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International Journal of Gynaecology... Apr 2020Uterine leiomyomas are one of the most common and yet understudied diseases in women. These tumors, commonly known as fibroids, affect women mainly during their... (Review)
Review
Uterine leiomyomas are one of the most common and yet understudied diseases in women. These tumors, commonly known as fibroids, affect women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African ancestry during their lifetime. This disease has a profound impact on health care delivery and costs worldwide. Though most women with fibroids are asymptomatic, approximately 30% of them will present with severe symptoms which can include abnormal uterine bleeding, anemia, pelvic pain and pressure, back pain, urinary frequency, constipation, or infertility, and will require intervention. Furthermore, fibroids have been associated with poor obstetrical outcomes. The current options for symptomatic fibroid treatment include expectant, medical, and surgical management, and interventional radiology procedures. This article reviews the recent progress and available management strategies for uterine fibroids and highlights areas where further research is needed to find new therapeutic targets and better personalize treatments.
Topics: Female; Humans; Leiomyoma; Pelvic Pain; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 31960950
DOI: 10.1002/ijgo.13102 -
American Family Physician Jan 2017Uterine fibroids are common benign neoplasms, with a higher prevalence in older women and in those of African descent. Many are discovered incidentally on clinical... (Review)
Review
Uterine fibroids are common benign neoplasms, with a higher prevalence in older women and in those of African descent. Many are discovered incidentally on clinical examination or imaging in asymptomatic women. Fibroids can cause abnormal uterine bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation, and dyspareunia. Ultrasonography is the preferred initial imaging modality. Expectant management is recommended for asymptomatic patients because most fibroids decrease in size during menopause. Management should be tailored to the size and location of fibroids; the patient's age, symptoms, desire to maintain fertility, and access to treatment; and the experience of the physician. Medical therapy to reduce heavy menstrual bleeding includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs. Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators are an option for patients who need symptom relief preoperatively or who are approaching menopause. Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery.
Topics: Diagnosis, Differential; Female; Humans; Leiomyoma; Middle Aged; Ultrasonography; Uterine Neoplasms
PubMed: 28084714
DOI: No ID Found -
Endocrine Reviews Jul 2022Uterine fibroids are benign monoclonal neoplasms of the myometrium, representing the most common tumors in women worldwide. To date, no long-term or noninvasive... (Review)
Review
Uterine fibroids are benign monoclonal neoplasms of the myometrium, representing the most common tumors in women worldwide. To date, no long-term or noninvasive treatment option exists for hormone-dependent uterine fibroids, due to the limited knowledge about the molecular mechanisms underlying the initiation and development of uterine fibroids. This paper comprehensively summarizes the recent research advances on uterine fibroids, focusing on risk factors, development origin, pathogenetic mechanisms, and treatment options. Additionally, we describe the current treatment interventions for uterine fibroids. Finally, future perspectives on uterine fibroids studies are summarized. Deeper mechanistic insights into tumor etiology and the complexity of uterine fibroids can contribute to the progress of newer targeted therapies.
Topics: Female; Humans; Leiomyoma; Myometrium; Risk Factors; Uterine Neoplasms
PubMed: 34741454
DOI: 10.1210/endrev/bnab039 -
Oncology Research and Treatment 2018Uterine leiomyosarcoma (uLMS) is a rare entity among malignant gynecologic tumors with a very unfavorable prognosis and the highest prevalence in the pre- and... (Review)
Review
Uterine leiomyosarcoma (uLMS) is a rare entity among malignant gynecologic tumors with a very unfavorable prognosis and the highest prevalence in the pre- and peri-menopause. Only early-stage tumors have an acceptable prognosis, provided the patient has been treated without injuring the uterus. uLMS is often diagnosed accidentally and the correct diagnosis ishampered by equivocal features similar to the far more frequent benign uterine fibroids. Surgery is the basis of therapy, and it should be done in order to remove the uterus intact. As vaginal, abdominal, and endoscopic surgery - possibly including morcellation - are the methods of choice for the treatment of uterine fibroids, pre-operatively undiagnosed leiomyosarcoma detected by pathologic examination will have a worsened prognosis. Systemic treatment and radiotherapy are of no proven value in the adjuvant setting. Thus, there is strong need for a reliable pre-operative risk score for leiomyosarcoma in order to justify diagnostic means beyond clinical routine and to choose the correct surgical pathway. The clinical problems in the diagnosis of leiomyosarcoma and treatment are exemplified by a case report of a 30-year-old childless patient. Diagnostic tools as well as treatment options in adjuvant and palliative situations are reviewed.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Chemoradiotherapy, Adjuvant; Diagnosis, Differential; Female; Humans; Hysterectomy; Leiomyoma; Leiomyosarcoma; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Prognosis; Risk Assessment; Ultrasonography; Uterine Neoplasms; Uterus
PubMed: 30321869
DOI: 10.1159/000494299 -
American Journal of Respiratory and... Nov 2020Lymphangioleiomyomatosis (LAM) is a metastatic neoplasm of reproductive-age women associated with mutations in tuberous sclerosis complex genes. LAM causes cystic...
