Multiple Uterine Leiomyomas Research Articles

Feasibility and safety evaluation of ultra-remote robot-assisted laparoscopic hysterectomy

ObjectiveTo assess the safety and feasibility of ultra-remote robot-assisted laparoscopic hysterectomy using the Edge Multi-Port Endoscopic Surgical Robot MP1000 (Shenzhen Edge Medical Co., Ltd., Shenzhen, China) combined with 5G communication technology. MethodsA case of remote robot-assisted laparoscopic hysterectomy was successfully completed on May 2024 by using the Edge Multi-Port Endoscopic Surgical Robot MP1000 at Zhongnan Hospital of Wuhan University and the People's Liberation Army General Hospital, approximately 1, 200 ​km apart. The procedure was simultaneously broadcast during the 36th Annual Meeting of the International Society for Gynecologic Endoscopy in Conjuction with the Peking University Gynecologic Oncology Summit Forum. ResultsA 49-year-old female was hospitalized in the Department of Gynecology of Zhongnan Hospital of Wuhan University for frequent urination for half a year and increased menstrual flow for over a month. The patient was diagnosed with abnormal uterine bleeding caused by multiple uterine leiomyoma and endometrial polyps, combined with moderate anemia. There were no contraindications for surgery, and the patient had surgical indications. On May 2024, the patient underwent a 5G remote robot-assisted laparoscopic hysterectomy and bilateral salpingectomy under general anesthesia. The procedure was successful, with no surgical complications and no interruptions during the live broadcast. The intraoperative blood loss was approximately 20 ​mL, and the surgery lasted about 70 ​min. The bidirectional latency during the operation was around 19 ​ms, with no adverse events related to the robot or the network. The patient recovered well postoperatively and was discharged on the fourth day with no postoperative complications. ConclusionPreliminary findings indicate that ultra-remote robot-assisted laparoscopic hysterectomy is safe and feasible with the support of 5G communication technology. This surgery represents the first globally broadcast remote procedure in the field of gynecology, marking a new milestone in the stability and safety of China's remote medical technology. Remote robotic surgery is expected to be widely promoted in the future, providing services to patients in areas with limited medical resources.

Clinical characteristics and treatment outcomes of angioleiomyoma of the female genital tract: a retrospective cohort study

BackgroundAngioleiomyoma, a benign tumour composed of smooth muscle cells and thick-walled vessels, is expected to be very rare in the female genital tract. This study aimed to describe the clinicopathological features and treatment outcomes of angioleiomyoma in the female genital tract.MethodsWe retrospectively reviewed 89 women with angioleiomyoma in the genital tract who were treated at Third Xiangya Hospital of Central South University between July 2008 and October 2023. Symptom remission rate was the primary outcome of the study.ResultsAngioleiomyomas accounted for 0.6% of leiomyomas of the female genital tract. The average age of the 89 women was 41.8 ± 8.7 years. Seventy women (78.7%) had a history of uterine surgery, of whom two patients had removed uterine angioleiomyoma by laparoscopic myomectomy. The angioleiomyomas of 61 (68.5%) women were located in the uterine corpus, 17 (19.1%) in the broad ligament, 10 (11.2%) in the cervix and only 1 (1.1%) in the vagina. Abnormal uterine bleeding was the main clinical manifestation of angioleiomyomas located in the uterine corpus or cervix, whereas the main clinical manifestation of angioleiomyomas in the broad ligaments was pelvic mass. Of the 89 women, 59 underwent surgery to preserve the uterus, and 30 underwent total hysterectomy or subtotal hysterectomy. The intraoperative blood loss was more than 500 ml (700–4,500 ml) in six women. The symptom remission rate was 100% after surgery. Among the 59 women with preserved uterus, 8 showed multiple uterine leiomyomas during follow-up, but it was difficult to determine whether they were angioleiomyomas. Angioleiomyomas recurred in one women who underwent total hysterectomy.ConclusionAngioleiomyoma is rare in the female reproductive tract, and patients may present with diverse symptoms, which are related to the location of the tumour. Hysterectomy and myomectomy are both effective treatment methods, but the risk of intraoperative bleeding should be recognised for multiple lesions and those with large diameters. Relapse may occur in some patients.

