Uterine Fibroids Research Articles

Relationship between menarche age and parity with the incidence of uterine myomas

Background: Uterine myomas, or fibroids, are one of the most common benign tumors that occur in women of reproductive age, with a reasonably high prevalence worldwide. However, rarely, potentially malignant uterine myomas can cause a variety of health problems, including excessive menstruation, pelvic pain, fertility disorders, and pregnancy complications. Objective: This study aims to analyze the relationship between menarche age and parity with the incidence of uterine myoma. Methods: Types and design of research the plan used in this exploration is quantitative exploration with a case control approach. Sampel berjumlah 138 responden masing-masing 102 ibu yang mengalami mioma uteri dan 36 ibu yang tidak mengalami efek buruk mioma uteri. Results: The test results measured using the chi-square test were obtained with p-value menarche age = 0.004 and parity p-value = 0.000, meaning that there was a very large relationship between menarche age and parity with the incidence of uterine myomas. Conclusion: It can be concluded that the earlier the age of menarche increases the risk of uterine myoma later in life. In contrast, slower menarche may be associated with a reduced risk of myomas. Other factors such as genetic, environmental, and lifestyle factors also influence the incidence of uterine myomas, but menarche age is one of the significant hormonal indicators of risk

3D printed gelatin/PTMC core/shell scaffolds with NIR laser-tuned drug/biomolecule release for cancer therapy and uterine regeneration

Surgical resection is an efficient treatment for cancerous tissues and uterine fibroids in the women uterus. However, the insufficiency of clinical interventions could result in tumor recurrence, and the defective tissues remained would cause intrauterine adhesions (IUAs) and further affect reproduction capacity. In this study, 3D printed hydrogel/poly(l-lactide-co-trimethylene carbonate) (PLLA-co-TMC, “PTMC” in short) core/shell scaffolds with NIR-tuned doxorubicin hydrochloride (DOX) and estradiol (E2) dual release were designed and fabricated for cancer therapy and uterine regeneration. Gelatin (Gel) and DOX were homogeneously mixed and then 3D printed to form Gel-DOX scaffolds. Gel-DOX scaffolds were then immersed in PTMC-PDA@E2 solution to fabricate Gel-DOX/PTMC-PDA@E2 core/shell scaffolds. Consequently, Gel-DOX/PTMC-PDA@E2 scaffolds could release DOX and E2 in a chronological manner, firstly delivering DOX assisted by phototherapy (PTT) to effectively kill Hela cells and then sustainably releasing E2 to promote uterine tissue regeneration. In vitro experiments showed that core/shell scaffolds exhibited excellent anticancer efficiency through the synergy of DOX release and hyperthermia ablation. Moreover, E2 could be sustainably released for over 28 days in vitro to promote the proliferation of bone marrow-derived mesenchymal stem cells (BMSCs). The novel Gel-DOX/PTMC-PDA@E2 core/shell scaffolds have therefore exhibited potential promise for the treatment of cancer therapy and uterine regeneration.

Drug resistance of tuberculosis patients at the makassar city community lung health center hospital: Case Study

Introduction: Drug-resistant tuberculosis (TB-RO) is still a health problem because of its rapid transmission with an increasing number of cases. Objective: This study aims to discover in-depth patient knowledge about tuberculosis and the family's role in treating drug-resistant tuberculosis patients. Methods: This research uses a qualitative case study approach with nine informants. The selection of informants was determined using a purposive sampling technique. Data collection was obtained through interviews and observations. Data analysis was carried out qualitatively. Result: The research shows that informants' knowledge about drug-resistant tuberculosis depends on their educational history. In contrast, informants with low educational backgrounds only know the term tuberculosis but do not know the causes and dangers of drug-resistant tuberculosis. Another thing that was found was that the family also played a role in the patient's treatment by providing support and encouragement for the informant during the treatment period. Conclusion: This research concludes that the informant's knowledge about tuberculosis plays an essential role in the occurrence of drug-resistant tuberculosis. The role of the family does not contribute to the occurrence of drug-resistant tuberculosis in the informant. It can be concluded that the earlier the age of menarche increases the risk of uterine myoma later in life. In contrast, slower menarche may be associated with a reduced risk of myomas. Other factors such as genetic, environmental, and lifestyle factors also influence the incidence of uterine myomas, but menarche age is one of the significant hormonal indicators of risk.

