Uterine Leiomyoma In Women Research Articles

Clinical case of delivery of a pregnant woman with large uterine leiomyoma and rehabilitation in the postoperative period

Abstract. Uterine leiomyoma is a benign neoplasm of the smooth muscles of the uterus, which is one of the causes of infertility and miscarriage in women in the modern world. Delivery of pregnant women with large uterine leiomyoma is a current problem, since there is no single and clear opinion regarding the tactics of managing such patients. In the past, most specialists were inclined to perform hysterectomy after cesarean section, as they considered it the safest method of therapy, since myomectomy during cesarean section raised many questions related to complications during surgery and in the postoperative period. This article examines the modern view of specialists and the experience of the authors on organ-preserving tactics for the treatment of large uterine leiomyomas in women during pregnancy and delivery and analyzes rehabilitation in the postpartum period. The aim of the study. The aim of the study was to analyze scientific literature data on the advisability of performing myomectomy during cesarean section and combining the experience of other specialists with our own experience of delivery of pregnant woman with large uterine leiomyoma using a complex of intraoperative preventive measures. Materials and methods. A clinical case of delivery of a pregnant woman with large uterine leiomyoma and rehabilitation in the postoperative period is described. A systematic online study of articles on the topic of myomectomy during cesarean section was conducted. Results and discussion. Data from a significant number of works by other specialists indicate that preliminary substantiation of factors that may complicate surgical intervention (uterine contractility, anatomical localization, number and diameter of fibroids, as well as the presence of large vascular structures), the use of a set of preventive intraoperative measures and modern suture materials can reduce the amount of blood loss and prevent unfavorable postoperative results. Our proposed algorithm of action, including the administration of tranexamic acid before opening the anterior abdominal wall, a long-acting oxytocin agonist and the hemostatic sponge «Surgicel», allows us to minimize the amount of intraoperative bleeding and the risks of uncontrolled bleeding. It should also be noted that the addition of a cesarean section with myomectomy does not affect the course of rehabilitation in the postoperative period. Conclusions. Based on a study of literary sources over the past 10 years and our own research, we can conclude that myomectomy during cesarean section is advisable in the absence of contraindications. A combination of postoperative rehabilitation measures, tactics and techniques of surgical intervention, and prevention of intraoperative blood loss make it possible to ensure high-quality recovery for patients.

The Effect of Vitamin D Supplementation on Size of Uterine Leiomyoma in Women with Vitamin D Deficiency

BACKGROUND: Uterine leiomyomas (fibroids) are the most common benign genital tumors in women. There is a high prevalence of vitamin D deficiency and uterine leiomyomas. AIM: To evaluate the effect of vitamin D supplementation on the size of uterine leiomyoma in women with vitamin D deficiency. MATERIALS AND METHODS: It is case–control prospective study which was done in Gynecology Ward at Basrah Maternity and Child Hospital from January 2020 to August 2022. Patients at ages 20–45 years were initially included in the study if they were diagnosed with 1–3 uterine fibroids with a mean diameter ≥10 mm. Serum vitamin D levels were estimated for all women before intervention and in those with deficiency of vitamin D (level <30 ng/mL). Patients with vitamin D deficiency were divided into 2 groups. The 1st group was women who received vitamin D 50,000 cholecalciferol (oral solution) IU weekly for 10 weeks followed by 2000 IU daily for 6–9 month (as study group), while 2nd group received placebo (control group). After the duration of treatment, vitamin D level was estimated and sonography was done to assess the fibroid size at 9–12 months later. In relation to the achievement of normal 25-OH-D3 levels, after the supplementation, the studied population were divided into 2 subgroup of patients: “gave response” and “non-responders” according to their response to treatment. RESULTS: Vitamin D level was 17.6 (±3.0) ng/mL and calcium status was 7 mg/dL among 43 females of the study group. Vitamin D level was 34.7 ± 5 ng/mL after 12 months vitamin treatment (p < 0.05). The early vitamin level among 23 control females was 22.4 ± 7.8 ng/mL in comparison to 24.6 ± 6.7 ng/mL after 12 months (p > 0.05). There was no change for calcium level before and after 12 months period (8.6 vs. 7.9 mg/dL respectively). No changes were noticed among both the study and the control groups as far as the type and position of leiomyoma between the 1st and the 2nd ultrasound after 12 months of therapy. CONCLUSION: Lower serum vitamin D levels are significantly associated with the occurrence of uterine fibroids.

