiomyosarcomas, where many sarcomas have markedly reduced or no steroid hormone receptors, thus, evolve to a hormone non-responsive state. Premenopausal leiomyomas are known to express higher levels of estrogen receptor-alpha (ERα), estrogen receptor-beta (ERβ) and progesterone receptor (PGR) than control myometrium, whereas postmenopausal leiomyomas have not been so well characterized molecularly. In this present investigation, ERβ, ERα and PGR gene expression were assessed in leiomyomas and in matched adjacent myometrium from a cohort of 14 postmenopausal patients using semi-quantitative Realtime PCR and RT-PCR. The mean average results showed that ERβ was 2.5-fold statistically significantly over expressed in postmenopausal leiomyomas compared to patient matched myometrium ( p = 0.038), whereas ERα and PGR were not significantly differently expressed. These results showed that up-regulation of ERβ occurred at the transcriptional level in postmenopausal leiomyomas. Quantitation of steroid hormone receptors from benign uterine tumors may be important for a more tailored therapy. In addition, a role for steroid hormones, specifically ERβ, is discussed in terms of benign tumor regression or tumor maintenance in postmenopausal leiomyomas.

Intravascular leiomyomatosis and benign metastasizing leiomyoma: an unusual case

Benign metastasizing leiomyoma (BML) and intravascular leiomyomatosis (IVL) are rare variants of uterine leiomyomas. In our search of available literature, there have been only two reports of these conditions occurring in the same patient. We report a case of a 42-year-old female presenting with a left L4 nerve root lesion, left paravesical lesion, left ovarian cyst, multiple pulmonary metastases, and an intracaval lesion. Histology confirmed these to be leiomyomata strongly positive for estrogen receptors. Treatment included surgery, in two stages, to remove the L4 nerve root, left paravesical lesion, intracaval lesion, and a single pulmonary nodule. The remaining tumor was treated with a gonadotrophin-releasing hormone agonist, resulting in significant reductions in tumor size. It was concluded that the lesions in the lungs were an example of BML arising from the initial diagnosis of uterine leiomyoma, and the caval lesion was an IVL. Long-term follow-up is recommended, and familiarity with rare forms of benign smooth muscle uterine tumors is essential in avoiding misdiagnosis and overtreatment.

Intravascular leiomyomatosis and benign metastasizing leiomyoma: an unusual case

Benign metastasizing leiomyoma (BML) and intravascular leiomyomatosis (IVL) are rare variants of uterine leiomyomas. In our search of available literature, there have been only two reports of these conditions occurring in the same patient. We report a case of a 42-year-old female presenting with a left L4 nerve root lesion, left paravesical lesion, left ovarian cyst, multiple pulmonary metastases, and an intracaval lesion. Histology confirmed these to be leiomyomata strongly positive for estrogen receptors. Treatment included surgery, in two stages, to remove the L4 nerve root, left paravesical lesion, intracaval lesion, and a single pulmonary nodule. The remaining tumor was treated with a gonadotrophin-releasing hormone agonist, resulting in significant reductions in tumor size. It was concluded that the lesions in the lungs were an example of BML arising from the initial diagnosis of uterine leiomyoma, and the caval lesion was an IVL. Long-term follow-up is recommended, and familiarity with rare forms of benign smooth muscle uterine tumors is essential in avoiding misdiagnosis and overtreatment.

Binding studies of lh in benign and malignant uterine tumors

the sera levels of luteninizing hormone were investgaited prior tq surgery in 10 postmenopaisal women with benign and 10 postmenopausal women with maliganant healthy

Binding studies of lh in benign and malignant uterine tumors

the sera levels of luteninizing hormone were investgaited prior tq surgery in 10 postmenopaisal women with benign and 10 postmenopausal women with maliganant healthy

An estimation of organs preserved surgical treatment of benign uterine and ovarian tumors

The purpose of research: an estimation and optimization of organs preserved surgery of benign tumors of uterus and ovary at present time.