Intramural myomas and fertility: To operate or not?

Intramural uterine myomas are very common among women of reproductive age, but their impact on natural and assisted fertility remains controversial. Although international federation of gynecology and obstretrics type 3 myomas may have the most negative impact on receptivity, available data are still not convincing. Surgical removal of these myomas is encouraged when they are symptomatic, but myomectomy for fertility-only reasons cannot be offered in daily clinical practice before in vitro fertilization treatment, as data are still inconclusive. Moreover, myomectomy is strongly associated with short and long-term complications, some of which may also affect the fertility outcome. A better understanding of the association between intramural myomas and fertility may open up new perspectives for the individualized management of infertile women with uterine myomatous masses.

The experiences of women diagnosed with uterine fibroids in the Kingdom of Eswatini

Background: Uterine fibroids (UFs) are benign uterine growths that significantly impact women’s daily activities, quality of life, fertility and expenditure.Aim: This study aimed to provide in-depth insights into the lived experiences of women diagnosed with UFs.Setting: The study was conducted in Eswatini health facilities across the four geographic regions.Methods: An explorative qualitative design was used; participants with confirmed UFs diagnoses or surgery related to UFs were purposively recruited for focus group discussions. Data collection was guided by the revised Wilson and Cleary model of health-related quality of life (HRQOL), which was iteratively analysed using Braun and Clark’s thematic analysis framework.Results: Sixty participants with confirmed UFs diagnoses or surgery related to UFs were included in this study. Five themes emerged: awareness of the disease, symptoms experienced, treatment and care, perceptions and beliefs and health-seeking behaviour. Most participants experienced physical symptoms, abdominal pain and vaginal bleeding. Among the emotional and psychological consequences experienced by the majority of participants were fear, worry, tension and (perceived) disrupted body image. The majority of the participants lacked knowledge of UFs, and their perceptions and health-seeking behaviour differed.Conclusion: Findings showed that most participants experienced physical, psychological, emotional and social challenges.Contribution: These experiences were influenced by lack of knowledge, symptoms experienced, poor treatment and care and perceptions and beliefs about UFs. Health education, client involvement, early diagnosis and effective treatment are recommended to improve the experiences of UFs.

Predictive value of contrast-enhanced MRI for the regrowth of residual uterine fibroids after high-intensity focused ultrasound treatment.

To investigate whether the signal intensity (SI) ratio of residual fibroid (RF) to myometrium using Contrast-Enhanced Magnetic Resonance Imaging (CE-MRI) could predict fibroid regrowth after high-intensity focused ultrasound (HIFU) treatment. A retrospective analysis was conducted among 164 patients with uterine fibroids who underwent HIFU. To predict the RF regrowth, the SI perfusion parameters were quantified using the RF-myometrium SI ratio on CE-MRI on day 1 post-HIFU and then compared with the fibroid-myometrium SI ratio on the T2-weighted image (T2WI) and Funaki classification 1 year later. Thirty cases from another center were used as an external validation set to evaluate the performance of RF-myometrium SI ratio. The predictive performance of the RF-myometrium SI ratio on CE-MRI on day 1 post-HIFU (Area Under Curve, AUC: 0.869) was superior to that of the preoperative and postoperative fibroid-myometrium SI ratios on the T2WI (AUC: 0.724, 0.696) and Funaki classification (AUC: 0.663, 0.623). Multivariate analysis showed that the RF- myometrium SI ratio and RF thickness were independent factors. The RF-myometrium SI ratio reflects the long-term rate of re-intervention (r = 0.455, p < 0.001). The RF-myometrium SI ratio on CE-MRI exhibits greater accuracy in predicting RF regrowth compared to the SI classification and the SI ratio on T2WI. The ratio of residual uterine fibroid to myometrial signal intensity on contrast-enhanced (CE)-MRI can reflect residual blood supply, predict regrowth of fibroids, and thus reflect long-term re-intervention rate and recovery situation of clinical high-intensity focused ultrasound (HIFU) treatment. Contrast-enhanced (CE)-MRI can indicate the blood supply of residual uterine fibroids after high-intensity focused ultrasound (HIFU) treatment. The predictive capability of CE-MRI ratio surpasses T2WI ratio and the Funaki. Residual fibroids can serve as a measure of the long-term efficacy of HIFU.