Рrediction of infertility in patients with uterine leiomyoma

Infertility is an important socio-economic problem due to the fact that planned childbearing occurs much later than three decades ago. In recent years, more attention has been paid to the role of uterine leiomyoma in the development of infertility. Uterine leiomyoma is a benign monoclonal, well-demarcated encapsulated tumor originating from the smooth muscle cells of the cervix or body of the uterus. Uterine leiomyoma is the most common uterine tumor in the reproductive age group, affecting 20-50 % of women. With conceptual changes in marriage and childbearing, the number of women over 35 with leiomyoma who want to have children has also increased significantly. The need to treat submucosal fibroids is widely recognized, but fibroids of other locations and sizes remain a clinical mystery. The purpose of the literature review was to determine the role of uterine fibroids in predicting infertility. It has been established that the incidence of uterine leiomyoma in women of reproductive age is on average about 40 %, infertility associated with this pathology occurs in 5-10 % of women. In 10 % of cases of infertility, uterine leiomyoma is the only established cause of infertility. Uterine leiomyoma is common among women of reproductive age, and as women continue to delay childbearing, an increasing number of patients will require fertility-preserving treatment options. Leiomyoma affects not only fertility but also obstetric outcomes. Women with intramural fibroids without cavity deformity have a 21 % reduction in live birth rates after in vitro fertilization compared with controls without fibroids. Despite advances in fundamental understanding of the biology of leiomyomas, the role of different fibroid variants remains a matter of discussion. The question of the negative impact of submucosal nodes on infertility today is not in doubt, and the effect of subserous and intramural nodes requires further study.

The results of immunohistochemical study of signaling pathways’ markers of proliferation in uterine leiomyoma in women using hormonal contraception.

Objective. To elucidate the influence of various components of hormonal contraception in women with uterine leiomyoma (UL) on the key molecular and cellular mechanisms of its proliferation. Methods. Antigen Ki-67, estrogen receptors (ER) and progesterone receptors (PR) were determined by immunohistochemical methods in 230 samples of UL preparations obtained during myomectomy. Depending on the composition of the components of hormonal contraceptives that women used for 12 months before the operation, 8 study groups were created: Group I - control, without the use of any hormonal contraception; Group II - the use of COCs containing 20 μg of ethinylestradiol and 0.075 mg of gestaden; Group III - COCs (30 μg ethinylestradiol and 0.075 mg gestaden) Group IV - COCs (30 μg ethinylestradiol and 0.15 mg desogestrel) Group V - COCs (30 μg ethinyl estradiol and 0.15 mg levonorgestrel) Group VI - COCs (30 μg ethinyl estradiol and 2 mg dienogest) Group VII - COCs (30 μg ethinylestradiol and 3 mg drospirenone) Group VIII - (intrauterine levonorgestrel releasing system (IUD-LNG). Results. In UL samples from group I, an increase of Ki-67 positive cells in 3.4 times was observed (3.1 ± 0.03%; p <0.04) in comparison with intact myometrium (IM) (0.9 ± 0.06%), which is evidence of a higher cell proliferation in the UL, a 3.1-fold increase in the H-index of ER expression - 39.4 ± 4.3 (p <0.05) versus 12.9 ± 1.6 in the group with IM I and in 2.6 times of PR expression - 21.1 ± 1.7 (p <0.05) compared to IM - 8.2 ± 1.4, which may indicate a greater sensitivity of UL to sex hormones and their promoter role in UL proliferation. Expression of Ki-67 in UL samples in women taking COCs, which included dienogest (1.8 ± 0.03%, p <0.05) - group VI and desogestrel (1.9 ± 0.03%, p <0.05) - group IV, was, 42.0% and 38.8% respectively, what ois less than in group I UL, which can be regarded as the cytoprotective effect of the progestogen component of COC on the mitotic activity of UL cells. A positive trend in the expression of Ki-67 persisted when women used COCs containing gestodene (2.1 ± 0.02%; p <0.05) - group III and levonorgestrel (2.2 ± 0.04%, p <0.05) - group V, in which the expression of Ki-67 was shown by a smaller number of PM cells, respectively, by 32.3% and 25.8% than in group I PM, and also to a lesser extent - in group VIII (COC with droperidone), where the mean value of Ki-67 expression in LM samples was 2.6 ± 0.02% and was 16.9% less than in LM group I. An increase in the dose of ethinyl estradiol in COCs from 20 μg (group II) to 30 μg (group III) did not significantly affect the expression of Ki-67, therefore, the content of estrogens in modern low-dose COCs does not contribute to an increase in proliferation in the LM, and the non-contraceptive antiproliferative effect is associated exclusively with biological and the pharmacological properties of individual gestagens in the composition of COCs. It was proved that the studied COCs did not significantly affect the expression of ER and PGR. There was no significant difference in the expression of the Ki-67 marker (2.9 ± 0.04%, p <0.05) in UL cells in women using LNG-IUD for contraception, compared with group I. Conclusion. The results of the study have shown that when choosing a drug for hormonal contraception in women with UL, preference should be given to combined hormonal drugs that contain progestogens with the most pronounced antiproliferative properties (dienogest, desogestrel and levonorgestrel).

