Expulsion of Fibroids to the Endometrial Cavity after Magnetic Resonance Imaging-guided High Intensity Focused Ultrasound Surgery (MRgFUS) Treatment of Intramural Uterine Fibroids

Abstract

ObjectivesThis report seeks to introduce some cases of the patients who received magnetic resonance imaging (MRI)-guided high intensity focused ultrasound (HIFU) surgery (MRgFUS)-based intramural uterine fibroids treatment where the post-MRgFUS intramural uterine fibroids decreased in its volume and protruded towards the endometrial cavity to be expelled by hysteroscopy.MethodsOf the 157 patients who had received MRgFUS treatment in the Obstetrics and Gynecology of the Hospital from March, 2015 to February, 2016; this study examined 6 of the cases where, after high intensity focused ultrasound treatment, intramural uterine fibroids protruded towards the endometrial cavity to be removed by hysteroscopic myomectomy. The high intensity focused ultrasound utilized in the cases were Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, The Netherlands) and Sonalleve HIFU system.ResultsThe volume of fibroids ranged from 26.0 cm3 to 199.5 cm3, averaging 95.6 cm3. The major axis length ranged from 4.0 cm to 8.2 cm, averaging 6.3 cm. Fibroid location in all of the patients was in intramural uterine before treatment but after the high intensity focused ultrasound treatment, the fibroids were observed to protrude towards the endometrial cavity in at least Day 5 or up to Day 73 to allow hysteroscopic myomectomy.ConclusionsIn some cases, after an intramural uterine fibroid is treated with MRgFUS, fibroid volume is decreased and the fibroid protrudes towards the endometrial cavity. In this case, hysteroscopic myomectomy can be a useful solution.

A Retrospective Analysis of the Treatment of Cesarean Scar Pregnancy by High-Intensity Focused Ultrasound, Uterine Artery Embolization and Surgery

“…Recently, HIFU has gained much attention, and several clinical applications have been reported over the course of the previous years, even in the field of gynecology, and for the treatment of uterine fibroids and adenomyosis (21)(22)(23)(24)(25). By focusing beams of ultrasound energy to CSP lesions, HIFU can accumulate high intensities in targeted tissues, which eventually result in complete coagulation necrosis, and the surrounding normal tissues that almost do not receive any damage (8).…”

Adverse events of focused ultrasound surgery for uterine fibroids and adenomyosis

“…Hysteroscopic myomectomy represents a useful alternative treatment to resolve this adverse event. 21 Uterine fibroid shrinkage can transform a transmural uterine fibroid into a submucosal uterine fibroid and finally a pedunculated The coronal temperature map displays that the sonication is reflected completely (white arrow) by utilizing scar patch (black arrow).…”

“…Furthermore, when the endometrial layer encircling the uterine fibroid becomes thin or turns necrotic owing to ischemic effect or hormonal changes, submucosal uterine fibroids or intramural uterine fibroids shallow to endometrium might be expelled into the uterine cavity. 21…”

“…23 A risk of infection of the necrotic tumor was reported; moreover, the cervix obstruction required a hysteroscopic surgery to clear up. [21][22][23] In a case reported by Kim et al, a 38-year-old patient with uterine fibroid was admitted to the hospital due to heavy menstrual bleeding and consequent anemia and was provided MRI-guided FUS therapy. At 2-week post-therapy, the patient was readmitted with a palpable vaginal mass.…”

Gonadotropin-releasing Hormone Agonist Plus Aromatase Inhibitor in the Treatment of Uterine Leiomyoma in Near Menopause Patient: A Case Series Study

“…In this procedure fibroid volume is decreased & the fibroid protrude toward the endometrial cavity, then hystroscopic myomectomy could be a good choice. 4 …”