Leiomyoma Location Research Articles

Outcomes of transvaginal radiofrequency ablation for symptomatic leiomyomas

ObjectiveDescribe the effect of transvaginal radiofrequency ablation for leiomyoma in symptomatic patients and post procedure follow-up. Material and methodsA retrospective forward-looking observational study was performed including 63 patients who underwent transvaginal radiofrequency ablation between January 2016 and December 2022 at San Cecilio University Hospital in Granada, Spain. The variables registered were: age, parity, the clinical features that lead to the medical visit and pre-surgical treatment. Prior to the procedure, leiomyoma location and volume were determined by transvaginal ultrasound. Follow-ups were scheduled at 6 and 12 months to evaluate symptom improvement, adverse outcomes, leiomyoma volume and if any necessary post-surgical treatment was required. ResultsMean leiomyoma volume at baseline, 6 months and 12 months was 83.3 (24.9–130.7), 42.4 (4.7–89.0) and 19.2 (1.9–80.4) cm3, respectively (p < .001). Significant differences were found between the baseline and 12 month visits (p < .001). At the annual follow-up, the mean rate of volume reduction was 79.5 %, being higher in women who reported symptom improvement compared to those who reported no change in symptom intensity from baseline (84.6% vs. 30.8 %). Patients with a lower initial volume and age over 40 were more likely to have treatment efficacy. 8 pregnancies were registered post procedure. ConclusionRadiofrequency is well tolerated, allowing for same-day discharge, rapid recovery and a safe approach for women who want to preserve their reproductive potential. Initial volume and age over 40 appear to be factors that should be considered in patient selection. Further studies are needed to continue evaluating the outcomes and identifying predictive factors.

Prevalence and Sonographic Patterns of Uterine Fibroid Among Women of Reproductive Age in Jos, Plateau State, Nigeria

Background: Uterine leiomyoma represents a major public health problem and is regarded as the most common benign gynecologic tumors affecting premenopausal women. It is associated with considerable morbidity and hospitalization. Objectives: This research was carried out to establish the prevalence and sonographic characteristics of uterine leiomyoma as well as the histological diagnosis of the tumor among Nigerian women of reproductive age living in Jos, Plateau State. Materials and Methods: It was a prospective cross-sectional hospital-based study, in which 295 women of the age between 20 years and 50 years were recruited randomly after obtaining informed consent from each woman. Abdominopelvic ultrasound scan was performed on each participant using a GE Logic 5 machine fitted with 3.5-MHz probe with emphasis on the location, number, and characterization of uterine leiomyoma(s); thereafter, transvaginal ultrasound scan using 7.5-MHz frequency probe was done for the subjects that have uterine fibroid for better delineation and location of the mass(es), followed by sonohysterography where necessary to ascertain its/their location(s). The histologic findings/diagnosis of the tumor postsurgery for those who had myomectomy in course of the study was correlated to the sonographic diagnosis. The number of fibroid nodules, location in the uterus, sonographic patterns, classification, and histological diagnosis were assessed descriptively and inferentially using the Statistical Package for the Social Sciences version 20 (SPSS20). The results were presented in the form of tables and charts. Results: The mean age for the participants was 32.66 ± 7.66 years ranging from 21 to 50 years, and the mean age of the sonographically confirmed fibroid cases was 34.99 ± 6.79 years with a range of 21–48 years. This study indicated that 28.33% (83/295) of the subjects had fibroid; the highest prevalence (49.7%) of the fibroid case occurred among women in their fourth decade and the lowest (8.4%) at the extremes of reproductive age. A significant positive association (P = 0.043) between nulliparity and the presence of fibroid was noted. The average number of fibroid nodules and volume of the largest nodule were estimated as 2.76 ± 1.93 and 344 ± 69.24 cm3, respectively; 57.80% of the fibroid were intramural with only 9.6% been submucosal. Most (86.70%) of the fibroids were located within the uterine corpus and the most common (38.6%) sonographic pattern of the nodules was hypoechoic. The histological findings postmyomectomy for those that had surgery in the course of the study showed cellular leiomyoma to be the most common (95.23%) type; there was no evidence of malignant transformation. Conclusion: The prevalence and sonographic pattern of leiomyoma among women of reproductive age in Jos have been assessed; it was found that characteristics of the fibroid and its location determine the clinical presentation and possibly the reproductive outcome of the patient; this could help in appropriate management of cases in the North Central or the whole nation.