Results of combined treatment of uterine leiomyoma in women of reproductive age

The purpose of the work. To study the effectiveness of the combined treatment of uterine leiomyoma (UL), taking into account the possibility of realizing reproductive function.Material and methods. The total number of women of reproductive age examined with a large UL (a dominant node more than 50 mm in diameter) was 94. At the first stage, all patients received preoperative preparation. At the first stage all patients received preoperative preparation. 35 patients with concomitant endometrial hyperplasia and/or with the presence of the progesterone receptor gene polymorphism PGR progins received aGn-RH in an average therapeutic dose once in 28 days, 3 injections. 59 patients with the reference genotype without endometrial pathology received mifepristone 50 mg daily for 3 months. After preoperative preparation, the patients underwent conservative myomectomy by laparotomy. Menstrual function, pelvic pain syndrome, size of leiomatous nodules, drug tolerance, frequency of pregnancy and recurrence were assessed. Statistical data processing was performed using Microsoft Excel software. The main statistical indicators such as frequency, mean and standard deviation were taken into account. The results were considered significant at p < 0.05.Results. Excessive menstruation and AUB occurred in 81.9% of patients. Amenorrhea occurred in 79.8% of patients after 1 month of therapy and in all patients after 3 months. Recovery of menstruation was noted in 10.6% of patients a month after the operation, in 59.6% of patients after two months and on the third cycle menstruation resumed in all patients. The frequency of pain syndrome unrelated to the menstrual cycle decreased from 52.1% to 9.6%, dyspareunia from 12.8% to 4.3%, dysmenorrhea from 47.9% to 8.5%. According to ultrasound data, after 1 month in the group of women receiving aGn-RH the size of the nodules decreased by an average of 22.9%, and after mifepristone by 16.9%, and after 3 months by 51.4% and 45.8%. The uterine volume decreased by 28.6% and 30.5%. Starting from the second month of treatment, symptoms caused by estrogen deficiency were noted in 39.4% of patients treated with aGn-RH and 20.3% in the mifepristone group. Overall, the treatment was defined as effective in 88.6% of the women treated with aGn RH and 93.2% of those treated with mifepristone. Relapse occurred in 11.4% of women after aGn-RH and in 5.1% of those in the mifepristone group. Pregnancy occurred in 69.2% of patients and resulted in delivery in 90.8% of cases.Conclusions. The use of preoperative hormonal preparation and a differentiated approach to medication selection leads to normalization of the patient's condition and a reduction in the size of the nodules, which allows organ-preserving surgical treatment with minimal uterine trauma. Preference should be given to anti-gestagens because, with equal efficiency compared to aGn-RH, they are better tolerated by patients and have a more pronounced positive effect on process stabilization and disease recurrence. This combined approach improves treatment efficiency to 91.5%, preserves the uterus in reproductive-age women and promotes pregnancy in 69.2% of cases.

Потенційний вплив мелатоніну на розвиток міоми матки у жінок репродуктивного віку (огляд літератури)

For a long time, Ukraine has been showing negative dynamics between birth and death rates. The demographic situation in any country is an important indicator. Therefore, the issue of women's health and ability to reproduce is significant and urgent. The purpose of the study was to analyze current data from domestic and foreign literature on provoking factors, etiology and pathogenesis of uterine fibroids, new approaches to treatment and the impact of this pathology on a woman's reproductive potential. Hyperplastic processes of the uterus in women of reproductive age are among the most common gynecological diseases. Uterine leiomyoma is the most common benign proliferative pathology. The presence of uterine leiomyoma leads to disorders of women's reproductive health, is one of the causes of infertility, in addition, significantly affects the quality of life of the patient due to constant pain, excessive uterine bleeding, dysfunction of adjacent organs. Many studies confirm the unfavorable course of pregnancy and the postpartum period in women with fibroids, namely: complicated pregnancy, reproductive losses, birth defects and postpartum complications. Despite the intensive work of scientists, the implementation of a large number of studies, the pathogenesis to this day remains multifaceted and poorly understood. Results and discussion. After analyzing current data from domestic and foreign literature on provoking factors, etiology and pathogenesis of uterine fibroids, the review article presents data on current opportunities, new approaches to treatment and the impact of this pathology on a woman's reproductive potential. For a long time, the pineal gland with the hormone melatonin has not been studied. During the scientific research, the review of the current domestic and foreign literature on the potential inhibitory effect of melatonin on uterine fibroid cells, and the direct and indirect effect on fertility was reviewed and analyzed. As a result of analysis of experimental and clinical data presented in the literature, it can be argued that melatonin has the ability not only to regulate biological rhythms, but also that it is promising to study metabolic and immunomodulatory effects, as well as antitumor effects, which gives us a chance to reduce surgery of this group of patients. Conclusion. The information presented in the review suggests that melatonin has the potential as a therapeutic agent for clinical trials against uterine leiomyoma in women of reproductive age. Therefore, there is a need to study deeply the etiopathogenesis of uterine leiomyoma and in particular the effect of melatonin on growth, reduction of surgical interventions, the impact on the pre- and postoperative period, and to determine melatonin as a therapeutic drug

