Subserosal Fibroids Research Articles

Transcervical Radiofrequency Ablation of Uterine Fibroids Global Registry (SAGE): Study Protocol and Preliminary Results

<h3>Study Objective</h3> To describe the protocol and preliminary results of the SAGE Registry, which characterizes the long-term (5-year) outcomes of transcervical fibroid ablation (TFA) with the Sonata® System when used to treat symptomatic uterine fibroids in real-world use. <h3>Design</h3> Ongoing post-market global registry. <h3>Setting</h3> Up to 50 clinical sites. <h3>Patients or Participants</h3> Up to 500 women who select TFA with the Sonata System for treatment of symptomatic uterine fibroids. <h3>Interventions</h3> Transcervical fibroid ablation in women with symptomatic uterine fibroids. <h3>Measurements and Main Results</h3> Main outcomes include changes in the symptom severity score and health-related quality of life subscales of the UFS-QoL, general health status on the EQ-5D, perceived treatment benefit, treatment satisfaction, work and activity patterns, overall patient treatment outcome, adverse events, pregnancy incidence and outcomes, and surgical reinterventions for heavy menstrual bleeding. One Hundred Sixty (160) women have been enrolled and treated to date, with a device-related adverse event rate of 0.6% and a serious procedure-related adverse event rate of 0.6%. Of 241 fibroids ablated, 10% were submucous, 52% transmural, 28% intramural, and 10% subserous. Ablated fibroid diameters ranged from <1 cm to >10 cm, with 27% of fibroids having maximum diameters >5 cm. <h3>Conclusion</h3> The SAGE registry represents the largest known study of TFA for uterine fibroids and will generate up to 2500 patient-years of outcome data. Preliminary results from the first 160 treated women suggest broad applicability of TFA to a wide range of fibroid types and sizes, including those with diameters > 5 cm, and an excellent safety profile. The wide repertoire of fibroid types treated in SAGE, including transmural, intramural, and subserosal fibroids, are not generally accessible to operative hysteroscopy.

Uterine Artery Clipping at the Level of the Ureteric Tunnel for Reduction of Blood Flow

Study Objective Though cervical myomas comprise only 5% of total uterine myomas, they present unique surgical challenge due to proximity to the uterine vessels and ureters. We aim to highlight an approach to robotic-assisted hysterectomy with a large cervical fibroid, with minimal blood loss and clear visualization of the displaced anatomy. Design Video Case Presentation. Setting A robotic-assisted hysterectomy (RAH) was performed under general anesthesia in dorsal lithotomy position at a university-affiliated hospital. Patients or Participants 41-year-old G0 with abnormal uterine bleeding in the setting of 5 × 4 × 5 cm subserosal fibroid of the left posterior cervix. The patient was pretreated with leuprolide acetate injections then letrozole to reduce the fibroid volume, however, no change in size was observed. The patient desired definitive management of the fibroid. Interventions Once in the operating room, a uterine manipulator could not be placed due to displacement of the cervix by the fibroid. Careful retroperitoneal dissection was performed to identify the uterine artery coursing over the ureter at the ureteric tunnel of Wertheim. Laparoscopic clips were applied to the uterine artery to decrease blood supply to the fibroid. After completion of the hysterectomy, the fibroid capsule was entered and myomectomy was completed, resulting in separation of the fibroid from the vagina. Measurements and Main Results Estimated blood loss was 50 cc. Final specimen were uterus, fallopian tubes, and cervix weighing 54 g and cervical fibroid weighing 99 g. The patient had an uncomplicated postoperative course and was discharged home on postoperative day 1. Conclusion This case demonstrates the use of minimally-invasive surgical approach to safely complete a hysterectomy in the context of a large, cervical myoma. Our video demonstrates improved hemostasis and visualization of the ureters throughout the case due to placement of vessel clips at the level of the ureteric tunnel. Though cervical myomas comprise only 5% of total uterine myomas, they present unique surgical challenge due to proximity to the uterine vessels and ureters. We aim to highlight an approach to robotic-assisted hysterectomy with a large cervical fibroid, with minimal blood loss and clear visualization of the displaced anatomy. Video Case Presentation. A robotic-assisted hysterectomy (RAH) was performed under general anesthesia in dorsal lithotomy position at a university-affiliated hospital. 41-year-old G0 with abnormal uterine bleeding in the setting of 5 × 4 × 5 cm subserosal fibroid of the left posterior cervix. The patient was pretreated with leuprolide acetate injections then letrozole to reduce the fibroid volume, however, no change in size was observed. The patient desired definitive management of the fibroid. Once in the operating room, a uterine manipulator could not be placed due to displacement of the cervix by the fibroid. Careful retroperitoneal dissection was performed to identify the uterine artery coursing over the ureter at the ureteric tunnel of Wertheim. Laparoscopic clips were applied to the uterine artery to decrease blood supply to the fibroid. After completion of the hysterectomy, the fibroid capsule was entered and myomectomy was completed, resulting in separation of the fibroid from the vagina. Estimated blood loss was 50 cc. Final specimen were uterus, fallopian tubes, and cervix weighing 54 g and cervical fibroid weighing 99 g. The patient had an uncomplicated postoperative course and was discharged home on postoperative day 1. This case demonstrates the use of minimally-invasive surgical approach to safely complete a hysterectomy in the context of a large, cervical myoma. Our video demonstrates improved hemostasis and visualization of the ureters throughout the case due to placement of vessel clips at the level of the ureteric tunnel.

