Resected Myoma Research Articles

Challenges Associated with Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) Management—A Case Report with Comprehensive Literature Review

Background: Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) is a poorly studied neoplasm that does not fulfill the definition of either leiomyoma or leiomyosarcoma. STUMP symptoms are indistinguishable from those of benign lesions; it has no specific biochemical markers or ultrasound presentations. The management of this type of tumor is particularly challenging due to significant heterogeneity in its behavior and the lack of clear guidelines; moreover, the lesion may recur after excision. Case Report: We report on a case of a 42-year-old patient diagnosed with a STUMP. The preliminary diagnosis was a submucous leiomyoma, which was removed hysteroscopically due to menorrhagia resulting in anemia. The histopathological examination of the resected myoma pointed to the diagnosis of STUMP. The hysterectomy was performed as the patient had completed her reproductive plans. There were no complications. The patient is currently recurrence-free after a 9-month follow-up. Discussion and Conclusions: The care of a patient diagnosed with STUMP requires a personalized approach and the cooperation of various medical disciplines, including molecular diagnostics, imaging techniques, and minimally invasive surgery. Management of STUMP must consider the patient’s plans for childbearing. All cases of tumors with “uncertain malignant potential” are a challenge in the context of patient-physician communication.

8886 Endometrial Wound Healing Duration after Hysteroscopic Treatment of Type 2 and 3 Myomas

<h3>Study Objective</h3> To assess the mean resolution time of the fovea after hysteroscopic treatment of type 2 and type 3 myoma. <h3>Design</h3> Prospective observational study. <h3>Setting</h3> University of Naples Federico II, Naples, Italy. <h3>Patients or Participants</h3> <b>W</b>omen aged 30-50 years, with at least one type 2 or type 3 myoma, history of infertility or uterine bleeding who underwent hysteroscopic myomectomy. <h3>Interventions</h3> <b>A</b>ll patients underwent hysteroscopic myomectomy, using a 15 Fr or 26 Fr resectoscope, either outpatient or in the operating room. All surgical procedures were performed by one expert hysteroscopist. Cold loop myomectomy applied to bipolar resectoscope was used for the removal of the intramural component of the myomas. All women underwent repeated follow-up office hysteroscopies every week after the surgical procedure for the first month and then every two weeks for the following months <h3>Measurements and Main Results</h3> Thirty-one patients with type 2 or 3 myoma with infertility (26/31) or uterine bleeding (15/31) were enrolled. The resectoscopic myomectomy was successful in all cases, without any significant complications. Overall, the mean diameter of resected myomas was 23 mm. The fovea was almost completely restored between three to six weeks after surgery in case of myomas < 2 cm and on average within 56 days for myomas of any size. The resolution was faster in women < 40 years old. No correlation was observed between the resolution time of the fovea and the different localization of the myomas <h3>Conclusion</h3> These preliminary data showed short time to resolution of the fovea in case of type 2 and 3 myomas hysteroscopically treated. The respect of the myometrium and the reduced thermal injury obtained thanks to the cold loop technique applied to bipolar resectoscope, may have influenced the resolution time of the fovea

Clinical experience of robotic myomectomy for fertility preservation using preoperative magnetic resonance imaging predictor.

ObjectiveThis study aimed to demonstrate the use of preoperative magnetic resonance imaging (MRI) findings to select the optimal surgical technique between single-site (SS) and multi-site (MS) robotic myomectomy based on clinical experience, for the preservation of fertility.MethodsNinety-eight patients who underwent SS or MS robotic myomectomy using the da Vinci® Si system after undergoing MRI were evaluated retrospectively. The correlation between preoperative MRI findings and the intraoperative or postoperative findings during robotic myomectomy for the preservation of fertility was analyzed. The reproductive outcome was investigated when the patient wished to conceive.ResultsThe mean age of the patients was 35.68±5.04 years and 80 patients (81.6%) were nulliparous. The total diameter of myomas on MRI was 106.75±54.52 mm. The number of resected myomas was 4.31±4.39 (range, 1–27), and the total weight of resected myomas was 293.11±281.13 (range, 30–1,260) g. Myomas with high signal intensity on MRI required less time for resection. MS robotic myomectomy was performed for an increased number and total diameter of a myoma or a deep-seated myoma. Postoperatively, all patients resumed normal menstruation. Of the 15 patients who wished to conceive, 12 (80%) conceived successfully. Of these, uterine dehiscence occurred in 1 patient and 10 patients underwent an uneventful cesarean section.ConclusionSS or MS robotic myomectomy can be recommended for patients who wish to conserve fertility. However, the optimal surgical technique should be selected based on preoperative MRI findings to predict an effective surgical process and the successful preservation of fertility.

