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Uterine fibroid: a review.

BACKGROUND: Uterine fibroid is a benign tumour of uterine smooth muscle. The purpose of this review is to bring to light the current spectra of presentation and management status of this benign and very important cause of menstrual and fertility disturbance in African women and the Black race in general. This is especially so with the trivialization of its aetological factors and treatment by claims from alternative medical practitioners. This review, therefore sought to document what is currently known about the condition and what could possibly be done to achieve better results in its management. METHODS: Literature on the subject above was reviewed using manual library search, electronic books such as CD-ROMS and journals articles published by various local and international authors on the subject; it also included internet search on relevant aspects of the topic. RESULTS: Fibroid is the commonest benign tumour of the female genital tract, it contributes about 70 to 80% of new growths in the female genital tracts, it is a cause of significant morbidity in women of reproductive age group and when complicated could be a significant cause of mortality. Spectrum of presentation mainly involves disturbance of menstruation, reduction in fertility, pressure and obstructive symptoms and rarely malignant presentations. When recognized early effective conservative and definitive therapies are available to offer relief for women and to make their menstrual and reproductive life more meaningful. CONCLUSION: From the literature reviewed, it was obvious that the subject of uterine fibroid is still not fully exhausted and there were a lot of research questions waiting to be answered on the aetiopathogenesis of the disease. There is also the need to fashion out better treatment alternatives that will reduce morbidity in the process of managing the patient as well as those that will further enhance reproductive potentials after treatment.

Diagnosis, Differential↗

Inflammatory fibroid polyp of the caecum in a patient with neurofibromatosis.

INTRODUCTION: Inflammatory fibroid polyp of the large intestine is uncommon. To our knowledge, this condition has not been reported in a patient with neurofibromatosis. CLINICAL PICTURE: In this report, a 66-year-old woman with neurofibromatosis was found to have a large polyp in the caecum. TREATMENT: Right hemicolectomy was performed because of the size of the polyp. OUTCOME: Pathological examination showed that the polyp was an inflammatory fibroid polyp. CONCLUSION: Clinicians should be aware that inflammatory fibroid polyps could be one of the many manifestations of neurofibromatosis in the gastrointestinal tract.

Aged↗

Effect of corporal fibroids on outcome following embryo transfer in donor-oocyte recipients.

PURPOSE: To evaluate the effect of intramural or subserosal fibroids in the uterine fundus or corpus on pregnancy outcome following transfer of embryos formed from donated oocytes methods. METHODS: Leiomyomata were measured in three dimensions by transvaginal sonography. Scanning was performed in two planes (sagittal and coronal) at the level of maximal width. The location was categorized by depth in the uterus. RESULTS: There was no difference in pregnancy rates in those with or without fibroids. However, there was a significantly higher miscarriage rate in the former group. CONCLUSION: Women with fibroids are generally older. Thus conclusions about the effect on miscarriage rates are complicated by the effect of the aging oocyte on miscarriages. This study eliminated the oocyte factor by using only younger donated oocytes.

Abortion, Spontaneous↗

[The management of uterine fibroids: Czech and Slovak Gynecologic Endoscopy Working Group (CSGE) clinical practice guidelines].

OBJECTIVE: The objective of this paper is to give a guideline to the management of uterine fibroids. DESIGN: Review. SETTING: Czech Society Gynecological Endoscopic Working Group. MATERIAL AND METHOD: The bibliographic data from Medline were reviewed from 2003-2004 using the key words: fibroid--leiomyoma--uterine artery occlusion--hysterectomy--myomectomy. CONCLUSION: The clinical guideline was prepared after the analysed data were supplied using the material and criteria of Society of Obstetricians and Gynaecologists of Canada (SOGC) for the management of uterine fibroids.

Female↗

Coexistence of Crohn's disease and inflammatory fibroid polyp of the small bowel. Report of a case and review of the literature.

