Leiomyoma Size Research Articles

Low first trimester maternal serum PAPP-A concentrations in women with non-cavity-distorting intramural uterine fibroids.

Reliable aneuploidy risk estimation in first trimester is prominently interconnected with accurate assessment of maternal serum biomarkers. Some maternal factors like insulin-dependent diabetes, weight, and rhesus status are known to alter levels of these biomarkers. Adjustment of biomarker values for specific factor is crucial to avoid excessive invasive procedures or missed diagnoses. We aimed to investigate the effects of noncavity distorting intramural uterine fibroids on first trimester aneuploidy screening test maternal serum biomarkers. Pregnant women who underwent first trimester aneuploidy screening test in a single tertiary center between 2011 and 2020 were retrospectively assessed. One hundred ninety-eight women were found to have at least one noncavity distorting intramural uterine leiomyoma (Figo type 3-6) of at least 2cm diameter and remaining women were assigned as controls. First trimester aneuploidy screening test parameters were compared. Pregnancy associated plasma protein-A (PAPP-A) MoMs were found significantly lower in leiomyoma group in comparison to control group (1.19 ± 0.60 MoM vs. 1.40 ± 0.73 MoM, p=0.002). PAPP-A MoMs in women with leiomyomas larger than 5.5cm were significantly lower in comparison to both control group and women with ≤5.5cm leiomyomas (0.82 ± 0.376 vs. 1.40 ± 0.73, p < 0.001; 0.82 ± 0.376 vs. 1.33 ± 0.61 p < 0.001, respectively). PAPP-A MoM and size of leiomyoma were found inversely correlated when fibroid size exceeds 5.5cm (r=-0.467, p < 0.001). Noncavity distorting intramural uterine leiomyomas >5.5cm are associated with low first trimester PAPP-A MoMs (<0.5). PAPP-A concentrations are inversely correlated with fibroid size in women with >5.5cm intramural uterine leiomyomas. Fibroids ≤5.5cm are not associated with alterations in first trimester aneuploidy screening test parameters.

A comparative prospective observational study on the use of ulipristal acetate versus mifepristone in reduction of the size of uterine leiomyoma

Background: Fibroid or uterine leiomyoma is the most common benign tumor of the uterus in the reproductive age group and found in one out of every four women. They are symptomatic in 50% of women, with the peak incidence occurring among women in their 30s or 40s. Fibroid can cause a variety of symptoms which include menstrual disturbances commonly menorrhagia and dysmenorrhea. It is a common indication of hysterectomy in Indians. An effective medical treatment option may reduce hysterectomy-associated morbidity and mortality. This study is undertaken to evaluate the efficacy and safety of medical management of myoma and contribution in the reduction of myoma size comparing the two drugs ulipristal and mifepristone. Aims and Objectives: The study was conducted to compare reduction of menorrhagia (By pictorial blood loss assessment chart score), reduction of fibroid size (using transvaginal ultrasonography), and improvement of hemoglobin (Hb) level. We are also evaluating safety or side effects using these drugs. Materials and Methods: The study includes 210 patients who are divided into two groups. Group A includes 105 patients who are treated with tablet Ulipristal Acetate 5 mg daily for 3 months and Group B includes 105 patients who are treated with tablet mifepristone 25 mg daily for 3 months. Results: Ulipristal and mifepristone both are effective in reduction of menorrhagia and improvement of Hb levels, but Ulipristal is more effective in reduction of size of uterine myoma than mifepristone after 3 months of treatment. Conclusion: Multicentric study over a larger population is required to reach a valid conclusion.

