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Treatment of prolapsed submucous fibroids.

Prolapsed submucous fibroids are not uncommon, and patients present with a vaginal mass which is often necrotic and infected. This is a retrospective study of 41 such patients seen at the King Edward VIII Hospital, Durban, over a 3-year period. Twenty-eight were treated by vaginal myomectomy and 13 by abdominal hysterectomy. Postoperative morbidity was slightly higher with hysterectomy, but comparable to that for hysterectomy for unprolapsed fibroids.

Adult↗

Inflammatory fibroid polyp of the duodenum.

Inflammatory fibroid polyp of the gastrointestinal tract is an unusual lesion of apparent submucosal origin but of unknown etiology. The stomach is most commonly involved with typical presentation being a rounded or oval polyp in the gastric antrum. Occurrence in the duodenum is distinctly rare since only three previous cases have been reported. We present a patient with an unusually long inflammatory fibroid polyp arising in the third portion of the duodenum.

Duodenal Neoplasms↗

Inflammatory fibroid polyp of the jejunum causing intussusception: a case report.

Inflammatory fibroid polyp is a rare benign lesion of the gastrointestinal tract. This report concerns a 56-year-old female who presented with intermittent abdominal pain, vomiting and diarrhea; she had had partial intestinal obstruction over a period of two months. Plain abdomen showed dilatation of the small bowels. Abdominal echo revealed intussusception of the small intestine. During exploratory laparotomy a polypoid dumb-bell shaped polyp was noted as the leading point of the jejunojejunal intussusception, segmental resection of the jejunum was performed. Histological features of the polyp met the diagnosis of inflammatory fibroid polyp.

Female↗

Serum CA 125 concentrations in women with endometriosis or uterine fibroids treated with gonadotrophin-releasing hormone agonist analogues.

We assessed the possible role of CA 125 in the monitoring of gonadotrophin-releasing hormone (GnRH) agonist analogue therapy in women with endometriosis and uterine fibroids. Serum concentrations of this cell surface antigen did not correlate with uterine volume and appeared to have no value in the assessment of shrinkage of uterine fibroids during GnRH agonist treatment. While CA 125 levels were not always elevated in subjects with endometriosis, they fell during treatment in all patients. The change accurately reflected therapeutic progress in these women and was of particular value in those patients who had commenced therapy with elevated levels. It is suggested that CA 125 may be useful in the monitoring of therapeutic progress in selected patients with endometriosis treated with GnRH agonists; the need for surgical follow-up may be obviated.

Antigens, Tumor-Associated, Carbohydrate↗

Uterine fibroids: protocols of integrated medical/surgical treatment.

Uterine fibroids are the most common solid pelvic tumor in women and in these last years their management has been deeply reviewed. An optimal integration of GnRH analogue treatment with different surgical techniques require an adequate work-up for the specific problems of each single patient. For a correct management of these patients, we divided them into 4 categories on the basis of symptoms and specific objectives to persuasive: a) perimenopausal patients; b) young patients, symptomatic or with large myomas, with no wish for more children; c) young patients, symptomatic or with large myomas, wishing to preserve fertility; d) infertile patients or patients with history of repeated miscarriages. Our suggested work-up is the following: a careful USGraphic evaluation of fibroid size and localization, a transvaginal doppler examination of the uterine blood supply, a complete haematochemical analysis, a hysteroscopy guided biopsy and a complete bone evaluation. On the basis of the above mentioned evaluations for each group we will use a different therapeutic approach in regard of either length of medical treatment (for tree to six months, for one or more cycles) or necessity of surgical treatment (with the possibility to get a natural menopausal), or different surgical techniques (operative hysteroscopy and/or laparoscopy, laparotomic myomectomy, vaginal or abdominal hysterectomy.

Abortion, Habitual↗

Medical pregnancy termination in the presence of a massive uterine fibroid.

Surgical termination of pregnancy in the presence of uterine fibroids may be technically difficult resulting in reduced efficacy of the termination procedure. We describe the first documented use of RU486 and gemeprost in the successful medical termination of a pregnancy in a uterus grossly enlarged by fibroids.

Abortifacient Agents↗

Inflammatory fibroid polyp of the jejunum causing intussusception.

Inflammatory fibroid polyp of jejunum is a very rare nonneoplastic lesion of gastrointestinal tract. We reported a 66-year-old male who presented with abdominal fullness, colicky pain, and vomiting for 4 days. Plain abdomen showed intestinal obstruction with dilated small bowel loops. The exploratory laparotomy was performed under the clinical impression of intussusception caused by small bowel tumor. The diagnosis of an inflammatory fibroid polyp causing jejunojejunal intussusception was confirmed after surgery.

Aged↗

Treatment of uterine fibroids with GnRH-analogues prior to hysterectomy.