Using pneumovaginoscopy to perform the removal of a vaginal fibroid

To describe and assess the feasibility of a novel surgical technique (pneumovaginoscopy) for performing vaginal surgery. Video of a single surgical procedure. A university hospital. A 42-year-old woman, gravida 2 para 2, presented with chronic pelvic pain. Vaginal examination revealed a 4-cm spherical mass bulging through her posterior vaginal wall. Magnetic resonance imaging identified this mass as either a subserosal pedunculated uterine fibroid (type 7 according to the FIGO classification) or an ectopic fibroid of the posterior vaginal wall (type 8). The whole procedure was performed using pneumovaginoscopy. The GelPOINT V-Path (Applied Medical, Rancho Santa Margarita, California) which is the device most often used to perform transvaginal natural orifice transluminal endoscopic surgical procedures, was introduced into the vagina to create a pneumovagina. Monopolar scissors were used to create an incision through the posterior vaginal wall to reach the fibroid. Myomectomy was performed using traction movements of the fibroid associated with the dissection of the capsule. The absence of a uterine pedicle at the end of the myomectomy was in favor of an ectopic fibroid of the vagina (type 8 of the FIGO classification). The vaginal defect was closed with interrupted sutures using the access points on the GelPOINT. The procedure was easily and efficiently performed using the pneumovaginoscopy technique and lasted less than an hour. The patient was discharged on postoperative day 1 without any postoperative complications. She was symptom-free at her 2-month postoperative visit. Compared to the classical vaginal approach, pneumovaginoscopy improves visualization through targeted lighting and close-up vision. This technique is particularly interesting in cases where the vaginal opening is narrow and for lesions located in the upper half of the vagina. Because of the unusual expansion of the vagina, increased caution is required to avoid bladder or rectal injuries. Pneumovaginoscopy is a novel technique that can be performed for vaginal pathologies with the same device used for transvaginal natural orifice transluminal endoscopic surgery. We described this technique and assessed its feasibility.