Outcome of Pregnancies Associated with Fibroids

Objectives: To evaluate the behaviour of uterine leiomyoma, their frequency and impact on the course of pregnancy Design: It was a descriptive study. Setting: Gynaecology and Obstetric Unit, Hayatabad Medical Complex, PGMI, Peshawar. Subjects: All the patients presenting to antenatal clinic or emergency having a pregnancy associated with fibroids from 1st July 2001 to 30th June 2002. Subject and Methods: Women diagnosed with leiomyoma during pregnancy were evaluated clinically and the findings were confirmed by ultrasound. Detection of leiomyoma during caesarean section also made the patient eligible for the study. In all there were 76 patients in the study. The size of leiomyoma, the type of leiomyoma, their effect on pregnancy outcome and complications were noted. Patients obstetric, and fertility history was recorded on a questionnaire. The concerned doctors were required to fill a performa regarding the outcome and complications the delivery of such patients. Data Analysis: After data collection, the data was analyzed using various statistical tests like percentage, relative risk (R.R), ods ratio (O.R), mean, standard deviation (S.D) confidence interval (C.I), using software SPSS version 8.0 and Epi-Info 6. Main Outcome Measures: The main outcome measures were noted down as the frequency of spontaneous pregnancy loss, vaginal delivery or the caesarean section. Results: Out of 76 patients (1.9%), 16 underwent spontaneous pregnancy loss (21 %, O.R 1.16. R.R 1.13, P 0.59), 31 had vaginal delivery (40.8%, O.R 0.21, R.R 0.62, P 0.0000) and 29 had caesarean section (38.2%. O.R 4.71, R.R 2.91, P 0.0000). The frequency of complicated deliveries was 73.3%. The different complications occurring were antepartum haemorrhage, acute abdomen, laparotomy, preterm labour, dysfunctional labour, retained placenta and retained products of conception. Conclusion: Although abortions, preterm delivery, dysfunctional labour and cesarean sections were common, the neonatal outcome in viable pregnancies was fairly good in women with uterine leiomyomas. Because of increased risk of complications all the patients with leiomyomas having pregnancy should be considered as high-risk cases.

Relugolix for oral treatment of uterine leiomyomas: a dose-finding, randomized, controlled trial

BackgroundUterine leiomyomas are the most common neoplasm affecting women and frequently cause heavy menstrual bleeding and pain. Gonadotropin-releasing hormone (GnRH) receptor antagonists provide fast symptom relief and show promise as a medical (non-surgical) treatment option and as a presurgical treatment to reduce leiomyoma size. The aim of this study was to evaluate the efficacy and safety of three dose levels of oral relugolix, a small molecule GnRH receptor antagonist, in Japanese women with uterine leiomyomas and heavy menstrual bleeding.Methods This phase 2, multicenter, double-blind, parallel-group study was conducted at 36 sites in Japan in women with uterine leiomyomas and heavy menstrual bleeding, defined as a pictorial blood loss assessment chart (PBAC) score of ≥ 120 in one menstrual cycle. Patients were randomized 1:1:1:1 to relugolix 10, 20, or 40 mg, or placebo, orally once daily for 12 weeks. The primary endpoint was the proportion of patients with a total PBAC score of < 10 from week 6 to 12. A sample size of 50 patients per group was estimated to provide ≥ 95% power, based on the comparison of relugolix 40 mg with placebo using a chi-square test with a significance level of 5% (two-sided).ResultsFrom November 2011 to September 2012, 216 patients were randomized and 214 patients (99.1%) were analyzed. The proportion (difference vs. placebo) of patients that achieved the primary endpoint in the placebo and 10-, 20-, and 40-mg relugolix groups were 0%, 20.8% (95% confidence interval [CI]: 9.3–32.3, P < .001), 42.6% (95% CI: 29.4–55.8, P < .001), and 83.3% (95% CI: 73.4–93.3, P < .001), respectively. Though treatment-emergent adverse events were similar between the 20- and 40-mg groups, the incidence rates were more frequent compared with the placebo group. Most of these adverse events were mild or moderate in intensity.ConclusionsRelugolix decreased menstrual blood loss in women with uterine leiomyomas in a dose–response manner, and was generally well tolerated.Clinical trial registration: ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT01452659, NCT01452659 (registered 17/10/2011); JAPIC Clinical Trial Information, https://www.clinicaltrials.jp, JapicCTI-111590 (registered 31/08/2011).