A case series on caesarean myomectomy

Uterine leiomyoma is the frequently identified benign tumor and its incidence is about 10%-20% in pregnant women. Treatment of myoma during caesarean section remains a debated subject in spite of advancement in medical treatment. A patient who undergoes myomectomy during cesarean section will not require a second operation, anesthetic complications and increased expenditure. Here, we report a series of 8 cases where myomectomy was performed during caesarean section for large anterior lower segment fibroids ranging in size from 4 to 12 cms.

An observational study of diagnostic hysterolaparoscopy for evaluation of infertility at a tertiary care hospital

Infertility is an illness recognised by the World Health Organisation (WHO) that refers to the inability to achieve a clinical pregnancy after engaging in regular, unprotected sexual intercourse for a period of 12 months or more. The incidence of primary infertility in India ranges from 3.9% to 16.8%. Hysteroscopy has emerged as a crucial technique for diagnosing infertility, providing a direct view of the uterine chamber to detect any possible abnormalities. The objective of this research is to analyse the use of diagnostic hysterolaparoscopy (DHL) in the evaluation of infertility. This research was a retrospective observational study that included 150 female patients who had a previous history of infertility. The study was done from May 2022 to September 2023. Information on the social and demographic characteristics of individuals and their medical history pertaining to infertility were collected by conducting interviews using a pre-tested, semi-structured questionnaire. Every participant took Dual-Hemisphere Language testing, and the gathered data were organised in Microsoft Excel. The significance threshold was established at 5% with a significance level of α = 0.05.: Out of the 150 patients that received DHL, 89 (59.33%) had primary infertility, whereas 61 (40.67%) had secondary infertility. Laparoscopy detected abnormalities in 35 (39.3%) of the individuals with primary infertility and 26 (42.6%) of the cases with secondary infertility. Abnormalities identified during hysteroscopy were 12 (13.4%) of the individuals with primary infertility and in 6 (9.83%) of the cases with secondary infertility. The prevalent abnormalities detected during hysteroscopy were uterine synechiae, fibroids, and uterine septa. The incidence of tubal obstructions was higher in the primary infertility group compared to the secondary infertility group.Diagnostic hysterolaparoscopy (DHL) is a very useful method for assessing infertility, namely in identifying adnexal adhesions, endometriosis, and uterine septa. In addition, DHL has the ability to detect several structural abnormalities in the uterus, fallopian tubes, and pelvis, which may assist in formulating suitable treatment strategies. So, both diagnostic and therapeutic intervention can be done at same sitting.

Retraction: Progesterone receptor antagonist provides palliative effects for uterine leiomyoma through a Bcl-2/Beclin1-dependent mechanism.

Retraction: Progesterone receptor antagonist provides palliative effects for uterine leiomyoma through a Bcl-2/Beclin1-dependent mechanism.