BACKGROUND/AIM: The Authors report a case of a woman aged 35, with concurrent appearance of Crohns disease and Inflammatory Fibroid Polyp of the terminal ileum. CASE REPORT: The combination of the two disorders was clinically manifested as an obstructive ileus. On the operative table, a 4-cm polypoid mass causing intussusception of the bowel was obvious. The resected specimen of the ileum showed profound distention, several ulcerations and fissures. The histological examination confirmed the diagnosis of Crohn's disease coexisting with an Inflammatory Fibroid Polyp. Immunostaining of the lesion for actin showed focal positivity. However, staining for desmin, CD31, S100-protein, PGM-1 CD34, CD117, and bc1-2, was negative. CONCLUSION: Coexistence of Inflammatory Fibroid Polyp with Crohn's disease causing obstructive ileus could be the first manifestation of the disease. The combination of the two disorders corroborates the reparative character of the lesion. Nevertheless, the exact etiopathogenetic relationship between the two entities remains obscure.

Abdomen, Acute↗

[Results of conservative surgery of uterine fibroids--5 years of follow-up].

OBJECTIVE: To evaluate the outcome of the myomectomy. DESIGN: Prospective study. SETTING: Gynecology-Obstetrics Ward, Regional Hospital Pardubice. METHODS: The group consists of 147 patients with uterine fibroid (or fibroids) in which was performed myomectomy from September 1997 till December 2001. Myomectomy was performed by hysteroscopy, laparoscopy, laparotomy or by posterior colpotomy. The mean age was 40.1 years. We evaluated short term (during the first year) and long term (after 5 years) outcomes including the pregnancy outcome. SHORT TERM OUTCOMES: During the 1st year 135 (91.84%) patients were without complications and satisfied with their status after the procedure. LONG TERM OUTCOMES: After 5 years 121 (82.31%) patients were without problems or reoperation. From the group of the women with the desire of the pregnancy the pregnancy rate was 71.05%. Deliveries of the viabile foetus were 77.78%. 38.10% delivieries were performed by Caesarian Section. CONCLUSION: At present it is often necessary to treat uterine fibroids without hysterectomy. We have several surgical approaches including the minimally invasive techniques that may be succesfull and the results may be satisfactory for most of the patients.

Adult↗

[Inflammatory fibroid polyp of the ileum presenting as intussusception: a case report in an adolescent].

Inflammatory fibroid polyp is an uncommon and benign submucosal lesion of the gastrointestinal tract. The maximal incidence is in the fifth and sixth decades. The main histological characteristics are diffuse inflammatory infiltrate with eosinophils and highly vascularized fibrocystic stroma. We report a case of 15-year-old patient who underwent emergency surgery because of acute intestinal obstruction as a result of an intussusception. The macroscopical study after segmental ileal resection showed a nodular lesion 3x2x2 cm, arising from the submucosa with an ulcerated surface. The pathologic diagnosis was ileal inflammatory fibroid polyp. Immunohistochemically, the cells reacted with vimentin and CD34. It has no malignant potential although extensive infiltration may occur. The etiology is unknown. We discuss the clinical, the pathological aspects and the possible etiological factors of the inflammatory fibroid polyp.

Adolescent↗

Uterus didelphys with fibroid uterus and ovarian cyst--rare Muellerian malformation.

Persistent Muellerian duct syndrome is a very rare anomaly. A woman of 46-year-old was admitted with the history of lower abdominal pain, bleeding per vaginum and irregular menstrual cycles for last 6 months. An irregular non-tender mass of 16 x 10cm in size was palpable in suprapubic region. Per vaginal examination revealed two cervices and an incomplete vaginal septum. Ultrasound abdomen showed one uterus with endometrial cavity clearly delineated with a fibroid and an ovarian cyst in the left lumbar region. On laparotomy, 2 uterii along with a fibroid from the anterior wall of left uterus and a left ovarian cyst was seen. Patient had undergone total abdominal hysterectomy and adnexa removal. The specimen showed florid adenomyosis with leiomyoma of fibroid.

Cervix Uteri↗

New approaches to the management of fibroids.

It is clear that gonadotropin-releasing hormone agonists have potential as a new therapeutic approach in the treatment of fibroids. They are effective in decreasing the size of most fibroids but, on ceasing treatment, regrowth does occur. Because of their effect on calcium homeostasis, long-term unopposed use of these agonists is not recommended. However, sequential addback therapies could be useful in both counterbalancing the hypoestrogenic side effects and in protecting bone mineral density. Although surgery is likely to remain the primary therapy for fibroids, pretreatment with gonadotropin-releasing hormone agonists for 3 to 4 months before myomectomy or before hysteroscopic resection offer many advantages in facilitating these procedures and reducing peroperative blood loss. Further studies are required to establish the most satisfactory treatment regimens with this exciting group of drugs for a condition whose etiology is still poorly understood.