High-intensity focused ultrasound ablation in the treatment of fumarate hydratase-deficient uterine leiomyoma

Objective This study aimed to explore the efficacy and safety of high-intensity focused ultrasound (HIFU) ablation for treating fumarate hydratase (FH)-deficient uterine leiomyomas. Method Ten patients with FH-deficient uterine leiomyomas treated with HIFU ablation at the Third Xiangya Hospital from July 2017 to January 2023 were enrolled in this study. The effectiveness and adverse effects of HIFU were analyzed. Results The median age of the patients who received HIFU was 32.0 years (range: 28–41 years). Only 2 patients had solitary uterine leiomyomas, whereas the remaining 8 patients had multiple uterine leiomyomas. The median diameter of the largest myoma was 56 mm (range: 41–99 mm). Magnetic resonance imaging showed that the FH-deficient uterine leiomyomas of 8 patients presented as mixed intensity on T2WI, that of one patient was hypointense, and that of another patient was hyperintense on T2WI. All patients successfully underwent HIFU ablation in one session without severe adverse effects. The median nonperfusion volume ratio (NPVR) was 40% (30.0%–78.0%) after HIFU treatment. Four patients had NPVR ≥70%. At 3-month follow-up after HIFU ablation, the clinical symptoms of 5 of the 8 patients with symptoms before treatment were relieved. Six months after treatment, 4 of the 8 patients with symptoms were still in remission. All patients received reintervention by March 2024. The reintervention rates were 20%, 70%, and 90% at 12, 24, and 36 months, respectively, after HIFU ablation. Conclusion HIFU is a safe and feasible treatment for FH-deficient uterine leiomyomas, and most patients show effective results in the short term after treatment. However, the reintervention rates are high, and the long-term effects are limited.

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.

Genetic liability to multiple factors and uterine leiomyoma risk: a Mendelian randomization study.

Uterine leiomyoma is the most common benign tumor in females of reproductive age. However, its causes have never been fully understood. The objective of our study was to analyze the causal association between various factors and uterine leiomyoma using Mendelian randomization (MR). Genetic variables associated with risk factors were obtained from genome-wide association studies. Summary-level statistical data for uterine leiomyoma were obtained from FinnGen and the UK Biobank (UKB) consortium. We used inverse variance weighted, MR-Egger, and weighted median methods in univariate analysis. Multivariable MR analysis was used to identify independent risk factors. A fixed-effect model meta-analysis was used to combine the results of the FinnGen and UKB data. In the FinnGen data, higher genetically predicted age at natural menopause, systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting insulin were associated with an increased risk of uterine leiomyoma, while higher age at menarche was associated with a reduced risk of uterine leiomyoma. Multivariable MR analysis of SBP and DBP showed that higher DBP might be an independent risk factor of uterine leiomyoma. In the UKB data, the results for age at natural menopause, SBP, DBP, and age at menarche were replicated. The result of the meta-analysis suggested that uterine leiomyoma could also be affected by polycystic ovary syndrome (PCOS), endometriosis, and 2-hour glucose level. Our MR study confirmed that earlier menstrual age, hypertension, obesity, and elevated 2-hour glucose post-challenge were risk factors for uterine leiomyoma, and the causal relationship between smoking and uterine leiomyoma was ruled out. In addition, later age of menopause and endometriosis were found to increase the risk of uterine leiomyoma, while PCOS was found to decrease the risk.

Inherited mutations affecting the SRCAP complex are central in moderate-penetrance predisposition to uterine leiomyomas