GnRH-analogues have a longer half-life and stronger receptor affinity than native GnRH. They block the secretion of gonadotropins from the anterior pituitary, producing a hypoestrogenic state. Preoperative treatment with GnRH-agonists for 3 months prior to hysterectomy reduces the size of uterine fibroids by about 50%. The hematologic profile is improved and subjective symptoms reduced. Other results are: a smaller peroperative blood loss, a shorter hospitalization time, and a tendency to easier operations. Side effects are predominantly hypoestrogenic. Treatment with GnRH-agonists before hysterectomy is recommended in cases of large fibroids, when technical problems may be anticipated, when preoperative anemia is present, or when it is desirable to postpone surgery.

Combined Modality Therapy↗

[Intestinal obstruction caused by inflammatory fibroid polyp. Report of a case].

The inflammatory fibroid polyps are rare lesions of the digestive tract, they were firstly described occurring in the stomach, however their distribution is universal. Several other denominations have been used to same lesion such as fibroma and eosinophilic granuloma. The clinical presentation varies according to the its location, frequently they are mistaken as gastrointestinal neoplasias. Intestinal obstruction is one of the manifestations, mainly when the lesion occurs nearby the ileum cecal region. The authors present a case of intestinal obstruction caused by a inflammatory fibroid polyp located in the ileum cecal valve, treated successfully by right colectomy.

Anastomosis, Surgical↗

Genetically-predicted placental gene expression links to uterine fibroids and endometriosis.

INTRODUCTION: Mother-to-child disease transmission begins in utero, with the placenta playing a critical role in pregnancy and offspring health. Uterine leiomyomata (fibroids, UFs) and endometriosis (ENDO) are common gynecologic diseases that have substantial overlaps in symptomology and risk factors, however drivers of disease risk remain unclear. The objective of this study was to investigate shared placental genetic associations across ENDO and UFs. METHODS: Genome-wide association study (GWAS) summary statistics were utilized from a published study of UFs (PMID: 40050615) and meta-analyzed for ENDO (24,092 cases and 548,255 controls). To improve our statistical power, we applied Multi-Trait Analysis of GWAS to the ENDO and UF GWAS. We estimated genetically predicted gene expression using S-PrediXcan across 49 tissues using GTEx v7 and a placental tissue expression model. RESULTS: We identified 54 and 14 genes where predicted expression in the placenta was significantly associated with UFs and ENDO, respectively. Twenty-one of these genes were shared between UFs and ENDO. Significant gene associations in placenta tissue were compared to the other 48 GTEx v7 tissue types to identify placenta specific associations. There were 40 and 13 significant gene-tissue associations specific to the placenta across UFs and ENDO, respectively. Eight of the placenta-specific genes were shared across UFs and ENDO. The strongest shared placenta-specific associations included PRKCI and HRH1. CONCLUSIONS: Our findings demonstrate a shared genetic relationship between UFs and ENDO in the placenta. The placenta specific associations suggest that dysregulation of early developmental pathways may contribute to a shared genetic origin of these diseases.

Female↗

Prospective data collection of a new procedure by a specialty society: the FIBROID registry.

OBJECTIVE: To describe registry methods and baseline patient demographics from a national sample of women undergoing uterine artery embolization for uterine leiomyomata. METHODS: Interventional radiology practices were recruited to submit data by a secure Web site on women undergoing uterine artery embolization for symptomatic leiomyomata. Baseline data included patient demographics, prior medical, surgical, and obstetrical history, uterine anatomy, and quality-of-life measures. Subsequent data collected included details of the uterine artery embolization procedure and hospital stay and outcomes at 30 days; patients were also offered the opportunity to participate in longer-term follow-up. Characteristics of white and African-American women were compared using t tests, chi(2), or Wilcoxon rank-sum tests as appropriate. RESULTS: As of December 31, 2002, 3,319 uterine artery embolization cases had been entered into the registry by 72 sites; number of patients entered by individual sites ranged from 1 to 514. Of these patients, 95.4% consented to participation in the short-term outcomes registry. Forty-eight percent of patients were African American, and 44.4% were white and non-Hispanic. Heavy menstrual bleeding was the single most bothersome symptom in 64.3% of patients. Compared with white non-Hispanic women, African-American women were significantly younger, more likely to be obese, had larger uteri and more numerous leiomyomata, more severe symptoms, and poorer quality-of-life scores before treatment. CONCLUSION: It is feasible to collect prospective data on new technologies. The FIBROID Registry prospectively collected data on more than 3,000 women undergoing uterine artery embolization for symptomatic leiomyomata. Baseline patient characteristics of this patient population seem to be similar to those of women undergoing other procedures for leiomyomata. LEVEL OF EVIDENCE: III.

Adult↗

Semiquantitative assessment of uterine perfusion using first pass dynamic contrast-enhanced MR imaging for patients treated with uterine fibroid embolization.