Bone Density↗

Use of GnRH depot analogue in the treatment of uterine fibroids.

Twelve patients with symptomatic uterine fibroid were treated with Goserelin acetate, a depot Gn-RH analogue administered s.c. in a dosage of 3.6 mg every 28 days for a 6 month period. Mean age of the patients was 39 (26-47). A menopausal-like state, evidenced by hot flushes, depression, vaginal dryness, hysteroscopic endometrial atrophy, and hormonal values (FSH, LH, E2), was seen in all patients. After only two months of treatment, a significant reduction was noted in the size of the fibroid, being even greater than that in the following four months. Only one patient in the series underwent surgery. General tolerability of the drug was optimal. These data suggest the efficiency of this type of treatment in obtaining a significant reduction of fibroid volume as well as subjective symptomatology. The cost-benefit ratio is optimal, allowing postponement of surgery and the possibility of vaginal, as opposed to abdominal, hysterectomy and affronting problems of anaesthesiology and post-operative recovery for patients "at risk".

Adult↗

Ultrasonic patterns of uterine fibroids.

The classic appearance of the echo-poor fibroid uterus occurs in less than one-third of leiomyomata uteri. The ongoing manifestations of the various types of internal degeneration produce a picture of diffuse or focal medium-amplitude internal echoes with increased through transmission. Calcification of fibroids results in irregular high-amplitude echoes or a ringlike echo pattern which must not be mistaken for a fetal head. The combination of wide dynamic range, gray scale scanning, and high-resolution real-time sonography optimizes the diagnosis of the fibroid uterus.

Female↗

Fibroid growth in response to high-dose progestogen.

OBJECTIVE: To challenge the conventional belief that leiomyomata are estrogen-dependent tumors by presentation of a case report suggesting high-dose progestogen therapy is associated with a dramatic increase in size of a fibroid uterus. DESIGN: Case report. SETTING: British university hospital. PATIENT: One white woman treated with tamoxifen and high-dose megestrol acetate for breast carcinoma. INTERVENTIONS: Megestrol acetate therapy withdrawn. MAIN OUTCOME MEASURE: Uterine size. RESULTS: While taking tamoxifen and high-dose megestrol acetate, the patient suffered a dramatic increase in size of her fibroid uterus, which reversed when the progestogen was withdrawn. CONCLUSION: This case report suggests that P may be important in fibroid growth.

Breast Neoplasms↗

Zoladex (goserelin acetate) and the anemic patient: results of a multicenter fibroid study.

OBJECTIVE: To compare the effects of goserelin acetate treatment with or without iron with iron alone. DESIGN: Multinational, multicenter, prospective, randomized, double-blind study. PATIENTS: Premenopausal women with menorrhagia or metrorrhagia and anemia associated with uterine leiomyomata awaiting hysterectomy. INTERVENTION: Patients were randomized to one of three 12-week treatment groups namely goserelin acetate 3.6 mg once monthly plus placebo iron; 3.6 mg goserelin acetate once monthly plus 600 mg/d iron; or sham injection once monthly plus 600 mg/d iron. MAIN OUTCOME MEASURE: Preoperative hemoglobin concentration; preoperative uterine and fibroid volumes and operative blood loss. RESULTS: Considering the entry and preoperative hemoglobin concentrations, there was a difference in least square means of just over 1 g/dL between the goserelin acetate plus iron and iron only groups and 2.6 g/dL between the goserelin acetate plus iron and goserelin acetate only group. These differences were both statistically significant. Uterine and fibroid volumes were decreased in the goserelin acetate-treated patients by between 37% and 40% and 44% and 47%, respectively, compared with 7% decreases for both in the iron only group. The differences in absolute changes were statistically significant for both the goserelin acetate-treated groups versus the iron-treated group. The least square geometric mean operative blood loss was greatest in the iron only group. CONCLUSION: In the patient with uterine leiomyomata and anemia, goserelin acetate in combination with iron therapy has shown significant advantages over the iron alone in restoring hematologic normality, decreasing uterine and fibroid volumes, and reducing operative blood loss.

