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PubMed1991

Uterine leiomyosarcoma with massive necrosis diagnosed during gonadotropin-releasing hormone analog therapy for presumed uterine fibroid.

Recurrence of heavy vaginal bleeding and massive necrosis of a uterine leiomyosarcoma are reported in a 41-year-old female who was being treated with GnRH-a for a presumed uterine fibroid. The pathogenic mechanisms of such an event are reviewed and discussed in light of the available literature on the subject of GnRH-a and the treatment of uterine smooth muscle neoplasms.

Adult↗
PubMed1989

Treatment of uterine fibroids with implants of gonadotropin-releasing hormone agonist: assessment by hysterography.

The effect of a potent, subcutaneously injected gonadotropin-releasing hormone (GnRH analog) (Buserelin, Hoechst, Frankfurt/Main West Germany) on the size of uterine leiomyomas and the uterine cavity area was studied in a group of 20 women. In all patients except 1, the uterine cavity area calculated by hysterosalpingography was decreased, with an average decrease of 35% (from 12.0 +/- 5.4 cm2 to 7.8 +/- 3.3 cm2) by 8 weeks of therapy. Significant decrease was observed in the group of women with initial uterine cavity area greater than 10 cm2. In patients with very large submucous fibroids, myomectomy by hysteroscopy and neodymium:YAG laser was easily performed. Rapid relief of symptoms such as menometrorrhagia permits the restoration of a normal hemoglobin concentration. In conclusion, use of GnRH analog represents an adjunct for preoperative reduction of tumor size and may permit surgical treatment by hysteroscopy.

Adult↗
PubMed1997

Incarceration of a gravid fibroid uterus.

The case of an incarcerated gravid fibroid uterus in a 32-year-old woman is presented. This rare complication of pregnancy is readily identified by specific symptoms, physical examination, and ultrasound findings. If the condition is undiagnosed and untreated, spontaneous abortion and preterm labor often occur.

Adult↗
PubMed1997

Inflammatory fibroid polyp in a continent ileo-anal pouch after colectomy for ulcerative colitis--case report.

The most frequent complication occurring in continent ileo-anal pouches after colectomy for ulcerative colitis (UC) is pouchitis. Recurrences of adenomas or carcinomas in pouches of familial adenomatous polyposis (FAP) patients are exceptional, whereas in those with ulcerative colitis dysplasia it is a very rare occurrence. We describe the case of a young woman who developed a mass in a J pouch three years after its construction following colectomy for ulcerative colitis. Histological and immunohistochemical studies showed that this mass had the features of an inflammatory fibroid polyp. A review of the literature of lesions observed in continent ileo-anal pouches after colectomy for UC would suggest that this lesion is an exceedingly rare complication of those devices.

Adult↗
PubMed2000

New approaches to the management of fibroids.

New and innovative treatments are available for the control of uterine leiomyomata, each with advantages and disadvantages. Most of these techniques have few data to support their use; they are generally poorly studied, with brief follow-up. Not much is known regarding risks, costs, and comparative value. Furthermore, many of these procedures are in a state of evolution, with current investigative results having little applicability to the future use of such tools. Given the increasing number of options available to the patient with fibroids, further investigation is needed. A series of high-quality, randomized, comparative trials are needed to assess the relative merits of these new alternatives to treatment.

Embolization, Therapeutic↗
PubMedDate not supplied

Computed tomographic image of an inflammatory fibroid polyp of the stomach.

Inflammatory fibroid polyp (IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of IFP and its computed tomographic (CT) findings. On CT, the tumor protruded into the stomach and was covered with mucosa that was well enhanced. The inside of the tumor was irregularly enhanced, reflecting the typical histological findings of IFPs. Not only endoscopy and endoscopic ultrasonography (EUS) but also CT findings may be useful to diagnose IFP before polypectomy.

Endosonography↗
PubMed1988

LHRH analogues in the management of uterine fibroids, premenstrual syndrome and breast malignancies.

