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Annals of Medicine and Surgery (2012) Nov 2021Uterine myoma occurs in 1.6-2% of pregnancies. Most myomas during pregnancy are asymptomatic, but 10-20% may develop complications. The most common complication is...
INTRODUCTION
Uterine myoma occurs in 1.6-2% of pregnancies. Most myomas during pregnancy are asymptomatic, but 10-20% may develop complications. The most common complication is abdominal pain, usually caused myoma degeneration or torsion of a pedunculated myoma.
CASE PRESENTATION
A 40-year-old pregnant woman was transferred with severe left upper abdominal pain with suspicion of left ovarian torsion at 32 weeks of gestation. Magnetic resonance imaging (MRI) demonstrated a 9.8 cm-sized oval mass abutting the uterine fundus, suggesting subserosal myoma with degeneration. She was admitted for pain control, and the pain was relieved in a few days with conservative management. Two years later, she revisited our hospital for the treatment. Total laparoscopic hysterectomy with bilateral salpingectomy was performed. A 6-cm isolated solid mass adhering to the omentum in the pelvic cavity was observed intraoperatively. The trace on the anterior wall of the uterus was considered to be a broken pedicle that had initially connected the mass.
CLINICAL DISCUSSION
In our case, the patient had severe abdominal pain, and ultrasound and MRI findings suggested subserosal myoma degeneration. A retrospective diagnosis of torsion was made following the surgery, which was assumed to cause the pain during pregnancy, and that an amputation occurred during or after the pregnancy.
CONCLUSION
Diagnosis is based on clinical manifestations and radiologic examination, however, it is usually difficult to diagnose preoperatively, especially among pregnant women who have diagnostic test limitations. Therefore, if a pregnant woman with a myoma complains of abdominal pain, various possibilities should be considered.
PubMed: 34840757
DOI: 10.1016/j.amsu.2021.103007 -
Medicine Apr 2018This study aimed to determine the expression of lactate dehydrogenase (LDH)-A and LDH-D in patients with uterine myoma, cellular leiomyoma (CLM), and uterine sarcoma and...
OBJECTIVE
This study aimed to determine the expression of lactate dehydrogenase (LDH)-A and LDH-D in patients with uterine myoma, cellular leiomyoma (CLM), and uterine sarcoma and to evaluate their prognostic significance.
METHODS
Protein expression levels of LDH-A and LDH-D were determined in tissue samples from 86 patients (26 uterine myoma, 10 CLM, 50 uterine sarcoma) by immunohistochemistry and their associations with clinicopathologic parameters and outcomes were analyzed in patients with uterine sarcoma.
RESULTS
The positivity rates for LDH-A and LDH-D were significantly higher in patients with uterine sarcoma compared with those with uterine myoma or CLM (P < .05). Patients with uterine sarcoma were classified as having uterine leiomyosarcoma (LMS), malignant endometrial stromal sarcoma, and malignant mixed Mullerian tumor, with 5-year overall survival rates of 59%, 71%, and 29%, respectively (P < .05). Univariate analysis showed that patients younger than 50 years and with stage I-II had better clinical prognoses. LDH-A-positive LMS patients had a poorer prognosis than LDH-A-negative patients (P = .03). The median survival time of LDH-A-positive patients was 35 months.
CONCLUSIONS
We demonstrated that LDH-D was expressed in patients with uterine sarcoma. Furthermore, the overexpressions of LDH-A and LDH-D in uterine sarcoma patients may contribute to further understanding of the mechanism of LDH in tumor metabolism in uterine sarcoma. Positive expression of LDH-A in patients with LMS may act as a potential prognostic biomarker in these patients.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Female; Humans; Immunohistochemistry; Isoenzymes; L-Lactate Dehydrogenase; Lactate Dehydrogenase 5; Lactate Dehydrogenases; Leiomyoma; Middle Aged; Prognosis; Retrospective Studies; Sarcoma; Survival Rate; Uterine Neoplasms; Young Adult
PubMed: 29620641
DOI: 10.1097/MD.0000000000010268 -
Fertility and Sterility Dec 2022To introduce a case of a uterus "hernia-like" myoma within the uterine cavity that was successfully treated with hysteroscopy.
OBJECTIVE
To introduce a case of a uterus "hernia-like" myoma within the uterine cavity that was successfully treated with hysteroscopy.
DESIGN
Step-by-step explanation of the case and surgical procedure using a video and slides. The Medical Ethics Committee of Women and Children's Hospital of Chongqing Medical University approved the study and decided for this video to be exempt from formal approval, and informed consent was obtained from the patient.
SETTING
Hospital.