Imaging features and clinical analysis of diffuse uterine leiomyomatosis cases

Objective: To discuss the imaging, clinical features and management of diffuse uterine leiomyomatosis (DUL). Methods: Six cases of DUL confirmed in Peking Union Medical College Hospital from August 2009 to September 2019 were reviewed on their image and clinical data. Retrospective analysis was conducted on their perioperative and postoperative follow-up data. Results: The average age of the first diagnosis of DUL was (27±3) years old. All of the patients complained menorrhagia and three patients suffered moderate to severe anemia. Three patients were diagnosed infertility. Pelvic ultrasound and MRI showed symmetrical enlarged uterus with complete replacement of the myometrium by innumerable, confluent leiomyomas.Four patients were treated with GnRH-a before operation to reduce the volume of myoma and correct anemia. Among the six patients, five had undergone myomectomy because of DUL before visiting Peking Union Medical College Hospital. Three patients underwent open myomectomy. The number of resected myoma was 188-300 and the bleeding volume was 1 200-2 500 ml. Two of them suffered recurrence at 51 and 40 months after operation. One received sirolimus for 20 months without recurrence until now. Other three patients underwent hysterectomy. One patient underwent partial small bowel resection and partial omentum resection because of severe pelvic adhesion during hysterectomy, and the blood loss was 2 000 ml. Conclusions: Pelvic imaging especially MRI is helpful for early recognition and preoperative evaluation for DUL. Fertility preservation is a great challenge for DUL patients. The risk of recurrence after myomectomy is high. Hysterectomy is the last choice to completely cure DUL at present.

Recovery of quality of life after laparoscopic myomectomy.

AimIt is commonly thought that laparoscopic surgery leads to faster postoperative recovery for its low invasiveness. We evaluated postoperative quality of life (QOL) after laparoscopic myomectomy (LM) by using the Euro‐QOL 5 dimension (EQ‐5D) score and analyzed its relationship to surgical factors.MethodsBetween 2014 and 2016, 541 patients underwent LM at our institution. We included 86 patients in the final analysis (16% response rate) who replied to the EQ‐5D questionnaire, in order to investigate postoperative QOL. We evaluated patients’ EQ‐5D score before the operation and on the 3rd, 7th, 14th, 21st and 28th postoperative day (POD). We investigated the degree of correlation between the EQ‐5D score and four surgical characteristics (operation time, intraoperative bleeding, number of resected myomas and weight of specimen). We examined correlation between EQ‐5D scores and chief complaints such as hypermenorrhea, dysmenorrhea, other pain, myoma enlargement, palpable tumor and desire for childbearing. We also examined correlation between EQ‐5D scores and other factors such as patient's age, infertility, history of abdominal surgery, marriage and body mass index.ResultsFull recovery, defined as an EQ‐5D score of 1.0, was reported 2.3% of patients by POD3, 18.6% by POD7, 58.1% by POD14, 73.3% by POD21 and 86.0% by POD28.Longer duration of operation correlated weakly with poor recovery on POD3. Intraoperative bleeding, number of resected myomas and weight of the specimen did not significantly influence EQ‐5D score. There was no correlation between chief complaints or other factors mentioned above and EQ‐5D score.ConclusionsMore than a half of the patients undergoing LM included in our study reported full recovery of QOL after 2 weeks. The time to recover QOL was slightly influenced by the operation time. However, when LM was finished without any complications, postoperative QOL eventually seemed to improve regardless of the surgical characteristics such as operation time, intraoperative bleeding, number of resected myomas and weight of specimen.

Is robot-assisted laparoscopic myomectomy limited in multiple myomas?: a feasibility for ten or more myomas.