Agonist analogues of LHRH are of potential value in the management of oestrogen-dependent conditions in women. However, their clinical effectiveness is a direct consequence of ovarian suppression which is in itself associated with adverse effects, in particular loss of bone mass. They are thus unsuitable for long-term use in premenopausal women with benign conditions but in future may have a wider role in combination with other agents. In women with uterine fibroids, therapy leads to reduction of uterine volume and alleviation of symptoms although the benefit is rapidly reversed when therapy ceases. Although there is a theoretical potential for combined therapy, successful combinations have yet to be identified. Thus, at the present time, agonists of LHRH do not offer a true alternative to surgery for the majority of women. They will be of value where there is a contra-indication to surgery and for women approaching the age of the natural menopause. They may also be of use prior to surgery, both in controlling symptoms and in reducing surgical morbidity and blood loss. LHRH agonists appear to be beneficial in the management of some women with severe premenstrual tension but intensify symptoms in others. Particular care is required in selection of women for such therapy because of the uncertain nature of the condition and its high rate of response to placebo therapy. Response is dependent on the degree of ovarian suppression and long-term use of LHRH agonists alone is clearly undesirable. However LHRH agonists alone or in combination with ovarian steroids are of potential value as a research tool. In premenopausal women with advanced breast cancer, concerns about the long-term effects of therapy with LHRH agonists are less important and these drugs offer a medical alternative to oophorectomy as first-line treatment in women with oestrogen receptor-positive tumours. Future developments are likely to include evaluation of combined therapy and comparative studies in women with early disease. As such studies involve long-term treatment, they will generate very useful information about the effects of therapy. This will be of great value to clinicians evaluating the role of LHRH agonists in the management of benign conditions.

Breast Neoplasms↗
PubMed1998

Imaging techniques for fibroid detection.

Ultrasound imaging techniques, both transabdominal and transvaginal, are the most accurate and widely used imaging modalities in the detection and characterization of uterine leiomyomas. The diagnosis of these tumours may be enhanced using ultrasound-guided uterine biopsy and hysterosonography. Magnetic resonance imaging provides accurate imaging information, but its cost and lack of significant superiority over ultrasound have hitherto limited its use. Computerized tomography, plain X-ray, and hysterosalpingography have little to offer in the assessment of fibroids.

Biopsy, Needle↗
PubMed1998

Gonadotrophin hormone-releasing hormone analogue treatment of fibroids.

Gonadotrophin hormone-releasing hormone analogue (GnRHa) therapy can induce a reduction in fibroid volume by up to 50% over a period of 3 months treatment. This effect may be beneficial in selected patients, prior to open or endoscopic myomectomy, to aid the surgical procedure by improving vision because of reduced blood loss and reduced uterine artery blood flow. Symptoms of excessive menstrual bleeding, pelvic pain and dysmenorrhoea will also be controlled. Long-term administration of GnRHa requires the use of concomitant add-back therapy, the optimal combination investigated to date being an oestrogen-progestogen continuous combined preparation.

Arteries↗
PubMed1998

Endoscopic treatment of uterine fibroids.

Endoscopic surgery is able to replace most abdominal operations in the surgical treatment of uterine leiomyomas. The use of gonadotrophin hormone-releasing hormone analogues, arterial embolization, hysteroscopy, new techniques of morcellation, laparo-vaginal gasless laparoscopy and laparoscopic mini-laparotomy have enabled the avoidance of laparotomy incisions in most patients. The previous disadvantages of laparoscopy, namely a prolonged operating time, excessive bleeding and inadequate closure, have been overcome. Case and controlled studies have demonstrated the effectiveness of endoscopy in fibroid treatment. The surgical techniques require advanced endoscopic training.

Electrocoagulation↗
PubMed2000

Outpatient uterine artery embolization for symptomatic uterine fibroids: experience in 49 patients.