Study of Women Presenting with Leiomyoma in Terms of Symptoms, Age of Presentation and Location

Abstract Aim and objective: To Categories women presenting with leiomyoma with respect to: • Age • Most common symptom • Location of leiomyoma Settings and Design: This was an observational study carried out in a tertiary health center for a period of 1 year from September 2019 to September 2020. Materials and Methods: A retrospective observational study was conducted in 35 women having pain in abdomen, abnormal uterine bleeding, who were presented to the department of obstetric and gynecology, Bharati Vidyapeeth deemed university, Pune between sept 2019 and sept 2020. All the patient presented with above mentioned symptoms were studied after obtaining consent from participant. Ultrasound was done and location of leiomyoma was studied. Fibroid were studied in terms of its, location and most common presenting symptoms and age of occurrence of symptoms. Results: In our study, themost common age group of presentation was 36-40 years (reproductive age group.) Most common type of fibroid was intramural (62.8 %) Most common symptoms was menorrhagia (57.1%). Most commonly associated with nulligravida (49.5%). Keywords: Ultrasound; Clinical symptoms; Abnormal uterine bleeding.

Change of uterine leiomyoma size during pregnancy and the influencing factors: A cohort study.

To evaluate the changes of uterine leiomyoma size during pregnancy and determine the factors influencing it. A prospective study was conducted from June 2016 to June 2018. Women with pregnancies complicated by leiomyoma were recruited. Ultrasound examinations were conducted to measure the size of leiomyoma during 6-7, 11-14, 22-24, 28-34weeks of pregnancy and before delivery. The clinical characteristics and delivery details of the pregnant women were collected. Changes in leiomyoma size during different gestation periods and the influencing factors were analyzed. Leiomyoma size commonly increased before 22-24weeks of pregnancy and the fastest growth occurred before 11-14weeks. From 22-24weeks to the date of delivery, the size of leiomyoma remained unchanged. The initial size of the leiomyoma showed negative correlation with the changes in leiomyoma diameters during pregnancy. Pre-pregnancy body mass index, fetus number, leiomyoma location, and parity were positively correlated with the size changes in leiomyoma from 22-24 to 28-34weeks of pregnancy. Before 22-24weeks of pregnancy, the size of the leiomyoma was gestation-dependent, which increases with gestational weeks. The fastest growth rate was before 11-14weeks. The growth of leiomyoma is affected by multiple factors, and different factors can play different roles during different periods of the pregnancy.

Therapeutic approach of uterine leiomyoma; choosing the most appropriate surgical option

The most common benign pelvic tumor in young women is uterine leiomyoma. It is often asymptomatic, but can cause symptoms such as pelvic-abdominal pain, vaginal bleeding, urinary and intestinal transit disorders. If there is a suspicion of malignancy, it is necessary to perform fractional uterine curettage to establish the histopathological diagnosis. The surgical treatment of uterine leiomyoma includes several procedures: myomectomy, subtotal or total hysterectomy. The procedure will be chosen depending on the patient's particularities: BMI, uterine size, leiomyoma location, surgical history or other associated pathologies. Laparoscopic hysterectomy has a 45-minute shorter duration of intervention than vaginal hysterectomy, and the conversion rate to the open procedure is lower. Laparoscopically treated cases have fewer postoperative complications compared to other surgical procedures and have a shorter hospitalization and recovery time. The recurrence rate of uterine leiomyoma is similar for both laparoscopic and open abdominal approach, and the frequency of long-term complications such as adhesion syndrome or pelvic pain is higher after the latter.

Vaginal leiomyoma: medical imaging and diagnosis in a resource low tertiary hospital: case report

BackgroundIn the literature under review there are about 300 reported cases of vaginal leiomyomas with none from Cameroon. We report a case of vaginal leiomyoma and highlight the diagnostic challenges faced at the Douala Referral Hospital (DRH), Cameroon.Case presentationA 36-year-old G3P3002 sexually active Cameroonian married woman reported dysuria, dyspareunia, cessation of sexual intercourse and offensive smelling vaginal discharge for 6 months and a 3-year history of a vaginal tumour; she was misdiagnosed despite ultrasonography and magnetic resonance imaging (MRI) but was corrected by an experienced radiologist. She underwent first look laparoscopy, surgical excision of the tumour through the vagina and histopathology analysis that confirmed leiomyoma.ConclusionPosterior location of vaginal leiomyomas found in this case is a rare occurrence. The diagnosis is based on careful examination and preoperative imaging (ultrasonography and MRI). However, the definitive diagnosis is usually made intra-operatively. We combined laparoscopic exploration of the internal genital organs and per vaginal excision of the vaginal leiomyoma. Thus, we recommend frozen section biopsy to exclude leiomyosarcoma.