Uterine leiomyomas (ULs) are benign smooth muscle tumors that are common in premenopausal women. Somatic alterations in MED12, HMGA2, FH, genes encoding subunits of the SRCAP complex, and genes involved in Cullin 3-RING E3 ligase neddylation are mutually exclusive UL drivers. Established predisposition genes explain only partially the estimated heritability of leiomyomas. Here, we examined loss-of-function variants across 18,899 genes in a cohort of 233,614 White European women, revealing variants in four genes encoding SRCAP complex subunits (YEATS4, ZNHIT1, DMAP1, and ACTL6A) with a significant association to ULs, and YEATS4 and ZNHIT1 strikingly rank first and second, respectively. Positive mutation status was also associated with younger age at diagnosis and hysterectomy. Moderate-penetrance UL risk was largely attributed to rare non-synonymous mutations affecting the SRCAP complex. To examine this disease phenotype more closely, we set out to identify inherited mutations affecting the SRCAP complex in our in-house sample collection of Finnish individuals with ULs (n= 860). We detected one individual with an ACTL6A splice-site mutation, two individuals with a YEATS4 missense mutation, and four individuals with DMAP1 mutations: one splice-site, one nonsense, and two missense variants. These individuals had large and/or multiple ULs, were often diagnosed at an early age, and many had family history of ULs. When a somatic second hit was found, ACTL6A and DMAP1 were silenced in tumors by somatic mutation and YEATS4 by promoter hypermethylation. Decreased H2A.Z staining was observed in the tumors, providing further evidence for the pathogenic nature of the germline mutations. Our results establish inactivation of genes encoding SRCAP complex subunits as a central contributor to moderate-penetrance UL predisposition.

8168 Umbilical Endometriosis and Vaginal Stump Endometriosis Developing after Total Laparoscopic Hysterectomy

<h3>Study Objective</h3> Even when endometriotic lesions in the pelvis are mild, they can survive in the vaginal stump and the trocar port-site after total laparoscopic hysterectomy. It is difficult to preoperatively assume the presence of fine lesions in the Douglas pouch when endometriosis is not detected elsewhere from imaging findings. Endometriotic lesions may survive in the vaginal stump, even in the absence of endometriosis in the uterus or adnexa. <h3>Design</h3> Case Presentation. <h3>Setting</h3> Yokohama City University. <h3>Patients or Participants</h3> A patient with less common/rare site endometriosis. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> A 40-year-old G0P0 presented with multiple uterine leiomyomas. Because of exacerbated hypermenorrhea, the patient underwent total laparoscopic hysterectomy and bilateral salpingectomy. Intraperitoneal findings included an approximately 1-cm endometriotic lesion in the peritoneum of the Douglas pouch, and partial adhesion of the rectum to the broad ligament. The vaginal canal was incised, and the uterus was transected, transvaginally morcellated and removed from the body cavity. Pathological examination revealed uterine leiomyoma, with no salpingeal abnormalities or endometriotic lesions. At 2 and 5 months postoperatively, the patient reported monthly genital bleeding; however, no apparent abnormalities were clinically observed. At 9 months postoperatively, the patient still experienced similar genital bleeding and noticed pain that occurred around the umbilicus simultaneously. Colposcopy revealed several red endometriosis-like lesions in the vaginal stump. The patient was eventually diagnosed with vaginal stump endometriosis. In addition, periodic pain appeared in the umbilical region as well, and the presence of endometriosis on umbilical port-site was suspected. Magnetic resonance imaging showed the umbilical trocar port-site endometriosis. Oral dienogest was started 11 months after surgery and maintained, and the patient's symptoms almost resolved after 5 months. <h3>Conclusion</h3> When patients complain of periodic genital bleeding or abdominal pain after total laparoscopic hysterectomy, vaginal stump and port-site endometriosis should be suspected. Vaginal stump endometriosis can be histologically diagnosed using colposcopy-guided biopsy, and dienogest may relieve symptoms.

Multiple painful skin papules, uterine leiomyomas and hysterectomy.

A 38-year-old woman presented with multiple papules and nodules. Her mother and maternal grandmother had similar lesions, and all three women had undergone hysterectomy at a young age. Histopathogical analysis revealed dense dermal nodules composed of eosinophilic spindle cells, and exposed elongated cells with abundant eosinophilic cytoplasm arranged in fascicles.

