Intramural Leiomyoma Research Articles

Ultrasound and Computed Tomography Findings of a Calcified Intramural Leiomyoma of Urinary Bladder in a Dog

Ultrasound and Computed Tomography Findings of a Calcified Intramural Leiomyoma of Urinary Bladder in a Dog

Intramural Leiomyomas and Fertility: A Systematic Review and Meta-Analysis.

To evaluate fertility outcomes based on size and number of intramural leiomyomas and outcomes after removal. Online searches: MEDLINE, ClinicalTrials.gov , PubMed, Cochrane Library, and PROSPERO Library from 1994 to 2023. A total of 5,143 studies were identified, with inclusion of 13 study groups. Outcomes for size and number of leiomyomas were reported with clinical pregnancy rates and ongoing pregnancy or live-birth rates. In data sets with maximum leiomyoma diameters of less than 6 cm for study inclusion, women with leiomyomas smaller than 3 cm had lower clinical pregnancy rates than women without leiomyomas, with an odds ratio (OR) of 0.53 (95% CI, 0.38-0.76) and, for ongoing pregnancy or live-birth rates, an OR of 0.59 (95% CI, 0.41-0.86). The ORs for clinical pregnancy rates in women with intermediately-sized leiomyomas (those between 3 cm and 6 cm) were lower than in women without leiomyomas, with an OR at 0.43 (95% CI, 0.29-0.63) and, for ongoing pregnancy or live-birth rates, an OR at 0.38 (95% CI, 0.24-0.59). In data sets without exclusion for women with larger-sized leiomyomas, clinical pregnancy rates were lower for those with leiomyomas smaller than 5 cm compared with those without leiomyomas, with an OR of 0.75 (95% CI, 0.58-0.96). Women with leiomyomas larger than 5 cm showed no differences in clinical pregnancy rate compared with women without leiomyomas, with an OR of 0.71 (95% CI, 0.32-1.58). Although women with a single leiomyoma in any location had no differences in outcomes, those with more than one leiomyoma had lower clinical pregnancy rates and ongoing pregnancy or live-birth rates, with an OR of 0.62 (95% CI, 0.44-0.86) and 0.57 (95% CI, 0.36-0.88), respectively. The clinical pregnancy rate for women undergoing myomectomy for intramural leiomyomas was no different than those with intramural leiomyomas in situ, with an OR of 1.10 (95% CI, 0.77-1.59). Even small intramural leiomyomas are associated with lower fertility; removal does not confer benefit. Women with more than one leiomyoma in any location have reduced fertility.

Spontaneous regression of a giant uterine leiomyoma after delivery: a case report and literature review

BackgroundUterine leiomyomas are hormone-dependent benign tumors and often begin to shrink after menopause due to the reduction in ovarian steroids. The influence of pregnancy on uterine leiomyomas size remains unclear. Here, we present a case of spontaneous regression of a giant uterine leiomyoma after delivery.Case presentationA 40-year-old woman presented with multiple uterine leiomyomas, one of which is a giant uterine leiomyomas (approximately 8 cm in diameter) that gradually shrinked after delivery. At over two months postpartum, the large myometrial leiomyoma had transformed into a submucosal leiomyoma, and over 3 years postpartum, both the submucosal leiomyoma and multiple intramural leiomyomas completely regressed.ConclusionSpontaneous regression of a giant uterine leiomyom is rare after delivery. Considering uterine leiomyoma regression until over 3 year postpartum,we need to observe the regression of uterine fibroid for a longer time postpartum in the absence of fibroid related complications. In addition, it will provide new insights for treatment options of uterine leiomyomas in the future.