ObjectiveTo evaluate the feasibility of robot-assisted laparoscopic myomectomy in multiple myomas over 10.MethodsA retrospective study was conducted for 662 patients who underwent robot-assisted laparoscopic myomectomy and open myomectomy by a single operator in a tertiary university hospital.ResultsA total of 30 women underwent removal of 10 or more uterine myomas by robotics and 13 patients were selected for this study. The average number of myomas removed was 13.7 (range 10–20). The maximum diameter of the myomas was 6.8 cm (range 5.0–10.0 cm). The sum of the diameters of each myoma was 34.7 cm (range 20.0–54.5 cm) and the mass of resected myomas for each case was 229.1 g (range 106.8–437.9 g). In no case was the robotic procedure converted into conventional laparoscopy or laparotomy, and all patients recovered without any major complications. In comparison with 13 cases of open myomectomy during the same period, robotic surgery took longer time than open surgery (360.5 vs. 183.8 minutes; P=0.001) but had shorter postoperative hospital days after surgery (mean 2.5 vs. 3.5 days; P=0.003).ConclusionRobot-assisted laparoscopic myomectomy could be an alternative to laparotomic myomectomy for numerous myomas over 10 in number.

Minilaparotomy Hysterectomy as a Suitable Choice of Hysterectomy for Large Myoma Uteri: Literature Review.

The objective of this paper is to propose minilaparotomy hysterectomy as the suitable choice for large uterus on the basis of our experienced case of performed minilaparotomy hysterectomy to 4,500 g myoma uteri and review published cases about this clinical condition. We presented a 44-year-old woman (gravida 0, virgin) who consulted our hospital because of the chief complaints of abnormal genital bleeding and hypermenorrhea. Transabdominal ultrasonography revealed that abdominal solid tumor reached over the navel. Her tumor was an indication of surgery; to do minilaparotomy hysterectomy with laparoscope was decided because her informed consent was obtained. A 6 cm transverse incision (Maylard incision) was made to the skin above the pubic hairline. At the end of surgery, the length of abdominal wound was 8.5 cm, operating time was 128 min, weight of resected myoma uteri was 4,500 g, and intraoperative blood loss was 895 mL. Blood transfusion was not done; postsurgical course was not a problem without anemia. We propose that a large uterine case in which it is difficult to perform vaginal or laparoscopic hysterectomy should be considered in order to select minilaparotomy hysterectomy up to around 5 kg weight of uterus, and the length of skin incision in minilaparotomy hysterectomy is necessarily <9 cm particularly in large uterus.

Cold loops applied to bipolar resectoscope: A safe "one-step" myomectomy for treatment of submucosal myomas with intramural development.

To assess the safety and efficacy of cold loop myomectomy applied to bipolar resectoscope to perform "one-step" myomectomy of submucosal myomas with intramural involvement. Seventy-two patients with at least one symptomatic G1 or G2 myoma (Wamsteker's classification) underwent cold loop myomectomy from January 2011 to January 2013. All surgical procedures were performed using a 26Fr resectoscope and bipolar energy source. At one month after the procedure, all patients underwent an office hysteroscopy check-up. A subgroup of seven infertile patients underwent an office hysteroscopy every two-weeks to evaluate recovery time of the myometrial fovea. Resectoscopic myomectomies were successfully performed in one surgical step in 70 out of 72 patients without any significant complications. Overall, the mean diameter of resected myomas was 32.2 ± 9 mm. Median operative time was 34.2 ± 24.1 min. Median fluid deficit was 761.22 ± 480.34 ml. The fovea was almost completely restored (>80%) six weeks after surgery in six of the seven infertile patients who underwent repeated follow-up office hysteroscopies every two weeks. Data from the present study show that the use of cold loops applied to bipolar resectoscope represent an effective, safe technique for "one-step" myomectomy of G1-G2 myomas, allowing rapid recovery of the myometrial fovea.

Office Hysteroscopic Laser Enucleation of Submucous Myomas without Mass Extraction: A Case Series Study.

Background and Objectives. A new two-step hysteroscopic myomectomy carried out in the office setting and without anesthesia was feasible for the excision of submucous myomas. The objective of this study was to assess whether removal of submucous myomas from the uterine cavity after hysteroscopic laser enucleation is necessary. Methods. Between June 2009 and April 2013, all outpatients with symptomatic myomatosis (bleeding, pelvic pain, and infertility) assessed ultrasonographically were eligible to participate in a prospective study. All patients underwent office hysteroscopic enucleation of submucous myomas. Enucleated myomas were left in the uterine cavity. Neither anesthesia nor antibiotic prophylaxis was used. Results. Sixty-one women (mean age: 47.3 years) were included. Regardless of hysteroscopic localization and grading, all myomas were enucleated. The mean (standard deviation, SD) diameter of the myoma as measured by the ultrasound scan was 22.6 (8.5) mm. In 29 cases (47.5%), the diameter of the resected myoma was >20 mm and in 10 cases (16.4%) >30 mm. After a mean follow-up of 68.2 (16.5) days, none of the patients showed a residual myoma inside the uterine cavity. Conclusions. The present results indicate that leaving laser-enucleated submucous myoma in the uterine cavity is a feasible and safe therapeutic option.