Assessment of placental complex function and miscarriage prevention in pregnant women with uterine fibroid

The objective: to reduce the frequency of the threat of pregnancy interruption and loss in women with uterine fibroid through treatment prediction and improvement.Materials and methods. A complex examination of 70 pregnant women with uterine fibroid at 15-16 weeks of pregnancy (main group) and 50 pregnant women without uterine fibroid at the same gestational term (control group) was carried out at 4 clinical bases of the Department of Obstetrics and Gynecology N1 of the Shupyk National Healthcare University of Ukraine in the time period of 2020-2022. Pregnant women in the main group were divided into 2 subgroups depending on the type of the nodes: Ia – 39 pregnant women with subserous type of fibroid nodes (type 5-6 according to FIGO) and Ib – 31 pregnant women with intramural fibroid (type 3-4 according to FIGO). The pregnant women in the main group received the complex of developed therapy for pregnancy interruption (micronized progesterone, magnesium preparations, vitamin B6, acetylsalicylic acid), in the control one – the common therapy (bed rest, abstinence from sexual life, micronized progesterone preparations, tranexamic acid).The concentrations of estradiol, progesterone, human chorionic gonadotropin (hCG) were determined in the blood plasma of all persons at 15–16 weeks and 24 weeks of pregnancy.Results. In the II trimester the concentration of estradiol in the blood of pregnant women with intramural uterine fibroid, especially with multiple forms, was significantly higher than in the control group (p&lt;0.05). At the same time, in pregnant women with intramural fibroid node(s) the mean concentration of estradiol exceeded the similar indicator in the group with the subserosal type (p&lt;0.05). These changes indicated the stress of the hormonal function of the placenta and were considered by us as one of the signs of the initial stage of placental dysfunction.With an increase in estradiol concentration, a significant decrease in progesterone amount was noted. Progesterone deficiency was significantly more common in the subgroup of pregnant women with multiple intramural uterine fibroid and nodes in contact with the uterine cavity, especially at the place of placenta attachment (type 3) – 165.24±14.71nmol/l compared to the control group – 219.96±16.63 nmol/l, and with pregnant women with subserosal node(s) – 210.61±18.57 nmol/l (р&lt;0.01), which confirms the threat of abortion and indicates the development of placental dysfunction. In the II trimester of pregnancy the concentration of hCG in women with uterine fibroid was significantly lower than in women without uterine fibroid and especially lower in multiple uterine fibroid. In the women of the main group progesterone and hCG concentrations in the blood plasma normalized (p&gt;0.05) after the treatment, but the level of estradiol in the group of pregnant women with multiple intramural uterine leiomyoma remained significantly higher (p&lt;0.05).Conclusions. Pregnant women with uterine fibroid have an increased risk of placental dysfunction with a disbalance of the main placental hormones: an increase in estradiol concentration and a relative decrease in progesterone and human chorionic gonadotropin, a shift in the estrogen-progesterone balance towards relative hyperestrogenia.The use of medical measures with long-term support with progesterone, magnesium and low doses of acetylsalicylic acid for the prevention of miscarriage in persons with the clinical manifestations of the threat of gestation is quite effective.

Reed’s syndrome: a combination of a renal cyst with leiomyoma of the skin and uterus (clinical observation)

Multiple cutaneous and uterine leiomyomatosis (MCUL), also known as Reeds syndrome, is a rare genodermatosis, with an autosomal dominant pattern of inheritance. It results from a germline heterozygous mutation of fumarate hydratase gene, that is classified as a tumor suppressor gene. Hereditary leiomyomatosis and renal cell cancer is characterized by the association of multiple cutaneous and uterine leiomyomatosis with renal cell carcinoma. The diagnosis of multiple leiomyomas is based on the identification of morphological characteristic rashes (small, oval, red-brown or flesh-colored nodules located around the hair follicles, often painful) and is confirmed by the method of pathomorphological examination. Treatment of leiomyomas depends on their number, size, area of skin lesion and severity of subjective symptoms. With single rashes, surgical excision of the largest and most painful elements is possible, with severe pain syndrome ― calcium channel blockers, alpha-blockers and gabapentin. Cryotherapy, diathermocoagulation, and laser ablation with a carbon dioxide laser are used to destroy the nodes.&#x0D; The presence of cutaneous leiomyomas in patients dictates the need for careful collection of anamnesis, including family and obstetric-gynecological, conducting a full-fledged clinical, laboratory and instrumental examination and consulting by related specialists. Annual screening for early detection and therapy of renal cell carcinoma is also mandatory.&#x0D; Due to the existing probability of the hereditary nature of Reeds syndrome, a thorough examination of the patients relatives is necessary.&#x0D; We report a case of a 58-year-old woman with Reeds syndrome: multiple cutaneous leiomyomas, uterine leiomyoma and renal cysts.