P–296 Examining the link between environmental toxin exposure and uterine leiomyoma: a systematic review

Abstract Study question Is there an association between exposure to certain environmental toxins and the prevalence of uterine leiomyoma in women? Summary answer Some evidence was obtained to suggest an association between phthalate esters, bisphenol A, heavy metals, persistent organic pollutants and the prevalence of uterine fibroids. What is known already Environmental toxins are naturally occurring, or human made chemicals that can act as endocrine disrupting chemicals (EDCs) by binding and activating estrogen receptors in the body. Uterine fibroids, often called leiomyoma are non-cancerous growths occurring in the uterus. Though often asymptomatic, they can cause pain, infertility, pregnancy complications and are a leading cause for hysterectomy. The aetiology of leiomyoma is not fully understood but both estrogen and progesterone have been implicated in their growth. We aimed to investigate the epidemiological evidence for the association between EDCs and the prevalence of fibroids. Study design, size, duration We undertook a systematic review and in keeping with PRISMA guidelines, a structured search of Medline, Embase, Scopus, and Web of Science was conducted (to October 2020). Case-control, cross-sectional, cohort and experimental studies were included. Participants/materials, setting, methods The included studies analyzed the association between one or more toxins and the occurrence, or growth of leiomyoma in humans, including human cell lines. The types of toxins, patient characteristics, association and outcome, body concentration of toxin and confounding variables were extracted and analyzed. Quality assessment was performed using the Newcastle-Ottawa Scale. Main results and the role of chance In total, 34 studies were included. The majority (76%) of studies revealed a significant association between the exposure studied and the prevalence of uterine leiomyoma. In examining body burden in cases vs controls, phthalate esters showed an association with increased odds of uterine leiomyoma, except in one case where a negative association was observed. In vitro experimental studies examining the effect of alkyl-phenols such as bisphenol A (BPA), octylphenol (OP) and nonylphenol (NP) demonstrated that these environmental estrogens can act to promote the proliferation of leiomyoma cells through a number of mechanisms, typically including the estrogen receptor alpha (ERa) signalling pathway. There were conflicting results for the association between alkyl-phenols and fibroids in case-control studies. A positive association between cadmium was demonstrated in only two studies. There were conflicting results for the association between lead, mercury, arsenic and uterine fibroids. Several metabolites of organophosphate esters, alternative plasticizers, and persistent organic pollutants were associated with an increased risk of uterine fibroids. Limitations, reasons for caution Separating these exposures from the multiple other factors that could affect the outcome of leiomyoma is challenging, but an important issue for future research. Wider implications of the findings: The link between some environmental toxins and uterine fibroids discussed is in agreement with previous literature. However, our review provides a more in depth analysis on specific dosage effects, odds ratios, and potential gene mechanisms of the exposures. This information could contribute to more accurate preventative measures. Trial registration number Not applicable

P-296 Examining the link between environmental toxin exposure and uterine leiomyoma: a systematic review