The feasibility of using first pass dynamic contrast-enhanced MRI to monitor semiquantitatively the perfusion changes of the uterus after uterine arterial embolization is demonstrated. Ten women, who underwent uterine arterial embolization for fibroid treatment, were included in this study. To derive a perfusion index, an additional axial slice through the abdominal aorta was obtained simultaneously when acquiring MR perfusion data. This technique may prove valuable in monitoring the outcome of uterine arterial embolization and documentation of preserved uterine perfusion after this procedure. J. Magn. Reson. Imaging 2000;12:1004-1008.

Adult↗

Intussusception due to inflammatory fibroid polyps of the ileum: a report of 12 cases from Africa.

Eleven cases of inflammatory fibroid polyp of the ileum from Malawi and 1 from Sierra Leone are described. All 12 patients presented with acute intestinal obstruction as a result of an intussusception caused by the polyp. The lesions are characterized by a variable proliferation of fibroblasts and small vessels which may involve the whole thickness of the bowel wall. Tissue mast cells and eosinophils were noted in the polyps. The aetiology of these lesions remains obscure but they appear to be reactive rather than neoplastic. The condition appears to occur more commonly in Malawi than in the United Kingdom or North America and is an important cause of small bowel obstruction in that part of Africa.

Adult↗

Inflammatory fibroid polyp of the ileum causing intussusception: report of two cases with emphasis on cytologic diagnosis.

Inflammatory fibroid polyp (IFP) of the gastrointestinal tract is a type of inflammatory pseudotumor or inflammatory myofibroblastic tumor that occurs most commonly in the stomach but also in the small and large bowel. Small-bowel IFP usually presents with intussusception. The purpose of the current study is to describe cytological features of this lesion with differential diagnoses since pathologists may be called on to render a diagnosis on fine-needle aspiration. Two cases of IFP are described with diagnostic features on imprint smears. Both were middle-aged obese women with a history of prior intra-abdominal surgical procedures who presented with signs of intestinal obstruction and were found to have a tumor causing intussusception. At intraoperative consult, scrape cytology specimens showed cellular smears with a heterogeneous population of myofibroblasts, inflammatory cells and vessels. The features together with clinical history are sufficient to suggest the diagnosis. IFP is a lesion with a characteristic morphology. The differential diagnosis includes several other lesions, hence triage of cytological specimen for culture, electron microscopy, and immunohistochemistry is important in facilitating a correct diagnosis. Although a surgical procedure may still be necessary once a diagnosis of IFP is made, treatment may be tailored for a less aggressive process.

Adult↗

Endoscopic evaluation of gastric inflammatory fibroid polyp.

Clinical and endoscopic manifestations of 18 gastric inflammatory fibroid polyps (IFP) in 16 patients who underwent endoscopic or surgical removal were retrospectively analyzed. All of the lesions were located within the pyloric antrum, and the sizes varied from 0.8 to 7.0 cm. On endoscopy, six polyps which measured 1.0 cm or less uniformly seemed to be sessile or intramural tumors, whereas four of the nine polyps between 1.1 and 2.0 cm in size were additionally accompanied by a central depression. The remaining three, which measured more than 2.0 cm, showed characteristic polypoid growth with ulcerations. Three polyps more than 1.0 cm in size occasionally prolapsed into the duodenal bulb. Three patients with these prolapsing polyps and two with polyps accompanied by ulcerations experienced abdominal pain, nausea, or severe anemia. Two polyps (11%) were precisely diagnosed as IFP by means of conventional forceps biopsy. Histological examinations revealed that all of the polyps proliferated within the submucosa. Therefore, this type of polyp may be subject to endoscopic removal to enable a precise diagnosis and treatment.

Adult↗

Inflammatory fibroid polyp of the ileum.

We report a patient who presented with recurrent right upper quadrant colics after a previous cholecystectomy. Radiological examination revealed the presence of a polypoid mass in the ileum caused by an anatomo-pathologically proven inflammatory fibroid polyp (IFP) in the ileum. Clinical and pathological aspects related to this rare benign lesion are discussed.

Female↗

Esophageal inflammatory fibroid polyp. Endoscopic and radiologic features.

We present the case of a 60-year-old male patient, who had several episodes of melena during the last years. One month ago he had a new episode of digestive bleeding, and an endoscopic study was performed that showed at 35 cm from the dental arcade a polypoid, pedunculated lesion, with a diameter of 5 cm and a submucosal aspect, a few erosions on its surface and a fibrin deposit. Its head reached the cardia, and it bled when touched by the endoscope. The biopsies taken were negative. X-ray and CT studies confirmed the existence of a mass compatible with a submucosal lesion. The patient was operated and the tumor was excised. The histologic study showed an inflammatory fibroid polyp, an entity very rarely described at the level of the stomach, duodenum, small intestine, and colon and exceptionally described at the esophageal level.

Esophageal Neoplasms↗