Headliners: Uterine Leiomyoma: Genetic Reprogramming and Benign Uterine Tumors

Cook JD, Davis BJ, Cai SL, Barrett JC, Conti CJ, Walker CL. 2005. Interaction between genetic susceptibility and early-life environmental exposure determines tumor-suppressor-gene penetrance. Proc Natl Acad Sci USA 102:8644–8649. Uterine leiomyomas (fibroids) are common benign tumors in the muscle tissue of the uterus. Previous research has suggested a link between environmental exposures and uterine fibroids. NIEHS grantee Cheryl Lyn Walker and colleagues at The University of Texas M.D. Anderson Cancer Center were interested in how such exposures contribute to uterine fibroids. They propose that early-life exposure to xenoestrogens may alter genetic programming during development, setting the stage for an adverse response to later natural estrogen stimulation. Uterine fibroids occur in up to 77% of women, can cause severe menstrual bleeding and pelvic discomfort, and result in more than 200,000 hysterectomies each year in the United States alone; although “benign,” they are far from harmless. Lesions causing symptoms range in size from 1 to 20 centimeters. Data indicate that 25% of white women have problematic lesions. Black women have about a threefold higher risk of developing fibroids and, in general, their clinical symptoms are worse. Diethylstilbestrol (DES), a xenoestrogen, is one environmental exposure that has been posited as contributing to uterine fibroids. To determine the actions of this chemical, Walker and colleagues studied rats with a genetic predisposition to developing uterine fibroids, exposing some of them to DES during their first week of life. By age 16 months, the DES-exposed animals had almost a 95% incidence of tumor formation, while the unexposed animals had a 64% incidence. There were more tumors in each affected DES-exposed animal, and the tumors were larger in size and more invasive, compared to controls. The researchers determined that DES did not cause a mutation in estrogen-responsive genes, but rather caused them to become “reprogrammed” so that they responded differently to natural estrogen stimulation later in life. These findings indicate that reprogramming of genes during the developmental period as a consequence of xenoestrogenic exposure can interact with a preexisting genetic condition to increase the formation and severity of uterine fibroids. If additional research confirms these results, this study’s findings could have implications for other hormonally mediated cancers such as those of the breast and prostate.

259. Uterine Fibroids Gene Therapy: Adenovirus-Mediated Herpes Simplex Virus Thymidine Kinase/Ganciclovir Treatment Inhibits Growth of Human and Rat Leiomyoma Cells

Introduction: Adenovirus-mediated herpes simplex virus thymidine kinase gene transfer in combination with ganciclovir (Ad-TK/GCV) is one of the major gene therapy strategies to eradicate tumor cells. Leiomyoma is a benign uterine tumor that affects high percentage of women in their reproductive age. Unfortunately, there is no effective and safe medical treatment available. Leiomyom is developed as discrete well-defined tumor, easily accessible with imaging techniques which makes it a good candidate for localized gene therapy approaches.

A Simplified Method to Decrease Operative Blood Loss in Laparoscopic-Assisted Vaginal Hysterectomy for the Large Uterus

Study Objective To evaluate the role of oxytocin in decreasing operative blood loss in laparoscopic-assisted vaginal hysterectomy (LAVH) for the large uterus (weight ≥ 500 g). Design Prospective clinical study (Canadian Task Force classification II-2). Setting Tertiary care university hospital. Patients Eighty-eight women scheduled for a hysterectomy for large benign uterine tumors. Intervention Two ampules of oxytocin (10 u/mL/amp) were added to 1000 mL of saline solution running at the rate of 40 mU/min during the course of LAVH. Measurements and Main Results Blood loss and blood transfusion rate were significantly greater in the group without oxytocin infusion (group B) than in the group with oxytocin infusion (group A), with 485.7 ± 321.6 mL versus 364.1 ± 173.2 mL (p <.05) and 26.7% versus 6.1% (p <.05), respectively. There was no significant difference in average age, body weight, and number of vaginal deliveries and cesarean sections between the two groups. There also was no significant difference in mean uterine weight, postoperative stay, and complications between the two groups. Conclusion Oxytocin infusion can cause uterine contractions that decrease uterine perfusion. It is a safe and inexpensive method to help decrease operative blood loss during LAVH for the large uterus.