Abstract Study question Is there an association between exposure to certain environmental toxins and the prevalence of uterine leiomyoma in women? Summary answer Some evidence was obtained to suggest an association between phthalate esters, bisphenol A, heavy metals, persistent organic pollutants and the prevalence of uterine fibroids. What is known already Environmental toxins are naturally occurring, or human made chemicals that can act as endocrine disrupting chemicals (EDCs) by binding and activating estrogen receptors in the body. Uterine fibroids, often called leiomyoma are non-cancerous growths occurring in the uterus. Though often asymptomatic, they can cause pain, infertility, pregnancy complications and are a leading cause for hysterectomy. The aetiology of leiomyoma is not fully understood but both estrogen and progesterone have been implicated in their growth. We aimed to investigate the epidemiological evidence for the association between EDCs and the prevalence of fibroids. Study design, size, duration We undertook a systematic review and in keeping with PRISMA guidelines, a structured search of Medline, Embase, Scopus, and Web of Science was conducted (to October 2020). Case-control, cross-sectional, cohort and experimental studies were included. Participants/materials, setting, methods The included studies analyzed the association between one or more toxins and the occurrence, or growth of leiomyoma in humans, including human cell lines. The types of toxins, patient characteristics, association and outcome, body concentration of toxin and confounding variables were extracted and analyzed. Quality assessment was performed using the Newcastle-Ottawa Scale. Main results and the role of chance In total, 34 studies were included. The majority (76%) of studies revealed a significant association between the exposure studied and the prevalence of uterine leiomyoma. In examining body burden in cases vs controls, phthalate esters showed an association with increased odds of uterine leiomyoma, except in one case where a negative association was observed. In vitro experimental studies examining the effect of alkyl-phenols such as bisphenol A (BPA), octylphenol (OP) and nonylphenol (NP) demonstrated that these environmental estrogens can act to promote the proliferation of leiomyoma cells through a number of mechanisms, typically including the estrogen receptor alpha (ERa) signalling pathway. There were conflicting results for the association between alkyl-phenols and fibroids in case-control studies. A positive association between cadmium was demonstrated in only two studies. There were conflicting results for the association between lead, mercury, arsenic and uterine fibroids. Several metabolites of organophosphate esters, alternative plasticizers, and persistent organic pollutants were associated with an increased risk of uterine fibroids. Limitations, reasons for caution Separating these exposures from the multiple other factors that could affect the outcome of leiomyoma is challenging, but an important issue for future research. Wider implications of the findings The link between some environmental toxins and uterine fibroids discussed is in agreement with previous literature. However, our review provides a more in depth analysis on specific dosage effects, odds ratios, and potential gene mechanisms of the exposures. This information could contribute to more accurate preventative measures. Trial registration number not applicable

Uterine leiomyoma in women of reproductive age: pregnancy and childbirth management (Literature review)

The article presents a review of the current literature on the problem of uterine leiomyoma (UL) in women of reproductive age during pregnancy and childbirth. We studied the main issues of uterine leiomyoma etiology and pathogenesis, as one of the leading causes of reproductive dysfunction and possible complications during pregnancy and childbirth.UL is the most common tumor of the female genitalia and occurs in 20–30% of women of reproductive age. It is impossible to determine a more accurate indicator of this pathology, given the asymptomatic course of more than 70% of cases and irregular consultations by obstetricians and gynecologists.There is evidence that uterine leiomyoma is associated with infertility in only 5–10% of cases, but only 2–3% of cases when all other causes are ruled out. The submucosal node has the most adverse effect on fertility and reduces the implantation frequency by 72% and increases the miscarriage risk by 60%. Subserous LM affects fertility to a lesser extent than submucosal LM, but large nodules can lead to infertility requiring surgical treatment. An individual approach to the treatment of women with intramural LM is required, as there is insufficient data on the node effect on fertility.The most common complications of pregnancy, childbirth and the postpartum period in women with uterine leiomyoma in 22–58% of cases are late preeclampsia, fetoplacental insufficiency, anemia of pregnancy, fetal growth restriction, incorrect position and presentation of the fetus. Pregnancy also adversely affects UL, leading to acute secondary changes and rapid tumor growth, which in turn can lead to severe obstetric complications.

30. Large Uterine Leiomyoma in Premenarchal 11-year-old Patient: A Case Report

<h3>Background</h3> Uterine leiomyomas, solid benign monoclonal tumors, are the most common pelvic tumor in women. Steroid hormones are thought to play a role in pathogenesis and they are known to increase with age in premenopausal women. These lesions are exceedingly rare in the pediatric and adolescent population and even more so in premenarchal females. <h3>Case</h3> An 11-year-old female presented with a firm abdominal mass, increasing in size over one year. She had mild cramping with intense physical activity. She denied urinary or gastrointestinal symptoms, except occasional sensation of urge without ability to void. She had no anorexia, fatigue, weight loss, or fevers. She was pre-menarchal with pubarche, adrenarche, and thelarche progressing in the preceding year. She was not sexually active. Her mother's menarche was age 12. Negative family history of cancer. On exam, she had a firm mass, measuring 23 cm from pubic bone. MRI confirmed a solid, circumscribed 8.5 × 16.5 × 15.9 cm mass with scattered areas of heterogeneity, small volume of pelvic free fluid, no lympadenopathy (figure 1). Due to concern for sarcoma, pediatric surgery performed an open biopsy. Pathology was consistent with leiomyoma. The mass was subsequently resected via a vertical midline incision. Intraoperatively, there was a firm mass originating from the anterior superior portion of the uterus, and small omental adhesion to the mass at the prior biopsy site (figure 2). A Penrose drain was tied around the base of the uterus and dilute vasopression was injected in the serosa. The mass was completely resected without entry into the endometrium. The uterus was closed from cornua to cornua in three layers. Pathology showed monomorphic proliferation of myoid cells, staining consistent leiomyoma, without coagulative necrosis or increased mitotic activity to suggest a higher grade process. Genetic testing was negative for hereditary leiomyomatosis, renal cell cancer (FH), multiple endocrine neoplasia (MEN1) and PTEN. <h3>Comments</h3> Despite the high incidence of uterine leiomyomas in women of a reproductive age, few cases have been documented in a premenarchal patient. This premenarchal status, along with the absence of any typical genetic markers for uterine leiomyomas, suggests that there may be additional factors that contribute to the development of leiomyomas.