Lymphangioleiomyomatosis (LAM) is a metastatic neoplasm of reproductive-age women associated with mutations in tuberous sclerosis complex genes. LAM causes cystic remodeling of the lung and progressive respiratory failure. The sources and cellular characteristics of LAM cells underlying disease pathogenesis remain elusive. Identification and characterization of LAM cells in human lung and uterus using a single-cell approach. Single-cell and single-nuclei RNA sequencing on LAM ( = 4) and control ( = 7) lungs, immunofluorescence confocal microscopy, ELISA, and aptamer proteomics were used to identify and validate LAM cells and secreted biomarkers, predict cellular origins, and define molecular and cellular networks in LAM. A unique cell type termed LAM was identified, which was distinct from, but closely related to, lung mesenchymal cells. LAM cells expressing signature genes included known LAM markers such as , , , and and novel biomarkers validated by aptamer screening, ELISA, and immunofluorescence microscopy. LAM cells in lung and uterus are morphologically indistinguishable and share similar gene expression profiles and biallelic mutations, supporting a potential uterine origin for the LAM cell. Effects of LAM on resident pulmonary cell types indicated recruitment and activation of lymphatic endothelial cells. A unique population of LAM cells was identified in lung and uterus of patients with LAM, sharing close transcriptomic identity. LAM cell selective markers, secreted biomarkers, and the predicted cellular molecular features provide new insights into the signaling and transcriptional programs that may serve as diagnostic markers and therapeutic targets to influence the pathogenesis of LAM.
Topics: Adult; Aged; Biomarkers, Tumor; Female; Humans; Lung Neoplasms; Lymphangioleiomyomatosis; Middle Aged; Single-Cell Analysis; Transcriptome; United States; Uterine Neoplasms
PubMed: 32603599
DOI: 10.1164/rccm.201912-2445OC -
Seminars in Reproductive Medicine Mar 2017Uterine fibroids, also known as uterine leiomyoma (UL), are monoclonal tumors of the smooth muscle tissue layer (myometrium) of the uterus. Although ULs are considered... (Review)
Review
Uterine fibroids, also known as uterine leiomyoma (UL), are monoclonal tumors of the smooth muscle tissue layer (myometrium) of the uterus. Although ULs are considered benign, uterine fibroids are the source of major quality-of-life issues for approximately 25% of all women, who suffer from clinically significant symptoms of UL. Despite the prevalence of UL, there is no treatment option for UL which is long term, cost-effective, and leaves fertility intact. The lack of understanding about the etiology of UL contributes to the scarcity of medical therapies available. Studies have identified an important role for sex steroid hormones in the pathogenesis of UL, and have driven the use of hormonal treatment for fibroids, with mixed results. Dysregulation of cell signaling pathways, miRNA expression, and cytogenetic abnormalities have also been implicated in UL etiology. Recent discoveries on the etiology of UL and the development of relevant genetically modified rodent models of UL have started to revitalize UL research. This review outlines the major characteristics of fibroids; major contributors to UL etiology, including steroid hormones; and available preclinical animal models for UL.
Topics: Animals; Biomarkers, Tumor; Disease Models, Animal; Female; Genetic Predisposition to Disease; Humans; Leiomyoma; Phenotype; Risk Factors; Signal Transduction; Uterine Neoplasms
PubMed: 28278535
DOI: 10.1055/s-0037-1599090 -
Diagnostic and Interventional Imaging Oct 2019Uterine leiomyomas, the most frequent benign myomatous tumors of the uterus, often cannot be distinguished from malignant uterine leiomyosarcomas using clinical... (Review)
Review
Uterine leiomyomas, the most frequent benign myomatous tumors of the uterus, often cannot be distinguished from malignant uterine leiomyosarcomas using clinical criteria. Furthermore, imaging differentiation between both entities is frequently challenging due to their potential overlapping features. Because a suspected leiomyoma is often managed conservatively or with minimally invasive treatments, the misdiagnosis of leiomyosarcoma for a benign leiomyoma could potentially result in significant treatment delays, therefore increasing morbidity and mortality. In this review, we provide an overview of the differences between leiomyoma and leiomyosarcoma, mainly focusing on imaging characteristics, but also briefly touching upon their demographic, histopathological and clinical differences. The main indications and limitations of available cross-sectional imaging techniques are discussed, including ultrasound, computed tomography, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography. A particular emphasis is placed on the review of specific MRI features that may allow distinction between leiomyomas and leiomyosarcomas according to the most recent evidence in the literature. The potential contribution of texture analysis is also discussed. In order to help guide-imaging diagnosis, we provide an MRI-based diagnostic algorithm which takes into account morphological and functional features, both individually and in combination, in an attempt to optimize radiologic differentiation of leiomyomas from leiomyosarcomas.