Outcome prediction for symptomatic patients with fibroids who underwent uterine artery embolization

PurposeTo predict the clinical outcome of symptomatic patients with uterine leiomyomas who underwent uterine artery embolization (UAE), based on clinical and radiological features. MethodsPatients with symptomatic uterine leiomyomas who underwent UAE from March 2010 to September 2019 were consecutively included in this retrospective study. Patients with persistent or recurrent symptoms and those who needed repeated UAE, myomectomy, or hysterectomy following the initial treatment were considered to have a poor outcome after UAE. The total and enhancing volume of the dominant leiomyoma in each location and uterine volume were obtained before and after UAE. Univariate and multivariate Cox proportional hazard analyses were used to evaluate the parameters that could predict poor outcome. ResultsA total of 116 patients (mean age, 45 ± 5 years) were included. Forty-six patients (46/116, 39.7%) showed poor outcome. Cox regression analysis showed higher hazard of poor outcome for younger patients vs. older patients (HR: 0.92, p-value: 0.01), patients with adenomyosis vs. patients without adenomyosis (HR: 2.47, p-value < 0.01), patients with adenomyosis thickness > 2.5 cm before UAE vs. patients without adenomyosis (HR: 4.2, p-value < 0.01) and for patients with intramural fibroid enhancement volume > 440 cm3 compared to patients with no intramural fibroids (p-value: 0.06). Multivariate Cox regression analysis including age, the thickness of adenomyosis, and intramural leiomyoma volume of enhancement before UAE was chosen as the best model to predict the outcome. ConclusionsPretreatment clinical and MRI features could identify patients with a higher risk for poor outcome after UAE.

SAT367 A Rare Case of Ovarian Cellular Fibroma Producing Testosterone

Abstract Disclosure: H.K. Rai: None. P. Dandona: None. Background: Ovarian fibromas are hormonally inactive, benign sex cord-stromal tumors. However, the occurrence of ovarian fibromas in a woman presenting with post-menopausal bleeding, hirsutism, and elevated testosterone levels raises suspicion of such tumors being functionally active.Case: 62-year-old menopausal woman presented for evaluation of worsening facial hair for the past year. She reported vaginal spotting for the past two months and was following up with a gynecologist. She denied acne, male pattern baldness, or any other virilizing features. She was also recently diagnosed with polycythemia; hematological workup was remarkable for elevated testosterone. Her blood work was significant for elevated testosterone levels and hemoglobin, results as follows: total testosterone: 160ng/dl (2-45 ng/dL), free testosterone: 25.4pg/ml (0.1-6.4 pg/ml), sex hormone binding globulin (SHBG): 26 nmol/L (14-73 nmol/L), estradiol: &amp;lt;15 pg/ml (post-menopausal range: &amp;lt;/=31 pg/ml), FSH: 17.3mIU/ml (23.0-116.3mIU/ml), LH: 19.1mIU/L (10.0-54.7 mIU/mL), prolactin: 5.7 ng/mL (2.0-20.0 ng/mL), DHEAS: 78 mcg/dL (12-133 mcg/dL), 8 AM cortisol: 17 mcg/dL (10-20 mcg/dL), ACTH: 11pg/ml (6-50pg/ml), Hb: 16.6g/dl (11.7-15.5 g/dL) and hematocrit: 49.8% (35.0-45.0%). Ultrasound pelvis showed heterogeneous thickened endometrium, small left-sided intramural leiomyoma of the uterus and ovaries were not well identified. MRI pelvis with and without contrast showed a 2.4 cm left uterine fibroid. A simple cyst was noted in the right ovary and two para-ovarian cysts were noted on the left ovary. The overall appearance of both ovaries was similar to a CT scan done a year earlier. She underwent a total hysterectomy with bilateral salpingo-oophorectomy. Surgical pathology was remarkable for cellular fibroma of both ovaries. After surgery, the patient's facial hair significantly improved, and she was noted to have normal testosterone levels (total testosterone: 23, free testosterone: 2.6, SHBG: 50). Her hemoglobin normalized as well, reaching a value of 13 g/dL. Conclusion: Our patient presented with post-menopausal bleeding, hirsutism, polycythemia, and increased testosterone levels. After she underwent total hysterectomy with bilateral salpingo-oopherectomy, her symptoms resolved. Testosterone and hemoglobulin levels returned to normal. Surprisingly, ovarian cellular fibroma on both sides was identified by surgical pathology. Ovarian cellular fibromas are rarely linked to endocrine activity, but with this case, we want to emphasize that its hormonal activity needs further exploration in the future. Presentation Date: Saturday, June 17, 2023