Effect of Vitamin D3 supplementation on symptomatic uterine leiomyoma in women with Hypovitaminosis D

Objective:The objective of this study is to evaluate the effect of Vitamin D3 on symptoms, uterine and leiomyoma volume in women with symptomatic leiomyoma and hypovitaminosis D.Materials and Methods:In this pilot, interventional, prospective study, 30 premenopausal women with uterine leiomyoma and concomitant hypovitaminosis D (<30 ng/ml) received Vitamin D3 in doses of 60,000 IU weekly for 8 weeks followed by 60,000 IU every 2 weeks for another 8 weeks. Change in symptoms, uterine, and leiomyoma volume was evaluated at 8 weeks and 16 weeks. Serum Vitamin D3 levels were repeated at 16 weeks of therapy.Results:A significant negative correlation was observed between the baseline 25-hydroxy Vitamin D (25(OH) Vitamin D3) and leiomyoma volume (r = –0.434, P < 0.001). There was significant reduction of menstrual blood loss by 29.89% (P = 0.003) and severity of dysmenorrhea, pelvic pain, and backache by 44.12%, 35%, and 50% (P < 0.001, 0.019, and 0.002), respectively, at 16 weeks. At end of therapy, there was 6% reduction in mean uterine volume and 11% in leiomyoma volume which was not significant. Serum 25(OH) Vitamin D3 was significantly higher than baseline level (17.44 ± 5.82 vs. 39.38 ± 8.22, P < 0.001) at end of therapy.Conclusion:Vitamin D3 supplementation is effective in reducing leiomyoma-related symptoms and stabilizing uterine and leiomyoma volume.

Cutaneous Leiomyomatosis – Case Report and Literature Review

Cutaneous leiomyomas are uncommon benign smooth muscle tumors that comprise of three distinct types such as piloleiomyoma, angioleiomyoma, and genital leiomyoma. The discovery in 2001 of the association between cutaneous leiomyomas, uterine leiomyomas in women, and an aggressive form of renal cell cancer (RCC) underscores the importance of accurate dermatologic diagnosis of CL so that appropriate cancer screening and counseling of patients and at-risk relatives can be instituted. The present case report will discuss the pathogenesis, clinical manifestations, diagnosis, and management of a piloleiomyoma.

Лейомиома матки: частота и прогноз

The main principles of state policy in the field of protection of reproductive rights of citizens in the Kyrgyz Republic are the orientation of state programs to improve the demographic development of the Kyrgyz Republic, as well as the availability and high quality of health services at all stages of organizing reproductive health care. One of the main directions of state policy in the field of protection of reproductive rights of citizens is the conduct of scientific research in this direction. In the structure of gynecological diseases in women of childbearing age in most countries of the world, uterine fibroids takes a leading place. The tactics of treating patients with uterine leiomyoma, aimed at preserving and implementing reproductive function, remains relevant and often discussed. All of the above dictates the need to continue scientific work in this direction. The purpose of the study was to analyze the frequency of uterine leiomyoma in women in the Kyrgyz Republic and to make a prognosis of this pathology until 2023. Materials and research methods — the study was conducted on the basis of the clinical maternity hospital National Center for Maternal and Child Welfare of the Ministry of Health of the Kyrgyz Republic. The data from the annual reports of the healthcare organizations of the Kyrgyz Republic submitted to the RCHEC for the period 2010–2018 was analyzed, the incidence of uterine leiomyoma is estimated by the analysis of the time series. Results — the analysis of the incidence of uterine leiomyoma in women of the Kyrgyz Republic established an increase in this pathology by 2.2 times in the analyzed period from 19.5 per 100 thousand women in 2010 to 43.5 per 100 thousand women by 2018, p&lt;0.001, the medium-term forecast confirmed the dynamics of the growth rate of uterine leiomyoma up to 65.8 per 100 thousand women by 2023, which is 3.4 times higher than 2010, p&lt;0.001. The frequency of occurrence of uterine leiomyoma in women during childbirth during the analyzed period is characterized by consistently high rates (6.8 per 1,000 births in 2010 and 6.6 per 1,000 births in 2018) with no tendency to decrease, the medium-term forecast confirms the stability process (by 2023, the indicator will be 7.2 per 1,000 births). The high incidence of this pathology requires the adoption of effective decisions in the health sector aimed at maintaining the reproductive potential of the country.