Topics: Algorithms; Contrast Media; Diagnosis, Differential; Diagnostic Imaging; Female; Humans; Leiomyoma; Leiomyosarcoma; Neoplasm Staging; Radiopharmaceuticals; Uterine Neoplasms
PubMed: 31427216
DOI: 10.1016/j.diii.2019.07.007 -
International Journal of Molecular... Aug 2021Uterine leiomyomas represent the most common benign gynecologic tumor. These hormone-dependent smooth-muscle formations occur with an estimated prevalence of ~70% among... (Review)
Review
Uterine leiomyomas represent the most common benign gynecologic tumor. These hormone-dependent smooth-muscle formations occur with an estimated prevalence of ~70% among women of reproductive age and cause symptoms including pain, abnormal uterine bleeding, infertility, and recurrent abortion. Despite the prevalence and public health impact of uterine leiomyomas, available treatments remain limited. Among the potential causes of leiomyomas, early hormonal exposure during periods of development may result in developmental reprogramming via epigenetic changes that persist in adulthood, leading to disease onset or progression. Recent developments in unbiased high-throughput sequencing technology enable powerful approaches to detect driver mutations, yielding new insights into the genomic instability of leiomyomas. Current data also suggest that each leiomyoma originates from the clonal expansion of a single transformed somatic stem cell of the myometrium. In this review, we propose an integrated cellular and molecular view of the origins of leiomyomas, as well as paradigm-shifting studies that will lead to better understanding and the future development of non-surgical treatments for these highly frequent tumors.
Topics: Animals; Epigenesis, Genetic; Female; Gene Expression Regulation, Neoplastic; Genetic Predisposition to Disease; Humans; Leiomyoma; Mutation; Uterine Neoplasms; Uterus
PubMed: 34445194
DOI: 10.3390/ijms22168483 -
Critical Reviews in Oncology/hematology Apr 2023Leiomyosarcoma (LMS) is a soft tissue sarcoma of smooth muscle origin that can arise in multiple anatomical sites and is broadly classified as extra-uterine LMS or... (Review)
Review
Leiomyosarcoma (LMS) is a soft tissue sarcoma of smooth muscle origin that can arise in multiple anatomical sites and is broadly classified as extra-uterine LMS or uterine LMS. There is substantial interpatient heterogeneity within this histological subtype, and despite multi-modal therapy, clinical management remains challenging with poor patient prognosis and few new therapies available. Here we discuss the current treatment landscape of LMS in both the localised and advanced disease setting. We further describe the latest advances in our evolving understanding of the genetics and biology of this group of heterogeneous diseases and summarise the key studies delineating the mechanisms of acquired and intrinsic chemotherapy resistance in this histological subtype. We conclude by providing a perspective on how novel targeted agents such as PARP inhibitors may usher in a new paradigm of biomarker-driven therapies that will ultimately impact the outcomes of patients with LMS.
Topics: Female; Humans; Leiomyosarcoma; Sarcoma; Antineoplastic Agents; Uterine Neoplasms; Biology
PubMed: 36893945
DOI: 10.1016/j.critrevonc.2023.103955 -
Ginekologia Polska 2018Uterine fibroids (UFs) are common benign tumors of the female genital tract, diagnosed in almost one-quarter of women of reproductive age. UFs may cause numerous... (Review)
Review
Uterine fibroids (UFs) are common benign tumors of the female genital tract, diagnosed in almost one-quarter of women of reproductive age. UFs may cause numerous clinical symptoms, including prolonged or heavy menstrual bleeding, pelvic pressure symptoms, pain, infertility and others. Submucous fibroids arise from the muscular part of the uterus and pen-etrate into the uterine cavity. They are mostly managed with the use of hysteroscopic myomectomy (HM), which provides direct visualization from the transcervical approach. The sheer number of HM standards and techniques is reason enough to review the available literature about HM-related complications. HM is a safe and effective treatment in patients with the normal size of the uterus and with no more than a few UFs. The procedure should not be initiated without adequate preparation and diagnosis, using the best methods available.
Topics: Female; Humans; Leiomyoma; Treatment Outcome; Ultrasonic Surgical Procedures; Uterine Myomectomy; Uterine Neoplasms
PubMed: 30091451
DOI: 10.5603/GP.a2018.0068