Abstract B006: Rescuing expression of a tumor suppressor gene – restoring FH in Hereditary leiomyomatosis and renal cell carcinoma

Abstract Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is a disorder characterized by the loss of fumarate hydratase (FH) activity, leading to the development of cutaneous leiomyomas, uterine leiomyomas, and aggressive early-onset type 2 papillary renal cell carcinoma. In HLRCC, the disease is driven by the somatic loss of the remaining functional FH allele in individuals carrying a germline pathogenic variant in one copy of the FH gene. The complete loss of FH activity disrupts the tricarboxylic acid (TCA) cycle, resulting in the accumulation of fumarate, which disrupts signaling pathways and contributes to the oncogenic phenotype. We recently identified a single nucleotide polymorphism (SNP) in an intronic region of the fumarate hydratase (FH) gene that leads to the loss of FH activity (Crooks et al., 2023). This SNP introduces a novel splice-acceptor site, resulting in the inclusion of an aberrant exon between wild-type exons 9 and 10. This ‘poison-like’ exon encodes a premature STOP codon, producing a nonfunctional truncated FH protein. Previous studies have shown that restoring FH activity can abrogate pathogenic behavior in patient-derived cells, highlighting the potential for therapeutic interventions targeting FH activity restoration. Our goal is to restore FH enzymatic activity by preventing the inclusion of this cryptic exon in carriers of this variant. To achieve this, we are exploring strategies to restore functional FH production by interfering with the inclusion of the pathogenic intron during splicing by removing the splice acceptor using CRISPR-Cas9 or base editing technologies. We tested these approaches by generating a reporter cell line that recapitulates the splicing pattern observed in patients, where expression of GFP depends on correct splicing between exon 9 and 10. We successfully identified antisense oligonucleotide (ASO) and single-guide RNA (sgRNA) sequences that restore GFP expression in our reporter cell lines. We are now evaluating the efficacy of these reagents in patient-derived cells. An alternative approach involves using synthetic RNA to restore FH expression. The expression of proteins from synthetic RNAs is a promising strategy for treating cancer and infectious diseases. We are currently investigating the efficiency of restoring FH activity through in-vitro transcribed (IVT) mRNA. This approach has the advantage of enabling FH function restoration in cells with mutations that are not amenable to antisense oligonucleotide (ASO) or gene editing techniques. This work serves as an avenue to investigate the application of nucleic acid therapies to restoring activity tumor suppressor genes in kidney cancer. Citation Format: Siddhardha S. Maligireddy, Mariana D. Mandler, Jodie C. Lunger, Christina M. Fitzsimmons, Daniel R. Crooks, Geetha M. Cawthon, Christopher J. Ricketts, Cathy D. Vocke, W. Marson Linehan, Pedro J. Batista. Rescuing expression of a tumor suppressor gene – restoring FH in Hereditary leiomyomatosis and renal cell carcinoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: RNAs as Drivers, Targets, and Therapeutics in Cancer; 2024 Nov 14-17; Bellevue, Washington. Philadelphia (PA): AACR; Mol Cancer Ther 2024;23(11_Suppl):Abstract nr B006.

Progress in High Intensity Focused Ultrasound Ablation for Fertility Preservation Therapy of Uterine Fibroids and Adenomyosis.

High intensity focused ultrasound (HIFU) is an effective and safe non-invasive treatment method, widely used in the treatment of uterine fibroids and adenomyosis in the field of gynecology. The side effects in HIFU is low in incidence and mild. HIFU can significantly alleviate the symptoms of patients, reduce lesion volumes, improve quality of life, and has good cost-effectiveness. HIFU can accurately ablate the uterine fibroids and adenomyosis lesions, without destroying normal myometrium and endometrium, and thus HIFU is a promising alternative to myomectomy in uterine fibroids patients with fertility desire. Several studies have shown that in terms of ovarian endocrine function protection, HIFU treatment is superior to uterine artery embolization, and similar to myomectomy. Existing limited researches show that patients with uterine fibroids have a favorable pregnancy rate and live birth rate, as well as a lower natural abortion rate after HIFU treatment. Pregnancy rate after HIFU treatment for uterine fibroids is not lower than myomectomy, and higher than uterine artery embolization. HIFU may have significant advantages in shortening pregnancy interval compared with myomectomy. However, the proportion of cesarean section delivery after HIFU treatment is relatively high, and gestational uterine rupture after HIFU treatment exist in literature. Higher quality clinical data is needed to confirm the pregnancy outcomes and safety after HIFU treatment in future.