Genome biology and gynecology: the application of oligonucleotide microarrays to leiomyomata

The technological developments of the prior decades have led to the sequencing of multiple organisms, most notably the human species itself as reported in the preliminary draft of the human genome in February 2001 (1, 2). The automated sequencer as developed by Leroy Hood at Caltech in 1986 (3) has made the Human Genome Project a reality, and the benefit of this research effort has now led to a variety of commercially available, relatively inexpensive microarray platforms that researchers may use to examine genome biology. The term genome refers to the ability to simultaneously examine all of the approximately 30,000 human genes in a single experiment. This technology has already been applied to ovarian cancer (4) as well as to benign uterine tumors such as leiomyoma as reported in this (5) and previous issues (6) of Fertility and Sterility.

Benign pulmonary metastasizing leiomyomatosis in pregnancy: a rare complication after cesarean section

Benign pulmonary metastasizing leiomyomatosis in pregnancy: a rare complication after cesarean section

Classical cadherin and catenin expression in normal myometrial tissues and uterine leiomyomas.

Uterine leiomyomas are the most common benign uterine tumors in the women of reproductive age. Previous studies have suggested that uterine leiomyomas are monoclonal tumors derived from a single neoplastic myometrial cell. However, the neoplastic transformation of myometrium to leiomyomas remains to be elucidated. The classical cadherins are a gene family of integral membrane glycoproteins that mediate calcium-dependent cell-cell adhesion in a homophilic manner. These cell adhesion molecules (CAMs) have been shown to play pivotal roles in tumorigenesis. Catenins are intracellular proteins that link the cytoplasmic domains of the cadherins to the cytoskeletons to promote the biological functions of these CAMs. In this study, we compared the expression of E-, N-, and P-cadherins and alpha-, beta-, and gamma-catenins in the uterine leiomyomas and the counterparts of normal myometrium of the same patients by using semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. Of these, E-cadherin (E-cad) was not detected in both uterine leiomyomas and myometrium, P-cadherin (P-cad) was similarly expressed in these two tissues, but N-cadherin (N-cad) mRNA and protein expression levels in uterine leiomyomas were significantly greater than those observed in the myometrium. Catenins were not differentially expressed in uterine myometrium and leiomyomas. The overexpression of N-cad in uterine leiomyomas suggests that this CAM may play a central role in the development of uterine leiomyomas.

Lifetime History of Oral Contraceptive Use and Development of Tumours of the Uterus and Ovary*

In der Literatur wurde konsistent bei Nutzung oraler Contraceptiva (OCs) ein reduziertes Risiko von Uterus- und Ovarialtumoren berichtet. Der Effekt von niedrigdosierten OCs ist weniger klar.

