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Frontiers in Bioscience (Elite Edition) Jan 2013Uterine myomas, the most common benign solid pelvic tumors in women, occur in twenty percent of them in reproductive years and form the most common indication for... (Review)
Review
Uterine myomas, the most common benign solid pelvic tumors in women, occur in twenty percent of them in reproductive years and form the most common indication for hysterectomy. Various factors affect the choice of the best treatment modality for a given patient. Asymptomatic myomas may be managed by careful follow up. Medical therapy should be tried as a first line of treatment for symptomatic myomas while surgical treatment should be reserved only for appropriate indications. Myomectomy would be preferred over hysterectomy in those wishing subsequent childbearing. Preoperative GnRH-analogue treatment reduces the myoma size and vascularity but may render the capsule more difficult to resect. Poor surgical risk women with large symptomatic myomas or those wishing to avoid major surgical procedures may be offered uterine artery embolization. Serial follow-up for growth and symptoms may be appropriate for asymptomatic perimenopausal women. The present article reviews the available therapeutic modalities for uterine myomas.
Topics: Antifibrinolytic Agents; Disease Management; Female; Gonadotropin-Releasing Hormone; Humans; Hysterectomy; Myoma; Norpregnadienes; Progestins; Uterine Artery Embolization; Uterine Myomectomy; Uterine Neoplasms
PubMed: 23276966
DOI: 10.2741/e592 -
Contrast Media & Molecular Imaging 2022The aim of this study was to analyze the diagnostic significance of ultrasonography combined with hysteroscopy for intrauterine space-occupying abnormalities. A total of...
The aim of this study was to analyze the diagnostic significance of ultrasonography combined with hysteroscopy for intrauterine space-occupying abnormalities. A total of 99 patients with uterine space-occupying abnormalities treated in hospitals were enrolled. The patients were divided into three groups according to different disease types: the submucosal myoma group, endometrial polyp group, and placenta residue group, with 33 patients in each group. The differences and diagnostic effects in intrauterine ultrasound, hysteroscopic findings, and surgical histopathology were observed in each group. Outcome measures: it was to compare the sensitivity, specificity, and accuracy of intrauterine ultrasound and angiography for intrauterine space-occupying lesions using surgical and pathological examination methods as the gold standard; the relationship between the location, number, size, appearance, and serosal layer of intrauterine lesions was clearly shown; the location, number, appearance, and echogenicity of space-occupying abnormalities under hysteroscopy were observed. The results showed that the diagnostic rates of endometrial polyps, submucous myoma, and residual placenta were 90.9%, 80.8%, and 72.7%, respectively. However, the sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of endometrial polyps were 90.0%, 66.7%, and 87.9%, respectively; those of hysteroscopy in the diagnosis of endometrial polyps were 96.7%, 66.7%, and 93.9%, respectively; and combined diagnosis was 96.7%, 100.0%, 97.0%, 100.0%, and 75.0%. The sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of submucous myoma of the uterus were 88.9%, 50.0%, and 81.8%, respectively; those of hysteroscopy in the diagnosis of submucous myoma of the uterus were 96.3%, 83.3%, and 93.9%, respectively; and combined diagnosis was 100.0%, 83.3%, 97.0%, 96.4%, and 100.0%. The sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of uteroplacental remnants were 87.5%, 66.7%, and 81.8%, respectively; those of hysteroscopy in the diagnosis of uteroplacental remnants were 91.7%, 77.8%, and 87.9%, respectively; and combined diagnosis was 95.8%, 88.9%, 93.9%, 95.8%, and 88.9%. In summary, ultrasonography combined with hysteroscopy can improve the diagnostic sensitivity and accuracy for intrauterine space-occupying abnormalities.
Topics: Female; Humans; Hysteroscopy; Myoma; Polyps; Pregnancy; Sensitivity and Specificity; Ultrasonography; Urogenital Abnormalities; Uterine Neoplasms; Uterus
PubMed: 36110976
DOI: 10.1155/2022/6192311 -
Journal of Gynecological Endoscopy and... Jan 2011Compared to myomas that occur in the uterine corpus, cervical myomas are closer to other organs such as the bladder, ureter, and rectum, and the approach needs to be...
Compared to myomas that occur in the uterine corpus, cervical myomas are closer to other organs such as the bladder, ureter, and rectum, and the approach needs to be modified, as the organs that have to be considered differ depending on the location of the myoma. Surgical difficulties associated with these cases are, poor access to the operative field, difficulty in suturing the repairs, increased blood loss, and distortion of the anatomy of the vital neighboring structures in the pelvic cavity.