Analysis of The Incidence of Uterine Leiomyoma Based on Body Mass Index and Neutrophil-Lymphocyte Ratio

Leiomyoma is the most common benign uterine tumor in the female with an incidence rate of 70-80%. The cause of these tumors is still unknown, but one of the known causes is that they grow in response to hormonal stimulation. Lymphocytic infiltration in this disease has been identified as an unusual finding. This suggests a potential role for lymphocytes in the development of such tumors. A bibliometric analysis of various sources found minimal research on the Neutrophil-Lymphocyte Ratio (NLR) in uterine leiomyoma, especially in Indonesia. This study analyzed the incidence of uterine leiomyoma based on Body Mass Index (BMI) and Neutrophil-Lymphocyte Ratio (NLR). This study used an observational analytic method with a case-control design. The sampling technique used was consecutive sampling and 129 samples were obtained in the form of 65 uterine leiomyoma case groups and 64 adenomyosis control groups. BMI variable parameters were obesity (&gt;25kg/m2) and not obese (≤25kg/m2), while NLR was at risk (&gt;3.53) and not at risk (≤3.53). Data analysis consisted of univariate, bivariate with a Chi-Square test, and continued with multivariate using logistic regression analysis. There was a significant relationship between BMI and uterine leiomyoma incidence (p = 0.028). There was also a significant relationship between NLR and uterine leiomyoma (p = 0.017). NLR had a 3,688-fold more association with the incidence of uterine leiomyoma than BMI. In conclusion, a relationship exists between BMI and NLR in the incidence of uterine leiomyoma. NLR can be a predictor of uterine leiomyoma, especially in women of reproductive age.

Mifepristone's Efficacy for Symptomatic Relief and Size Reduction in Uterine Fibroids: A 2023 Prospective Observational Study at Rabia Balkhi Hospital, Afghanistan

Mifepristone's Efficacy for Symptomatic Relief and Size Reduction in Uterine Fibroids: A 2023 Prospective Observational Study at Rabia Balkhi Hospital, Afghanistan

Robust Radiomics Models for Predicting HIFU Prognosis in Uterine Fibroids Using SHAP Explanations: A Multicenter Cohort Study.

This study sought to develop and validate different machine learning (ML) models that leverage non-contrast MRI radiomics to predict the degree of nonperfusion volume ratio (NVPR) of high-intensity focused ultrasound (HIFU) treatment for uterine fibroids, equipping clinicians with an early prediction tool for decision-making. This study conducted a retrospective analysis on 221 patients with uterine fibroids who received HIFU treatment and were divided into a training set (N = 117), internal validation (N = 49), and an external test set (N = 55). The 851 radiomics features were extracted from T2-weighted imaging (T2WI), and the max-relevance and min-redundancy (mRMR) and the least absolute shrinkage and selection operator (LASSO) regression were applied for feature selection. Several ML models were constructed by logistic regression (LR), decision tree (DT), random forest (RF), support vector machine (SVM), extreme gradient boosting (XGBoost), and light gradient boosting machine (LGBM). These models underwent internal and external validation, and the best model's feature significance was assessed via the Shapley additive explanations (SHAP) method. Four significant non-contrast MRI radiomics features were identified, with the SVM model outperforming others in both internal and external validations, and the AUCs of the T2WI models were 0.860, 0.847, and 0.777, respectively. SHAP analysis highlighted five critical predictors of postoperative NVPR degree, encompassing two radiomics features from non-contrast MRI and three clinical data indicators. The SVM model combining radiomics features and clinical parameters effectively predicts NVPR degree post-HIFU, which enables timely and effective interventions of HIFU.

