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At least 19 recordsLinked to original sources
PubMed1998

Cytogenetic abnormalities in uterine myomas are associated with myoma size.

Uterine leiomyomata (myomas) are associated with a variety of characteristic cytogenetic abnormalities. The significance of these chromosomal aberrations in the pathobiology of myomas remains to be determined. The present study investigated the relationship between myoma cytogenetic abnormalities and size. A total of 114 myoma specimens were obtained from 92 patients undergoing myomectomy or hysterectomy. The maximum diameter of each myoma was measured and a portion of each myoma obtained for cytogenetic analysis. Karyotypes were analysed and categorized as normal, abnormal (non-mosaic) or mosaic. Cytogenetic analyses revealed 73 (64%) normal, 20 (18%) abnormal (non-mosaic), and 21 (18%) mosaic karyotypes. Mean myoma diameter was 6.5+/-0.44 cm with a range of 0.4-27 cm. Differences between the mean myoma diameter of specimens with normal versus abnormal karyotypes was determined by the Kruskal-Wallis test. The mean myoma diameter among specimens with abnormal (non-mosaic) karyotypes was significantly greater than myomas with normal karyotypes (10.2+/-5.9 versus 5.9+/-4.2 cm; P < 0.001). The proportion of abnormal (non-mosaic) karyotypes in myomas >6.5 cm was compared to myomas <6.5 cm by chi2-analysis; myomas >6.5 cm demonstrated a significantly higher proportion of abnormal (non-mosaic) karyotypes when compared to myomas <6.5 cm (75 versus 34%; P < 0.02). In summary, a significant relationship exists between clonal cytogenetic abnormalities and myoma size, suggesting that chromosomal abnormalities associated with individual myomas enhance myoma growth.

Adult↗
PubMed2001

Vaginal expulsion of submucous myomas after laparoscopic-assisted uterine depletion of the myomas.

STUDY OBJECTIVE: To determine the safety and side effects that may be caused by laparoscopic-assisted uterine depletion (LAUD) of submucous myomas. DESIGN: Retrospective chart review and follow-up (Canadian Task Force classification II-2). SETTING: University-affiliated tertiary referral center. PATIENTS: Five hundred twenty women with symptomatic myomas warranting surgical treatment, who wished to retain their uteri. INTERVENTION: Laparoscopic bipolar coagulation of uterine arteries and anastomotic sites of uterine arteries with ovarian arteries. MEASUREMENTS AND MAIN RESULTS: Postoperative sonographs showed submucous myomas in 53 (10.2%) women. During follow-up for a mean of 8.6 months very few complications occurred; however, nine women (1.7%) experienced vaginal expulsion of myomas from 2 weeks to 5 months postoperatively. Four of them were readmitted within 43 days with high fever and fetid discharge, and cervical cultures revealed heavy growth of Escherichia coli in three. Vaginal myomectomy was performed in six patients, and one woman passed the myoma spontaneously. Histopathologic studies of these nine specimens showed that two had infarction, three had coagulative necrosis, and four had degeneration. After treatment, all nine women had normal menstruation and their symptoms resolved during follow-up of at least 3 months. CONCLUSION: In our experience LAUD led to satisfactory symptomatic improvement and reduction in myoma volume and few complications. If vaginal expulsion of submucous fibroids can be viewed as a side effect, we should pay close attention to women with submucous myomas, especially within 2 months of LAUD. Otherwise, more dangerous complications could occur.

Adult↗
PubMedDate not supplied

[Pseudosarcomatous leiomyomas of the uterus. Fusiform cell myomas, plexiform myomas and myomas with nuclear anomalies].

The authors report 14 cases of atypical myomata wich might have been mistaken for sarcomata were it not for the fact that they were devoid of mitotic features. Four of the myomata were immature types with small fusiform cells and without connective tissue fibres. Two of the myomata had a plexiform structure several cm. in diameter and appaered to correspond to tissue that was undergoing endothelial and periocytal regeneration round an old focus of necrosis. These features could only be made out precisely under the microscope. The other eight myomata were mature in form and associated with abnormal nuclei (large, hyperchromatic irregular multi-nuclear giant cell clumps) surrounding the periphery of centres of hypoxia, more commonly after pregnancy (3 cases) or treatment with progesterone (2 cases).

Adult↗
PubMed1997

[Hysteroscopic myoma resection of submucous myomas with largely intramural components].