Uterine Myoma: an Ultrasonographic Study of Patterns at the Central Hospital in Warri, Delta State, Nigeria

This analysis considered the sonographic patterns of uterine myoma seen at the Central Hospital in Warri, Delta State, Nigeria. Ultrasonographic records of the uteri of 312 women seen from December 2017 to January 2021 were retrieved from the Central Hospital in Warri, Nigeria. Information on the leiomyoma size, weight, occurrence site, types and number of nodules were fetched from available ultrasonographic reports. Ethical approval was obtained from the Research/ Ethical Committee of Human Anatomy Department at the Delta State University, Abraka, and the Warri Central Hospital. Data was entered into Statistical Package for the Social Sciences (version 23). Results were presented in mean and simple percentage of occurrences of sampled parameters. The chi-square test was used to obtain association between categorical variables, while setting p-value &lt; 0.05 as statistically significant. A total of 312 cases of women with leiomyoma were detailed. The 45-50 years age group had the highest frequency of 52 (16.7%). Regarding the location of the leiomyoma in the different parts of the uterus, the anterior corpus was the commonest site of occurrence of the leiyomyoma accounting for a frequency of 80 (25.6 %) while the fundus had the least frequency of 53 (17%). Based on volume and number of observed nodules, about 160 (51.3%) of assessed leiomyoma lesions were &gt; 200cm3, whereas 152 (48.7%) were &lt; 200cm3. Also, 1-5 nodules were observed in 117 cases, accounting for about 37.5% of the leiomyoma lesions. Conclusively, this study has shown that an insignificant association exists between patient age and the weight, size, type and number of nodules of leiyomyoma Keywords: Leiomyoma, uterine, myoma, ultrasonography.

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.

The dilemma of cesarean myomectomy: Is it safe or not?

To evaluate the safety and effectiveness of myomectomy during cesarean section. The data of fifty-four pregnant who underwent cesarean myomectomy and twenty-six pregnant with uterine leiomyoma who had cesarean section without myomectomy between the years of 2017 and 2020 in our tertiary clinic were examined retrospectively. There was no significant difference in terms of maternal age, weeks of gestation, gravida, parity, use of additional uterotonics, type of leiomyoma, size of leiomyoma, cesarean indications, blood transfusion requirement, postoperative fever, preoperative hemoglobin (g/dl), change in hemoglobin (g/dl), preoperative hematocrit (%), change in hematocrit (%), length of hospital stay between the two groups (p˃0.05). While no significant difference was observed according to the location of the leiomyomas between the anterior, fundal and posterior location between the two groups, cervical leiomyomas were significantly higher in the CS group (p˂0.05). This study shows that cesarean myomectomy is a safe procedure in selected cases. It also offers the advantage of avoiding a second operation in patients.

GIANT SIZED EXTRAVESICAL BLADDER LEIOMYOMA MIMICKING UTERINE CERVICAL LEIOMYOMA: A CASE REPORT WITH 8 YEARS’ POSTOPERATIVE FOLLOW-UP AND A REVIEW OF THE LITERATURE

The incidence of bladder leiomyoma is estimated at only 0.43% because most bladder tumors arise from the urothelium. Moreover, 30% of them are the extra-vesical type. The symptoms include urinary tract obstruction, bladder irritation, and dysuria, with the possibility of dyspareunia or hematuria depending on the size and location of the tumor. Bladder leiomyomas cannot be diagnosed solely by combining symptoms and imaging techniques. We present a rare case of giant sized extravesical-type bladder leiomyoma with a diameter of 15.5x14.5x14 cm, which was misdiagnosed as a uterine cervical leiomyoma. It caused unilateral ureteral distension without related symptoms. During the 8-year postoperative follow-up, the patient had two healthy full-term pregnancies and no recurrence was observed. We reviewed the literature of the most recent five years and discussed the characteristics of 22 bladder leiomyoma cases. Unlike the literature, the present case is unique due to the giant size of the bladder leiomyoma, its ureteral complications, and long follow-up period. Bladder leiomyomas are rare bladder tumors which should be borne in mind during the differential diagnosis of a pelvic mass. Surgical excision is the most useful procedure for diagnosis and treatment.