PATIENT(S)
A 37-year-old woman, gravida 1, para 1, with a history of secondary infertility for 2 years and heavy menstrual bleeding for 7 months, which eventually resulted in anemia, was diagnosed with a type 1 (International Federation of Gynecology and Obstetrics leiomyoma subclassification system) myoma approximately 4 cm in diameter using ultrasonography. Her hemoglobin level was 8.6 g/dL (11.5-15.0 g/dL), red blood cell count was 3.6 ×10-12/L (3.8-5.1 ×10-12/L), and hematocrit was 26.7% (35%-45%).
INTERVENTION(S)
Hysteroscopic myomectomy with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the hernia-like myoma. Blunt dissection combined with oxytocin (20 U I.V.) and uterine dilation pressure reduction was used to induce the hernial content (myoma) protrusion into the uterine cavity.
MAIN OUTCOME MEASURE(S)
The hernia-like myoma was completely resected by hysteroscopy, and all symptoms disappeared.
RESULT(S)
The hernia-like myoma was successfully and completely resected by hysteroscopy. The operative time was 37 minutes. No surgical-related or anesthesia-related complications occurred. During the follow-up period, the patient had regular menstrual cycles without hypermenorrhea, and her anemia had improved. The 5-month follow-up ultrasound examination and hysteroscopy revealed that the uterine cavity had recovered well. The patient conceived 7 months after the procedure and delivered at term (39 weeks 1 day) via cesarean section.
CONCLUSION(S)
A hernia-like myoma covered with endometrium is a degenerative myoma that herniates into the myometrium and forms a hernia sac-like defect. Hysteroscopy is an effective and feasible method for treating hernia-like myoma.
Topics: Humans; Child; Female; Pregnancy; Adult; Uterine Neoplasms; Cesarean Section; Leiomyoma; Uterine Myomectomy; Hysteroscopy; Menorrhagia; Hernia
PubMed: 36307291
DOI: 10.1016/j.fertnstert.2022.08.857 -
International Journal of Molecular... Aug 2023Tuberous sclerosis complex (TSC) is a multisystem disorder characterized by seizures, neuropsychiatric disorders, and tumors of the heart, brain, skin, lungs, and...
Tuberous sclerosis complex (TSC) is a multisystem disorder characterized by seizures, neuropsychiatric disorders, and tumors of the heart, brain, skin, lungs, and kidneys. We present a three-year follow-up of a patient with TSC-associated rhabdomyoma detected in utero. Genetic examination of the fetus and the parents revealed a de novo variant in the gene (c.3037delG, p.Asp1013IlefsTer3). Oral everolimus was initiated in the pregnant mother to regress the fetal tumor, which was successful. To the best of our knowledge, there is very little information regarding the use of everolimus therapy during pregnancy. West-syndrome was diagnosed when the proband was four months old. The symptoms were well-manageable, however temporarily. Therapy-resistant focal seizures were frequent. The patient had good vitals and was under regular cardiological control, showed a balanced circulation, and did not require any medication. Subependymal giant cell astrocytoma (SEGA) identified by regular neuroimaging examinations remained unchanged, which may be a consequence of early intrauterine treatment. Early detection of the pathogenic variant, followed by in utero administration of everolimus and early vigabatrin therapy, allowed the detection of a milder developmental delay of the proband. Our study emphasizes how early genetic testing and management of epilepsy are pivotal for proper neurodevelopmental impacts and therapeutic strategies.
Topics: Female; Pregnancy; Humans; Infant; Everolimus; Follow-Up Studies; Rhabdomyoma; MTOR Inhibitors; Fetus; Mothers; TOR Serine-Threonine Kinases
PubMed: 37629066
DOI: 10.3390/ijms241612886 -
The Tokai Journal of Experimental and... Sep 2019After a FDA recommendation in April 2014, power morcellation (PM) in laparoscopic myomectomy (LM) has become less common. We now collect a myoma using manual...
INTRODUCTION
After a FDA recommendation in April 2014, power morcellation (PM) in laparoscopic myomectomy (LM) has become less common. We now collect a myoma using manual morcellation (MM) from a wound in the umbilical region. In this study, we compared the PM and MM methods.
METHODS
The subjects were 69 patients who underwent LM from April 2013 to March 2016 using PM (n = 37) or MM (n = 32). With PM, the myoma was collected using a 4-hole 12-mm parallel trocar in the left lower abdomen. Using MM, an EZ ACCESS (2-cm skin incision) was placed on the umbilical region, and the myoma was put in a collection purse and guided into the access hole for MM using scissors under direct vision.
RESULTS
None required allogeneic transfusion or a transition to open surgery, and had surgical or post surgical complications. At multiple linear regression analysis, which was adjusted by age, body mass index, and intraoperative blood loss, significant difference was not observed in operation time between the PM and MM groups.
CONCLUSION
Manual morcellation was found to be a safe method for collection of myoma that prevents scattering of tissues and does not prolong the operation time.
