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Cureus May 2023Leiomyomas are the most common pelvic tumors, cervical uterine myoma being rare of all uterine fibroids with an incidence of 0.6% of all fibroids. Based on their...
Leiomyomas are the most common pelvic tumors, cervical uterine myoma being rare of all uterine fibroids with an incidence of 0.6% of all fibroids. Based on their location, cervical myomas can be classified as extra cervical (sub-serosal myoma) and intracervical. Cervical fibroids can further be anterior, posterior, lateral, and central depending on their position. The surgical treatment of cervical leiomyomas poses more difficulty; due to the risk of intraoperative Hemorrhage and the potential injuries because of contiguity and dislocation of adjacent organs. We present the case of a 46-year-old female, presenting with pain abdomen and abdominal distension. Contrast enhanced-magnetic resonance imaging showed a giant cervical myoma. Enucleation of myoma was done followed by total abdominal hysterectomy with bilateral salpingectomy. Injury to the ureter can be avoided with preoperative cystoscopy-guided bilateral ureteral stenting, intraoperative tracing of the ureter before applying a clamp, and dissection inside the fibroid capsule.
PubMed: 37384103
DOI: 10.7759/cureus.39602 -
JSLS : Journal of the Society of... 2015The purpose of this study is to assess the rate of persistent submucosal myomas and intrauterine scarring after hysteroscopic myomectomy, as well as to evaluate the...
BACKGROUND AND OBJECTIVES
The purpose of this study is to assess the rate of persistent submucosal myomas and intrauterine scarring after hysteroscopic myomectomy, as well as to evaluate the preoperative and intraoperative sonohysterographic findings that will predict persistence of myomas, scarring, and the need for repeat surgery.
METHODS
Charts from all hysteroscopic myomectomies performed by a single surgeon between 2003 and 2011 were reviewed for preoperative, intraoperative, and postoperative sonohysterographic findings. Predictors included myoma number, diameter and percent extension into the cavity of the largest fibroid, and percent surgically resected. These predictors were assessed with postoperative sonohysterography. Statistics included t test, logistic regression, χ(2) test, and Fisher exact test.
RESULTS
Among the 79 cases with postoperative sonohysterograms, 17 (21.5%) had persistent submucosal myoma, and 9 (11.4%) had intrauterine scarring on postoperative sonohysterogram. Repeat hysteroscopic myomectomy was required in 11 (13.9%), but none required lysis of adhesions. The myoma number was not a significant predictor. A higher percentage of myoma within the cavity (63.35% vs 44.89%, P < .05) and smaller myoma size (2.22 cm vs 3.31 cm, P < .01) were significant predictors of a complete resection, a normal postoperative sonohysterogram, and avoidance of repeat surgery. On regression analysis, the percent of the myoma resected was the most significant outcome predictor (P < .001).
CONCLUSION
Larger myomas with a lower percent found within the uterine cavity are less likely to be completely resected. Percent resection at the time of surgery is the most significant predictor of a normal postoperative sonohysterogram, as well as the best predictor of the need for repeat surgery.
Topics: Adult; Female; Humans; Hysteroscopy; Leiomyoma; Logistic Models; Middle Aged; Retrospective Studies; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms
PubMed: 25848194
DOI: 10.4293/JSLS.2014.00105 -
BMC Surgery May 2021This study aimed to evaluate the compatibility of robotic single-site (RSS) myomectomy in comparison with the conventional robotic multi-port (RMP) myomectomy to achieve...
BACKGROUND
This study aimed to evaluate the compatibility of robotic single-site (RSS) myomectomy in comparison with the conventional robotic multi-port (RMP) myomectomy to achieve successful surgical outcomes with reliability and reproducibility.
METHODS
This retrospective case-control study was performed on 236 robotic myomectomies at a university medical center. After 1:1 propensity score matching for the total myoma number, total myoma diameter, and patient age, 90 patients in each group (RSS: n = 90; RMP: n = 90) were evaluated. Patient demographics, preoperative parameters, intraoperative characteristics, and postoperative outcome measures were analyzed.