IGF-1 in gynaecology and obstetrics: update 2002

Recent discoveries on endocrine, paracrine and autocrine involvement of insulin-like growth factor-1 (IGF-1) in the proliferation of many tissues raised the attention of its role in reproduction and in the growth of various cancers as well as of benign proliferations. The intention of this article is to focus on IGF-1 in the field of gynaecology. Perimenopausal women who exhibit high IGF-1 and low IGF binding protein (IGFBP) levels, like IGFBG-3, have an increased risk of developing breast cancer. A higher risk for cervical, ovarian and endometrial cancer is related to high IGF-1 levels in post- and premenopausal women. It has been shown that myomas, by far the most common benign uterine tumor in women, grow in the presence of IGF-1, in vitro as well as in vivo. Studies show that IGF-1 is involved in the differentiation of various reproductive tissues, like endometrium and ovarian tissues. Patients suffering from polycystic ovary syndrome (PCO) frequently show insulin resistance accompanied by an increase of IGF-1 in plasma. Plasma IGF-1 levels are higher in cases of severe endometriosis, however, in endometriosis and in PCO IGF levels locally in the endometrium are reduced, what might explain infertility. Recently, it was shown that IGF facilitates the implantation of the human embryo in the endometrium during IVF. Implantation is a paradox where different immune systems have to collaborate to make implantation and survival of the pregnancy possible. IGF seems to be the starter molecule so that the two epithelia can fuse. A disturbance can result in complications during pregnancy i.e. spontaneous miscarriage, preeclampsia as well as defects of the embryo. Therefore, IGF is a useful marker in successful pregnancy as well. A better mechanistic understanding of IGF-1 action on the cellular level not only provides more elegant mechanistic explanations for the scientist, but the practitioner might find it interesting to utilize its diagnostic potential as a marker for various diseases. The relation between systemic IGF levels and local tissue IGF-1 levels has not yet been determined for all conditions.

Cotyledonoid leiomyoma: a benign uterine tumor with alarming gross appearance.

Cotyledonoid leiomyoma or grapelike leiomyoma is a very rare tumor among the ever-expanding repertoire of growth variants described in benign uterine leiomyoma. We report a case of cotyledonoid leiomyoma in a 55-year-old woman who presented with menorrhagia and uterine prolapse. A large multinodular fungating tumor adhering to the right posterolateral wall of the uterus and extending to the broad ligament was discovered at vaginal hysterectomy. With a provisional diagnosis of sarcoma, total hysterectomy and bilateral salpingo-oophorectomy were performed. Postoperatively, the patient was well with no evidence of recurrence at 14 months. Pathologic examination revealed a 10-cm, red-brown tumor that comprised multiple bulbous processes protruding over the uterine surface, in continuity with a dissecting intramyometrial component. It was composed of fascicles and nodules of bland-looking smooth muscle cells with prominent perinodular hydropic degeneration. Coagulative necrosis, mitoses, and nuclear atypia were absent. Cotyledonoid leiomyoma apparently results from a combination of several uncommon growth patterns operating together, including subserosal growth, dissecting growth, and perinodular hydropic degeneration. Increased awareness of this grossly alarming variant of benign uterine leiomyoma can help avoid overtreatment.

Telomerase activity in needle biopsied uterine myoma-like tumors: differential diagnosis between uterine sarcomas and leiomyomas

Preoperative differential diagnoses between uterine sarcomas and leiomyomas are difficult. As telomerase activation is thought to be essential for the immortality of malignant cells, it is considered a potentially useful diagnostic marker. The aim of the present study was to evaluate the potential diagnostic use of measuring telomerase activity in needle biopsy samples to distinguish uterine sarcoma from leiomyoma. Sixty-two patients with suspected uterine sarcomas based on clinical findings or magnetic resonance imaging findings, and who were scheduled for surgery, underwent transcervical ultrasound-guided needle biopsy. Three samples were obtained per patient for histopathological examination and telomerase activity measurement. Telomerase activity was measured using the telomeric repeat amplification protocol and correlated with final histopathological findings of surgical specimens. Of the 62 patients, 6 leiomyosarcomas and 1 endometrial stromal sarcoma (high grade) were diagnosed by histopathology. In 6 of the 7 samples from uterine sarcomas, relatively high telomerase activity (22-102 units) was detected, whereas only low telomerase activity (11-18 units) existed in 3 of the remaining 55 samples from benign or borderline uterine smooth muscle tumors. At a cut-off value of 20 units, sensitivity, specificity, positive predictive, and negative predictive values for detecting uterine sarcoma were 86% (95% confidence interval, 59-100%), 100% (94-100%), 100% (54-100%) and 98% (95-100%), respectively. The results indicated that telomerase activity in needle biopsy samples is a useful diagnostic marker to distinguish uterine sarcoma from leiomyoma.