Uterine corpus tumors and tumor-like lesions: A clinicopathological evaluation of 430 patients

Abstract Background: Globally, uterine corpus tumors significantly increase women’s mortality and morbidity. Histopathological examination plays a crucial role in effectively managing patients with these tumors. Aims: This study aims to explore uterine tumors and tumor-like lesions, with a secondary objective specifically focusing on categorizing their histopathological characteristics using the 2020 World Health Organization classification of uterine corpus tumors. Moreover, the study seeks to analyze the clinical parameters of patients afflicted by these tumors and tumor-like lesions to discover possible correlations between histopathological findings and clinical features. Materials and Methods: A study involving a retrospective and prospective analysis over 3.5 years, encompassing 430 cases of histopathologically confirmed uterine corpus tumors and tumor-like lesions. Results: The tumors and tumor-like lesions in our study were classified into three main categories: benign tumors (95.2%), which were the most prevalent; malignant tumors (4.5%); and borderline tumors (0.3%). Among the benign tumors, leiomyoma was the most common, accounting for 91.1% of cases, with intramural leiomyomas being the most prevalent subtype at 60.2%. Most of the patients diagnosed with these tumors were multiparous female patients (95.6%), aged between the fourth and fifth decades of life (80%), and commonly presented with menorrhagia (42.5%). Hyalinization was the most frequently observed secondary change (24.2%), and cellular leiomyoma was the most common histological variant (N = 4). Endometrial carcinoma was the sole type identified in our study for malignant tumors. These patients were mainly in the age group of 60–69 years (47%), multiparous (88.2%), and presented with post-menopausal bleeding (41.2%). Grade I endometrioid carcinoma was the predominant histopathological type, accounting for 88.2% of the malignant cases. Among the other lesions identified in our study, there was one case of STUMP (smooth muscle tumor of uncertain malignant potential) and 15 cases of adenomyoma. Endometrial polyp (N = 57, 95%) was the most common type among the tumor-like lesions. In their fifth decade, these polyps were predominantly found in multiparous female patients (N = 50, 87.7%). Menorrhagia was the most common presentation; most polyps were solitary and sessile. Additionally, we observed a single case of papillary proliferation of the endometrium with mucinous, ciliated, and clear cell metaplasia without any atypia and two instances of Arias-Stella reaction. Conclusion: Benign tumors were more common than malignant tumors in the uterine corpus. Among these, leiomyoma was the most frequently observed benign lesion, whereas endometrial carcinomas were the predominant malignant lesions. It is essential to emphasize that certain specific lesions, such as endometrial polyps, metaplasia, and Arias-Stella reaction, can mimic malignant tumors even upon careful histopathological examination. Therefore, being aware of these tumor-like lesions is crucial. Histopathology plays a vital role in accurately diagnosing various tumors and tumor-like lesions in the uterine corpus.

Uterine Torsion Due to Uterine Fibroid in Non-Pregnant Women: A Case Report

Uterine torsion is a rare gynecological emergency. It occurs mainly in gravid uterus and extremely rarely in non-gravid uterus. In this article, we report a case of torsion of non-gravid uterus accompanied by a large intramural leiomyoma with focus on computed tomography and magnetic resonance imaging.

