Arterial embolization of myomas (AEM) is an established option for the conservative treatment of uterine leio-myomas; it treats all present uterine nodules at once, is less invasive than other procedures and effective in controlling symptoms, and does not require long term hospitalizations. Nevertheless, the potential impact on endometrial morphological and functional outcomes after the procedure is still controversial based on reports of endometritis or eventual transient ischemia. This study evaluated endometrial reorganization in uterine leiomyoma patients, before and after AEM, through gene expression analyses of extracellular matrix and cytokines genes in the endometrial tissue. Eight patients with leiomyomas were evaluated before AEM and 6 months after. The examinations included transvaginal pelvic ultrasonography, dosing of the follicle-stimulating hormone, and endometrial biopsy during the second phase of the menstrual cycle. RNA was extracted from endometrial samples, cDNA was synthesized, and applied on PCR array™ plates to evaluate the expression of extracellular matrix (ECM) genes and cytokines and their receptors' genes (CYT). The ECM overexpressed genes were MMP (1, 3, 10, 11, and 14), CTGF1, ICAM1, TBHS1, ITGA2, ITGA3, ITGB3, COL7A1, COL12A, SPP1, and TNC; ADAMTS8 was underexpressed. The CYT overexpressed genes were SPP1, BCL6, CXCL12, IL-8, and CEBPB; CXCL13 and CCL21 were underexpressed. The ECM results showed overexpression of proteases that are responsible for dysfunctions in the ECM, and of genes responsible for adhesion and membrane components. The CYT results showed overexpression of chemokines responsible for endometrial repair, and underex-* Corresponding author. A. Bernardo et al. 936pression of cytokines involved in inflammatory processes in the endometrial tissue. AEM treatment did not negatively affect the endometrial function at 6 months after embolization. This study broadens the knowledge about using a procedure that is relevant to the treatment of leiomyomas and contributes to the establishment of future guidelines for the decision making process for physicians and patients.

ObjetivO: Avaliar o impacto da embolização arterial de miomas (EAM) sobre o volume uterino (VU), na função ovariana. MétOdOs: Trinta pacientes com leiomioma se submeteram à EAM. Foram realizados exames de USPTV e FSH antes e três meses após a EAM. Foram analisados o VU em cm³, o diâmetro do mioma dominante (DMD) em cm e o FSH em UI/mL, expressos por média±desvio padrão (DP) e submetidos a análise estatística pelo teste não paramétrico de Mann-Whitney. ResultadOs: Foram incluidos na análise 29 casos. A média do VU pré-EAM foi 402,4±165,9 cm³, DMD pré-EAM 5,9±2,1 cm. O VU pós-EAM foi 258,9±118,6 cm³, DMD pós-EAM foi 4,6±1,8 cm. A média da dosagem de FSH pré-EAM foi 4,9±3,5 UI/mL e pós-EAM foi 5,5±4,7 UI/mL com p=0,5. Houve redução de 35% do VU, de 22% no DMD e a EAM não alterou significativamente os valores de FSH após três meses. COnClusãO: O procedimento diminui significativamente o VU e DMD e, não há aumento significativo dos níveis séricos de FSH, não havendo, portanto, alterações na função ovariana. AbstractPuRPOse: To evaluate the impact of uterine artery embolization (UAE) on uterine volume (UV), greater myoma diameter (GMD) and ovarian function three months after the procedure, by transvaginal pelvic ultrasonography (TVPUS) and by the determination of follicle-stimulating hormone (FSH). MethOds: Thirty patients with leiomyomas were submitted to UAE. TVPUS and FSH determination were performed before and three months after UAE. UV was determined in cm³, GMD in cm and FSH in IU/mL. Data are reported as as mean±standard deviation (SD) and were analyzed statistically by the nonparametric Mann-Whitney test. Results: Twenty-nine patients were analyzed. Before UAE, mean UV was 402.4±165.9 cm³ and GMD was 5.9±2.1 cm. After UAE, mean UV was 258.9±118.6 cm³ and GMD was 4.6±1.8 cm. Mean FSH concentration was 4.9±3.5 IU/mL before UAE and 5.5±4.7 IU/mL after UAE, with p=0.5. There was a 35% reduction of UV and a 22% reduction of GMD, with no changes in FSH values after three months. COnClusiOn: The procedure significantly reduced UV and GMD but did not cause a significant increase in FSH levels, thus causing no changes in ovarian function.departamento de Ginecologia da universidade Federal de são Paulo -uniFesP -são Paulo (sP), brasil.

O condiloma acuminado gigante (tumor de Buschke-Loewenstein) apresenta comportamento clínico destrutivo, embora histologicamente benigno, de início. Descreve-se caso de localização vulvar e ano-retal com transformação maligna para carcinoma espinocelular invasivo. A paciente foi tratada com radioterapia pré-operatória seguida de excisão local ampla, com evolução favorável. Os autores fazem revisão pormenorizada desta rara entidade e comentam sobre as possibilidades terapêuticas.

The objective of this study was to evaluate collagen of endometrial/uterine tissue before and after uterine arterial embolization (UAE). Fifteen consecutive patients with a diagnosis of uterine fibroids were included. Clinical diagnosis of uterine fibroids had been confirmed by ultrasonography. Uterine arterial embolization procedure was performed with microsphere with 300-700-my diameter. Selective catheterization of uterine arteries was carried through bilaterally and was guided by angiography. For collagen evaluation, endometrial biopsy was taken in secretory phase with Novak curette before UAE and 3 months after the procedure. Groups were assessed for analysis using Student's t test. Collagen fibers percentage was reduced (p<0.0001) in the group after UAE (81.05± 1.50) comparing the group before UAE (84.08±1.46). In conclusion, there is a significant reduction in collagen of endometrial/uterine tissue in patients submitted to UAE.