TO THE QUESTION ON UTERINE FIBROIDS DURING PREGNANCY

Uterine fibroids is an extremely common tumor of the female reproductive system, among whose manifestations are infertility, spontaneous abortions, incorrect fetal position, placenta previa, premature delivery, bleeding during and after delivery, and an increased risk of cesarean section. According to the literature, myomas are changing in size during pregnancy and in the postpartum period. Aim of the study. To assess the dynamics of uterine fibroid size change during pregnancy and the effect of an existing uterine fibroid on the course of pregnancy and labor. Materials and methods. Outpatient records of patients aged 24 to 45 years (mean age 33.36 ± 4.63 years) who were diagnosed with Pregnancy and uterine fibroids from 2016 to 2021 at Verum Medical Center were evaluated (n = 57). The size of the fibroids (volume and diameter) before, during (I or II prenatal screening) and after pregnancy (first pelvic ultrasound after delivery) was used for statistical analysis. Forty-one of the 57 patients had pelvic ultrasound before, during, and after pregnancy and were included in the statistical analysis of changes in uterine myoma size. Results. Among the patients included in the statistical analysis, uterine fibroids increased in volume by 194.38% ± 86.9 (40.98% ± 18.4 in diameter) during pregnancy, and decreased by 53.98% ± 14.93 in diameter and by 54.28% ± 29.62 of baseline in the postpartum period. A significant number of fibroids (39.47%) did undergo involutionary changes and were not visualized in the first postpartum ultrasound. The live birth rate was high at 90% (64% of deliveries were through natural childbirth and 26% through cesarean section). Conclusions. There was no effect of intramural, intramural-subserosal, and subserosal uterine fibroids with an average diameter of £20 mm on pregnancy and live birth in women. A great amount of uterine fibroids nearly triple in size during pregnancy, but after delivery they return to their original size and even halve in size. This can be regarded as a confirmation of the absence of a negative effect of pregnancy, or, possibly, a positive effect on uterine fibroid size, which requires further investigation.

Uterine Fibroids and Infertility.

Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Uterine fibroids are the most common tumor in women, and their prevalence is high in patients with infertility. Fibroids may be the sole cause of infertility in 2–3% of women. Depending on their location in the uterus, fibroids have been implicated in recurrent pregnancy loss as well as infertility. Pregnancy and live birth rates appear to be low in women with submucosal fibroids; their resection has been shown to improve pregnancy rates. In contrast, subserosal fibroids do not affect fertility outcomes and their removal does not confer any benefit. Intramural fibroids appear to reduce fertility, but recommendations concerning their treatment remain unclear. Myomectomy should be discussed individually with the patient; other potential symptoms such as dysmenorrhea or bleeding disorders should be included in the indication for surgery.

Primary Leiomyoma of ovary – A rare case report presenting with clinical diagnosis of subserosal uterine fibroid

Primary leiomyoma of ovary are rare benign ovarian tumors. We present a rare case report of ovarian leiomyoma who was planned for laparotomy with a clinical diagnosis of subserosal uterine fibroid. Twenty three years old unmarried girl presented with heaviness and mass in lower abdomen, gravid uterus size of 20 weeks. Abdominal Ultrasonography raised suspicion of subserous fibroid. MRI pelvis was suggestive of ovarian neoplasm versus broad ligament fibroid. On laparotomy and removal of mass, histopathology and immunohistochemistry confirmed leiomyoma of ovary. Presently she is on follow up without any complaints. Ovarian leiomyoma is clinically often misdiagnosed and should be kept in differential diagnosis in lower abdominal masses.

Concomitant Use of Laparoscopic Radiofrequency Ablation with Hysteroscopic Myomectomy for Large, Multi-Fibroid Uterus