From February 1992 to December 1995 hysteroscopical myoma resections were performed in 70 patients suffering from recurrent bleeding disorders. In 24 cases of single myoma these were submucous with their largest portion located in the uterine wall. In all cases a pretreatment was performed with 2-3 injections of GnRH-analogues. The indication for resection must be proved critical in submucous myoma with their largest portion in the uterine wall, because a higher rate of complications is described. A simultaneous sonographical or laparoscopical control is necessary. In 2 cases of large myomas second resections were performed. The hysteroscopical resection of submucous myoma with their largest position in the uterine wall is a procedure for a surgeon with much experience in the field of operative hysteroscopy. In a follow up of 5 to 52 months a normal menstruation was reached in all patients. No intra- or postoperative complications were seen, no hysterectomy had to be performed until now. The resection of submucous myoma with their largest portion in the uterine wall is a surgery without a higher complication rate when carried out by an experienced surgeon.

Adult↗
PubMedDate not supplied

[Significance of myoma-induced complications in pregnancy. A comparative analysis of pregnancy course with and without myoma involvement].

In the present study we analyzed the relation between complications in pregnancy--fetal growth retardation, premature rupture of membranes, preterm labour, abruptio placentae, mode of delivery, puerperium--and the size, number and location of myomas. A retrospective comparison was performed in 474 patients (94 pregnant women with myoma and 380 with a normal uterus as controls). The course of pregnancy, the mode of delivery and the puerperium were examined. The study showed that retroplacental submucous myomas increase the risk of fetal growth retardation (14% vs. 6.6%) and abruptio placentae (3.2% vs. 1.3%). The size of the myomas was not relevant. A caesarean section, especially for fetal malpresentation, was also more frequent in patients with submucous myoma (52.9% vs. 27.9%). There was no difference, however, in the postpartal course between the submucous myoma group and the controls, respectively. Subserous or intramural fibroids had no influence on the course of pregnancy, the mode of delivery or the postpartal period.

Adult↗
PubMed1984

[Estrogen biosynthesis in human uterine myoma tissue. The distribution of androstenedione aromatase activity in uterine myoma tissue].

Although it is well known that the development of uterine myoma is influenced by estrogen, the details of its remain unknown. In this study, estrogen biosynthesis (androstenedione aromatase activity) was investigated in the myoma tissue (the central, surface and middle parts of the tumor) and in the myometrial tissue of the same uterus (5 cases). The tissue homogenate (500 mg w. w.) was incubated with [6,7-3H]-androstenedione (100pmol) and NADPH (1.5mg) at 37 degrees C for 1h in air. After stopping the enzyme reaction with ethyl acetate, [4-14C]-estrone and [4-14C]-estradiol-17 beta (10,000dpm, 250 micrograms, respectively) were added to the incubated sample. The sample extracted with ethyl acetate was subjected to Bio-Rad AG1-X2 column, thin layer chromatography and co-crystallization to constant specific activity and 3H/14C ratio. Estrogen formed in the incubated sample was calculated from the 3H/14C ratio of the final crystal. The myoma tissues (14 samples) converted from androstenedione to estrone (36-466 fmol/h/g), while the myometrial tissues of the same uterus did to a lesser extent (22-78 fmol/h/g), while the myometrial tissues of the same uterus did to a lesser extent (22-78 fmol/h/g). Thus, aromatase activity was significantly higher in the myoma tissue rather than in the myometrial tissue of the same uterus. Less estradiol was formed than estrone in both tissues. The distribution of aromatase activity in the tumor was also investigated, and it was found that the enzyme activity tends to become greater away from the center and towards the surface of the tumor. These results suggest that aromatase activity for androgen contributes to the development of uterine myoma.

Adult↗
PubMed1996

[Change in the spectrum of uterus-preserving myoma operations including endoscopy and dual myoma therapy].

OBJECTIVE: On the basis of the evaluation of 300 patients who underwent myoma surgery with the desire for uterus preservation at the Department of Obstetrics and Gynaecology of Heidelberg University, a management scheme including endoscopic techniques was developed. METHOD: Despite the patients' wish for organ preservation, in 12 cases (family planning complete, therapy-resistant sterility, no desire for a child) with an extremely large uterus (20th-24th week of gestation) or a degenerated, intramural myoma (a sarcoma not being excluded), a primary hysterectomy had to be performed. Overall, 37.9% of patients underwent conventional, 42% laparoscopic and 20.1% hysteroscopic surgery. Additionally, to objectify the role of a pretreatment with GnRH analogues (GnRHa), the following control parameters were examined in 128 patients with and 160 patients without pretreatment: rate of primary laparotomies, conversion, secondary hysterectomy, intraoperative bleedings, amount of distension medium and percentage of repeat interventions. RESULTS: No significant differences in the study parameters between study and control groups could be found in the patients treated by laparoscopy. In the hysteroscopy group, conversion rate (13.3 vs. 7%), operation time (35 vs. 21.9 min), rate of severe intraoperative bleeding (33.3 vs. 9.3%), amount of distension medium necessary (difference 2.1 litres) and rate of repeat interventions (40.4 vs. 16.3%) differed significantly between study and control groups. CONCLUSION: In the operative management, the key question is when to perform an invasive procedure. The second question should be which access route is the most convenient. The decision whether to give GnRHa pretreatment is also an individual one, especially in cases of a conventional or laparoscopic operative procedure. A preoperative GnRHa therapy is mandatory before hysteroscopy for submucous myoma.