Clinicopathological observation and analysis of uveal leiomyoma

Objective: To analyze the clinical and histopathological features of uveal leiomyoma. Methods: A retrospective study was performed on 19 patients with uveal leiomyoma confirmed by histopathological examination in Beijing Tongren Hospital from January 2018 to May 2023. All patients underwent local resection of the tumor. Clinical data of the patients, such as gender, age, clinical manifestations, tumor location, size, and B-scan ultrasound examinations were collected. The pathological morphological characteristics of the tissue (cell type) and the expression of the immune markers, including smooth muscle actin, actin, and neural cell adhesion molecule (CD56), were evaluated. Results: Among the 19 intraocular leiomyoma patients, there were 5 males and 14 females. The average age was (38.9±13.7) years, ranging from 14 to 64 years. The course of the disease ranged from 1 to 36 months with an average of (9.3±8.7) months. The most common clinical manifestation was blurred vision (12/19), followed by decreased vision (4/19), increased IOP (2/19), and visual occlusion (1/19) in patients. The tumor was located in the ciliary body in 10 female and 5 male patients, including 2 patients with the iris involved, and in the choroid in 4 female patients. Two patients with a history of breast fibronenoma had uveal leiomyoma in the ciliary body and the choroid, respectively. One patient with a history of uterine leiomyoma suffered uveal leiomyoma in the ciliary body. B-scan ultrasonography showed that the tumor was a solid and medium-low echoic lesion with a clear boundary in all eyes. We divided these leiomyomas into two histopathological types: spindle cell type (15/19) and round cell type (4/19). Immunohistochemical staining disclosed smooth muscle actin and actin were expressed in all tumor cells (19/19, 100%), and CD56 was positive in 16 of 19 eyes (84.2%). The positive expression rates of estrogen and progesterone were 0/19 and 2/19. During the follow-up of 7 to 71 months after surgery, no tumor metastasis occurred. Only 1 male patient had tumor recurrence. Conclusions: The most common site of uveal leiomyoma is the ciliary body, the major clinical manifestation is blurred vision, and the prognosis is good. Most of the tumors are spindle cell tumors, with myogenic and neurogenic histological characteristics. Although uveal leiomyoma is more frequently found in women of reproductive age, it shows no significant correlation with estrogen and progestational hormones.

Experience of using robot-assisted (da Vinci) operations in the treatment of common endometriosis

Background. Currently, genital endometriosis is considered as one of the most severe conditions in women of reproductive age, which has detrimental consequences for social, professional and psychological functioning. It ranks third in the structure of gynecological diseases after inflammatory diseases of the female reproductive system and uterine fibroids. Because of this, it acquires a more pronounced social significance and ceases to be only a medical problem. Aim. To study the results of surgical treatment of patients with severe forms of genital endometriosis using the da Vinci surgical robotic complex.Materials and methods. A retrospective analysis of the treatment results of 51 patients operated on at the N.I. Pirogov National Medical and Surgical Center for the period from January 2015 to July 2024, who underwent robot-assisted (da Vinci) operations for deep endometriosis involving neighboring organs. The duration of surgery and hospital stay, the amount of blood loss, the frequency of intra- and postoperative complications, the clinical course of the disease in the long-term postoperative period, the frequency of detection of residual infiltration in the postoperative period, and the implementation of reproductive plans were analyzed.Results. The duration of the surgical intervention was 220.8 ± 21.87 minutes. The postoperative bed-day was 6.9 ± 1.5 bed days. The average blood loss was 160.2 ± 67.58 ml. There were no intraoperative complications. Postoperative complications accounted for 7.8 %. Residual infiltration occurred in 11.7 % of cases. 94.1 % of the patients had no clinical symptoms of endometriosis in the long-term postoperative period. The pregnancy rate was 31.9 %.Conclusion. Surgical treatment of deep endometriosis using da Vinci surgical robotic complex in the amount of radical removal of endometrioid infiltrate has a positive effect on both the clinical course of the disease and the reproductive potential of a woman. Real-time fluorescence navigation has demonstrated additional imaging capabilities in robotic surgery for deep endometriosis, potentially increasing the radicalism of surgical treatment of infiltrating endometriosis and may lead to a reduction in recurrence rates.

A case of a patient at reproductive age with BRCA2 and CHEK2 mutations and multiple uterine fibroids.

A case of a patient at reproductive age with BRCA2 and CHEK2 mutations and multiple uterine fibroids.