RESULTS
The body mass index, parity, preoperative hemoglobin levels, mean maximal myoma diameter, and anatomical type of myoma showed no mean differences between RSS and RMP myomectomies. The RSS group was younger, had lesser number of myomas removed, and had a smaller sum of the maximal diameter of total myomas removed than the RMP group. After propensity score matching, the total operative time (RSS: 150.9 ± 57.1 min vs. RMP: 170 ± 74.5 min, p = 0.0296) was significantly shorter in the RSS group. The RSS group tended to have a longer docking time (RSS: 9.8 ± 6.5 min vs. RMP: 8 ± 6.2 min, p = 0.0527), shorter console time (RSS: 111.1 ± 52.3 min vs. RMP: 125.8 ± 65.1 min, p = 0.0665), and shorter time required for in-bag morcellation (RSS: 30.1 ± 17.2 min vs. RMP: 36.2 ± 25.7 min, p = 0.0684). The visual analog scale pain score 1 day postoperatively was significantly lower in the RSS group (RSS: 2.4 ± 0.8 days vs. RMP: 2.7 ± 0.8 days, p = 0.0149), with similar consumption of analgesic drugs. The rate of transfusion, estimated blood loss during the operation, and length of hospital stay were not different between the two modalities. No other noticeable complications were observed in either group.
CONCLUSIONS
Da Vinci RSS myomectomy is a compatible option with regard to reproducibility and safety, without significantly compromising the number and sum of the maximal diameter of myomas removed. The advantage of shorter total operative time and less pain with the same amount of analgesic drugs in RSS myomectomy will contribute to improving patient satisfaction.
Topics: Aged, 80 and over; Case-Control Studies; Female; Humans; Laparoscopy; Leiomyoma; Operative Time; Pregnancy; Reproducibility of Results; Retrospective Studies; Robotic Surgical Procedures; Uterine Myomectomy; Uterine Neoplasms
PubMed: 34044817
DOI: 10.1186/s12893-021-01245-9 -
Przeglad Menopauzalny = Menopause Review Sep 2023During a year, myomas may undergo radical changes in their dimensions - from decreasing by 90% to growing by 200%. On average, myomas of the uterus increase in volume by... (Review)
Review
During a year, myomas may undergo radical changes in their dimensions - from decreasing by 90% to growing by 200%. On average, myomas of the uterus increase in volume by 20-30% annually in the premenopausal period. On the other hand, myomas regress spontaneously in about 20% of women. After menopause uterine fibroids stabilize or regress. Every new or growing lesion of the uterus after menopause has to be diagnosed. There is no general definition of fast growing uterine myoma. The presence of fast growing uterine myoma, regardless of its definition, is associated with some clinical issues: it may become symptomatic (pain, bleeding, bulk symptoms), may be responsible for infertility, and a malignant process (leiomyosarcoma) may be present. Regardless of common belief, the risk of sarcoma is not related to the size of the uterus or its fast enlargement. The prevalence of sarcoma in myomas is 0.26%, and in rapidly growing myomas is 0.27%. Treatment should be individualized, selected for the age of the woman and her expectations (preservation of fertility, uterus), symptoms, size and localization of the myomas. The methods of surgical treatment of unsuspected "rapidly growing myomas" are the same as those of common uterine fibroids. Minimally invasive surgery is optimal, but a decision has to be made after evaluation of the risk factors of sarcoma.
PubMed: 37829270
DOI: 10.5114/pm.2023.131497 -
Journal of Obstetrics and Gynaecology... Feb 2017The diagnosis of an unsuspected leiomyosarcoma after hysterectomy for the treatment of a presumed benign leiomyoma is a rare but highly clinically significant event. In...
The diagnosis of an unsuspected leiomyosarcoma after hysterectomy for the treatment of a presumed benign leiomyoma is a rare but highly clinically significant event. In order to facilitate removal of large uterine specimens using a minimally invasive surgical approach, morcellation with extraction in pieces is often performed. In the event of unsuspected malignancy, this may result in abdominal dispersion of the tumor and contribute to poorer survival. Modern surgical innovations always work toward improving minimally invasive strategies. Laparoscopy, rooted in practices for years, supplanted laparotomy for many indications. For extraction of large uteri, morcellation is currently the only way to externalize surgical specimens (myomas, uteri), without increasing the skin opening while allowing to reduce postoperative complications when compared to laparotomy. However, in 2014, the Food and Drug Administration warned against the use of uterine morcellation because of an oncological risk. Some practicing academicians have challenged this recommendation. The incidence of uterine sarcomas is still poorly identified and preoperative diagnostic facilities remain inadequate. The small number of retrospective studies currently available do not reinforce any recommendation. The evaluation of morcellation devices and the improvement of preoperative diagnostic modalities (Imaging, preoperative Biopsy) are being improvised continually so as to minimize the oncological risks. Even during conventional myomectomy, tissue spillage occurs during resection of leiomyoma(s). Adverse oncologic outcomes of tissue morcellation should be mitigated through improved patient selection, preoperative investigations, and novel techniques that minimize tissue dispersion. Preoperative endometrial biopsy and cervical assessment to avoid morcellation of potentially detectable malignant and premalignant conditions is recommended.