Correlation of the Levels of Vitamin D with Size of Leiomyoma in a 450-bedded Maternity Hospital of Delhi

Correlation of the Levels of Vitamin D with Size of Leiomyoma in a 450-bedded Maternity Hospital of Delhi

Uterine Leiomyoma and Pregnancy Outcome: An Experience at Tertiary Care Setup

Objective: To determine the impact of leiomyoma in pregnant women a tertiary care set up in Hyderabad. Methods: This prospective observational study conducted at OPD of Gynecology unit-III, Liaquat University of Medical and Health Science Hyderabad, from June 2018 to December 2018. A total of 18,402 pregnant women of age 20-45 years were attended, out of which 195 had leiomyoma and they were asked to take part in study. Data regarding demographic characteristics including complications during pregnancy, and indications of caesarean section was collected via study proforma. Results: Total 186 out of 195 females were studied, their mean age was 31.23+3.12 years, average gestational age was 33.12+3.15 weeks and average size of Leiomyoma was 3.12+2.15cm. The most common complications were PPH among 28.49% of cases, blood transfusion was required in 39.25% of the cases, miscarriage occurred in 6.45% of the cases, cord prolapse was seen in 24.3% cases, placental abruption in 5.91% cases, placenta previa in 11.32% cases and retained placenta was observed among 1.61% of the cases. Preterm labour occurred in 5.38% of the cases and IUGR was seen in 10.22% of the cases. Out of all cases, 10 females underwent preterm delivery, while 12 underwent fetus delivery before 24 weeks (miscarriage). Among all term pregnancies, 78.66% underwent C-Section due to failure in progress, cord prolapsed, fibroid in lower segment, breech presentation and low-lying placenta. Conclusion: Fibroid complicates pregnancy itself and also the outcome. Rural area dwelling women are at more risk, which include increase in caesarean section and a multifold increased risk of PPH and associated hysterectomy in these cases. Keywords: Leiomyoma, Uterine Fibroids, Pregnancy, complications.

Aorta Tetrafurcation

A 35-year-old woman (gravida 0) presented to the gynecology clinic with a 1-year history of heavy menstrual bleeding and pelvic pain. Ultrasonography revealed an enlarged uterus with 1 intramural leiomyomatous node measuring 10 cm × 10 cm × 10 cm, and laparoscopic myomectomy was scheduled. Given the leiomyoma size, temporary uterine ischemia by clipping its arteries was planned to reduce blood loss. Intraoperatively, the isolation of the uterine arteries was hindered by an enlarged uterus; therefore, the internal iliac arteries were chosen for clipping.

A retrospective study of 323 total laparoscopic hysterectomy cases for various indications and a case report treating caesarean scar pregnancy

BackgroundThe application of laparoscopic surgeries has been increasing, and various uterine diseases in addition to leiomyoma/adenomyoma have become indications for total laparoscopic hysterectomy (TLH). Therefore, data acquisition and analysis of TLH procedures, including TLH for rare uterine diseases, have become important for improving surgical procedures and patient selection. To determine the prevalence of and risk factors for the occurrence of intraoperative and postoperative complications of TLH, we performed a multivariate analysis of the records in our hospital.MethodsWe retrospectively reviewed the medical records of 323 patients who underwent TLH for the treatment of leiomyoma/adenomyoma (278 cases), low-grade (pre)malignant uterine tumours (40 cases) and other rare uterine diseases (5 cases) from January 1, 2015, to December 31, 2019. Of the rare uterine diseases, one case of caesarean scar pregnancy for which TLH was performed is introduced as a case report. To assess the effects of 11 representative factors, including patient characteristics, uterus and leiomyoma sizes, indications for TLH and others, we performed a multivariate logistic regression analysis.ResultsAmong the 323 cases, 20 intraoperative complications and 15 postoperative complications were reported. In the multivariate analysis, “ovarian tumour” and “heavy uterus” were positively associated and “nulliparity” was negatively associated with intraoperative complications. There were no significant risk factors for postoperative complications. The only risk factor for operative complications directly related to the resected uterus was “heavy uterus”. Therefore, we could perform TLH relatively safely for patients with other indications besides leiomyoma/adenomyoma.ConclusionsConsidering the factors detected in this analysis, the indications for TLH may be expanded. Owing to the increase in TLH for indications other than leiomyoma/adenomyoma, a more accurate determination of the treatment approach can be achieved.

