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Morcellation Techniques for Fibroid Uterus
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Prakash Trivedi, Soumil Trivedi, Anjali Sonawane, Aditi Parikh
The fundamental steps of myomectomy or hysterectomy open or laparoscopic are the same and can lead to the spread of disease, but as morcellation was made out to be the culprit, our study on contained visual in-bag morcellation suggests the following:Pre operative Diagnosis of leiomyosarcoma is not possible with certainty. The unexpected incidence of leiomyosarcoma is exceedingly low.Further if one operates on an unexpected leiomyosarcoma, it will spread by any approach and could already have pre-existing intravascular spread.The Vienna Oncology group’s 24-year study on leiomyosarcoma suggests that none actually started from a fibroid.Genetic evidence suggests that leiomyosarcoma is due to selective gene suppression and fibroids are the expression. Therefore, leiomyosarcoma progressing from a leiomyoma is an unlikely event.Finally, contained visual bag morcellation should be the norm not only to address the concern of leiomyosarcoma, but also to prevent iatrogenic parasitic fibroids.
Malignant Inferior Vena Cava Leiomyosarcoma
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Clinically, leiomyosarcomas present with an abdominal mass, abdominal pain, lower limb edema, or as incidental findings [1,4]. Occasionally patients may have fever and leucocytosis as a result of tumor necrosis invoking an inflammatory response.
Leiomyomata and Reproduction
Published in John C. Petrozza, Uterine Fibroids, 2020
The classic indication for myomectomy includes symptomatic women who experience heavy menstrual bleeding or bulk symptoms. Patients with leiomyomata that are rapidly growing may benefit from further evaluation and treatment to exclude an occult malignancy such as leiomyosarcoma [7]. There has been significant controversy regarding the impact of uterine myomas on fertility and pregnancy outcome. As a result, the benefit (likelihood of conception, pregnancy loss, live birth and obstetrical complications) of myomectomy in women with asymptomatic myomas has also been uncertain. Data regarding the association of fecundity and fibroid size, location and conception (spontaneous vs. undergo ART—assisted reproductive technology) after myomectomy are inconsistent. In addition, most individual studies were retrospective or insufficiently powered, and meta-analyses evaluate very heterogeneous studies. As a result, the interpretation of conflicting results has been challenging.
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.
Primary leiomyosarcoma of cervical spine invading the vertebra without obvious osteoclasia: Case report and literature review
Published in The Journal of Spinal Cord Medicine, 2022
Han Sun, Min Zhuang, Dong Cheng, Chenlei Zhu, Zhiwei Liu, Xubin Qiu
Primary leiomyosarcomas are rare malignant tumors of smooth muscles. Patients with leiomyosarcoma usually suffered from poor prognosis for the high metastatic recurrence rate and relative resistivity to radiotherapy and chemotherapy.1 In most cases, leiomyosarcoma arise in the retroperitoneum, subcutaneous tissue of the extremities, and intra-abdominal space such as gastrointestinal tract and uterus. Primary leiomyosarcoma of bone is quite rare, among which most cases occur in the femur and tibia. Primary leiomyosarcomas located in the cervical spinal regions were much scarcer. To our knowledge, only three relevant cases with obvious osteoclasia have been reported.1–3 In this report, we want to describe a case of primary leiomyosarcoma in the spinal canal which have invaded the C4 vertebra but did not exhibit obvious osteoclasia.
Molecular differential analysis of uterine leiomyomas and leiomyosarcomas through weighted gene network and pathway tracing approaches
Published in Systems Biology in Reproductive Medicine, 2021
Nora Naif Sahly, Babajan Banaganapalli, Ahmed N. Sahly, Ali H. Aligiraigri, Khalidah K. Nasser, Thoraia Shinawi, Arif Mohammed, Abdulhakeem S. Alamri, Nabeel Bondagji, Ramu Elango, Noor Ahmad Shaik
Uterine leiomyosarcomas (ULMS or leiomyosarcomas) are a rare class of post-menopausal uterine malignant tumors with an estimated annual incidence of 0.64 per 100,000 women. Originating from myometrium or myometrial vessels, these are characterized with early metastasis, poor prognosis, and high rates of recurrence, with limited therapeutic efficacy (Mas and Simon 2018). Commonly mutated genes in ULMS are PTEN, YWHAE, ATRAX, VIPR2, and P53 (Cuppens et al. 2018). Although majority of leiomyosarcomas are of de novo origin, in some cases, leiomyomas are suggested to be their precursors (Sala et al. 2013). The clinical distinction of leiomyosarcomas from leiomyomas is very difficult due to their common myometrial origin and overlapping clinical features (Santos and Cunha 2015). Although, in general, diagnostic options like biopsy-based histopathological testing, ultrasonographic (with ultrasound, CT, MRI) examinations, serum markers (LDH) and cancer antigen (CA-125) detection options are available, each has its limitations in distinguishing malignant leiomyosarcomas from benign leiomyomas with certainty (Chen et al. 2018). These characteristics underline the need to better understand the molecular basis of these heterogeneous tumors, which may potentially contribute to postoperative diagnosis and therapeutic management (ElSokary et al. 2020).