Primary Broad Ligament Endometroid Adenocarcinoma: A Case Report and Review of Literature

Since the broad ligament is closely related to other structures, such as the uterus, fallopian tubes, and ovaries, secondary involvement of it due to primary malignancy elsewhere is common. Primary broad ligament malignancies are rare. Only 29 cases of primary broad ligament malignancies have been reported in the literature, out of which only 5 cases of endometrioid adenocarcinoma [1]. Generally, the primary broad ligament tumor diagnosis is made retrospectively, intraoperatively, or on histopathological examination, due to its rarity. I have encountered a case where laparotomy and myomectomy were planned with a preoperative diagnosis of large subserous leiomyoma and intramural leiomyoma. Per operatively large friable mass was present between 2 leaves of the broad ligament on the right side, and a large adenomyoma was present in the posterior wall of the uterus. Subsequently, adenomyomectomy and excision of the broad ligament mass was done. On histopathology, the broad ligament mass was diagnosed as endometroid adenocarcinoma, and the uterine mass as an adenomyoma.

Two oncomiRs, miR-182-5p and miR-103a-3p, Involved in Intravenous Leiomyomatosis

Leiomyomas, also referred to as fibroids, belong to the most common type of benign tumors developing in the myometrium of the uterus. Intravenous leiomyomatosis (IVL) tends to be regarded as a rare type of uterine leiomyoma. IVL tumors are characterized by muscle cell masses developing within the uterine and extrauterine venous system. The underlying mechanism responsible for the proliferation of these lesions is still unknown. The aim of the study was to investigate the expression of the two epigenetic factors, oncomiRs miR-182-5p and miR-103a-3p, in intravenous leiomyomatosis. This study was divided into two stages: initially, miR-182-5p and miR-103a-3p expression was assessed in samples coming from intravenous leiomyomatosis localized in myometrium (group I, n = 6), intravenous leiomyomatosis beyond the uterus (group II; n = 5), and the control group, i.e., intramural leiomyomas (group III; n = 9). The expression level of miR-182-5p was significantly higher in samples coming from intravenous leiomyomatosis (group I and group II) as compared to the control group (p = 0.029 and p = 0.024, respectively). In the second part of the study, the expression levels of the studied oncomiRs were compared between seven samples delivered from one woman during a four-year observation. The long-term follow-up of one patient demonstrated significantly elevated levels of both studied oncomiRs in intravenous leiomyomatosis in comparison to intramural leiomyoma samples.

Клинические и фенотипические признаки недифференцированной дисплазии соединительной ткани при интрамуральной миоме матки как маркеры прогнозирования инфертильности

Objective. To examine associations between clinical and phenotypic signs of undifferentiated connective tissue dysplasia (UCTD) and uterine leiomyoma, as well as fertility and infertility in case of intramural uterine leiomyoma. Patients and methods. In this retrospective cross-sectional study, 400 patients were included and divided into two groups. The study group consisted of 370 patients with intramural leiomyoma, including 240 infertile and 130 fertile patients (70 women in the first trimester of pregnancy and 60 women delivered less than 12 months ago, in whom leiomyoma was diagnosed before and/or during pregnancy). The control group consisted of 30 patients without leiomyoma and infertility who referred for a preventive examination. Results. The frequency of clinical and phenotypic signs of UCTD was significantly higher (2.5-fold) in patients with leiomyoma compared to healthy controls. A number of UCTD signs were significantly associated with infertility in intramural leiomyoma (De Quervain syndrome, mitral valve prolapse, hematomas due to minor trauma, hyperpigmentation, history of uterine appendage torsion, scoliosis, varicose veins, iron-deficiency anemia). Based on the findings, significant diagnostic coefficients and informativeness coefficients for several UCTD signs, expressed in rounded scores, were obtained using mathematical calculations, which allows their use as prognostic criteria for fertility/infertility in intramural leiomyoma. The identified clinical symptoms are apparently both systemic (manifested as UCTD signs) and localized (leiomyoma formation and infertility). Conclusion. A high frequency of the combination of clinical and phenotypic signs of UCTD with infertility in intramural uterine leiomyoma was established. The present study allowed us to determine significant signs of UCTD, the presence of which is associated with a high risk of infertility. The results of the study and the risk score can be used to assess potential fertility in intramural leiomyoma in patients of reproductive age and to choose treatment tactics. Key words: uterine leiomyoma, undifferentiated connective tissue dysplasia, infertility, infertility risk prediction