Intake of Lycopene and other Carotenoids and Incidence of Uterine Leiomyomata: A Prospective Ultrasound Study

BackgroundUterine leiomyomata (UL) are the leading indication for hysterectomy in the United States. Dietary supplementation with lycopene was associated with reduced size and incidence of oviduct leiomyoma in the Japanese quail. Two US prospective cohort studies of women reported little association between intake of lycopene, or other carotenoids, and UL incidence. However, these studies relied on self-reported physician-diagnosed UL, which is prone to misclassification. ObjectiveThis study examines the association between dietary intake of carotenoids and UL incidence. DesignData were derived from the Study of the Environment, Lifestyle, and Fibroids, a prospective cohort study. Women completed self-administered baseline questionnaires on demographic characteristics, reproductive history, and lifestyle, including a 110-item validated food frequency questionnaire, from which dietary intakes of carotenoids—including alpha carotene, beta carotene, cryptoxanthin, lutein-zeaxanthin, and lycopene—and vitamin A were estimated. Participants/settingOne thousand two hundred thirty Black women aged 23 to 35 years who did not have a previous diagnosis of UL, cancer, or autoimmune disease were eligible for enrollment (2010-2012). Participants were residents of the Detroit, MI, metropolitan area. Main outcome measuresTransvaginal ultrasound was used to assess UL at baseline and 20, 40, and 60 months of follow-up. Statistical analyses performedCox regression was used to estimate hazard ratios and 95% CIs, adjusted for energy intake, age at menarche, education, body mass index, parity, age at first birth, years since last birth, current use of oral contraceptives or progestin-only injectables, alcohol intake, and cigarette smoking. ResultsAmong 1,230 women without prevalent UL at baseline, 301 incident UL cases during follow-up were identified. Intakes of lycopene, other carotenoids, and vitamin A were not appreciably associated with UL incidence. Hazard ratios comparing quartiles 2 (2,376 to 3,397 μg/day), 3 (3,398 to 4,817 μg/day), and 4 (≥4,818 μg/day) with quartile 1 (<2,376 μg/day) of lycopene intake were 1.03 (95% CI 0.72 to 1.47), 1.22 (95% CI 0.86 to 1.72), and 0.95 (95% CI 0.67 to 1.36), respectively. ConclusionsStudy findings do not support the hypothesis that greater carotenoid intake is associated with reduced UL incidence.

Prediction of Need for Morcellation during Total Laparoscopic Hysterectomy

Study Objective With all the concerns surrounding uterine morcellation, our objective was to identify predictors of the need for morcellation during total laparoscopic hysterectomy (TLH). Design A retrospective cohort study (Canadian Task Force classification II-2). Setting University Hospital Center. Patients or Participants Women undergoing a TLH for a benign gynecologic pathology form January 1st 2017 to January 31th 2019. Interventions All women underwent a TLH. If the uterus was to voluminous to be removed vaginally, surgeons favored in-bag morcellation by laparoscopy. Uterine weight (uterine length x maximum width x anteroposterior diameter x 0.52) and characteristics (number and volume of leiomyomas) were assessed prior to surgery by ultrasound or MRI in order to predict the need for morcellation. Measurements and Main Results A total of 252 women underwent a TLH during the two-year period. Women had a mean age of 46±7 (30–71) years old and the three main indications for surgery were abnormal uterine bleeding (77%), chronic pelvic pain (36%) and bulk symptoms (25%). Mean uterine weight was 325 (17-1572)±272 grams, with 11/252 (4%) uterus being >1000 grams and 71% of women had at least one leiomyoma. Among women with a uterine weight 500 grams, 49 (100%) required morcellation. In addition to the estimated uterine weight (≥ 250 versus Conclusion Uterine weight estimated by preoperative imaging as well as the size and number of leiomyomas are useful predictors of the need for morcellation.