Topics: Age Factors; Blood Loss, Surgical; Body Mass Index; Female; Humans; Laparoscopy; Leiomyoma; Morcellation; Operative Time; Regression Analysis; Retrospective Studies; Uterine Myomectomy; Uterine Neoplasms
PubMed: 31448397
DOI: No ID Found -
International Journal of Hyperthermia :... 2023This study compared the feasibility and efficacy of transabdominal ultrasound (TAU) and combined transabdominal and transvaginal ultrasound (TA/TV US)-guided...
OBJECTIVE
This study compared the feasibility and efficacy of transabdominal ultrasound (TAU) and combined transabdominal and transvaginal ultrasound (TA/TV US)-guided percutaneous microwave ablation (PMWA) for uterine myoma (UM).
METHOD
This study enrolled 73 patients with UM who underwent PMWA the transabdominal ultrasound-guided (TA group) or the combined transabdominal and transvaginal ultrasound-guided (TA/TV group) approaches. The intraoperative supplementary ablation rates, postoperative immediate ablation rates, lesion reduction rates and other indicators three months postoperatively were compared between the groups. The display of the needle tip, endometrium, uterine serosa, rectum and myoma feeding vessels under the guidance of TAU, transvaginal ultrasound (TVU) and TA/TV US were evaluated in the TA/TV group.
RESULTS
In the TA/TV group, the real-time position of the needle tip and the endometrium complete display rate of the same lesions with TVU guidance were significantly higher than those using TAU. TA/TV US guidance significantly improved the complete display rate of each indicator. The intraoperative supplementary ablation rate in the TA/TV group was lower than that in the TA group. Similarly, the postoperative immediate ablation and volume reduction rates of the lesions three months postoperatively were higher than those in the TA group, especially for lesions with a maximum diameter ≥6 cm.
CONCLUSION
TA/TV US is an effective monitoring method that can be used to improve imaging display. Its use is recommended in patients with obesity, poor transabdominal ultrasound image quality and large myoma volumes.
Topics: Female; Humans; Microwaves; Leiomyoma; Ultrasonography; Myoma; Ultrasonography, Interventional; Uterine Neoplasms
PubMed: 36535945
DOI: 10.1080/02656736.2022.2154576 -
Gynecology and Minimally Invasive... 2019There are still contradictory opinions on the success rates of uterine artery embolization (UAE) for the treatment of myomas. In this scenario, our study aims to assess...
OBJECTIVE
There are still contradictory opinions on the success rates of uterine artery embolization (UAE) for the treatment of myomas. In this scenario, our study aims to assess the effect of UAE on myoma shrinkage.
MATERIALS AND METHODS
The study included 337 women in reproductive age affected by a single symptomatic intramural myoma and declined surgery, undergoing UAE. The uterus and myoma diameters and volumes were determined on ultrasonographic scans before and 3, 6, and 12 months after the procedure.
RESULTS
The mean uterine volume before intervention was 226.46 ± 307.67 mm, whereas myoma volume was 51.53 ± 65.53 mm. Further myoma progression was registered in only four patients. In remaining women, uterus volume in average decreased for 149.99 ± 156.63 mm, whereas myomas decreased for 36.57 ± 47.96 mm. The mean volume reduction rate of the uterus was 49.54 ± 35.62 and for myoma was 57.58 ± 30.71. A significant decrease in both uterine and myoma volume was registered in every stage of the follow-up. The highest average decrease in uterine volume was in the first 3 months and myoma volume between 3 and 6 months following UAE. After 12 months follow-up, successful outcome (volume regression >50% respect to the baseline) was registered for uterus in 97.4% and for myoma in 67.9% of investigated patients.
CONCLUSION
UAE was proven to allow a good success rate and can be considered as an effective alternative procedure for myoma treatment.
PubMed: 31741842
DOI: 10.4103/GMIT.GMIT_50_19 -
Gynecology and Minimally Invasive... 2020Uterine fibroids or uterine myomas are one of the most common benign diseases of the uterus. Symptoms associated with myomas can make surgical removal of myomas... (Review)
Review
Uterine fibroids or uterine myomas are one of the most common benign diseases of the uterus. Symptoms associated with myomas can make surgical removal of myomas necessary. Besides the traditional abdominal route, laparoscopic myomectomy (LM) has gained more acceptances over the last few decades, and it is anticipated that laparoscopy is associated with lower adhesion development. Therefore, we conducted this review to analyze the evidence on adhesions after LM. The PubMed database was searched using the search terms "myomectomy" alone and in combination with "adhesions," "infertility OR fertility outcome," and "laparoscopy" among articles published in English and German. Although the well-known advantages of laparoscopy, for example, less pain, less blood loss, or shorter hospital stay, myomectomy belongs to high-risk operations concerning adhesion formation, with at least every fifth patient developing postsurgical adhesions. In laparoscopic surgery, surgeons´ experience as well tissue trauma, due to desiccation and hypoxia, are the underlying mechanisms leading to adhesion formation. Incisions of the posterior uterus may be associated with a higher rate of adhesions compared to anterior or fundal incisions. Adhesions can be associated with severe complications such as small bowel obstruction, chronic pelvic pain, complications in further operations, or impaired fertility. Tissue trauma and the experience of the surgeon in laparoscopic surgery are most of the influencing factors for adhesion formation after myomectomy. Therefore, every surgeon should adopt strategies to reduce adhesion development in daily routine, especially when it conducted to preserve or restore fertility.