PubMed: 22442532
DOI: 10.4103/0974-1216.85277 -
Journal of Minimally Invasive Gynecology Nov 2023Although it is assumed that myomectomy improves uterine myoma-related symptoms such as pelvic pain and heavy menstrual bleeding (HMB), validated measures are rarely...
STUDY OBJECTIVE
Although it is assumed that myomectomy improves uterine myoma-related symptoms such as pelvic pain and heavy menstrual bleeding (HMB), validated measures are rarely reported. This study aimed to verify the effect of myomectomy on myoma-related symptoms.
DESIGN
A retrospective cohort study.
SETTING
A university-affiliated hospital.
PATIENTS
Our study included 241 patients with a myoma diagnosis and received a myomectomy between 2004 and 2018. Data were collected from the patient medical file and patients responded in 1 questionnaire.
INTERVENTIONS
Transcervical resection of myoma (TCRM) and laparoscopic or abdominal myomectomy (LAM).
MEASUREMENTS AND MAIN RESULTS
One year after TCRM, a significant number of women experienced symptom improvement for pelvic pain (79% [19/24, p = .01]) and HMB (89% [46/52, p <.001]). For other myoma-related symptoms, abdominal pressure (43%, 10/23), sexual complaints (67%, 2/3), infertility (56%, 10/18), and other complaints (83%, 5/6), improvements were not statistically significant. One year after LAM, a significant number of women experienced symptom improvement for pelvic pain (80%, 74/93), HMB (83%, 94/113), abdominal pressure (85%, 79/93), sexual complaints (77%, 36/47), and other complaints (91%, 40/44). One year after myomectomy, 47% (30/64) (TCRM) and 44% of women (78/177) (LAM) described no myoma-related symptoms. Most women (82% [172/217]) were satisfied with the postoperative result after 1 year and 53% (114/217) would have liked to receive the myomectomy earlier in life. Average quality of life (measured on a 10-point Likert scale) increased from 6.3 at baseline to 8.0 at 1 year after TCRM and from 6.2 to 8.0 1 year after LAM, resulting in a difference of 1.7 points (p <.001; 95% confidence interval, 1.1-2.3) and 1.9 points (p <.001; 95% confidence interval, 1.4-2.3), respectively.
CONCLUSION
One year after myomectomy, most women have benefited from myomectomy, concluded by a significant number of women who experienced myoma-related symptom improvement, positive patient satisfaction, and a significant improvement in reported quality of life. Validation of results after conventional treatment such as myomectomy is essential in counseling patients for surgical treatment in today's evidence based practice. In addition, it is necessary to make an adequate comparison with new treatment options for myomas. To provide this, further research should preferably be conducted prospectively or by randomization.
Topics: Female; Humans; Uterine Myomectomy; Uterine Neoplasms; Retrospective Studies; Quality of Life; Myoma; Pelvic Pain; Laparoscopy
PubMed: 37453499
DOI: 10.1016/j.jmig.2023.07.001 -
Journal of Medical Case Reports Apr 2022Cardiac tumors in infants and children are rare. The most common cardiac tumor is rhabdomyoma, which may be associated with tuberous sclerosis. However, not all cardiac...
BACKGROUND
Cardiac tumors in infants and children are rare. The most common cardiac tumor is rhabdomyoma, which may be associated with tuberous sclerosis. However, not all cardiac rhabdomyomas are pathognomonic for tuberous sclerosis, and not all congenital cardiac tumors are rhabdomyomas. During the prenatal period, early cardiac tumor detection provides important information about fetal wellbeing, delivery planning, and necessary postnatal care.
CASE PRESENTATION
We report a 36-year-old African American pregnant women. At 32 weeks 5 days gestational age, the male fetus had a fetal echocardiogram due to fetal arrhythmia. The fetal echocardiogram showed two small echogenic, RV apex and septal masses, suspicious of rhabdomyomas. After a routine pregnancy and a normal spontaneous vaginal delivery (39 weeks 1 day), the male baby was admitted to the neonatal intensive care unit for further monitoring and postnatal evaluation.