Uterine leiomyomas: a demographical and clinico-pathological exploration in a rustic setup of Tamil Nadu: a comprehensive study

Aim: The aim of this study is to evaluate the prevalence of uterine leiomyomas in a rural setup of Tamil Nadu and also to analyse its plethora among the various neoplastic lesions of female genital tract as well as the various demographical and clinico-pathological spectrum of the same. Material and Methods: A twenty-five years retrospective study was conducted in the Department of Pathology in a rural teaching institute, Rajah Muthiah Medical College and Hospital, in Chidambaram. A total of thousand two hundred hysterectomy specimens clinically diagnosed as uterine leiomyomas were included in the study and all the other female genital tract specimens were excluded from the study. Result: 1200 cases were studied in the study period among the total two thousand and twenty-two female genital tract neoplastic lesions that were received in the department during the twenty-five-year period. The most common age group affected was 5th decade. The most common clinical presentation was menstrual disturbances among which menorrhagia was the commonest symptom. Taking into account the number of leiomyomas present in a uterus, single leiomyomas outnumbered multiple ones by a vast margin and taking the anatomical location of leiomyoma in a uterus into consideration, intramural leiomyoma stood well ahead of submucosal and subserosal leiomyomas. Conclusion: Almost 2/3rd of the total female genital tract neoplastic lesions received from the inception of college to December 2012 were Uterine leiomyomas there by making it the most common neoplasm of female genital tract reported in our hospital in a rural setup for a total period of twenty five years starting from the inception of college until December 2012.

Αdnexal cystic lymphangiomas in patients with massive leiomyomatous uterus: a not so uncommon finding on pelvic MRI.

To investigate any association between the presence of an adnexal cystic lymphangioma (ACL) and an enlarged leiomyomatous uterus. A retrospective observational study was conducted by two expert radiologists using a 10-year MRI database (2008-2018); 85 patients (mean age: 45.5years ± 10.9) were considered eligible due to the presence of a single (n = 31) or multiple (n = 54) leiomyomas causing distortion of the uterine contour and uterine enlargement. The association of specific leiomyoma features (longest diameter (Dmax), location, number) and uterine volume with the presence of ACL was statistically tested. Diagnosis of ACL was based on typical imaging features (n = 14) and intraoperative/histological findings (n = 3). ACL (unilateral = 9, bilateral = 8) was recorded in 17/85 (20%) of patients; it was more frequently observed when the largest leiomyoma was located in the uterine fundus (33.3%). Patients with ACL had significantly more leiomyomas (median: 5 vs. 2, p = 0.043), greater Dmax of largest leiomyoma (median: 13.3 vs. 7.2cm, p < 0.001), and larger uterine volumes (median: 676.7 vs. 223.1cm3, p < 0.001) compared to patients without ACL. ROC curve analysis for a number of leiomyomas showed that the optimal cut-off for the prediction of ACL was the presence of 5 leiomyomas with 53.8% sensitivity and 84% specificity (AUC = 0.65, 95% CI 0.51-0.83, p = 0.049), Dmax of largest leiomyoma 9.1cm with 76.5% sensitivity and 77.9% specificity (AUC = 0.83, 95% CI 0.73-0.94, p < 0.001), and uterine volume 311cm3 with 71% sensitivity and 75% specificity (AUC = 0.79, 95% CI 0.66-0.92, p < 0.001). The presence of ACL is significantly associated with number of leiomyomas, Dmax of largest leiomyoma, and uterine volume; prospective evaluation of our results is needed to investigate its clinical significance.