Similar PAI-1 Expression in Visceral and Subcutaneous Fat of Postmenopausal Women

Recent studies showed that intraabdominal visceral fat located in the mesenterium and omentum may significantly influence the circulating plasminogen activator inhibitor type 1 (PAI-1). To substantiate this link, we performed analysis of PAI-1 expression in human visceral and subcutaneous adipose tissues in peri- and postmenopausal women. The samples of both visceral and subcutaneous fat from 28 generally healthy women (aged 45–69 years) with a wide range of body mass index (BMI; 22.30–38.67 kg/m 2), who underwent surgical operation due to benign ovary and uterine tumours, were obtained. In these samples, expression of mRNAs for PAI-1, tumour necrosis factor α (TNFα), acyl-CoA synthetase (ACS), and glucose transporter (GLUT-4) was analysed by relative quantitative RT PCR and correlated with plasma PAI-1 antigen. In addition, visceral fat area was measured with computer tomography. Both types of fat tissues contained similar quantities of PAI-1 mRNA, and there was no correlation between plasma PAI-1, measured both by antigen and activity, with either visceral or subcutaneous fat PAI-1 mRNA. Furthermore, there was no significant association between the expression of PAI-1 mRNA and TNFα mRNA in tested fat samples. PAI-1 mRNA in both fat tissues was significantly correlated with plasma levels of estradiol (positive correlation) and follicle-stimulating hormone (FSH; negative correlation). Finally, the expression of PAI-1 mRNA was negatively correlated with mRNA of ACS present in both fat tissues. In summary, this study directly indicates that PAI-1 mRNA is similarly expressed in both subcutaneous and visceral fat of peri- and postmenopausal women and its expression strongly depends upon lipid metabolism.

Uterine adenomyomas excluding atypical polypoid adenomyomas and adenomyomas of endocervical type: a clinicopathologic study of 30 cases of an underemphasized lesion that may cause diagnostic problems with brief consideration of adenomyomas of other female genital tract sites.

We report 30 uterine tumors composed of an admixture of endometrioid glands, endometrioid stroma, and smooth muscle that lacked the characteristic features of atypical polypoid adenomyoma. The patients ranged from 26 to 64 (median 47) years of age. The usual presenting symptom was abnormal vaginal bleeding, which was "massive" in two patients. Six patients were treated by polypectomy only, with hysterectomy performed in the remainder. Twenty-seven adenomyomas were in the corpus (22 submucosal, two mural, and three subserosal) and three in the cervix. The subserosal and submucosal examples were polypoid. The tumors were 0.3 to 17 cm in greatest dimension, and firm with cystic areas often present on sectioning. Focal hemorrhage was described in five cases. On microscopic examination, the tumors were composed of glands and cysts lined by endometrial-type epithelium separated by endometrial stroma and smooth muscle, with smooth muscle predominating. Minor foci of tubal-type epithelium (14 cases), mucinous endocervical-type epithelium (2 cases), and squamous epithelium (1 case) were present. The smooth muscle component was cellular in three cases and contained occasional bizarre nuclei in three cases. The epithelial cells were uniformly bland. No mitotic activity was observed in the epithelial or mesenchymal elements in 20 cases. In the remainder, up to 5 mitotic figures/10 high-power fields were observed in the epithelium (3 cases), the stroma and smooth muscle (3 cases), or both compartments (4 cases). Follow-up in 14 cases revealed no recurrence or extrauterine spread in any case. A diagnosis of adenocarcinoma or adenosarcoma was entertained by the submitting pathologist in five of 14 consultation cases. Adenomyomas are unusual benign uterine tumors that can be misdiagnosed, in part, because the lesion has not often received attention in the literature. The most realistic considerations in the differential diagnosis are atypical polypoid adenomyoma and adenosarcoma. The former, by definition, has epithelial atypia and the latter a malignant (usually low grade) stromal component with typically absent or inconspicuous smooth muscle. Distinction of adenomyoma from adenosarcoma may have significant therapeutic implications, particularly in young women.