Genetic basis of endometriosis comorbidity

Introduction. The results of a number of studies indicate the comorbidity of endometriosis with various diseases, such as uterine fibroids, endometrial cancer, migraine, depression, infertility, bronchial asthma, and stomach diseases.Aim. Present literature data on the comorbidity of endometriosis and various diseases.Materials and methods. A review of the literature for 2021–2023 in the databases PubMed (National Library of Medicine), Cochrane Library, CyberLeninka, Medline, as well as in scientific citation databases (Scopus, Web of Science).Results and discussion. This paper analyzes data on the comorbidity of endometriosis and various diseases such as uterine myoma, endometrial cancer, migraine, depression, infertility, bronchial asthma, and gastric diseases. It was found that the comorbidity of endometriosis and the described diseases is based on common risk factors (early age of menarche, late menopause, absence of childbirth in the anamnesis, chronic inflammatory diseases of the pelvic organs, smoking, chronic stress, exposure to phthalate esters), molecular pathogenetic mechanisms (changes in gene expression, sex hormone levels, aberrant immune response, subclinical inflammatory response, hyperestrogenism, characteristic of both endometriosis and comorbid diseases), as well as genes involved in the development of these diseases. According to the results of full genomic studies, more than 170 polymorphic loci associated with the development of endometriosis and various comorbid diseases have been identified, and a positive correlation between endometriosis and these diseases has been revealed.Conclusion. These studies dictate the need to take into account in clinical practice the syntropy of endometriosis with other diseases, which, in turn, requires a multidisciplinary approach to the management of patients with endometriosis.

Evaluating the Role of the Hysteroscopic Cold Resection System in Combination with Electric Resection System for the Surgical Removal of Type 3 Uterine Fibroids: A Retrospective Case Study

Evaluating the Role of the Hysteroscopic Cold Resection System in Combination with Electric Resection System for the Surgical Removal of Type 3 Uterine Fibroids: A Retrospective Case Study

Multiple morcelloma of the peritoneal cavity: a case report

Introduction. Uterine fibroids are benign monoclonal hormone-sensitive tumors arising from smooth muscle cells of the cervix or body uterus. Myomectomyhas become a treatment «golden standard» upon transition to the strategy of organ-preserving surgery. The introduction of morcellation into wide clinical practice allowed to expand the indications for laparoscopic myomectomy, which is usually much better tolerated by patients due to lower invasiveness, short period of rehabilitation and low blood loss. However, the use of morcellators along with the obvious advantages has also specific complications particularly emergence of iatrogenic parasitic fibroids of the abdominal cavity upon improper surgery technique.Aim: analysis of a clinical case of multiple morcelloma.Case presentation. Female patient I., 57 years old, underwent laparoscopic myomectomy in 2003. In 2023 during a routine examination at the Central Clinical Hospital «RZD-Medicine» multiple asymptomatic iatrogenic fibroids of the abdominal cavity were revealed. The patient underwent planned surgical intervention to remove all abnormal masses.Results. During the revision upon surgical intervention, a node of 1.5×1.5 cm was found on the parietal peritoneum along the left anterior wall, as well as a node of 1.5×1.5 cm on the parietal peritoneum along the right anterior wall. There was also observed a 2×3 cm node at the edge of the omentum. In the left and right side of peritoneum of the sacro-uterine ligament, there were found nodes of up to 1 cm in size. In the area of the small intestinal mesentery, a dense node of 4.5 cm was observed 70 cm away from the ileocecal valve. Due to small size, all the fibroids were extirpated and removed from the abdominal cavity without morcellation, complete hemostasis was performed. No complications were noted during postoperative period.Conclusion. Iatrogenic fibroids are quite rare but nevertheless a potential complication of laparoscopic myomectomy. Gynecologists should pay special attention to follow proper technique upon surgical intervention. Morcellation and subsequent extraction of fibroids should be performed strictly with use of airtight container to avoid ingress of myomatous tissue into the abdominal cavity followed by emergence of iatrogenic fibroids.