Circular RNA expression profiling identifies novel biomarkers in uterine leiomyoma

BackgroundCircular RNAs (circRNAs) have recently been identified in the development and progression of multiple human diseases. However, the significance of circRNAs in uterine leiomyoma (ULM) remains to be elucidated. Here, we aim to explore the expression profile of circRNAs in ULM and the potential of cicRNAs to be used as biomarkers or therapeutic targets.MethodsGlobal circRNA expression Profiles for ULM was performed by microarray in ULM tissue and matched adjacent normal myometrium counterpart. Bioinformatics analysis, qRT-PCR validation, and receiver operating characteristic (ROC) diagnostic accuracy was applied for differentially expressed circRNAs. Cell proliferation and spheroid formation assay were performed to assess the functional role of candidate circRNA.Results579 up- and 625 down-regulated circRNAs were identified between ULMs and adjacent normal myometrium tissues. Bioinformatics analysis suggested that most differentially expressed circRNAs participate in pathways were related to pathological processes of ULM. The qRT-PCR validation results for 6 circRNAs (hsa_circ_0083920, hsa_circ_0056686, hsa_circ_0062558, hsa_circ_0020376, hsa_circ_0043597, hsa_circ_0026353, and circ_0017248) matched the microarray results. ROC analysis showed that hsa_circ_0083920, hsa_circ_0056686, hsa_circ_0062558, hsa_circ_0020376, and hsa_circ_0043597 could accurately distinguish the ULM samples from the myometrium samples. Additionally, hsa_circ_0056686 was validated to be upregulated in ULM and was associated with the leiomyoma size (P = 0.0446). Reduction of endogenous hsa_circ_0056686 expression significantly suppressed leiomyoma cell proliferation and spheroid formation capacity.ConclusionsThis study provides an integrated analysis of circRNAs in ULM, and gives new insight into the complex epigenetic mechanisms of ULM. Aberrantly expressed circRNAs may contribute to the pathogenesis of ULM and hsa_circ_0056686 might be a potential therapeutic target.

Effectiveness of Dry Cupping Therapy in the Management of Uterine Fibroid: A Case Report

Uterine fibroid is considered as the most common pelvic tumor in women during their reproductive years. Symptomatic uterine fibroids can cause abnormal uterine bleeding, anemia, pressure symptoms and fertility issues and also have a significant influence on patient’s quality of life. These are the most common indications for hysterectomy worldwide. We report a 43-year-old woman with abnormal vaginal bleeding and dysmenorrhea due to large size of uterine leiomyoma which was candidate for myomectomy. Due to her virginity she couldn’t undergo uterine surgery. She preferred to use non-surgical treatments and presented to our traditional Persian medicine outpatient clinic. In order to control menorrhagia and dysmenorrhea, dry cupping therapy was recommended to her for three times a week. After a period of two months, dysmenorrhea and vaginal bleeding were decreased noticeably. In addition, a significant reduction in tumor size was observed. This case shows dry cupping therapy can be effective and safe in decreasing fibroid-related symptoms like dysmenorrhea and excess bleeding and also the size of fibroid. It seems that this method can be integrated with current therapeutic approaches. However, further clinical studies need to establish the efficacy and safety of dry cupping therapy for the management of uterine fibroids.

Effect of Oxytocin Infusion on Reducing Blood Loss during Abdominal Myomectomy

Background: Open myomectomy remains the main option has been shown to have satisfactory results as regard fertility preservation and symptom resolution, especially when the number and size of leiomyomas do not permit any other routes of intervention. Hemorrhage remains the most important concern with open myomectomy. Blood loss during surgery mainly depends on the number, size of the removed fibroids and the technique adopted during myomectomy. Objective: Evaluation of the effect of intra-operative oxytocin infusion in decreasing blood loss during abdominal myomectomy. Patients and Methods: This controlled clinical trial was on 134 women: 67 interventional group and 67 control group who were candidates for elective abdominal myomectomy at Al-HusseinUniversityHospital. After induction of general anesthesia and immediately prior to the operation, an infusion of 30 IU oxytocin in 500 ml normal saline at a rate of 120 ml/h was started in the study group patients during myomectomy. In placebo group patients, a pure normal saline infusion was used at the same volume and rate. Results: There was no significant difference between the studied groups regarding preoperative hemoglobin. Postoperative hemoglobin was significantly higher among oxytocin group. Hemoglobin reduction was significantly lower among oxytocin group. Conclusion: The infusion of oxytocin intra-operatively (immediately after induction of general anesthesia) may be a safe and reliable method to help decrease blood loss during abdominal myomectomy.