PubMed: 28242959
DOI: 10.1007/s13224-017-0970-y -
Journal of Translational Medicine Jan 2021Hysteroscopy is a commonly used technique for diagnosing endometrial lesions. It is essential to develop an objective model to aid clinicians in lesion diagnosis, as...
BACKGROUND
Hysteroscopy is a commonly used technique for diagnosing endometrial lesions. It is essential to develop an objective model to aid clinicians in lesion diagnosis, as each type of lesion has a distinct treatment, and judgments of hysteroscopists are relatively subjective. This study constructs a convolutional neural network model that can automatically classify endometrial lesions using hysteroscopic images as input.
METHODS
All histopathologically confirmed endometrial lesion images were obtained from the Shengjing Hospital of China Medical University, including endometrial hyperplasia without atypia, atypical hyperplasia, endometrial cancer, endometrial polyps, and submucous myomas. The study included 1851 images from 454 patients. After the images were preprocessed (histogram equalization, addition of noise, rotations, and flips), a training set of 6478 images was input into a tuned VGGNet-16 model; 250 images were used as the test set to evaluate the model's performance. Thereafter, we compared the model's results with the diagnosis of gynecologists.
RESULTS
The overall accuracy of the VGGNet-16 model in classifying endometrial lesions is 80.8%. Its sensitivity to endometrial hyperplasia without atypia, atypical hyperplasia, endometrial cancer, endometrial polyp, and submucous myoma is 84.0%, 68.0%, 78.0%, 94.0%, and 80.0%, respectively; for these diagnoses, the model's specificity is 92.5%, 95.5%, 96.5%, 95.0%, and 96.5%, respectively. When classifying lesions as benign or as premalignant/malignant, the VGGNet-16 model's accuracy, sensitivity, and specificity are 90.8%, 83.0%, and 96.0%, respectively. The diagnostic performance of the VGGNet-16 model is slightly better than that of the three gynecologists in both classification tasks. With the aid of the model, the overall accuracy of the diagnosis of endometrial lesions by gynecologists can be improved.
CONCLUSIONS
The VGGNet-16 model performs well in classifying endometrial lesions from hysteroscopic images and can provide objective diagnostic evidence for hysteroscopists.
Topics: China; Deep Learning; Endometrial Hyperplasia; Endometrial Neoplasms; Female; Humans; Hysteroscopy; Pregnancy; Sensitivity and Specificity; Uterine Diseases
PubMed: 33407588
DOI: 10.1186/s12967-020-02660-x -
Women's Health (London, England) Nov 2014In recent years, there has been an increasing focus on the contributory role of uterine fibroids to infertility. The prevalence of these tumors increases with age, which... (Review)
Review
In recent years, there has been an increasing focus on the contributory role of uterine fibroids to infertility. The prevalence of these tumors increases with age, which becomes significant as more women are delaying childbearing. Therefore, fibroids and infertility frequently occur together. Treatment varies with fibroid location and size. The various methods of treatment include open myomectomy, laparoscopic or robot-assisted myomectomy, medical treatment, uterine artery embolization and magnetic resonance guided focused ultrasound surgery. While there is a general consensus on the treatment of submucosal fibroids, the management of intramural fibroids in the infertility patient remains controversial. This paper aims to review and summarize the current literature in regards to the approach to uterine fibroids in the infertile patient.
Topics: Female; Humans; Infertility, Female; Leiomyoma; Uterine Neoplasms
PubMed: 25482490
DOI: 10.2217/whe.14.27 -
Taiwanese Journal of Obstetrics &... Sep 2021To present a case of vulvar myoma and the factors differentiating this tumor from Bartholin's cyst. (Review)
Review
OBJECTIVE
To present a case of vulvar myoma and the factors differentiating this tumor from Bartholin's cyst.