Benign leiomyoma with multiple metastases to vertebrae and calvarium: An index case with comprehensive review of endocrine targets

"Benign" metastatic leiomyomas (BML) are indolently growing metastatic tumors which mostly associate with uterine leiomyomas in women in reproductive ages. The reason to define these lesions as "benign" despite metastasis is their pathological features with low mitotic counts, lack of or minimal nuclear atypia, pseudocyst formation, and coagulative necrosis unlike leiomyosarcomas. Despite lack of pathological malignant features, they may cause significant morbidity and even mortality. Here, we describe a BML case with metastases to vertebrae and skull bones. Vertebral and skull metastases of BMLs were very rarely reported. In treatment of these tumors, hysterectomy and GnRH modifier treatments are widely employed. GnRH agonists act by desensitization and downregulation of the GnRH receptors, while GnRH antagonists act via the canonical competitive blockage. These treatments reduce FSH and LH levels, thereby reducing the systemic levels of sex steroids which stimulate leiomyoma growth. However, leiomyomas inherently harbor aromatase activity and synthesize their own estrogen; hence, treatment with systemic estrogen antagonists may provide better tumor control. Another important factor in BML pathogenesis is progesterone, and both progesterone receptor antagonists and high-dose progesterone receptor agonists may reduce BML growth. Following surgical treatment of the calvarial mass and radiotherapy of the vertebral metastatic foci, our BML case was successfully managed with hysterectomy and anastrozole treatment. Higher awareness of BML cases and their molecular endocrinological features in the neurosurgical community may pave to develop better strategies for treatment of these tumors causing high morbidity.

The effect of vitamin D supplementation on the size of uterine leiomyoma in women with vitamin D deficiency.

Background:Uterine leiomyomas (fibroids) are the most common benign pelvic tumors in women of reproductive age with an incidence ranging from 5.4% to 77%, Also, there is a high prevalence of vit D deficiency in Iran and there are the numbers of in vivo and vitro biological studies on the relationship of vitamin D and uterine leiomyomas. The aim of this study was to evaluate the effect of vit D supplementation on the size of uterine leiomyoma in women with vit D deficiency.Methods:This double-blind prospective clinical trial was performed on 69 patients with uterine leiomyomas who had vit D deficiency. Group A (n=35) was treated with vit D 50,000 IU every 2 weeks for 10 weeks, while group B (n=34) received placebo with same color and shape. Finally, the leiomyoma size in both groups was compared (IRCT: 20160521027998N5).Results:After a 10-week intervention, 25-hydroxyvitamin D3 levels were significantly higher in group receiving vitamin D (36.08 vs 16.25 ng/ml). (P<0.001) Leiomyomas size in vit D group significantly decreased as compared to placebo group (52.58 vs 61.11 mm, respectively).Conclusion:Our results showed that administration of vit D3 may reduce the size of leiomyoma. It seems that vitamin D administration is the effective way to treat leiomyoma.

The Arg399Gln (rs25487) Polymorphism of XRCC1 Gene as a Predictor for Uterine Leiomyoma in Women of Babylon Province/Iraq

The Arg399Gln (rs25487) Polymorphism of XRCC1 Gene as a Predictor for Uterine Leiomyoma in Women of Babylon Province/Iraq

Genetic predisposition to uterine leiomyoma is determined by loci for genitourinary development and genome stability.

Uterine leiomyomas (ULs) are benign tumors that are a major burden to women's health. A genome-wide association study on 15,453 UL cases and 392,628 controls was performed, followed by replication of the genomic risk in six cohorts. Effects of the risk alleles were evaluated in view of molecular and clinical characteristics. 22 loci displayed a genome-wide significant association. The likely predisposition genes could be grouped to two biological processes. Genes involved in genome stability were represented by TERT, TERC, OBFC1 - highlighting the role of telomere maintenance - TP53 and ATM. Genes involved in genitourinary development, WNT4, WT1, SALL1, MED12, ESR1, GREB1, FOXO1, DMRT1 and uterine stem cell marker antigen CD44, formed another strong subgroup. The combined risk contributed by the 22 loci was associated with MED12 mutation-positive tumors. The findings link genes for uterine development and genetic stability to leiomyomagenesis, and in part explain the more frequent occurrence of UL in women of African origin.