ODP427 The Concomitant Existence of Turner Syndrome and Non-classic Congenital Adrenal Hyperplasia

Abstract Background Turner syndrome and Congenital adrenal hyperplasia are distinct examples of disorders of sexual development. Because they share common clinical features, their coexistence is difficult to diagnose.1 Currently, only ten cases have been reported in the literature.2 Clinical Case: A 54-year-old, born and raised as a female, consulted a gynecologist because of ambiguous genitalia. Her late presentation was due to reluctance of medical care. During her teenage years, she had cyclic hypogastric cramps but never had menstrual bleeding. In her late 20s, she noted virilizing features such as receding hairline, hirsutism and deepening of voice. None of her parents and siblings presented the same features. She had a short stature (height: 147.32 cm), wide spaced nipples with absent breast bud and shortened 4th metatarsals. Genital examination showed a pair of labia without palpable mass and testes, and a prominent phallic structure measuring 3-4 cm (Prader Stage V). Hormonal assays revealed low normal FSH (4.58, &amp;gt;3. 03 mIU/mL, low LH (0.48, &amp;gt;1.8 mIU/mL), elevated testosterone (4.7, n&amp;lt;0.75 ng/mL) and progesterone (14.47, &amp;lt;1.4 ng/mL), and normal estradiol (66, n: 23-139 pg/mL). Tumor markers such as ß-hCG, ɑ-fetoprotein, LDH and CA-125, electrolyte analysis and thyroid function test showed no abnormalities. Both pelvic ultrasonography and abdominal MRI demonstrated a large abdominopelvic mass (14.7×17.1×8.4 cm) with no identifiable normal looking uterus, ovaries, or testes. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathologic analysis of the specimen revealed submucous and intramural leiomyoma uteri, atrophic endometrium without abnormality on both ovaries and fallopian tubes. Karyotype analysis indicated 45×[2] / 46, XX [48], Mosaic 45,×/ 46 XX consistent with Turner's syndrome. Because virilization is not a typical feature, further evaluation using 17-hydroxyprogesterone was performed. The result yielded elevated basal (235, n&amp;lt;6 nmol/L) and postsynacthen result (60 minutes) (241, n&amp;lt;30 nmol/L), hence, the diagnosis of non-classic congenital adrenal hyperplasia was established. Conclusion The individual incidence of Turner syndrome and non-classic congenital adrenal hyperplasia is not uncommon, but their coexistence is rare. In the absence of Y chromosome in Turner syndrome, presence of virilization should warrant investigation for congenital adrenal hyperplasia. Presentation: No date and time listed

The impact of anemia on treatment management and clinical outcomes of women hospitalized for uterine leiomyomas.

Uterine leiomyomas are the most common benign gynecological tumors. Symptomatic leiomyomas represent a major cause of hospitalization, particularly those associated with abnormal uterine bleeding (AUB) and anemia. The aim of this study was to identify predictors of anemia in women hospitalized due to uterine leiomyomas and evaluate its impact on treatment management and clinical outcomes. Population-based retrospective study of women hospitalized for uterine fibroids in public hospitals in mainland Portugal between 2010 and 2015. Data were extracted from the national database of the Central Administration of the Portuguese Health System. Comparative and multivariable logistic regression analysis was performed to assess outcomes. A total of 36 295 patients were hospitalized due to uterine leiomyomas during this period. Of those, 11.5% presented with anemia. Age, obesity, intramural type of leiomyoma and AUB are independent predictors of anemia (p < 0.001, AUC 0.7056). Anemia was associated with a high risk of inpatient hospitalization (OR: 5.161, 95% CI: 4.376-6.085), urgent admission (OR: 1.953, 95% CI: 1.797-2.121), radical surgical approach (OR: 2.559, 95% CI: 2.298-2.849), laparoscopic hysterectomy (OR: 1.575, 95% CI: 1.393-1.780) and intra- and post-operative complications (OR: 5.285, 95% CI: 4.332-6.448). It was also associated with longer hospital stays (p < 0.001). These outcomes were more pronounced in acute anemic patients. Anemia has a significant impact on treatment approaches and clinical outcomes of women hospitalized for uterine leiomyomas. Age, obesity, intramural leiomyomas and AUB are some predictors of anemia that could represent a risk-stratification opportunity, allowing for its prompt identification and correction, therefore improving patient care.