Adult↗
PubMed2000

Relationship of myoma cell size and menopausal status in small uterine leiomyomas.

CONTEXT: Although myomas shrink after menopause, the cellular mechanism for this phenomenon has received little attention. It was recently demonstrated that fibrous degeneration is significantly associated with postmenopausal status in both small and large myomas. OBJECTIVE: The purpose of the present study was to evaluate whether reduction in myoma cell size is also associated with postmenopausal status in small myomas. DESIGN: Tumor size and patient age have also been related to fibrous degeneration in small (<1 cm) myomas. Therefore, in the present study, 10 pairs of premenopausal and postmenopausal small myomas were matched within 3 years for patient age, within 1 mm for size, and within 1 grade for degree of fibrous degeneration. Most of the women were in their 50s, the decade during which postmenopausal fibrous degeneration in small myomas is most prevalent. Myoma cell size was derived by morphometric evaluation of relative myoma cell area (correcting for percentage of stroma, as measured by point counting) and by direct counting of the number of myoma cells per unit area in trichrome-stained sections. RESULTS: Small myomas from postmenopausal women had significantly (P <.05) smaller cell sizes than did size-matched myomas from age-matched premenopausal women. Myoma cell sizes and nucleus-cell (N/C) ratios were highly variable, especially in premenopausal myomas. CONCLUSIONS: Reduction in myoma cell size is significantly associated with postmenopausal status in small uterine leiomyomas and may be an important mechanism for postmenopausal shrinkage of myomas. In addition, the high variability of myoma cell size and N/C ratio may further support the somatic mutation theory (ie, the theory that diverse mutations may account not only for variations in the growth potential of uterine myomas, but also for variations in their cellular details).

Cell Size↗
PubMed2000

Effects of hormone replacement therapy on postmenopausal uterine myoma.

OBJECTIVES: To evaluate the effects of sequential continuous hormone replacement therapy (HRT) on myoma size and on pulsatility index (PI) of uterine arteries and to verify the correlation between uterine artery flow impedance and the growth rate of myoma in women receiving HRT. METHODS: In a prospective 1-year study 60 postmenopausal women were enrolled into three study-groups to receive continuous transdermal 17beta-oestradiol 0.05 mg/day plus nomegestrolo acetate 5 mg/day sequentially added: 20 patients (group A) unaffected by uterine myomas, 20 patients (group B) with single asymptomatic myoma <3 cm/14 cm3, 20 patients (group C) with single asymptomatic myoma >3 cm/14 cm3. The changes in myoma volume and in PI were assessed by means of transvaginal ultrasonographic scan every 3 months. The patients with myoma were divided into two subgroups: quiescent myoma (B1, C1) and growing myoma (B2, C2). RESULTS: No significant increase of uterine fibroids volume was found after 1-year HRT (24.14+/-20.02-->28.81+/-30.02 cm3). Six out of eight myomas growing during HRT belonged to group C. The uterine artery basal PI value of group A was significantly higher (P<0.01) than the corresponding PI in group B and C. At 3 months follow-up, uterine artery PI was significantly higher (P<0.01) than the basal value in both group B (1.70+/-0.22-->1.88+/-0.16) and C (1.59+/-0.28-->1.92+/-0.21). The baseline PI values in group B1 and C1 were significantly higher than the baseline values observed in group B2 and C2 (1.76+/-0.17 vs. 1.32+/-0.02, 1.76+/-0.16 vs. 1.24+/-0.08) and significantly lower than those observed in group A (2.39+/-0.47). After 3 months of HRT, the PI values were not significantly higher than the baseline values in groups B1 and C2 (1.76+/-0.17-->1.90+/-0.17; 1.24+/-0.08-->1.74+/-0.16), while they were significantly higher in group C1 (1.76+/-0.16-->2.01+/-0.17). CONCLUSIONS: Sequential continuous HRT does not increase the volume of the uterine myoma. The findings of very low resistance index in the uterine arteries of women with growing myoma may indicate the risk of growth of the neoplasia during HRT. The assessment of PI in the uterine arteries could be helpful in predicting the growth rate of the myomas before starting HRT.

Estradiol↗