An interesting case of large multi-leiomyomas in uterine cervix with concomitant pregnancy and review

The incidence of uterine leiomyoma in women aging from 35 to 50 years is reported to be 70-80%. Generally, leiomyoma is classified according to the locations and directions of growth, and the most common types including subserosal, intramural, and submucous myoma. Only about 0.4% of leiomyoma develops in the cervix of uterus, and it would be even rare to find a cervical leiomyoma with a size similar to a full-term uterus, as reported here, which poses a challenging situation for gynecologists.

New views on the treatment of uterine leiomyoma in women of reproductive age

Uterine leiomyoma is the most common reproductive system disease in women of fertile age, which takes the leading place in frequency among tumors of the female sexual sphere. It is diagnosed in 20–70% of women of reproductive age. The uterine leiomyoma is still often treated surgically, and is the most common cause of hysterectomies.The article examines the issues of increasing the effectiveness of treatment of uterine leiomyoma and its complications in women of reproductive age by using combined methods of conservative treatment. The results of examination and treatment of 55 patients aged 27–45 with different forms of leiomyoma are presented: intramural nodes (18–32.7%), intramuralsubserous (21–38.3%) and intramural-submucous (16–29.0%). The size of the dominant node varied from 4.5 to 12 cm. Clinical manifestations of leiomyoma was hyperpolimenorrhea (82.3%), lower abdominal pain (34.7%), frequent urination (15%). Also, 86% of women suffered from a decrease in hemoglobin in the blood.In respect of all patients, organ-preserving surgical treatment was planned in connection with the desire of women to giving birth to a child. Patients took ulipristal acetate in a continuous regimen of 5 mg per day and indole-3-carbinol with epigallocatechin-3-gallate 1 tablet 2 times a day for 12 weeks. Women with anemia concurrently with this basic therapy took iron preparations inside.43 (78.3%) women had amenorrhea since the beginning of treatment within a month. The mean decrease in the size of the uterus was 40.7%. After the end of treatment, 49 (89.0%) patients successfully underwent conservative myomectomy, and in 6 (11.0%) patients after the termination of treatment surgical intervention was avoided. During the year after the termination of the course of treatment 13 women became pregnant.In using the combination therapy with ulipristal acetate in combination with indole-3-carbinol and epigallocatechin-3-gallate for 3 months the hemoglobin level was normalized, and the size of the leiomyoma was decreased, which is important for the safe operation. This therapy is a method of choice for the treatment of young women, who intend to exercise their reproductive function.

Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: systematic review and meta-analysis.

To analyze the diagnostic accuracy of two- (2D) and three- (3D) dimensional saline contrast sonohysterography (SCSH) in the detection of endometrial polyps and submucosal uterine leiomyomas in women of reproductive age with abnormal uterine bleeding compared with gold standard hysteroscopy. A systematic review of diagnostic studies that compared 2D- and/or 3D-SCSH with hysteroscopy and anatomopathology was conducted according to PRISMA and SEDATE recommendations. The databases MEDLINE, EMBASE and The Cochrane Library were searched electronically using specific terms with no restriction on language or publication year. Quality assessment of included studies was performed using the QUADAS-2 tool. Meta-analysis was performed with the Meta-DiSk program and data presented as forest plots and summary receiver-operating characteristics (SROC) curves. Pooled sensitivity, specificity and positive (LR+) and negative (LR-) likelihood ratios of SCSH in the detection of uterine cavity abnormalities were calculated. A total of 1398 citations were identified and five studies were included in the systematic review and meta-analysis. Pooled sensitivity and specificity of 2D-SCSH in detecting endometrial polyps were 93% (95% CI, 89-96%) and 81% (95% CI, 76-86%), respectively, with pooled LR+ of 5.41 (95% CI, 2.60-11.28) and LR- of 0.10 (95% CI, 0.06-0.17). In the detection of submucosal uterine leiomyomas, pooled sensitivity and specificity were 94% (95% CI, 89-97%) and 81% (95% CI, 76-86%), respectively, with pooled LR+ of 4.25 (95% CI, 2.20-8.21) and LR- of 0.11 (95% CI, 0.05-0.22). 2D-SCSH had good accuracy in detecting endometrial polyps and submucosal uterine leiomyomas, with areas under the SROC curves of 0.97 ± 0.02 and 0.97 ± 0.03, respectively. Studies that analyzed the diagnostic accuracy of 3D-SCSH could not be compared due to high heterogeneity related to menopausal status, type of technique used and primary outcome being investigation of infertility. 2D-SCSH proved to be a highly sensitive method for detection of endometrial polyps and submucosal uterine leiomyomas, making it a potential first-line diagnostic method in the work-up for women with abnormal uterine bleeding. More studies are needed on 3D-SCSH in women of reproductive age. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.