Pathologic Changes in Uterine Leiomyomas After Extended Treatment With Ulipristal Acetate

Ulipristal acetate is a selective progesterone receptor modulator that acts on progesterone receptors in uterine muscle and endometrium. It is effective in reducing the size of uterine leiomyomas (fibroids) and in managing associated menorrhagia. Although ulipristal acetate-associated pathologic changes have been previously documented in the endometrium, it is unclear what morphology can be expected in posttreatment fibroids. We herein report 2 cases in which patients underwent hysterectomy, after at least two 3-mo courses of ulipristal acetate. The fibroids demonstrated some pathologic changes that have previously been described associated with gonadotropin-releasing hormone agonist treatment and other progestogens. In addition, both cases demonstrated plexiform/"patchwork" fibrosis and vascular medial myxoid degeneration. Mitotic activity was absent; however, the presence of ischemic necrosis and mild nuclear atypia may mimic a more aggressive neoplasm in some areas. Awareness of these histopathologic patterns is important in the setting of ulipristal acetate treatment, to avoid over-diagnosis of "uncertain malignant potential" or malignant smooth muscle tumors.

The largest adrenal leiomyoma: A case report and literature review

Leiomyoma is a benign tumor of smooth muscle origin. Primary leiomyoma of the adrenal gland is very rare. Adrenal tumors are often diagnosed during the ultrasound or computerized tomography (CT) study as incidentaloma. According to the literature review, up to 2018, the largest size of adrenal leiomyoma which had ever been reported was 12 × 10 × 8 cm in dimension (Maher et al.). Herein, we report the largest adrenal leiomyoma with the tumor mass of 600 g (14,1x11,4x10,1 cm) from a female patient admitted to our hospital.

Long-term vitamin D treatment decreases human uterine leiomyoma size in a xenograft animal model

To study the effects of short- and long-term vitamin D treatment on uterine leiomyomas invivo through cell proliferation, extracellular matrix (ECM) degradation, and apoptosis. Preclinical study of human leiomyoma treatment with vitamin D in an nonhuman animal model. Hospital and university laboratories. Human leiomyomas were collected from patients and implanted in ovariectomized NOD-SCID mice. Mice were treated with vitamin D (0.5 μg/kg/d or 1 μg/kg/d) or vehicle for 21 or 60 days. Vitamin D effect in xenograft tissue was assessed by monitoring tumor size (18F-FDG positron-emission tomography/computerized tomography and macroscopic examination), cell proliferation (immunohistochemistry and quantitative real-time polymerase chain reaction [qRT-PCR]), ECM (Western blot), transforming growth factor (TGF) β3 (qRT-PCR), and apoptosis (Westrn blot and TUNEL). Short-term treatment with vitamin D did not appear to alter leiomyoma size, based on invivo monitoring and macroscopic examination. However, long-term high-dose treatment induced a significant reduction in leiomyoma size. Cell proliferation was not decreased in the short term, whereas 1 μg/kg/d vitamin D in the long term significantly reduced proliferation compared with control. Although collagen-I and plasminogen activator inhibitor 1 were not modified by short-term treatment, they were both significantly reduced by long-term high-dose vitamin D. Similarly, long-term high-dose vitamin D significantly reduced TGF-β3 expression. Finally, apoptosis significantly increased with both short- and long-term high-dose vitamin D treatment. Long-term vitamin D acts as an antiproliferative, antifibrotic, and proapoptotic therapy that provides a safe, nonsurgical therapeutic option for reducing uterine leiomyoma size without side-effects.