Study Objective To discuss the combination of minimally invasive myomectomy techniques for large multi-fibroid uteri to ensure resolution of all associated symptoms. Design Case Study. Setting Suburban hospital, Michigan. Patients or Participants 37-year-old Caucasian G2P1011. Interventions 1. Hysteroscopic resectoscope of submucosal fibroid (TruClear) 2. Ultrasound guided laparoscopic radiofrequency ablation (Acessa system) of intramural, subserosal, and broad ligament fibroids Measurements and Main Results Patient presented with a longstanding history of a bulky, multi-fibroid uterus. Her symptoms included menorrhagia (resulting in anemia), lower abdominal pressure, cramping and back pain. Two prior gynecologists had recommended open hysterectomy given that she had completed childbearing, however she desired uterine conserving surgery. Physical exam revealed a BMI of 24 and a 20-week multi-fibroid uterus. Previous ultrasound noted a multi-fibroid uterus measuring 19 × 14.1 × 8.3 cm and pre-operative MRI demonstrated the largest intramural fibroid to measure 10.9 × 9.1 × 9.2 cm in the posterior lower uterine segment. A pedunculated submucosal (type 0) fibroid was also identified with significant distortion of the endometrial cavity. She elected to proceed with laparoscopic radiofrequency ablation with ultrasound guidance for the type 4-8 fibroids with concurrent mechanical resection of her submucous fibroid. The procedure was performed without complication and the total operative time was less than 2.5 hours. She was discharged from recovery in good condition. At 6-month follow-up, she noted significant reduction in pain, pressure and cramping, with almost complete resolution of menorrhagia. Conclusion Uterine sparing concomitant multi-modality surgery can be considered for patients presenting with large fibroids, including those with submucosal fibroids as a cause for their symptoms. Laparoscopic radiofrequency ablation combined with hysteroscopic resection, even for fibroids larger than 8 cm, can provide dramatic relief of menorrhagia, bulk and pain symptoms.

Giant Parasitic Fibroid Mimicking Gist: A Clinical Dilemma

ABSTRACTBackgroundParasitic fibroids are a rare type of fibroids without direct uterine attachment. They pose a diagnostic dilemma and often present atypically.Case descriptionWe report a rare case of large secondary parasitic fibroid in a 24 year unmarried female who presented with history of lump abdomen for 6 months. She had history of laparoscopic myomectomy done 2.5 years back for the same complaint with histopathology report suggestive of leiomyoma. On examination, it was found to be subserosal pedunculated fibroid. All the tumor markers were negative except CA 125 which was 225 IU/mL. Exploratory laparotomy was done. Uterus was normal size and seen separately. Bilateral tubes and ovaries were normal. A mass of size 30 × 22 × 15 cm, firm in consistency occupying all the quadrants of abdomen, was observed. It had no attachment to the uterus or to the bowel. Mass weighing 6.5 kg was removed completely and sent for histopathology. HPE report confirmed leiomyoma. Her postoperative period was uneventful.ConclusionIf the patient had prior history of myomectomy and mass is separate from the uterus with its blood supply away from uterus, diagnosis of parasitic leiomyoma should be considered.Clinical significanceDuring morcellation procedures, a thorough inspection and washing of peritoneal cavity must be carried out, and endoscopic bag should be used to prevent secondary parasitic leiomyoma.How to cite this articleKurude VN, Gitte V, Raheja A,et al. Giant Parasitic Fibroid Mimicking Gist: A Clinical Dilemma. J South Asian Feder Menopause Soc 2020;8(1):49–51.

Pedunculated Fibroid Mimicking an Ovarian Cancer

Large myoma may show various type of degenerative change and have alteration of radiological view. Subserosal or pedunculated fibroid with cystic degeneration may mimic complex ovarian mass on radiological imaging. A 34 year female, para one, with normal menstrual period presented with radiological diagnosis of complex adnexal mass and CA 125 value 100 u/ml. Postoperative finding revealed cystic degeneration of pedunculated subserosal fibroid receiving blood supply from adherent omentum.&#x0D; Keywords: Cystic degeneration, pedunculated fibroid, complex ovarian mass.&#x0D;

Parasitic Pelvic and Infradiaphragmatic Leiomyomatosis Following Laparoscopic Myomectomy