Insufficient Leiomyoma Infarction in Uterine Artery Embolization: Relationship with Tumor Location

PurposeTo evaluate which leiomyoma location in the uterus predicts insufficient tumor infarction after uterine artery embolization (UAE). Materials and MethodsIn this single-institution retrospective study, 45 patients (mean age, 43.4 y ± 4.1) underwent UAE for leiomyomas using trisacryl gelatin microspheres alone with “pruned-tree” endpoint performed by qualified interventional radiologists between October 2015 and July 2017. Technical outcomes and complications were assessed. All patients underwent unenhanced and enhanced MR imaging before and after UAE. A total of 476 tumors of ≥ 1 cm observed in all patients were evaluated. Multivariate generalized linear mixed model analysis was performed to investigate relationships between insufficient tumor infarction (< 90%) on contrast-enhanced MR imaging after UAE and baseline factors, including tumor location in the long-axis, front-back, and inner-outer directions and tumor size. ResultsAll patients successfully underwent UAE with no major complications. Multivariate analysis revealed that there was a higher likelihood of insufficient infarction of tumors at the cervix (odds ratio [OR] 80.45; 95% confidence interval [CI] 9.97, 649.09; P < .001) and lower body (OR 4.31; 95% CI 2.52, 7.38; P < .001) than at the upper body and of tumors at the front than at the back wall (OR 2.20; 95% CI 1.32, 3.67; P = .002). Tumor size (OR 0.71; 95% CI 0.61, 0.82; P < .001) was a significant factor, whereas tumor location in the inner-outer direction was not. ConclusionsInsufficient leiomyoma infarction after UAE was more likely to involve tumors at the cervix, lower body, or front wall of the uterus or smaller tumors.

Clinical Outcomes of Minimally Invasive Enucleation of Leiomyoma of the Esophagus and Esophagogastric Junction

ObjectiveMinimally invasive enucleation is the treatment of choice in symptomatic patients with esophageal leiomyoma. Comprehensive long-term follow-up data are lacking. Aim of this study was to review the clinical outcomes of three procedures for enucleation of leiomyoma of the esophagus and esophagogastric junction. MethodsA single institution retrospective review was performed using a prospectively collected research database and individual medical records. Demographics, presenting symptoms, use of proton-pump inhibitors (PPI), tumor location and size, treatment modalities, and subjective and objective clinical outcomes were recorded. Barium swallow and upper gastrointestinal endoscopy were routinely performed during the follow-up. Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and Short-Form 36 questionnaires were used to compare quality of life before and after treatment. ResultsBetween 2002 and 2017, 35 patients underwent minimally invasive leiomyoma enucleation through thoracoscopy (n = 15), laparoscopy (n = 15), and endoscopy (n = 5). The overall morbidity rate was 14.3% and there was no mortality. All patients had a minimum of 1-year follow-up. The median follow-up was 49 (IQR 54) months, and there were no recurrences of leiomyoma. At the latest follow-up, the SF-36 scores were unchanged compared to baseline. However, there was a higher incidence of reflux symptoms (p < 0.050) and PPI use (p < 0.050) after endoscopic treatment. ConclusionsMinimally invasive enucleation is safe and effective and can be performed by a variety of approaches according to leiomyoma location and morphology. Overall, health-related quality of life outcomes of each procedure appear satisfactory, but PPI dependence was greater in the endoscopic group.

Histopathological study of Uterine Leiomyoma in Hysterectomy Specimens

Background: Uterine leiomyoma is the most common benign neoplasm in women of reproductive age group. Hysterectomy is a mode of therapy in uterine Leiomyoma. The objective of this study was to evaluate the histopathological changes in hysterectomy specimens with uterine leiomyomas.METHODS: This is a retrospective study of one hundred sixty eight patients who underwent hysterectomy for uterine leiomyoma.Results: Uterine leiomyoma was most common in the age group of 41-50 years (54.76%). Most common location of leiomyoma was intramural (51.2%). Degenerative changes were seen in 10.72% cases. Hyaline degeneration was the most common type of degeneration (7.14%). Proliferative endometrium was the most common endometrial pattern (63.1%) in uterine leiomyoma. Associated malignant lesions were observed in 1.8 % cases of uterine leiomyoma.CONCLUSION: Uterine leiomyoma is associated with degenerative changes and coexistent benign and malignant patholologies. Histopathological examination of hysterectomy specimens should be done to confirm the diagnosis and rule out other pathologies, especially malignant lesions.

Development of a Model for the Prediction of Treatment Response of Uterine Leiomyomas after Uterine Artery Embolization.