埋没したIUDリングにより子宮内腫瘤を形成したと考えられた1例

We report a case of an intrauterine tumor mass caused by an embedded intrauterine device (IUD). The patient was preoperatively diagnosed as a submucous leiomyoma of the uterus and underwent a hysteroscopic myomectomy. We discovered the IUD postoperatively inside the submucous leiomyoma. The patient is a 73 years old gravida 2, para 2. She had a history of hypertension and was on oral medication. She had forgotten that she had undergone an IUD insertion. At her clinic visit, her chief complaint was metrorrhagia. An endometrial polyp was suspected and she was referred to our hospital. A transvaginal ultrasound examination imaged a tumor-like lesion in the uterine cavity with both hypoechoic and hyperechoic areas. Magnetic resonance imaging (MRI) showed a well-circumscribed tumor with focal high signal intensity in T2 weighted images. Both the cervical and endometrial cytology were negative at her previous clinical examination. We performed an outpatient hysteroscopy and found a pedunculated mass at the uterine fundus. The preoperative diagnosis was a submucous leiomyoma; she underwent a myomectomy via operative hysteroscopy under general anesthesia. Complete resection of the myoma was performed, and an IUD was discovered inside the resected myoma. She had a benign postoperative course, and no post-myomectomy adhesions developed.

Vaginal myomectomy for subserosal and intramural fibroids

Our aim was to explore the feasibility and safety of vaginal myomectomy in patients with subserosal and intramural uterine fibroids. Between June 2007 and June 2011, 38 patients with subserosal and intramural uterine fibroids were offered vaginal myomectomy. We analyzed the indications, operative performance, postoperative complications, recovery and fertility follow-up (24 months) of the patients. Results. Vaginal myomectomy was successful in all cases. One of our patients (38 years old) developed pelviperitonitis along with vaginal cuff dehiscence 7 days after surgery, and required subtotal abdominal hysterectomy. None of the cases required conversion to laparotomy or laparoscopy. Uterus size varied between 6 and 12 gestational weeks. The number of resected myomas was restricted to a maximum of three per patient and their weight varied from 125 to 175 g per myoma. The mean operative time was 31.68 ± 5.27 min; the intraoperative blood loss was 112.36 ml ±70.76 ml and none of the patients required transfusions. Hospitalization was 2.34 ± 0.6271 days. One patient developed fever 48 hours after surgery but symptoms disappeared after a 5 day antibiotics regimen; 2 patients delivered full-term babies at 12 and 24 months after surgery, respectively. Conclusions. Vaginal myomectomy, a minimally invasive technique with minimal tissue injury, is a feasible, safe and well tolerated alternative to abdominal myomectomy for well selected cases. <br/><a href=

腹腔鏡補助下子宮筋腫核出術と腹腔鏡下子宮筋腫核出術の侵襲についての比較検討

Background: In regard to myomectomy carried out using a laparoscope, there has been a recent transition from laparoscopic-assisted myomectomy (LAM) via a small incision to total laparoscopic myomectomy (LM). However, there are few reports documenting that LM is actually less invasive than LAM. Here, we compared the difference in invasiveness between LAM and LM. Method: We compared the data from 111 patients undergoing LAM and 85 patients undergoing LM at our hospital, after obtaining informed consent, between January 2009 and December 2012. We limited our analysis to patients in whom the specimen weight was 600 g or lower and excluded those who underwent simultaneous multiple organ surgery, such as surgical manipulation of the ovary. Variables for comparison were: the amount of blood loss, the operative time, the white blood cell count on postoperative day 1, the CRP level on postoperative day 3, and the postoperative maximum score on the VAS scale. Results: In the absence of any significant difference in the weight of the extracted specimens, the number of resected myomas was significantly larger in the LAM group. The intraoperative blood loss and the operative time were significantly lower and shorter, respectively, in the LAM group; however, the CRP level on postoperative day 3 and the postoperative maximum score on the VAS scale were significantly lower in the LM group. No significant difference was observed in the white blood cell count on postoperative day 1. Conclusion: These results suggest that LM is less invasive than LAM in the early postoperative stage.