Peritoneal karsinomatozisi taklit eden dissemine peritoneal leiomyomatozis

Disseminated peritoneal leiomyomatosis is a benign and very rare disease usually affecting premenopausal women. We present a 39 year old lady with intramural leiomyoma and disseminated peritoneal leiomyomatosis. The definitive treatment of disseminated peritoneal leiomyomatosis is surgical, depending on the degree of the disease. Before deciding on aggressive treatment, it should be kept in mind that peritoneal fibroids can mimic malignant peritoneal tumors.

Effect of ultrasound on subserosal and intramural fibroids in vitro: A quasi-experimental study of physical therapy

The aim of this study was to determine the effect of ultrasound (US) on extra subserosal and intramural uterine fibroids in vitro. A quasi-experimental, randomized, pre-post intervention study of physical therapy was conducted. Thirty women, who underwent myomectomy for subserosal or intramural fibroids with any leiomyomas' volumes in the operating room of Bab El-Sharia Hospital, participated in the study. Thirty uterine fibroids whose were collected from participants were randomly divided into three groups (I, II and III), and exposed to ultrasound therapy for 15, 30, and 45 minutes respectively. Leiomyomas volumes were measured using the fluid displacement method before and after the application of US. The samples were kept in saline solution immediately after their excision from operating room to be transferred to physical therapy department in same hospital to apply ultrasound therapy. Results of all study groups (I, II, and III) showed a statistically significant decrease in the volume of subserosal and intramural leiomyoma post US application (p&gt;0.05). However, there was no statistically significant difference in the size of the subserosal and intramural leiomyoma between study groups (p&lt;0.05). In conclusion, the ultrasound therapy is effective in shrinking the volume of subserosal and intramural leiomyomas without effect of long duration ultrasound therapy.

EFFECT OF LEIOMYOMA ON MATERNAL AND FETAL OUTCOMES DURING PREGNANCY

Aim: The study aimed to determine the effects of leiomyoma size, number, location, and type on obstetric and fetal outcomes, retrospectively.&#x0D; Materials and Method: A total of 292 singleton pregnancies, who were attended to perinatology unit of Zekai Tahir Burak Women’s Health Training and Research Hospital in Ankara as part of routine antenatal follow-up between January 2007 and 2014 and delivered at or beyond 24 weeks were included. The study group consisted of patients with leiomyoma of 4 cm or more. Patients who underwent myomectomy during cesarean delivery, who had co-morbidities, uterine anomalies, or fetal malformations were excluded from the study. Obstetric and fetal outcomes were recorded.&#x0D; Results: Vaginal delivery rate was significantly higher in patients with a single leiomyoma when compared to patients with 2 or more leiomyoma (p=0.009). Diagnosis of preterm labor was significantly higher in patients with leiomyoma size larger than 10 cm when compared to patients with leiomyoma sizes 4-7 cm and 7-10 cm (p =0.005 and p=0.002, respectively). The presentation anomaly rate was significantly higher in patients with leiomyoma sizes bigger than 10 cm when compared to patients with leiomyoma sizes 4-7 cm (p=0.008) and 7-10 cm (p =0.045). The need for transfusion was lower in the group with leiomyoma measuring 4-7 cm when compared to leiomyoma measuring 7-10 cm and those larger than 10 cm (p=0.010 and p = 0.011, respectively). Cesarean delivery rate was higher in patients with leiomyoma localized to the cervix and corpus in comparison to those localized to the corpus only (p =0.008). Vaginal delivery rate (40.9%) was higher in patients with intramural leiomyoma when compared to subserous (p=0.002) and combined (p=0.004) leiomyoma.&#x0D; Conclusion: The prevalence of leiomyoma during pregnancy is increasing due to women planning pregnancy later in life, the increasing incidence of fibroids with age, and the rise of cesarean delivery rates which enables us to diagnose more cases in recent years. Patients with leiomyoma should be placed on close surveillance for possible complications during pregnancy, delivery and postpartum.