Background: Uterine artery embolization (UAE) is one of the minimally-invasive alternatives to hysterectomy for treatment of uterine leiomyomas. There are various factors affecting the outcomes of UAE, but these have only been sporadically studied.Study Objective: To identify factors associated with the efficacy of UAE for the treatment of uterine leiomyoma, and to develop a model for the prediction of treatment response of uterine leiomyomas to UAE.Study design: A retrospective cohort study (Canadian Task Force Classification II-2)Patients: One hundred ninety-eight patients with symptomatic uterine leiomyomas.Intervention: UAEMeasurements and Main Results: Among 198 leiomyoma patients who were treated with UAE, 104 who underwent pelvic magnetic resonance imaging (MRI) with diffusion-weighted imaging were selected for developing prediction model. Variables that were statistically significant from the univariate analysis were: location of leiomyoma, total number of lesions, sum of leiomyomas diameters, T2 signal intensity of largest leiomyoma, and T2 leiomyoma:muscle ratio. After a logistic regression analysis, leiomyoma location and T2 signal intensity of the largest leiomyoma were found to be statistically significant variables. Using intramural myomas defined as controls, submucosal leiomyomas showed a greater response to UAE with an odds ratio of 7.6904. The odds ratio of T2 signal intensity with an increase in signal intensity of 10 was 1.093. Using these two variables, we developed a prediction model. The AUC in the prediction model was 0.833, and the AUC in the validation set was 0.791.Conclusion: We identified that submucosal leiomyomas and those leiomyomas that show high signal intensity on T2-weighted imaging will exhibit a greater response to UAE. Prediction models are clinically helpful in selecting UAE as an appropriate treatment option for managing uterine leiomyoma.

Selective Progesterone Receptor Modulators for the Treatment of Uterine Leiomyomas.

Uterine leiomyomas have drawn much attention since being described more than 200 years ago. These common benign uterine tumors often present with prolonged menstrual bleeding, pelvic pressure, and reproductive disorders and pose a true financial burden on health care systems all over the world. Over the past few decades, surgical treatment of uterine leiomyomas has received most of the focus compared with other treatment options. Choosing the appropriate surgical technique depends on many factors such as uterine leiomyoma location, patient's age, interest in future fertility, concomitant comorbidities, and the patient's preference. Pharmacologic treatments such as gonadotropin-releasing hormone agonists and antagonists have been used for the treatment of symptomatic uterine leiomyomas with only partial success. Myriad side effects and limited clinical results have rendered them less popular and have exposed a true need for new effective medical treatments. Recently, treatment with selective progesterone receptor modulators has shown promising results with shrinkage of uterine leiomyomas and a prolonged clinical effect. Selective progesterone receptor modulators provide hope for women with this challenging condition and are a promising new option in the armamentarium of medical treatments for uterine leiomyomas.

Leiomyoma Infarction after Uterine Artery Embolization: Influence of Embolic Agent and Leiomyoma Size and Location on Outcome

PurposeTo study the factors that might impact infarction of individual uterine leiomyomas and total tumor burden after uterine artery embolization (UAE). Materials and MethodsThis retrospective study included 91 patients (mean age, 44 y [range, 34–54 y]) who underwent UAE with tris-acryl gelatin microspheres (TAGMs) or nonspherical polyvinyl alcohol (PVA) particles. Twenty-one patients were treated with PVA (23%) and 70 were treated with TAGMs (77%). A total of 356 uterine leiomyomas were assessed, with a median uterine volume of 533 cm3 (range, 321–848 cm3). A reader masked to demographic and technical details reviewed contrast-enhanced magnetic resonance images before and 3 months after UAE to estimate the extent of tumor infarction. ResultsThere was no significant difference in global or individual tumor infarction rate between embolizations with TAGMs and PVA particles (P = .73 and P = .3, respectively). Global infarction was not affected by age (P = .53), race (P = .12), number of leiomyomas (P = .72), or uterine volume (P = .74). Leiomyoma size did not influence individual tumor infarction (P = .41). Leiomyoma location was the sole factor that influenced individual tumor infarction rates, with pedunculated serosal tumors significantly less likely to show complete infarction than transmural tumors (odds ratio, 0.24; P = .01). ConclusionsNonspherical PVA particles and TAGMs produce similar rates of uterine leiomyoma infarction. Complete infarction of individual tumors is less likely in serosal and pedunculated serosal tumors.