Factors Affecting Fertility Following Laparoscopic Myomectomy

Abstract Objective: This study was performed to assess the factors affecting fertility following laparoscopic myomectomy (LM). Design: A retrospective review of 36 women who underwent LM between January 2003 and September 2008 was performed. Materials and Methods: Between patients who were able to become pregnant after LM and patients who were unable to do so, comparisions were made of age of the patients, gonadotrophin hormone-releasing analogues pretreatment, number and diameter of resected myomas, type of the largest resected myoma, operation time, amount of hemorrhage, and reaching the uterine cavity during the surgery. A Mann–Whitney U test or χ2 test was used to investigate differences between the two groups. Results: Of 36 women, 14 achieved postoperative pregnancy. Between the group of 14 patients who were able to become pregnant and the group of 22 patients who were unable to do so, there was significant difference in the mean age of the patients (mean±standard deviation, 31.9±4.0 vs. 35.6±3.4, p...

Gasless laparoscopically assisted myomectomy using a wound retraction system

The purpose of this study was to elucidate the feasibility of gasless laparoscopically assisted myomectomy (LAM) using a wound retraction system. This method treats symptomatic uterine myomas by combining laparoscopy with a mini-laparotomy to enucleate myoma nodules and to close the uterine myometrium. This study includes 275 patients who underwent gasless LAM. For patients with fewer than three myoma nodules, the location of the largest nodule was classified as anterior, fundal, or posterior. The operative outcomes, intraoperative and postoperative courses, and complications were examined. All operations were performed satisfactorily, and no conversions to laparotomy were required. None of the patients developed serious complications. The mean blood loss and operating time were 190.3 mL and 152.2 minutes, respectively. The mean myoma size was 8.9 cm, and the mean number of myomas per patient was 2.8. The average postoperative hospital stay was 5.7 days. There were no significant differences in resected myoma size, blood loss, and surgical duration with respect to the location of the largest nodule. Gasless LAM with a wound retractor is feasible and allows surgeons to perform myomectomy safely and cost-effectively, without requiring advanced laparoscopic surgical skills and while maintaining minimum invasiveness.

Torsion of Pedunculated Subserous Myoma

We report a case of torsion of a pedunculated uterine leiomyoma. A 56-year-old married Chinese female presented at the emergency department with complaints of severe lower abdominal pain on July 27, 2010. A transabdominal sonogram revealed multiple uterine masses, including a pedunculated mass. With a preoperative diagnosis of torsion of a pedunculated subserosal leiomyoma, the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. On gross inspection, the resected myoma was ischemic, and both focal hemorrhage and necrosis were noted in the pathology report. In conclusion, torsion of a pedunculated uterine myoma is rare but represents a surgical emergency to improve symptoms and avoid consumptive coagulopathy. doi:10.4021/jmc136w

Torsion of Pedunculated Subserous Myoma

We report a case of torsion of a pedunculated uterine leiomyoma. A 56-year-old married Chinese female presented at the emergency department with complaints of severe lower abdominal pain on July 27, 2010. A transabdominal sonogram revealed multiple uterine masses, including a pedunculated mass. With a preoperative diagnosis of torsion of a pedunculated subserosal leiomyoma, the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. On gross inspection, the resected myoma was ischemic, and both focal hemorrhage and necrosis were noted in the pathology report. In conclusion, torsion of a pedunculated uterine myoma is rare but represents a surgical emergency to improve symptoms and avoid consumptive coagulopathy. J Med Cases. 2011;2(2):62-63 doi: https://doi.org/10.4021/jmc136w

Torsion of a Uterine Leiomyoma

To report a case of torsion of a pedunculated uterine leiomyoma. A 38-year-old female virgin presented at the emergency department with complaints of severe lower abdominal pain on November 30, 2005. A transabdominal sonogram revealed multiple uterine masses, including a pedunculated mass. With a preoperative diagnosis of torsion of a pedunculated subserosal leiomyoma, the patient underwent an abdominal myomectomy. On gross inspection, the resected myoma was ischemic, and both focal hemorrhage and necrosis were noted in the pathology report. Torsion of a pedunculated uterine myoma is rare but represents a surgical emergency to improve symptoms and avoid consumptive coagulopathy.