CONCLUSIONS
Rhabdomyomas are extremely rare and unique tumors. These tumors are very dangerous, but they usually regress after birth. During the prenatal period, early cardiac tumor detection provides important information about fetal wellbeing, delivery planning, and necessary postnatal care. We present this case to share our findings with our pediatric colleagues. Although a rarely reported case, we hope this cardiac rhabdomyoma case report and literature review can increase cardiac tumor awareness.
Topics: Adult; Child; Female; Fetal Diseases; Heart Neoplasms; Humans; Infant; Infant, Newborn; Male; Pregnancy; Rhabdomyoma; Tuberous Sclerosis; Ultrasonography, Prenatal
PubMed: 35449076
DOI: 10.1186/s13256-022-03371-1 -
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 -
International Journal of Applied &... 2021A giant uterine fibroid is a rare tumor of the uterus. Uterine leiomyomas are the most common type of a benign tumor that arises from the female pelvis. Uterine...
A giant uterine fibroid is a rare tumor of the uterus. Uterine leiomyomas are the most common type of a benign tumor that arises from the female pelvis. Uterine leiomyoma is a smooth muscle tumor. Its prevalence is more in reproductive age group and decreases after menopause. They are rare in adolescents. In reproductive age group, the preferred mode of management of fibroid is myomectomy. For large myomas, the role of laparoscopic myomectomy is still controversial. Laparoscopic myomectomy for giant myoma is technically challenging and should be performed by an experienced surgeon. We herein report the case of a 32-year-old unmarried girl who visited our hospital with the complaint of progressive abdominal distension and discomfort from the past 4-5 months. Ultrasonography was done, and it showed a markedly enlarged uterus containing a 16 cm × 17 cm subserosal fibroid and 3 cm × 4 cm intramural fibroid. Magnetic resonance imaging suggestive of three myoma, one sub serosal myoma at fundal region of 11.2 cm × 9.6 cm × 14.2 cm, second intramural fibroid in the lateral wall of the uterus of 3 cm × 3 cm and a small submucosal fibroid of dimension 1.1 cm × 0.9 cm × 0.8 cm. Laparoscopic myomectomy was planned and completed successfully with no intra- and postoperative complications. Intraoperative finding was suggestive of 20 cm × 20 cm × 18 cm fundal fibroid and 2 cm × 3 cm lateral wall fibroid. The defect was closed using V-lock suture in two layers. The myoma was removed by tissue morcellator. In the literature, only a few cases reported of successful removal of giant myoma by laparoscopy.
PubMed: 33912432
DOI: 10.4103/ijabmr.IJABMR_382_19 -
Journal of the Chinese Medical... Oct 2012Myoma is the most common benign neoplasm that can occur in the female reproductive system, most frequently seen in women in their 50s. Although the majority of myomas... (Review)
Review
Myoma is the most common benign neoplasm that can occur in the female reproductive system, most frequently seen in women in their 50s. Although the majority of myomas are asymptomatic, some patients have symptoms and/or signs of varying degrees. Typical myoma-related symptoms or signs include: (1) menstrual disturbances like menorrhagia, dysmenorrhea and intermenstrual bleeding, (2) pelvic pain unrelated to menstruation, (3) compression symptoms, similar to a sensation of bloatedness, urinary frequency and constipation, (4) subfertility status such as recurrent abortion, preterm labor, dystocia with an increased incidence of Cesarean section, and postpartum hemorrhage, and (5) cosmetic problems due to increased abdominal girth However, there are undoubtedly some clinical presentations secondary to uterine myomas are not so specific, such as: (1) uncommon compression-related symptoms, (2) cardiac symptom and atypical symptoms secondary to vascular involvement or dissemination, (3) abdominal symptoms mimicking pelvic carcinomatosis, (4) dyspnea, (5) pruritus, (6) hiccup or internal bleeding, and (7) vaginal protruding mass or uterine inversion. Familiarization with these symptoms and awareness of other unusual or atypical presentations of uterine myomas will remind clinical practitioners of their significance, and of the necessity of follow-up examinations and individualized management to fit the needs and childbirth desires of the patients.
Topics: Female; Humans; Middle Aged; Myoma; Uterine Neoplasms
PubMed: 23089399
DOI: 10.1016/j.jcma.2012.07.004 -
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 -
Journal of the Formosan Medical... Aug 2016
Topics: Fatal Outcome; Heart Neoplasms; Humans; Infant, Newborn; Male; Rhabdomyoma; Tomography, X-Ray Computed
PubMed: 27185619
DOI: 10.1016/j.jfma.2015.12.005