Robot-assisted laparoscopic hysterectomy for early-stage endometrial cancer with massive uterine leiomyomas: A case report

Introduction and importanceCompared to conventional laparoscopic surgery, robot-assisted surgery enables precise operation, with the aid of high-resolution 3D images and articulated forceps, even in cases where the uterus is very large.Case presentationA 48-year-old woman with severe obesity was referred to our hospital with atypical genital bleeding for half a year. She was diagnosed with multiple uterine leiomyomas and early endometrial cancer with presumed advanced stage classification (stage IA). Robot-assisted laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node biopsy were performed. Due to the difficulty of removing the uterus transvaginally, the umbilical incision was extended by 7 cm, which allowed the uterine tissue removal without shredding or leakage into the pelvic cavity. The patient was discharged 5 days postoperatively, with no postoperative complications.Clinical discussionRobot-assisted surgery has often been used for the management of early-stage endometrial cancer. Robot-assisted laparoscopic hysterectomy has significantly fewer intraoperative and postoperative complications than laparoscopic and abdominal hysterectomy.ConclusionImproving this surgical procedure allows for safe and easy robot-assisted uterine malignant tumor removal even in cases where the patient presents with severe obesity and huge uterine leiomyomas.

Uterine leiomyomatosis in adolescents and young adults (AYAs) may represent a narrow phenotypic variant of FH tumour predisposition syndrome

FH Tumour Predisposition Syndrome, also known as Hereditary Leiomyomatosis and renal cell cancer (HLRCC), or Reed Syndrome, is an autosomal dominant condition clinically characterized by multiple cutaneous leiomyomas, multiple early-onset uterine leiomyomas and early-onset renal cell cancer. Here we report a young female with FH Tumour Predisposition Syndrome with no clinical features except early-onset uterine leiomyomas. Whilst there is a significant history of uterine leiomyomas in her family, there is no history of cutaneous leiomyomas or renal cell cancer (RCC). Uterine leiomyomatosis in young adults may represent a narrow phenotypic variant of FH Tumour Predisposition Syndrome. It is important that young women who present with multiple leiomyomata or leiomyomata with atypical features are referred for molecular genetic testing.

Multiple uterine leiomyomas removal by single hole laparoscope without pneumoperitoneum suspension

Multiple uterine leiomyomas removal by single hole laparoscope without pneumoperitoneum suspension

Multiple uterine leiomyomas removal by single hole laparoscope without pneumoperitoneum suspension.

Multiple uterine leiomyomas removal by single hole laparoscope without pneumoperitoneum suspension.

Морфологічні особливості ендо- та міометрія у пацієнток з лейоміомою матки і безплідністю

The objective: determination of morphofunctional features of leiomatous nodes and endometrium in women with uterine leiomyoma and infertility to restore reproductive function and prevent recurrence of the underlying disease. Materials and methods. In order to restore reproductive function and prevent recurrence of the underlying disease, morphofunctional features of leiomatous nodes and endometrium in women with uterine leiomyoma and infertility were determined. Thirty samples of leiomyomatous nodes and endometrium were examined, among which 15 were obtained from women with multiple uterine leiomyoma and infertility and 15 samples from women with uterine leiomyoma with isolated uterine leiomyoma. During the study, a general-histological method was used for staining with hematoxylin-eosin and picrofuxin by van Gizon, as well as immunohistochemical methods. Histological examination of the endometrium was performed according to conventional protocol, taking into account the day of the menstrual cycle and R.W. Noyes criteria. Results. In the morphological examination of leiomyomatous nodes in the vast majority of cases the presence of uterine leiomyomas of simple and cell types or their combination was established. In women with multiple uterine leiomyoma, simple-type leiomyoma (53.3%) was predominant, and in patients with isolated leiomyoma the signs of cellular uterine leiomyoma (66.7%) were more frequently found. In 80.0% of women with uterine leiomyoma revealed pathology of the endometrium, such as glandular and glandular-fibrous polyps, simple and complex atypical endometrial hyperplasia, which confirms the theory about the only pathogenetic mechanisms of the emergence of hyperplastic processes of female organs. In 66.7% of women with multiple leiomyomas, signs of chronic endometritis have been found, which exacerbates the pathological process and can have a negative impact on the reproductive function, such as secretory endometrial transformation and impaired blastocyst implantation, and explains a much higher percentage of infertility in the group. Conclusion. In women with impaired reproductive function, patients with uterine leiomyoma, it is necessary to conduct a study of the receptivity of the reproductive organs, namely - the endometrium and leiomatous nodes. This will make it possible to use one or another method of treatment in order to restore reproductive function and prevent recurrence of the underlying disease. Keywords: infertility, uterine leiomyoma, endometrium, receptive apparatus.