Laparoscopic myomectomy during pregnancy resulting in septic necrosis of the myometrium

Case reportA 35 year old primiparous woman attended the emer-gency department at 17 weeks of gestation for acute rightiliac fossa pain with guarding. Rebound pelvic examinationwas painful. The patient’s temperature was 38.6jC andlaboratory tests showed no leucoytosis. Ultrasound re-vealed a single intrauterine viable pregnancy equivalentto dates and additionally a uterine mass in the left lateralwall of the uterus, 5 cm in length. Due to a suspectedadnexal torsion, a laparoscopy was performed, whichrevealed a degenerating pedunculated uterine leiomyomawithout torsion of the pedicle. It was situated on theanterior surface of the uterus below the right uterine cornu.Because the woman was so symptomatic, myomectomywas performed by resection of the myoma using monopolarcutting diathermy via a hook electrode with a 40 W poweroutput. Despite the insertion of an endoloop constrictingthe pedicle prior to electroresection, the top of the pediclewas slightly electrocoagulated to ensure perfect hae-mostasis. The uterine cavity was not opened. The myomawas extracted via a transumbilical approach, by morcella-tion. Histological examination confirmed the diagnostic ofaseptic degeneration of uterine leiomyoma. Abdominalpain occurred six days post-operatively, with associatedileus and pus at the umbilical incision but with no fever.The umbilicus was irrigated with Betadine and penicillin Vwas started. Clinical improvement occurred and she wasdischarged from hospital. She returned two weeks laterwith an intestinal obstruction mass in the right iliac fossaand a recurrence of umbilical infection. Ultrasound exam-ination showed collection of 10 cm diameter, comparedwith the area of myomectomy extending to the neighbour-ing myometrium. Laparotomy was performed via an umbil-ical median incision and revealed an abscess on the anteriorsurface of the uterus. It was situated on the scar of thepedicle of the resected myoma. Following peritoneal lavage,a full thickness of myometrium was lost due to uterinenecrosis. An area approximately 7 2 cm of the amnioticsac was clearly visible (Fig. 1). The edges of the defectwere brought together with three slow absorption stitches.The remainder of the abdominopelvic cavity was normal.The right iliac fossa was drained using a natural rubbercorrugated drain (Peters Laboratories, France). Parenteralantibiotics were initiated with piperacilline and tazobactam,gardenerella vaginalis, peptostreptococcus and anaerobicnegative gram bacillus were obtained on bacteriology. Oralmedication (amoxicilline and clavulanic acid) was contin-ued for three weeks. Tocolysis was achieved using indo-methacin following laparatomy. The remainder of thepregnancy was normal. The woman was readmitted at ges-tation for 37 weeks to elective caesarean section. The babyweighed 3530 g with an Apgar score of 10 at 5 minutes oflife. During the caesarean section, adhesions were identifiedin the right iliac fossa and were divided. There was noobvious defect in the uterine wall. There was a placentaaccreta and removal of placenta was distinct. The area ofaccreta was adjacent to the previous myomectomy. Due toprofuse arterial bleeding from this area, the uterine pedicles,

Gonadotropin-releasing hormone agonist therapy induces apoptosis in uterine leiomyoma

Objective: We examined uterine tissue samples obtained from premenopausal women with uterine leiomyoma treated with gonadotropin-releasing hormone agonist (GnRHa) to investigate the mechanism of the effects of GnRHa. Study design: Surgically resected myoma tissue obtained from 26 premenopausal patients with uterine leiomyoma treated with GnRHa, 20 premenopausal patients with uterine leiomyoma who did not receive GnRHa treatment, and 15 postmenopausal women with uterine leiomyoma were examined histologically. Results: GnRHa treatment reduced the size of uterine leiomyomata and induced significant hyaline degeneration in tumor tissue. Le y -antigen expression was detected in 18 (69.3%) of 26 GnRHa-treated patients ( P < 0.02) and in 12 (80.0%) of 15 postmenopausal women ( P < 0.05), but in only eight (40.0%) of the 20 premenopausal patients who did not receive GnRHa. Apoptotic cells, detected by the nick-end labeling method were observed in 14 patients (53.8%) in the GnRHa-treated group, 10 patients (50.0%) in the non-treated group, and 12 postmenopausal women (80.0%). Conclusion: Our findings suggest that induction of apoptosis may be a mechanism of the effect of GnRHa in leiomyoma.

Recurrence of myomas after myomectomy in women pretreated with leuprolide acetate depot or placebo

The recurrence of myomas and myoma-related symptoms was evaluated in women participating in a randomized, double-blind, P-controlled study of the efficacy of LA depot before myomectomy. After 27 to 38 months of follow-up, the recurrence of myomas was found to be greater when at least four myomas were resected. Myoma recurrence was not associated with pretreatment or preoperative uterine volume, resected myoma mass, or preoperative medical therapy.