CASE REPORT
A 50-year-old woman presented with a nodule over the left labia majora. Pelvic examination showed swelling and redness of the left labia majora. A 2-cm nodule with firm consistency was found near the vaginal opening. There was no inguinal lymphadenopathy. Bartholin's cyst was suggested, and oral cephalexin was prescribed for 1 week, but no improvement was seen. Therefore, she underwent excision of the nodule. Pathology revealed it to be a benign vulvar myoma. The patient recovered well, and no recurrence was noted after 2 months of follow-up.
CONCLUSION
Vulvar myoma is rare. Sexual history, nodule consistency, and imaging are helpful, but the final diagnosis of vulvar myoma is usually made following surgical excision and histopathological analysis.
Topics: Bartholin's Glands; Biopsy; Cysts; Female; Humans; Leiomyoma; Middle Aged; Myoma; Treatment Outcome; Vulvar Neoplasms
PubMed: 34507676
DOI: 10.1016/j.tjog.2021.07.026 -
American Journal of Translational... 2022Posterior cervical myoma poses a challenge for gynecologic surgeons, especially in women who want to preserve their fertility. The objective of this study is to...
OBJECTIVES
Posterior cervical myoma poses a challenge for gynecologic surgeons, especially in women who want to preserve their fertility. The objective of this study is to summarize our experience with and strategy for this difficult situation.
METHODS
Between July 2019 and June 2021, 13 patients with posterior cervical myoma underwent laparoscopic myomectomy in our department. In addition to using the conventional strategy for laparoscopic myomectomy, other measures such as uterine suspension and preliminary exposure of vital structures, including the uterine artery and ureter, were implemented to enhance safety and improve efficacy. The perioperative outcomes for these patients were retrospectively evaluated.
RESULTS
All surgeries were completed successfully with no conversion to laparotomy. There were no intraoperative complications or needs for blood transfusion. Uterine suspension was performed in all cases, while preliminary exposure of the uterine artery and ureter was performed in nine cases (69.2%). Uterine artery ligation was necessary in two cases. The mean surgical duration was 78.5 ± 12.3 minutes, mean blood loss was 54.2 ± 11.9 mL, and the mean specimen weight was 171.5 ± 59.8 g. Histopathologic analysis revealed leiomyomas in all cases. The postoperative course and follow-up were uneventful.
CONCLUSION
By uterine suspension and preliminary exposure of vital structures, including the uterine artery and ureter, laparoscopic myomectomy for posterior cervical myoma can be performed safely.
PubMed: 36628214
DOI: No ID Found -
American Society of Clinical Oncology... Apr 2022Uterine sarcomas are rare mesenchymal tumors that are aggressive cancers. The rarity of these tumors, and consequently limited prospective data, has made surgical... (Review)
Review
Uterine sarcomas are rare mesenchymal tumors that are aggressive cancers. The rarity of these tumors, and consequently limited prospective data, has made surgical management of uterine sarcomas challenging. One major obstacle in the management of uterine sarcomas is establishing the diagnosis prior to surgery, which is crucial for appropriate intraoperative management. This paper serves to review aspects of surgical management of uterine sarcomas that remain unanswered. Distinguishing common benign myomas from rare uterine sarcomas is important for operative planning and subspecialty care because benign myomas are frequently managed with minimally invasive hysterectomy or myomectomy, whereas the mainstay of management of uterine sarcomas is hysterectomy without specimen fragmentation. Preoperative clinical presentation, serum studies, imaging, and histologic examination all have limitations in establishing a preoperative diagnosis. In addition, patients are often of reproductive age and desire fertility preservation. Although surgery remains the cornerstone for management, high-quality data guiding best practices are sparse. Morcellation should be avoided. Expert pathologic review, imaging to assess for metastatic disease, and consideration of hormone receptor testing are advisable. Recent data have further informed surgical approach and fertility preservation in early-stage disease, but controversy remains. Despite substantial advancement in the medical management of uterine sarcomas, surgical management of uterine sarcomas remain challenging. Larger studies with long-term follow-up are needed to guide fertility preservation surgery options, both local resection and ovarian preservation, further in young women. Development of novel methods to differentiate between benign and malignant uterine masses is needed.
Topics: Female; Humans; Leiomyoma; Myoma; Prospective Studies; Sarcoma; Soft Tissue Neoplasms; Uterine Neoplasms
PubMed: 35471831
DOI: 10.1200/EDBK_350955