Bifocal Intestinal Endometriosis Mimicking Colonic Tumor: A Case Report

Introduction: Endometriosis is a gynaecological disorder, defined as presence of endometrial glands and/or stroma in any location outside the endometrial cavity and it is usually seen in women of reproductive age group. It involves many organs including the intestine and may cause acute large bowel obstruction. Case Presentation: A 32-year-old nulligravida woman presented with 5 years history of recurrent constipation, recurrent lower abdominal pain, menstrual irregularities and dysmenorrhea. An assessment of intestinal obstruction and multiple uterine leiomyoma was made following series of investigations including plain abdominal x-ray, abdomino-pelvic ultrasound, CT and proctoscopy. She had exploratory laparotomy and a mass was found in the caecum and transverse colon with multiple mesenteric lymph nodes. She subsequently had extended right hemicolectomy with ileo-colic anastomosis and myomectomy. Postoperative condition of the patient was satisfactory. The diagnosis of bifocal intestinal endometriosis was made on histopathological assessment. Conclusion: It is advised that endometriosis should be part of differential diagnosis in a young woman presenting with recurrent signs and symptoms of intestinal obstruction and colonic mass especially on a background of dysmenorrhea.

Hereditary leiomyomatosis and renal cell carcinoma syndrome-associated renal cell carcinoma: Morphological appraisal with a comprehensive review of differential diagnoses.

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an autosomal dominant syndrome wherein affected individuals are at risk for the development of cutaneous leiomyomas, early-onset multiple uterine leiomyomas, and an aggressive subtype of renal cell cancer. HLRCC is caused by germline mutations in the fumarate hydratase (FH) gene, which inactivates the enzyme and alters the function of the tricarboxylic acid/Krebs cycle. This article reviews the hitherto described morphologic features of HLRCC-associated renal cell carcinoma (RCC) and outlines the differential diagnosis and ancillary use of immunohistochemistry and molecular diagnostics for these tumors. The morphologic spectrum of HLRCC-associated RCC is wide and histologic features, including tumor cells with prominent nucleoli, perinucleolar halos, and multiple architectural patterns within the same tumor, which are suggestive of this diagnosis. FH immunohistochemistry in conjunction with genetic counseling and germline FH testing are the important parameters for detection of this entity. These kidney tumors warrant prompt treatment as even smaller sized lesions can demonstrate aggressive behavior and systemic oncologic treatment in metastatic disease should, if possible, be part of a clinical trial. Screening procedures in HLRCC families should preferably be evaluated in large cohorts.

256P - Lnc-AL445665.1-4 may be involved in the development of multiple uterine leiomyoma through interacting with miR-146b-5p