Purpose: Uterine leiomyomas are the most common indication for gynecological surgery. The use of power morcellators has facilitated myomectomy, but appears to be associated with leiomyoma seeding, leading to parasitic leiomyomatosis. This is a case report of a patient with parasitic leiomyomatosis following laparoscopic myomectomy, which was detected incidentally during elective gallbladder surgery. Case Report: A 42-year-old female was treated for symptomatic cholelithiasis in July 2018 by elective laparoscopic cholecystectomy. Three years earlier, the patient had undergone laparoscopic myomectomy using a power morcellator for the removal of a subserosal uterine fibroid 21 cm in diameter. During laparoscopy, a firm nodule, roughly 2 cm in diameter was observed on the right infradiaphragmatic surface, and two smaller, similar pelvic nodules. The infradiaphragmatic nodule was excised and histopathological examination identified it as leiomyoma tissue, confirming the case as parasitic leiomyomatosis. Discussion: Parasitic leiomyomatosis is a rare entity first described in 1909. Reports of its incidence have increased since the advent of laparoscopic surgery for the treatment of uterine fibroids and there appears to be an association with the use of power morcellators for fragmentation of large myomas, which may promote seeding. Parasitic myoma cells display increased expression of estrogen and progesterone receptors, and increased angiogenetic capacities compared with their uterine counterparts. Further studies are required to ascertain whether power morcellators play a key role in myoma dissemination, and to evaluate possible therapeutic solutions.

A Case Report with Literature Review: Parasitic Leiomyoma

Leiomyoma is a benign tumour composed mainly of smooth muscle cells. It contains varying amount of fibrous connective tissues. Parasitic leiomyoma is a rare manifestation of uterine leiomyoma defined as a pedunculated subserosal fibroid that undergoes torsion and detaches from the uterus. We are reporting a case of parasitic leiomyoma in a 55 Y/O female patient that had already given her consent for the case to be published. She presented with increased abdominal girth since 6 months and body weight and consulting for possible bariatric surgery 1 month prior to presentation. Ultrasonography revealed a large heterogeneous mass starting from the pelvic region to the middle and upper abdomen of more than 37 cm compatible with an adnexal mass. On abdominopelvic MRI: presence of an enlarged heterogeneous mass that seems taking its origin from the right ovary, an exploratory laparotomy was performed. Identification and complete excision of a huge mass of cystic and solid component adherent to the uterus and the mesentery of the small bowel. Histopathologically mass was confirmed as a hyelanized leiomyoma with a focal necrobiosis with no signs of malignity. Parasitic leiomyomas are rare tumors. Imaging modalities help in diagnosis but not always. The definitive treatment is surgical excision, presenting this case due to its rarity and diagnostic difficulties posed.

Unexpected Parasitic Fibroid Necessitates Mandatory Contained Morcellation

Objective: Uterine leiomyomas are the most common benign pelvic tumours in women, occurring in at least 25% of reproductive aged women and up to 80% on pathologic examination of surgically removed uteri. Parasitic leiomyomas, first described in 1909, are a rare type of extra-uterine fibroid which are thought to arise from a subserosal fibroid which obtains a blood supply from other structures with resultant deterioration of its uterine pedicle. The rise of laparoscopic surgery and power morcellation has seen an increasing incidence of the iatrogenic parasitic fibroid. The FDA has put a warning on the use of power morcellation due to the risk of disseminating a uterine sarcoma, which has resulted in a drastic decline in the use of power morcellation and the entry of “morcellation bags” into the market.

Prognostic value of pre-embolisation MRI features of uterine fibroids in uterine artery embolisation

To evaluate the prognostic value of pretreatment pelvic magnetic resonance imaging (MRI) features in uterine artery embolisation (UAE) for symptomatic fibroids. MRI characteristics of 109 fibroids (≥3 cm) in 70 patients were analysed retrospectively. Imaging was performed 1.8±1.3 (SD) months before and 6.6±1.8 months after UAE. On pretreatment images, signal intensity (SI) of fibroids was compared with that of the myometrium and skeletal muscle on T1- and T2-weighted sequences; the contrast enhancement pattern and localisation of fibroids were also analysed. Fibroid volume reduction (VR) was assessed by control imaging. The numerical analogue quality-of-life score was obtained before and after UAE. Statistical analysis was performed using the Mann-Whitney U-test, Kruskal-Wallis test, and Wilcoxon signed-rank test. The mean fibroid volume decreased by 51.1±30.8% during the 6.6±1.8 months (p<0.001). Mean quality-of-life score improved by 48.2±27.6 points (p<0.001). The mean VR of submucosal fibroids (82.1±18.5%) was greater than that of intramural (49.4±30.7%) and subserosal (43±28.3%) fibroids (p<0.001 for both). Fibroids that were isointense/hyperintense to myometrium on T2-weighted images showed a better response than hypointense fibroids (63.7±25.8% versus 48.6±31.3%, respectively; p=0.041). On contrast-enhanced images, isointense/hyperintense fibroids showed a better VR than hypointense fibroids (61.3±27.4% versus 47.6±31.6%, respectively; p=0.035). Baseline fibroid volume of <50 cm3 was also associated with favourable imaging outcome (p=0.021). T2 SI compared to skeletal muscle and T1 SI compared to myometrium or skeletal muscle did not show association with VR. Localisation, T2 SI, contrast enhancement, and <50 cm3 fibroid volume were associated with better VR; these may help with treatment decisions.