Endometrial myomectomy: a novel surgical method during cesarean section

Study objective: Comparing surgical outcomes of a novel surgical technique endometrial myomectomy (EM) to serosal myomectomy (SM) during ceserean section (CS).Design: Retrospective cohort study (Canadian task force classification level II 1).Setting: Private hospital.Patients: Fourty-six women with leiomyomas during cesarean sectionInterventions: Endometrial myomectomy and serosal myomectomy during cesarean section between 2013 and 2016.Main outcome measures: Total 22 consequtive cases (Group 1) underwent EM in the last 2 years. The control group created from SM (Group 2) cases performed before EM implemented in our practice. Group 2 was matched based on anteriorly located intramural or submucosal leiomyoma. The size, location and number of leiomyoma, hematological course during pre- and postoperative period, the need for blood transfusion, duration of surgery, and any prolongation of hospital stay also documented.Results: Median number of leiomyoma was higher in EM than in SM (p = 0.001). Median myomectomy procedure time and amount of intra-operative bleeding in SM were higher than EM (respectively, p = 0.005 and p = 0.001). In terms of other variables, there is no difference between the two myomectomy groups (p > 0.05).Conclusion: This novel technique EM is a safe, feasible surgical technique compared with SM. Besides the less intra-operative blood loss, it also has the potential to diminish the risk of abdominal adhesion formation.

The Rising Phoenix-Progesterone as the Main Target of the Medical Therapy for Leiomyoma.

Leiomyomas, also known as uterine fibroids, are a common benign tumor in women of reproductive age. These lesions disrupt the function of the uterus causing menorrhagia and pelvic pressure as well as reproductive disorders. These women pose a true challenge for clinicians in the attempt of choosing the suitable treatment for each patient. Patient's age, interest in fertility preservation, and leiomyoma location and size are all factors to be taken into account when deciding upon the preferable therapeutic option. For the past few decades, surgical treatment was the only reliable long-term treatment available. A variety of surgical approaches have been developed over the years but these developments have come at the expense of other treatment options. The classical medical treatment includes gonadotropin-releasing hormone (GnRH) agonists and antagonists. These agents are well known for their limited clinical effect as well as their broad spectrum of side effects, inspiring a need for new pharmacological treatments. In recent years, promising results have been reported with the use of selective progesterone receptor modulators (SPRM). Long-term clinical trials have shown a reduction in bleeding and shrinkage of leiomyoma mass. These results instill hope for women suffering from symptomatic leiomyomas seeking an effective, long-term medical option for their condition.

Clinical study of uterine Leiomyoma and its associated risk factors

Introduction: Uterine leiomyomas have historically been viewed as major indication for hysterectomy. As new therapies have developed, the heterogeneity of this disease has become therapeutically relevant. An awareness of the role of risk factors, growth factors, hormones and genetics in tumor etiology is the key to understanding of this disease. This study was undertaken to know the various risk factors associated with uterine leiomyoma. Objective: To Study the clinical features and various risk factors associated with leiomyoma of uterus. Materials and Methods: This is a hospital based prospective study of 55 uterine leiomyoma cases. After taking consent all cases were enrolled into the study and detailed history regarding mode of presentation, clinical features and various risk factors of uterine leiomyoma was taken, all cases underwent transvaginal ultrasound to know the location of leiomyoma. Specimen of leiomyoma was sent for histopathological examination and analysed. Results: Mean age group of the cases was between 41 – 50 years. Mean age at menarche was 12.9 years. Maximum numbers of cases were in the group of PARA – 2. Abnormal uterine bleeding like Menorrhagia, Polymenorrhea, Metrorrhagia, and Dysmenorrhea were the most common modes of presentation followed by pain and increased urinary frequency. In the present study 49.09% of subjects were above normal BMI range. Individuals with sedentary life style were at higher risk of developing leiomyoma. Intramural was the commonest location of fibroid followed by subserosal and submucus fibroids. On Histopathological examination, leiomyoma was confirmed and Cervicitis was the most common accompanying feature followed by adenomyoisis and degeneration. Conclusion: Leiomyoma of uterus is multifactorial in origin with various factors acting in conjunction. Increased oestrogen exposures due to factors modulate myometrial cells and act as tumor promoters. Reproductive age of patient, early menarche, obesity and parity are most common risk fctors which modulate estrogen response.