BackgroundThe clinical behaviors and cytogenetics of solitary uterine leiomyomas (SUL) and multiple uterine leiomyomas (MUL) vary. Our previous study demonstrated that miR-146b-5p played important roles in the development of SUL and MUL. Long non-coding RNAs (lncRNAs) can participate in the pathogenesis of several diseases by regulating microRNAs; however, their roles in regulating miR-146b-5b and in the pathology of leiomyomas are unclear. MethodsPair-matched uterine leiomyoma and adjacent normal myometrium tissue samples were collected from 37 patients with leiomyomas, including 15 with SUL and 22 with MUL. Six paired samples were used for lncRNAs microarray analysis. Targeted lncRNAs were selected by bioinformatics analysis, and were verified by qRT-PCR and a dual-luciferase reporter assay.Growth curve analysis and qRT-PCR were used to evaluate the effect of silencing the lncRNA lnc-AL445665.1-4 on cell proliferation and miR-146b-5p expression, respectively. ResultsFifty-five of the selected lncRNAs were predicted to target miR-146b-5p. Four lncRNAs were selected after Venn diagram analysis showing common dysregulation in the three groups. Lnc-AL445665.1-4 was selected for further exploration. qRT-PCR showed that lnc-AL445665.1-4 expression was significantly up-regulated in MUL compared with SUL in an additional 12 and 19 paired SUL-normal and MUL-normal samples, respectively. The dual-luciferase reporter assaydemonstrated the presence of binding sites on lnc-AL445665.1 for miR-146b-5p. Silencing lnc-AL445665.1-4 not only inhibited cell proliferation but also negatively regulated the expression of miR-146b-5p. ConclusionsOur results suggest that lnc-AL445665.1-4 may be involved in the development of MUL by interacting with miR-146b-5p. Lnc-AL445665.1-4 could be a novel target for genetic therapy or serve as a biomarker for predicting the recurrence of MUL in patients that have undergone myomectomy. Legal entity responsible for the studyZhengyu Li and E. Yang. FundingHas not received any funding.All authors have declared no conflicts of interest.

A case of pulmonary benign metastasizing leiomyoma: clinicopathologic, immunohistochemical, and PET/CT analyses

The pulmonary benign metastasizing leiomyoma (BML) is an extremely rare disease case, of which the pathogenesis was not elucidated. The accumulation of additional case reports and analyses is needed. A case of pulmonary BML is presented. A 48-year-old asymptomatic female patient that underwent a hysteromyomectomy 11 years ago was found to have abnormal shadows on a chest X-ray during a regular health check-up in 2012. Multiple nodular was observed in both lungs and uterine under computed tomography (CT) examination. Transbronchial lung biopsy surgery with a resection of the lesion was performed. The results revealed the pulmonary nodule was formed by benign smooth muscle cells which displayed very low mitotic activity. The samples showed highly positive signals for α-smooth muscle actin (αSMA), Desmin and Vimentin. Estrogen receptor (ER) and progesterone receptor (PR) were also immunoreactive positive. HMB-45, CD117 (C-kit) and S-100 were found to be negative with low Ki-67 index in the tumor cells. The pathological diagnosis was pulmonary BML. A total hysterectomy with adnexectomy were performed for the multiple uterine leiomyomas and pulmonary BML one week after diagnosis was made. From then on, the pulmonary nodules in both lungs were stable in 7 years postoperation, based on chest CT scan. When a solitary lung nodule is detected in a patient with a history of uterine leiomyoma, as an option, pulmonary BML, accurately diagnosing and proper treatment to has important implications for clinical outcome.

2932 Total Laparoscopic Hysterectomy: 5 Step Approach for Uteri Larger than 500 Grams

Video Objective To demonstrate a five step approach facilitating successful completion of Total Laparoscopic Hysterectomy (TLH) in patients with uteri larger than 500 grams. Setting Tertiary health care facility. Two consecutive patients underwent TLH for fibroid uterus, abnormal uterine bleeding and pelvic pain. Interventions Total Laparoscopic Hysterectomy, Bilateral Salpingectomy (BS) and Cystourethroscopy. Two consecutive patients with large uteri who failed medical management and desired definitive surgical management were selected. Both patients diagnosed with multiple uterine leiomyomas and underwent pre-operative endometrial biopsy and magnetic resonance imaging to minimize risk of occult malignancy. Patient one had a uterus measuring 22 × 15 × 12 cm and patient two had a uterus measuring 20 × 16 × 13 cm. They both had history of multiple prior abdominal surgeries. The mean total operative time was 78 minutes and EBL was 50 ml in both cases. They were discharged on postoperative day one and had no complications. Conclusion TLH is a feasible option for women with a uterus larger than 500 grams. Despite the uterine size and multiple prior abdominal surgeries, a systematic approach to performing TLH allows safe completion of surgery with relatively short surgical time and minimal blood loss while affording the recognized benefits of minimally invasive surgery.