Adult↗

Intussusception due to inflammatory fibroid polyp of the ileum. A report of two cases from Turkiye.

Intussusception due to inflammatory fibroid polyps is a very rare entity. In this article two cases of inflammatory fibroid polyps of the ileum (A 32-year old man and a 50-year old woman) in Turkiye are described. Both patients were admitted to the hospital because of acute intestinal obstruction as a result of an intussusception caused by a polyp. The lesions were characterized by an eozinophil containing loosely structured fibrous tissue comprising an onion-skin like arrangement of reticular fibers with spindle-shaped nuclei localised in the submucosa and the base of the mucosa, and variable proliferation of fibroblasts and small vessels. The aetiology of these polyps remains obscure but they appear to be a reactive process (allergic or foreign body reaction) rather than neoplastic. Nkanze et al reported 12 cases of intussusception due to fibroid polyps in Africa. Our two cases are the first cases in Turkiye.

Adult↗

Office gynecology: fibroids-when not to operate.

The mere presence of uterine fibroids is not, since qua non, an indication for their surgical removal. Knowing when not to operate is probably more important for the physician than knowing when to operate. It is easy to fall into diagnostic and therapeutic traps when uterine fibroids are known to be present, especially when they occur concomitantly with a condition such as irregular uterine bleeding, infertility, or pregnancy. The contributions of such conditions to problems in diagnosing and managing fibroids must be kept in mind by the prudent physician; a decision in favor of medical rather than surgical management is often best.

Dilatation and Curettage↗

Clinical efficacy of the antiprogesterone RU486 in the treatment of endometriosis and uterine fibroids.

To evaluate the long-term effects of treatment with RU486 and to test its efficacy in endometriosis, a 3-month trial was conducted to evaluate the effects of daily administration (100 mg/day or approximately 2 mg/kg/day) on the functional activity of the reproductive axis, as well as implants, in patients with symptomatic pelvic endometriosis. All women became amenorrhoeic and acyclic. However, ovarian suppression was incomplete. In 24 h sampling studies, mean luteinizing hormone (LH) and LH pulse amplitude were increased without a change in LH pulse frequency. Additionally, an antiglucocorticoid effect was demonstrated. Treatment resulted in improvement in pelvic pain in all subjects without significant changes in the extent of disease as evaluated by laparoscopy. We also attempted to reduce the growth of uterine fibroids by using 50 mg/day of RU486 for 3 months in 10 patients. Myoma size decreased approximately 22% at 4 weeks, 39% at 8 weeks and 49% at 12 weeks. Serum concentrations of LH, androstenedione and testosterone increased in the first 3 weeks of treatment and then returned to baseline. In conclusion, daily administration of RU486 resulted in ovarian inhibition and menstrual acyclicity and in an improvement in the pain associated with pelvic endometriosis and decreased the size of uterine fibroids. This ovarian inhibition was achieved without oestrogen deprivation and may provide a novel long-term approach to the treatment of ovarian steroid-dependent disease processes.

Abdominal Pain↗

Inflammatory fibroid polyp presenting with intestinal invagination: sonographic and correlative imaging findings.

We report a case of a large inflammatory fibroid polyp of the small bowel presenting with intussusception in a 22-year-old man. Sonography demonstrated a solid, mobile, homogeneous, echogenic mass surrounded by the typical mural layers of an invaginated ileum. CT demonstrated a well-defined intraluminal solid mass with an attenuation of 17 HU. The pathologic diagnosis after segmental ileal resection was ileal inflammatory fibroid polyp.

Adult↗

Inflammatory fibroid polyps of the gastrointestinal tract. An immunohistochemical and electron microscopic study.

Seven cases of inflammatory fibroid polyp (IFP) are studied, two of them with electron microscopy. The morphologic findings suggest a myofibroblastic origin for the proliferating cells. Other histogenetic hypothesis which propose a neural or vascular nature for this lesion are ruled out. The ultrastructural features of the proliferating cells are different from schwann and endothelial cell tumors. Moreover, the immunohistochemical technique to detect Factor VIII related antigen was negative in the intercapillary cells of the seven cases. Our conclusion is that inflammatory fibroid polyp of the gastrointestinal tract represent a reactive lesion of myofibroblastic nature.

Adult↗