Retrospective analysis of patients’ operative material during reproductive period with leiomyoma

Leiomyoma is known to be a benign tumor of unknown etiology of the uterus. It is most common in women of reproductive age with a cumulative frequency of 5.4% to 77.0%, and 80.0% of them suffer from this problem throughout their lives. However, some authors question the binding role of estrogen-progesterone in the growth of leiomyoma. However, due to the ineffectiveness of conservative treatment of leiomyoma, surgical intervention is still an effective method of curing the patient. There are no means of complete regression and prevention of this pathology. The aim of our study was retrospective analysis of operative material of patients of reproductive period with leukemia of the uterine body. Patients in both groups were divided into 40-year-olds and 41-50-year-olds according to age. The obtained results were processed using SPSS-21 software package of mathematical statistics. Pearson x2 criterion was used to test the reliability.Comparison of retrospective analysis of archival material revealed: A sharp increase in the incidence of intramural leiomyoma of the uterine body, due to many factors: social, ecological, stressful conditions, the introduction of modern diagnostic methods in practice. Proliferative, recurrent and latent leiomyomas are characterized by histostructural features. The process of growth of leiomyoma nodes is determined by the active products of the extracellular matrix, which leads to an increase in their size and does not depend on the histostructure, localization, number and size of the nodes Extracellular matrix products are important not only in terms of leiomyoma growth, but it is also likely to be among the factors that limit the free uncontrolled spread of tumor proliferation in the uterine body muscle and inhibit the assimilation process. This is confirmed by the absence of malignancy. Retrospective analysis of the material provides the basis for the search for molecular mechanisms of leiomyoma development. The results obtained will be important for the selection of drug treatment in terms of inhibition of myocyte proliferative processes, expression of growth factors and activation of apoptosis.

RETROSPECTIVE ANALYSIS OF OPERATIVE MATERIALS OF PATIENTS OF REPRODUCTIVE PERIOD WITH LEIOMYOMA

Leiomyoma is a benign tumor of unknown etiology of the uterus. Leiomyoma is stimulated by an excess of steroids, disruption of apoptotic mechanisms, and local growth factors.We conducted a retrospective analysis of the operative material with leiomyoma of the reproductive period of women with the uterine body. The study revealed: a sharp increase in the incidence of intramural leiomyoma; Histological structural features are characteristic of proliferative, recurrent, and latent leiomyomas; Active products of the extracellular matrix, which is important not only in terms of leiomyoma growth, but it is likely to be among the factors that limit the free uncontrolled spread of tumor proliferate in the uterine body muscle and inhibit the assimilation process; Retrospective analysis of the material provides a basis for the search for molecular mechanisms of leiomyoma development. The results obtained will be important for the selection of drug treatment (in terms of inhibition of myocyte proliferative processes, expression of growth factors and activation of apoptosis).