Validation of a Simulation Model for Laparoscopic Myomectomy Developed with 3D-Printed Molds

PURPOSE: To develop a model that can be used by Ob-Gyn residents when performing simulation for laparoscopic myomectomy. BACKGROUND: Laparoscopic myomectomy (LM) is a challenging procedure encountered by Ob-Gyn residents during residency training. Limited commercial simulation products exist but are cost-prohibitive for consistent use. METHODS: Uterine and fibroid molds were generated using Pixelogic® Z-brush design software and printed from a 3D printer using polylactic acid filament. Smooth-On® Dragon Skin silicone of varying densities was used for the uterus and fibroids. The model consisted of a uterine body with four fundal subserosal fibroids – two placed anteriorly and two placed posteriorly—fallopian tubes, and round ligaments. Residents evaluated the model and its effectiveness in simulating LM upon simulation completion. RESULTS: Five uterine models with four fibroids each were constructed for a total cost of $318 (printed molds, silicone, and pigment); replacement models cost $30 (silicone and pigment only). The model functioned well within the trainer box using surgical instruments and suture; however, the base of the fibroid adhered to the myometrium making excision of the entire specimen difficult. All residents (N=13) used the model. Residents felt the model was realistic (4/5), helps develop skills needed for LM (4.5/5), and will increase resident competency in laparoscopy (4.8/5). DISCUSSION: Our model provides a realistic simulation of LM at low cost. One model can be used by up to four residents. We can repair previously used models with silicone allowing them to be reused. We have updated the model to decrease fibroid adherence to the myometrium and facilitate complete excision.

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas.

Abnormal uterine bleeding refers to any change in the regularity, frequency, heaviness or length of menstruation. There are several potential causes for bleeding disturbance, the two most common being primary endometrial dysfunction and fibroids. Management of abnormal uterine bleeding involves both medical and surgical options and will largely depend on a patient's fertility plans. The use of levonorgestrel-releasing intrauterine devices for heavy menstrual bleeding is increasing in Australia, and they are considered first-line medical management for women accepting of hormonal therapies. Tranexamic acid, non-steroidal anti-inflammatory drugs, the combined oral contraceptive pill and oral progestins offer alternatives. Hysterectomy offers a definitive surgical approach to abnormal uterine bleeding and is associated with high levels of patient satisfaction. Women wishing to preserve their fertility, or avoid hysterectomy, may be offered myomectomy. Submucosal fibroids should be removed via hysteroscopy in symptomatic or infertile patients. Intramural and subserosal fibroids may be removed via an open or laparoscopic approach. There are several minimally invasive options, including uterine artery embolisation, magnetic resonance-guided focused ultrasound and endometrial ablation, but patients should be aware that there is insufficient evidence to ensure fertility preservation with these procedures and further research is needed. Areas for additional research include cost-effectiveness of treatments and quality of life comparisons between management options using patient reported outcome measures to evaluate patient satisfaction.

Systematic review of uterine artery embolisation practice guidelines: are all the guidelines on the same page?