PubMed: 33312861
DOI: 10.4103/GMIT.GMIT_87_20 -
JBRA Assisted Reproduction Dec 2017This study aimed to analyze the results of hysterosonography performed prior to in vitro fertilization (IVF) and to correlate anomalous findings with hysteroscopy.
OBJECTIVE
This study aimed to analyze the results of hysterosonography performed prior to in vitro fertilization (IVF) and to correlate anomalous findings with hysteroscopy.
METHODS
Findings from 197 hysterosonograms of patients examined in an assisted reproduction clinic between January 2012 and August 2014 were included. Enrollment criteria: patients in preparation for IVF not recently submitted to uterine examination through hysterosalpingography or hysteroscopy referred to hysterosonography. Uterine cavity evaluation was considered anomalous when one or more of the following were found: polyps, submucous myomas, uterine synechiae, Müllerian duct anomalies. Individuals with cavity abnormalities that might interfere with IVF results were referred to hysteroscopy.
RESULTS
Normal test results were seen in 170/197 of the cases (86.3%). Eighteen of the 197 cases (9.1%) were suspected for polyps, two (1%) for submucous myoma, six (3.5%) for synechiae, and one (0.5%) for Müllerian duct anomalies. Sixteen of the patients diagnosed with abnormalities underwent hysteroscopy to confirm or treat the suspected pathology. In only two cases there was no agreement between tests: one patient suspected for synechiae and another for polyps were not confirmed; another individual suspected for polyps was found to have focal endometrial thickening in hysteroscopy. The positive predictive value (PPV) in our study was 93.7%.
CONCLUSION
In most cases, the diagnoses obtained by hysterosonography showed normal uterine cavities. The most common anomalous findings were polyps, followed by synechiae, submucous myoma, and Müllerian duct anomalies. Hysterosonography is a good option for evaluating the uterus and offers a high positive predictive value, while hysteroscopy stands as the gold standard.
Topics: Adult; Endosonography; Female; Fertilization in Vitro; Humans; Hysteroscopy; Leiomyoma; Polyps; Retrospective Studies; Uterine Diseases; Uterine Neoplasms; Uterus
PubMed: 28960053
DOI: 10.5935/1518-0557.20170051 -
Romanian Journal of Morphology and... 2020The most frequent tumoral condition of the uterus is represented by uterine myoma. The diagnosis, in most cases, is established by clinical examination and ultrasound...
The most frequent tumoral condition of the uterus is represented by uterine myoma. The diagnosis, in most cases, is established by clinical examination and ultrasound scan. Nevertheless, there are rare cases, in which the surgical findings reveal a retroperitoneal tumor instead of a uterine myoma. These could be represented by schwannomas or Castleman disease. The schwannomas are rarely malignant and arise from the Schwann cells of nerve fibers. These tumors are frequently found at the level of the head, neck and mediastinum and rarely in the pelvis. Generally, schwannomas localized at retroperitoneal level are asymptomatic and with a very slow growth rate. The treatment consists in complete surgical resection. The recurrence rate is low and, generally, the prognosis is good. The Castleman disease is considered a rare entity, but it should be always taken into consideration when it comes to a differential diagnosis in a young patient who presents a retroperitoneal mass at imagery exams. The condition affects the lymphatic system and is characterized by a hyperplasia of the lymph nodes, sometimes associated with herpes virus infection. The clinical picture is often non-specific; the pain may be the only symptom. The imaging methods are not always conclusive for the final positive diagnosis and the histopathological examination is always necessary. Pelvic Castleman disease can be misdiagnosed as myoma or an adnexal tumor. In this article, we review the present knowledge regarding the pathogenesis, pathology and management of these rare retroperitoneal tumors. Both conditions, when located in pelvis must be taken into consideration in the differential diagnosis of uterine myomas, especially in the pedunculated form.
Topics: Female; Humans; Rare Diseases; Retroperitoneal Neoplasms
PubMed: 32747890
DOI: 10.47162/RJME.61.1.01