PURPOSE: To assess the feasibility of performing uterine artery embolization as an outpatient treatment for symptomatic uterine fibroids. MATERIALS AND METHODS: Forty-nine consecutive patients (mean age, 44.5 years; range, 28-54 years) underwent uterine artery embolization during a 12-month period. Embolization was performed with 350-500 microm polyvinyl alcohol particles (44 of 49) or Gelfoam pledgets (five of 49). At discharge, patients were given instructions regarding the constitutional symptoms to expect after embolization. A specific medication regimen consisting of prochlorperazine, ketorolac, meperidine, and hydrocodone was prescribed for relief of these symptoms. All patients were telephoned within 24 hours of discharge. During long-term follow-up, a questionnaire was administered to all patients to evaluate the periprocedural experience. Three-month clinical follow-up was available in 26 patients and 6-month imaging follow-up was available in 16 patients. RESULTS: Fourteen patients presented with menorrhagia, six had bulk-related symptoms (abdominal distension, stress incontinence, pelvic pain), and 29 had both. Technical success for bilateral embolization was 98%. Forty-seven of 49 patients were discharged to home 6-8 hours after the procedure; two patients required overnight observation in an ambulatory unit (one because of postprocedure hypertension and one because of a late procedure completion time). At the first follow-up phone call, reported symptoms included pelvic pain/cramping in 83.7% (41 of 49), fatigue in 75.5% (37 of 49), nausea/vomiting in 46.9% (23 of 49), and a nonpurulent vaginal discharge in 18.4% (nine of 49). These symptoms were satisfactorily controlled with discharge medications in 48 of 49 patients. No patients returned to the hospital or visited an emergency room during the first 48 hours after discharge. Forty-six of 49 patients were satisfied with the decision for home discharge. The average uterine volume reduction in 16 patients with 6-month imaging follow-up was 47.5%; 88.5%, of patients (23 of 26) with 3-month clinical follow-up reported improvement or elimination of symptoms. CONCLUSION: With defined telephone follow-up, staff availability, and a protocol designed to alleviate the postprocedure constitutional symptoms, uterine artery embolization is both safe and effective when performed as an outpatient procedure.

Adult↗
PubMedDate not supplied

Increased expression of stromelysin 3 mRNA in leiomyomas (uterine fibroids) compared with myometrium.

OBJECTIVE: To determine the level of expression of selected matrix metalloproteinases in uterine leiomyoma compared with unaffected myometrium in an effort to explain the abnormal accumulation of extracellular matrix in the leiomyoma. METHODS: The levels of matrix metalloproteinase (MMP) mRNA in leiomyoma and myometrium were measured in samples from 22 patients during either proliferative (n = 6) or secretory phases (n = 16) of the menstrual cycle. Relative amounts of collagenase (MMP-1) and stromelysin (MMP-3) mRNAs were measured by Northern blot analysis, and amounts of stromelysin 3 (MMP-11) and matrilysin (MMP-7) mRNA from each sample were determined by semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and normalized to beta-actin mRNA. RESULTS: The levels of MMP-1 and MMP-3 mRNAs were similar in both leiomyoma and unaffected myometrium. The levels of MMP-11 mRNA were twofold greater in leiomyoma compared with myometrium throughout the menstrual cycle, and the differences in the levels of MMP-11 were significantly different during the secretory phase. The level of MMP-7 mRNA expression was similar in leiomyoma, myometrium, and endometrium. CONCLUSIONS: Among the metalloproteinases examined in this study, only the levels of MMP-11 mRNA were elevated in leiomyoma compared with myometrium. The increased expression of MMP-11 in uterine leiomyoma compared with myometrium is analagous to previously reported elevations of MMP-11 mRNA in dermatofibromas compared with unaffected skin. The increased expression of MMP-11 mRNA in fibroid tumors suggests that this MMP may be involved in the formation of a more fibrous extracellular matrix in leiomyoma relative to unaffected myometrium.

Collagenases↗
PubMedDate not supplied

[Uterine fibroids embolization: results about 454 cases].

OBJECTIVE: To determine the effectiveness of uterine arterial embolization (UAE) as primary treatment in the management of symptomatic leiomyomas. PATIENTS AND METHOD: UAE was performed on 454 patients (age range: 21-68) with menorrhagia, bulk-related symptoms or both, due to leiomyomas. The effectiveness of this therapy in the control of symptoms and reduction of uterine and leiomyoma volume was measured by clinical and imaging controls at 3, 6 and 9 months after the procedure. RESULTS: Four hundred and thirty-three patients were evaluated, and 42 failures were observed (9.6%). Six months after the procedure, 391 patients were symptom-free. Follow-up ultrasonic examination showed an average reduction of 55% in dominant myoma volume at 6 months, 70% at 1 year. Twenty-seven women became pregnant (30 pregnancies). Complications related to procedure, and requiring surgery, occurred in three cases. Principal complications are amenorrhoea and fibroid sloughs. Severe complications are rarely found. DISCUSSION AND CONCLUSION: UAE is an efficient therapy in the management of symptomatic myomas and proves to be a valid alternative to surgical procedure. The future of this mini-invasive and conservative technique appears to be a very promising one.

