Pathobiology of myomatosis uteri: the underlying knowledge to support our clinical practice

Becker, Sven; Cezar, Cristina; Hermann, Anja; Larbig, Angelika; Leicher, Lasse; Sardo, Attilio Di Spiezio; Tanos, V.; Wallwiener, Markus; Verhoeven, Hugo C.; Wilde, Rudy Leon De

doi:10.1007/s00404-017-4494-6

Cited by 12 publications

(6 citation statements)

References 33 publications

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“…In gynecology, HIFU is proposed for treating symptomatic uterine myomata [2,7,8], a benign disease that affects 33-77% of women worldwide, threatening their fertility and quality of life [9]. Furthermore, HIFU is being increasingly used in Asiatic countries as a non-invasive intervention for adenomyosis, and different primary malignant and metastatic tumors, such as hepatocellular carcinoma, breast, prostate and pancreatic cancer, small size renal tumors, carcinoma of esophagus, glioblastoma and bone tumors [2].…”

Section: Introductionmentioning

confidence: 99%

Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper

Roche

Rafiq

Devassy

et al. 2022

JCM

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Minimally invasive interventions for myomata treatment have gained acceptance due to the possibility of preserving fertility with reduced trauma induced by laparotomy as way of entrance. There are insufficient data regarding outcomes of high intensity focused ultrasound (HIFU) in non-Asiatic women. Therefore, we revised the available evidence to present an expert opinion that could support physicians, patients and policy-makers for considering this approach in other populations. We revisited systematic reviews, randomized controlled trials and cohort studies from January 2018 to August 2021 using PubMed and Google scholar, regarding short and long term outcomes after ablation with focused ultrasound waves. In total, 33 studies, including 114,810 adult patients showed that outcomes of this approach depend on several parameters directly related with resistance to thermal ablation, especially fibroid size and vascularization. Two studies report satisfactory outcomes in Afro-American women. In accordance to the technique used, fibroid volume reduction showed to be higher in fibroids <300 cm3 after ultrasound guided HIFU than after MRI guided. Compared to myomectomy and uterine artery embolization, HIFU seems to have shorter hospital stay, higher pregnancy rates and similar adverse events rates, with skin burn being the most reported. Symptoms and quality of life improvement is similar to myomectomy but lower than embolization, however reintervention rate is higher after HIFU. Lacks evidence about long-term sarcoma risk after ablation. Available evidence shows that HIFU can be considered as a uterine sparing treatment for women of different ethnicities suffering of uterine myomatosis, especially for those wishing to preserve their fertility.

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Section: Introductionmentioning

confidence: 99%

Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper

Roche

Rafiq

Devassy

et al. 2022

JCM

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“…Leiomyomata are monoclonal benign tumors that arise from myometrial cells with complex pathobiological origins involving genetic, epigenetic, hormonal, environmental, proinflammatory, angiogenetic, and growth factors [22]. Uterine myomata may present as single or multiple tumors easily recognized through ultrasound examination, although MRI or CT are sometimes required for further therapeutic decision-making.…”

Section: Discussionmentioning

confidence: 99%

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

Devassy

Wilde

et al. 2023

JCM

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Contained electromechanical morcellation has emerged as a safety approach for laparoscopic myomatous tissue retrieval. This retrospective single-center analysis evaluated the bag deployment practicability and safety of electromechanical in-bag morcellation when used for big surgical benign specimens. The main age of patients was 39.3 years (range 21 to 71); 804 myomectomies, 242 supracervical hysterectomies, 73 total hysterectomies, and 1 retroperitoneal tumor extirpation were performed. A total of 78.7% of specimens weighed more than 250 g (n = 881) and 9% more than 1000 g. The largest specimens, weighing 2933 g, 3183 g, and 4780 g, required two bags for complete morcellation. Neither difficulties nor complications related to bag manipulation were recorded. Small bag puncture was detected in two cases, but peritoneal washing cytology was free of debris. One retroperitoneal angioleiomyomatosis and three malignancies were detected in histology (leiomyosarcoma = 2; sarcoma = 1); therefore, patients underwent radical surgery. All patients were disease-free at 3 years follow-up, but one patient presented multiple abdominal metastases of the leiomyosarcoma in the third year; she refused subsequent surgery and was lost from follow-up. This large series demonstrates that laparoscopic bag morcellation is a safe and comfortable method to remove large and giant uterine tumors. Bag manipulation takes only a few minutes, and perforations rarely occur and are easy to detect intraoperatively. This technique did not result in the spread of debris during myoma surgery, potentially avoiding the additional risk of parasitic fibroma or peritoneal sarcoma.

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“…4,8 Likewise, insulin-like growth factors, epidermal growth factor and transforming growth factor have also been described. 9,10 Other risk factors that have been implicated have been delayed onset of menstruation, menopause, obesity, late onset of reproductive life, and nulliparity. 11…”

Section: Introductionmentioning

confidence: 99%

Uterine fibroids: a review

Arguelles-Castillo,

Pérez,

Rojas

et al. 2024

Int Surg J

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Myomatosis of large elements are benign tumors resulting from the growth of muscular and fibrous tissue, which can be embedded or adhered to the uterine wall and their classification varies between submucosal, intramural or subserous depending on the depth they reach. More frequently, symptomatic patients report the presence of abundant abnormal uterine bleeding, dysmenorrhea, dyspareunia and infertility. This pathology represents 40-60% of all hysterectomies, of the total, 30% in women of childbearing age. Different possible triggers of uterine fibroids have been described, which is why it is considered to be of multifactorial origin. Ultrasound is usually used frequently due to its high availability and low cost, this being the first diagnostic image of choice and the gold standard, through transvaginal ultrasound. The management of myomastomas entails a great social problem, since therapy seeks treatment methods that prevent the recurrence of the disease, and in case of satisfied parity, hysterectomy is the ideal option, but in those patients still of fertile age and with desire of pregnancy, less drastic procedures such as myomectomy will be carried out. Finally, some post-surgical complications have been discussed, among which the generation of adhesions due to the scarring resulting from the surgical intervention was described, which could generate infertility or greater difficulty in conceiving.

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Pathobiology of myomatosis uteri: the underlying knowledge to support our clinical practice

Abstract: A good understanding of the pathobiologic mechanisms of myomatosis gives reasons to physicians to elect conservative or combined therapies, and allow affected women to receive an individualized management, according to age, reproduction desire, and clinical condition.

Cited by 12 publications

References 33 publications

Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper

Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

Uterine fibroids: a review

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