To evaluate the degree of concordance amongst the currently available guidelines informing the use of uterine artery embolisation (UAE), and identify any inconsistencies present. Standards of practice and quality improvement guidelines were retrieved through a search of PubMed and EMBASE. Additional sets of guidelines were retrieved directly from the websites of known obstetrics and gynaecology and radiological associations. Eleven guidelines were retrieved from organisations located in Europe, North America, and Australia. Two main points of divergence were identified in the presented guidance: firstly, on whether submucosal, subserosal, and/or pedunculate fibroids should be considered a relative contraindication to UAE; secondly, on whether UAE should be recommended as an option in patients desiring future fertility. The guidelines reviewed generally suggest UAE to be a safe and effective option for fibroid treatment that can be offered as an alternative to surgical management; however, the number of differing interpretations arising from an apparently similar pool of evidence raises questions about the objectivity of practice guidelines. Although practice guidelines are understood to be a synthesis of clinical evidence and expert opinion, a systematic approach to presenting evidence is necessary to clearly distinguish empirically versus experientially informed guidance.

The expression of moesin, p21-activated kinase 4 (PAK 4), matrix metalloproteinases (MMP 2, MMP 9), and CD34 in the eutopic and ectopic endometrium in adenomyosis

To investigate the expression of moesin, p21-activated kinase 4 (PAK 4), matrix metalloproteinases (MMP 2, MMP 9), and CD34 in the eutopic and ectopic endometrium in different forms of adenomyosis. Fifty uteri removed for diffuse adenomyosis and for adenomyomas were examined in reproductive-aged (n=25) and premenopausal (n=25) women. A comparison group included 20 uteri removed for intramural and subserosal fibroids in reproductive-aged and premenopausal women. The investigators performed histological and immunohistochemical (using antibodies to moesin, PAK 4, MMP 2, MMP 9, and CD34) examinations of the eutopic and ectopic endometrium. Different forms of adenomyosis were characterized by the irregular border of the endometrium and myometrium due to that there were multiple foci of ingrowth of the basal layer of the endometrium through the terminal plate into the myometrium. In both diffuse adenomyosis and adenomyomas, the basal layer of the eutopic and ectopic endometrium differed many (3-8.5) times, showing the higher expression of the enzymes in the epithelial and stromal cells, which affected their invasive activity (moesin, PAK 4, MMP 2 and MMP 9), and the increased number of CD34 cells in its stroma. At the same time, there were no statistically significant differences in their expression in the basal layer of the eutopic and ectopic endometrium in diffuse adenomyosis and adenomyomas. The findings favor the theory of the pathogenesis of adenomyosis due to the invasion of the eutopic endometrium into the myometrium.

Caesarean myomectomy: TE or not TE?

Many years ago as a trainee I removed a subserosal fibroid during a caesarean section that was hanging by a thin stalk on the back of the uterus. The berating I received was severe and disproportionate to my crime. The rule was that myomectomy performed at caesarean section was not just frowned upon, but expressly forbidden. This article is protected by copyright. All rights reserved.

Submucosal fibroids, intracavitary fibroid – A case report

Introduction: The vast majority of women with fibroids go through life, have their children without knowing they harbor fibroids in their wombs. Women, who do have symptoms, it includes pain and heavy menstrual bleeding. Fibroids are classified according to their location within the uterine wall-intramural fibroids; subserosal fibroids; submucosal fibroids. A pedunculated lesion within the cavity is termed an intracavitary fibroid and can be passed through the cervix. Cervical fibroids.

Giant mesenteric fibromatosis – A case report

Mesenteric fibromatosis or intra-abdominal desmoids tumor is a rare clinical entity. It is a locally aggressive tumor but not metastasizing proliferation. We report a case of a 27-year-old woman with no significant medical and a previous cesarean section, admitted for abdominal pain. The CT abdominal evaluation revealed subserosal uterine fibroid. The patient underwent an elective laparotomy and a mass measuring 20/15/15 cm in diameter to the medial wall of the cecum was discovered. Complete removal was accomplished with right hemicolectomy. Histopathological examination reported mesenteric fibromatosis. Postoperatively, patient was well and 6 month follow-up showed good recovery. Moreover the next month she became pregnant and the pregnancy and birth were uneventful.