Low vascularity predicts favourable outcomes in leiomyoma patients treated with uterine artery embolization

To investigate the clinical factors predicting outcomes of leiomyoma treated with uterine artery embolization (UAE). A total of 183 uterine leiomyoma patients undergoing UAE were retrospectively analyzed. Patient age, characteristics of vascular supply in magnetic resonance imaging (MRI)/digital subtraction angiography (DSA), number, size and location of leiomyoma were recorded. Leiomyoma regrowth, new leiomyoma appearance and recurrence of any previously reported symptoms were carefully monitored over a mean follow-up of 30months (median 32months, range 12-80). Potential recurrence risk factors were analyzed by univariate and multivariate cox regression analysis. Twenty-three recurrences were recorded. The difference in the vascularity classification systems between MRI and DSA was not statistically significant (P = 0.059). High vascularity in MRI, high vascularity in DSA and multiple leiomyoma showed a significant risk of recurrence using univariate and multivariate analysis (P = 0.004, P < 0.001 and P = 0.023, respectively). The other factors were not significantly associated with leiomyoma recurrence (P > 0.05). Low vascularity and solitary leiomyoma indicated favourable outcomes in patients treated with UAE. • Low vascularity and solitary mass predicted favourable outcomes in UAE-treated patients. • MRI might provide information on vascularity in leiomyoma before UAE. • Variations in vascular supply, age, size, location were not associated with recurrence.

Leiomyoma in the Retzius space

Parauterine location of leiomyomas is observed to be an extremely rare clinical condition. However, when benign or malignant primary tumours are detected in that area, they are often found in the Retzius space. There have been only six cases of leiomyomas in the Retzius space reported in the literature so far. The paper presents one such leiomyoma case located in the Retzius space. This extremely rare location of the tumour justifies its presentation. The medical records of the patient treated in the outpatient’s obstetrics and gynaecology (ob-gyn) clinic, her case history, and hospital records, supplemented by information obtained from the patient’s daughter, were analysed. The patient, a 50-year-old woman with type 2 diabetes, was referred to hospital for diagnosed secondary anaemia due to heavy menstruation for four months, which was associated with intramural leiomyoma in the anterior wall of the uterine body. Clinical examination found a large leiomyoma located in the anterior wall of the uterus. Laparotomy was performed: apart from and a leiomyoma in the uterine body it found a tumour, 140 × 100 mm in size, in the Retzius space. Total resection of the tumour was performed. Since the leiomyoma was located in the uterine wall, hysterectomy with bilateral excision of adnexa was also performed. The patient was discharged home in generally good condition on the sixth day following the operation. Concomitant occurrence of leiomyoma atypically located in the Retzius space and leiomyoma in the uterine body made perioperative diagnosis very difficult.

Incidence and predictive factors for complications after uterine leiomyoma embolization.

What is the risk of complications after uterine leiomyoma embolization and what are the factors associated with complications? The cumulative risk of complications after embolization is relatively low even in the long term, but submucosal leiomyoma location may increase the risk. A broad spectrum of complications after leiomyoma embolization have been described with widely varying rates. There is uncertainty over the actual risk of complications and the factors associated with this risk. This was a prospective cohort study of 288 consecutive women undergoing leiomyoma embolization in the general gynaecology clinic of a university teaching hospital between January 2001 and December 2010. Complications occurring after embolization were categorized as major or minor according to the severity of their impact on health, the level of care required and the outcome. Cumulative complication rates were estimated by survival analysis and log-rank tests according to baseline variables. Multivariable Cox proportional hazards analysis was performed to adjust for confounders. There were 48 patients who experienced a complication at a median of 5 months (95% confidence interval, 4.1-11.4) after embolization. Complications were minor in 38 patients and major in 10 patients. The cumulative overall complication rate was 13% (95% CI, 9.0-17.0) at 6 months, 16% (95% CI, 11.0-20.0) at 1 year, 17% (95% CI, 12.0-22.0) at 3 years and 18% (95% CI, 12.9-22.8) at 5 years. The most frequent complication (19/48, 39.6%) was leiomyoma expulsion, which occurred spontaneously in 13 (68.4%) of these cases and required assistance in 6 (31.6%) cases. Eight (2.8%) patients underwent re-intervention, including six hysteroscopic myomectomies, one laparoscopic myomectomy and one hysteroscopic adhesiolysis, as a result of a complication. Submucosal leiomyoma location was the only baseline variable associated with an increased risk for complications [Hazard ratio (HR), 2.28, 95% CI, 1.24-4.18, P = 0.008]. Our population did not include women of African descent, who have been reported to be at higher risk of post-procedural complications compared with Causcasian women. If such women were involved in the study, higher morbidity rates might have been observed. Women with submucosal leiomyomas at the time of embolization are more likely to have post-procedural complications. This is important new information for counselling patients contemplating this therapeutic approach. The authors have no competing interests to declare. The study was not supported by any external grant.