Resectoscopic Surgery Part I: Overcoming Obstacles and Mastering the Basics

The introduction of the continuous flow gynecologic resectoscope (CFGR) in 1989 revolutionized minimally invasive gynecologic surgery (MIGS) by introducing such intrauterine procedures as hysteroscopic myomectomy, polypectomy, and endometrial ablation. However, with the subsequent introduction of global endometrial ablation (GEA) devices and hysteroscopic morcellators (HMs), the CFGR has fallen into relative disuse—a regrettable situation since it remains ideally suited for accomplishing many procedures that are otherwise not achievable with these newer technologies. Procedures which involve greater precision and control—endomyometrial resection (EMR), hysteroscopic metroplasty, the correction of isthmoceles, the resection of intramural myomas, and the management of late-onset endometrial ablation failure—are only possible with the CFGR. In addition, the CFGR permits a variety of functions that would otherwise require several different disposable platforms. Despite the benefits of the gynecologic resectoscope, there are clear impediments to its use including a scarcity of educational resources and trained experts, medico-legal concerns, institutional obstacles to organizing an operative team, and the need to develop and maintain an adequate caseload. In Part I of this three-part series, the author will review why the CFGR remains a relevant and indispensable tool for the minimally invasive gynecologic surgeon, the composition of an operating room team, and the instrumentation and skills necessary to accomplish basic resectoscopic surgery. In Part II, we will describe how ultrasound guidance can be used to assist the execution of more challenging intermediate-level cases. Finally, in Part III, we will discuss the most demanding cases for the resectoscopic surgeon—the treatment of post-ablation failures and the removal of intramural leiomyomas—which are clinical scenarios that require ultrasound guidance and well-honed resectoscopic surgical skills.

Pathomorphological features of the endometrium in patients with abnormal uterine bleeding in the presence of uterine leiomyoma

Hypothesis/Aims of study. One of the problems discussed in the field of obstetrics and gynecology is the combined pathology of the reproductive system. Among the female reproductive system disorders associated with uterine leiomyoma, endometrial pathology prevails in the form of local inflammatory, receptor and hormonal changes. The aim of this study was to evaluate the structural features of the endometrium and its receptivity in patients with uterine leiomyoma, depending on its histological type and localization.&#x0D; Study design, materials and methods. We examined 128 women with leiomyoma manifesting abnormal uterine bleeding, using clinical, instrumental and morphological methods.&#x0D; Results. Combined pathological changes in the endometrium are more characteristic of submucous leiomyoma compared to intramural and subserous leiomyomas. The proliferative activity of endometrial cells in submucous leiomyoma is two or more times higher than in intramural and subserous leiomyoma. In submucous leiomyoma, cell proliferation occurs significantly more often than in other locations of myomatous nodes.

HISTOPATHOLOGICAL STUDY OF BENIGN AND MALIGNANT LESIONS OF UTERUS AND CERVIX IN HYSTERECTOMY SPECIMENS

Background: The present study was aimed to obtain insight into the varied histopathological patterns of lesions of uterus and cervix in hysterectomy specimens and their age-wise distribution in Index MedicalCollege, Hospital and Research Center.&#x0D; Methodology: This was anobservational study conducted on 100 cases of hysterectomy specimens received at tertiary care hospital Indore. All the specimen was subjected to detailed gross and histopathological examination.&#x0D; Results: Mean age of patients was 44.78±8.64 years. The most common age group was 41-50yrs (42%). Maximum cases were diagnosed as AUB/ DUB/Menorrhagia (31%) followed by fibroid uterus (28%). Uterus was bulky in 70%, cut sections revealed single fibroid in majority i.e. 39% cases and endometrium was in proliferative phase (early 12%, mid 30%, late 19%). Most common histopathological diagnosis of uterus was leiomyoma in 39% cases whereas chronic nonspecific cervicitis (47%) was most common histological diagnosis of cervix. Intramural leiomyoma were most common and were associated with degenerative changes in 33 cases. Hyaline degeneration was observed in maximum cases.&#x0D; Conclusion: The most common indication for hysterectomies in our institution is excessive uterine bleeding. Fibroid uterus as the cause of bleeding is the most common pathology for which hysterectomy is performed. Chronic cervicitis is the most common finding and Adenomyosis continued to be missed preoperatively and diagnosed postoperatively on histopathological examination. Every hysterectomy specimen should be subjected to histopathological examination to confirm various pathological lesions.&#x0D; Keywords: Leiomyoma, histopathology, spectrum, uterus, cervix, hysterectomy