Fibroid Preoperative Imaging: Magnetic Resonance Imaging
Botros R.M.B. Rizk, Yakoub Khalaf, Mostafa A. Borahay in Fibroids and Reproduction, 2020
The clinical presentation of uterine leiomyomas is variable, depending on size, number, and location of these leiomyomas. Leiomyomas are classified as submucosal, intramural, and subserosal based on their relationship to the endometrium and external contour of the uterus. Heavy menstrual bleeding and painful periods are the most frequent symptoms and can be caused by submucosal leiomyomas that distort the uterine cavity [22] and large intramural fibroids [23]. Bulk symptoms could be related to size, and usually occur with subserosal, pedunculated, and large intramural leiomyomas [24]. The negative effects of leiomyomas on pregnancy are determined by both location and size. Submucosal and large (greater than 5 cm) intramural leiomyomas have the strongest risk for decreased implantation and higher risk of spontaneous abortion [25,26].
Histogenesis of Irreversible Changes in the Female Genital Tract After Perinatal Exposure to Hormones and Related Substances
Takao Mori, Hiroshi Nagasawa in Toxicity of Hormones in Perinatal Life, 2020
Prenatal DES exposure with adequate doses results in uterine tumors at an advanced age in both mice and rats.59,141 Treatment of pregnant CD-I mice with an intraperitoneal injection of DES at 16 days and 16 hr of gestation or later resulted in 14 out of 143 female offspring having uterine adenocarcinomas at an age of 19 to 20 months.135 Leiomyomas were observed in 3 out of 64 controls. When females exposed to DES in fetal life were mated to normal control males, this second generation offspring had an increased incidence of uterine tumors, while the incidence of commonly occurring tumor types in this strain was similar in controls and in females with past generation DES exposure.142 The mechanism for this second generation effect is unknown. Among 18 female rats exposed to DES on the 19th day after conception 3 endometrial polyps and 1 fibroma were found.141 No uterine tumors were found among 34 controls.
GnRH Antagonists in the Treatment of Uterine Fibroids
John C. Petrozza in Uterine Fibroids, 2020
Flierman et al. [34] observed similar results with the use of ganirelix. Nineteen premenopausal women were treated using 2 mg daily, subcutaneous injections for a maximum of 12 weeks (median 19 days). Leiomyoma size and uterine volume were monitored using weekly ultrasound and pre- and post-treatment MRI. Serum LH, FSH, E2 and progesterone were assessed weekly. Treatment was discontinued when a 10% decrease in fibroid or uterine size was detected over four consecutive ultrasound measurements. For 11 subjects over 6 weeks, ultrasound revealed a median 42.7% (14%–77%) decrease in leiomyoma volume and a 46.6% (6.1%–78.6%) decrease in uterine volume. MRI revealed a median 29.2% (35.6%–62.2%) decrease in leiomyoma volume and a 25.2% (28.9%–63.6%) decrease in uterine volume. Six of these subjects noted a reduction in fibroid volume by one-third within 16 days of treatment. Serum LH and E2 levels dropped below limits of detection within 1 week in nearly all subjects. FSH and progesterone levels also remained low throughout treatment. Furthermore, the authors noted that tumor echogenicity changed with treatment. Of note, one patient had an increase in leiomyoma and uterine volume, in spite of decreasing estrogen levels. The most common reported side effects were hot flashes (75%) and headache (45%), though none were reported prior to week 3 of treatment. All participants underwent surgery within 2 weeks of their final dose of ganirelix.
Simultaneously occurring disseminated peritoneal leiomyomatosis and multiple extrauterine adenomyomas following hysterectomy
Published in Baylor University Medical Center Proceedings, 2019
Jessica A. Belmarez, Hamid R. Latifi, Wei Zhang, Carolyn M. Matthews
Leiomyomas are benign tumors composed of proliferating smooth muscle cells. They are the most common uterine tumors in women of reproductive age, with prevalence estimated as high as 77%.1 Extrauterine leiomyomas, on the contrary, are quite rare. When multiple discrete extrauterine leiomyomas are found to be distributed along the peritoneal surfaces, the entity is referred to as disseminated peritoneal leiomyomatosis (DPL). Adenomyomas are benign tumors composed of smooth muscles cells, endometrial glands, and endometrial stroma. Extrauterine adenomyomas are even rarer than extrauterine leiomyomas; only 22 cases have previously been reported.2 The finding of both types of tumors simultaneously is exceedingly rare and to our knowledge has not previously been reported in the literature. In this case study, we focus on these two rare conditions, briefly review the literature, discuss differential diagnoses, review a few leading theories behind the pathophysiology, and explore treatment options.
A peri-urethral mass – what are the possible diagnoses?
Published in Journal of Obstetrics and Gynaecology, 2018
Case reports of peri-urethral leiomyoma are sparse (Blaivas et al. 2004), with fewer than 40 reported in the literature (Chong et al. 2003). When considering possible diagnoses, leiomyoma is rare; in a case series of peri-urethral masses from the USA only 5% of masses were found to be caused by leiomyoma, with the most common cause being urethral diverticula (Blaivas et al. 2004). Leiomyoma in this area is often mistaken for uterine prolapse, and its symptoms may include dysuria, urinary frequency, urinary retention and dyspareunia (Chong et al. 2003). Leiomyomas are benign, slow-growing tumours that arise from any smooth muscle layer in the body. In the female genital tract, the majority of leiomyomas are uterine in origin; however, the broad ligament, fallopian tubes, ovaries and vagina have been reported as extrauterine sites for leiomyoma growth (Chong et al. 2003). Rarely leiomyomas can be found in the bladder (Erdem et al. 2012). Possible sites of origin of the peri-urethral leiomyoma include the vaginal smooth muscle, local arterial musculature or smooth muscles of urethra (Gupta et al. 2015).
Weight change and risk of uterine leiomyomas: Korea Nurses’ Health Study
Published in Current Medical Research and Opinion, 2018
Ji-Eun Lee, Sihan Song, Eunyoung Cho, Hee Jung Jang, Heeja Jung, Hea-Young Lee, Sue Kim, Oksoo Kim, Jung Eun Lee
Uterine leiomyomas, benign tumors that originate from the smooth muscle of the uterus, are the most common tumors among women. Uterine leiomyomas are the leading cause of hysterectomies in the US1 and Korea2. According to the Health Insurance Review and Assessment Service of Korea, the number of women affected by uterine leiomyomas has increased annually, with 286,086 cases reported in 2012, rising to 340,191 cases reported in 20163. Because most leiomyomas are asymptomatic and remain undiagnosed, the incidence of these tumors is likely even higher than that reported. Leiomyoma-related symptoms include uterine bleeding, pelvic pain, and reproductive problems, such as infertility4. Uterine leiomyomas may worsen health-related quality-of-life5, and symptoms related to uterine leiomyomas may be associated with health-related quality-of-life among women with uterine leiomyomas6.
Related Knowledge Centers
- Paraneoplastic Syndrome
- Polycythemia
- Smooth Muscle
- Esophagus
- Small Intestine
- Neoplasm
- Cancer
- Uterus
- Malignancy
- Erythropoietin