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Surgical Treatment of Fibroids
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Ibrahim Alkatout, Liselotte Mettler
In spite of numerous theories, the etiology of fibroid formation remains unclear. While a genetic disposition must be given, as Africans have a much higher frequency of multiple myomas than Caucasians, certain up- and down-regulations in the genes of patients with or without myomas have been described. However, as yet, no clear guidelines for the prevention of fibroids are available. Hereditary leiomyomatosis and renal cell carcinoma syndrome are rare syndromes involving fibroids. Individuals with the gene that leads to both fibroids and skin leiomyomas have an increased risk of developing a rare case of kidney cell cancer (papillary renal cell carcinoma).
Hysteroscopic Myomectomy
Published in John C. Petrozza, Uterine Fibroids, 2020
Karissa Hammer, John C. Petrozza
Fibroids can grow on any aspect of the uterus. The International Federation of Gynecology and Obstetrics (FIGO) classification system creates a standardized way of describing their location. The FIGO grades 0, 1 and 2 refer to submucosal fibroids that are those best suited for treatment with a hysteroscopic approach. FIGO grade 0 is a pedunculated myoma completely within the uterine cavity, grade 1 has less than half of the myoma within the myometrium and grade 2 has equal to or more than half of its volume within the myometrium and the remaining tissue within the uterine cavity. Each of these locations gives a surgeon access to the fibroid through the endometrial cavity, thus a hysteroscopic approach is the best surgical access for minimally invasive removal [1].
Implantation and In Utero Growth
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Kugajeevan Vigneswaran, Ippokratis Sarris
Uterine fibroids are growths arising from the myometrium consisting of fibrovascular cells. They develop under the influence of estrogen and progesterone, as evidenced by the presence of hormone receptors on their surface. Fibroids invariably are coated in a vascular pseudo-capsule and develop a gradually increasing vascular supply with increasing mass (Figure 13.4).
Long-term risk of uterine malignancies in women with uterine fibroids confirmed by myomectomy: a population-based study
Published in Journal of Obstetrics and Gynaecology, 2022
Recent studies suggest that leiomyosarcomas do not arise from the malignant change of fibroids. However, several studies have shown that having a history of uterine fibroids is related to uterine cancer (Brinton et al. 2005; Fortuny et al. 2009; Wise et al. 2016; Johnatty et al. 2020). In previous studies, uterine cancer was diagnosed soon after the diagnosis of uterine fibroids; thus, there is a possibility that the existing uterine cancer could be mistaken for uterine fibroids. (Brinton et al. 2005; Wise et al. 2016). Some fibroids were based on self-reports, and some fibroids were not diagnosed prior to diagnosis of endometrial cancer. (Johnatty et al. 2020). Due to these problems, our study was conducted with patients who had uterine fibroids confirmed by myomectomy. Since no studies have yet investigated the long-term risk of uterine cancer in patients with uterine fibroids confirmed by myomectomy, we conducted this study to determine whether uterine fibroids confirmed by myomectomy are a risk factor for uterine cancer.
Growing on (in)fertile ground: an evolutionary concept analysis of Black female fertility
Published in Human Fertility, 2021
Morine Cebert, Rosa Gonzalez-Guarda, Eleanor Stevenson
Fibroids are benign uterine smooth muscle tumours. Symptoms of fibroids vary among women but typically are heavy and irregular menstrual bleeding, early pregnancy loss and infertility (Ikhena & Bulun, 2018). Studies discussed fibroids and their frequency in the reproductive histories of Black women. Fibroid prevalence and incidence were higher in Black women than White women (Owen & Armstrong, 2015; Styer et al., 2017) possibly existing in upwards to 50% of Black women; making fibroids in Black women 2–3 times more common than in White women (Ezugwu, Iyoke, Ezugwu, & Ugwu, 2014). Among all ethnic groups compared, Black women were more likely to present with symptoms at a younger age and opted for more fertility sparing treatment plans since gold standard treatment is hysterectomy or myomectomy (Borah, Laughlin-Tommaso, Myers, Yao, & Stewart, 2016; Sabry & Al-Hendy, 2012).
Hysteroscopic treatment of submucosal fibroids in perimenopausal women: when, why, and how?
Published in Climacteric, 2020
S. G. Vitale, G. Riemma, M. Ciebiera, S. Cianci
Recently, the use of ulipristal acetate (UPA), a selective progesterone receptor modulator, has been discussed in terms of controlling fibroid-related symptoms52. Moreover, a 3-monthly preoperative treatment with UPA was proposed to facilitate the hysteroscopic myomectomy of submucosal fibroids. Several studies were conducted to validate the hypothesis53. It was reported that, unlike GnRHs, hysteroscopic myomectomy was not negatively affected by UPA pretreatment. Also, it was associated with a high probability of performing a complete resection of fibroids in complex cases, with a decreased duration of the surgical procedure, as well as improved patient satisfaction after 3 months54,55. However, the main problem connected to UPA is that it is not available in all countries. Moreover, some cases were reported to develop liver failure that was possibly related to the use of this drug56. Nevertheless, numerous authors are still supporting this drug and believe that it may be considered a valuable option in the treatment of uterine fibroids57. Vilaprisan, a new selective progesterone receptor modulator, was the subject of extensive research in endometriosis and uterine fibroids and could be a new agent in this indication, especially if the role of UPA changed. However, new results concerning its toxicity in animals halted current research in this matter58.