Adult↗
PubMed2001

Randomized double-blind study evaluating the efficacy on uterine fibroids shrinkage and on intra-operative blood loss of different length of leuprolide acetate depot treatment before myomectomy.

OBJECT: To determine whether length of pre-operative treatment with gonadotrophin-releasing hormone agonists (GnRHa) may have different effects on uterine shrinkage and intra-operative blood loss, 36 patients with symptomatic uterine fibroids awaiting myomectomy were randomly divided into two groups. METHOD: Twenty patients received long-term GnRHa administration, six monthly depot injections of leuprolide acetate (LA), while 16 patients were treated with two monthly LA injections before surgery. The hemoglobin concentration and estradiol, follicle-stimulating hormone and luteinizing hormone concentrations were measured before and after treatment in both groups. RESULTS: Uterine volume decreased in the long-term treated group from 680+/-276 cm3 to 486+/-195 cm3 (36%) after two and to 388+/-172 cm3 (51%) after six LA injections. In the short-term treated group the basal uterine volume decreased from 745+/-320 cm3 to 456+/-177 cm3 (39%) after two LA injections. The uterine volume decrease was statistically significant (p<0.05) after two LA injections in both groups while the decrease observed between two and six LA injections was not significant (p>0.05). The intra-operative blood-loss was not significantly different between the two groups studied, 315+/-93 cm3 and 336+/-88 cm3. CONCLUSION: Two pre-operative GnRHa depot injections offer similar results, in terms of uterine shrinkage and intra-operative blood loss, and a longer treatment seems to be justified in cases of anemia.

Adult↗
PubMed2000

Inflammatory fibroid polyp of the esophagus.

The case of a 76-year-old woman with a submucosal tumor of the esophagus, whose principal symptoms were dysphagia and epigastric/retrosternal pain, is reported here. Endoscopy, barium swallow and a CAT scan all pointed to extramucosal localization. The lesion was located in the lower esophagus lying on the stomach fundus. An ulcer in the region of the cardia complicated the tumor. Two sets of conventional biopsies failed to detect malignancy, only inflammation and intestinal metaplasia were seen in the specimens of the mucosa surrounding the ulcer. The endoscopic ultrasonographic findings were an indistinct margin, hypoechogenicity, homogeneous appearance and location within the second and third echographic layer. The surgical resection of the tumor was complemented by an anterior partial fundoplication. The histologic study revealed an inflammatory fibroid polyp, which is a rare, benign, non-capsulated submucosal lesion composed mainly of loose connective tissue and vessels, with an eosinophilic inflammatory component. This lesion is seldom found in the esophagus.

Aged↗
PubMed2004

Uterine artery embolisation for symptomatic fibroids: the effect of the large uterus on outcome.

OBJECTIVE: The aim of this study was to evaluate the efficacy of uterine artery embolisation (UAE) in myomatous uteri larger than 24 week's gestation (780 cm3). DESIGN: Prospective case control study. SETTING: Universitas Hospital, University of the Free State, Bloemfontein, South Africa. POPULATION: Sixty-one women, who underwent UAE, were included in the study. The study group comprised of 12 women with uteri > or =780 cm3 and the control group 49 women with uteri <780 cm3. METHODS: UAE was performed and the difference in outcome for the two groups was determined at 12 months. MAIN OUTCOME MEASURE: Symptomatic improvement with embolisation of the large uterus. RESULTS: Reduction of dysmenorrhoea, menorrhagia and pressure effects was similar for both groups. The median reduction in uterine volume (pre- to post-embolisation) was 188 cm3 (range 28-2038 cm3) with a 95% CI for the median difference for paired data of 146.5 and 236. Only 66% of the study group had, however, a reduction in volume to <780 cm3. The complication rates were similar for the two groups with regards to post-embolisation syndrome, fibroid slough, haematoma formation, infection, hysterectomy and failure to embolise. Satisfaction was similar between the two groups, with 91% of women satisfied with the procedure. CONCLUSION: The large uterus does not decrease UAE's efficacy. Although 33.3% of the study group still had a uterus of > or =780 cm3, symptom reduction was still similar for both groups. Women may thus still be left with a large uterine volume but without symptoms. This must be taken into consideration when counselling women with an extremely large uterus for UAE.

Adult↗