Uterine Fibroids

Abstract

terine fibroids (leiomyomas) represent the most common tumor in women. These lesions disrupt the functions of the uterus and cause excessive uterine bleeding, anemia, defective implantation of an embryo, recurrent pregnancy loss, preterm labor, obstruction of labor, pelvic discomfort, and urinary incontinence and may mimic or mask malignant tumors. By the time they reach 50 years of age, nearly 70% of white women and more than 80% of black women will have had at least one fibroid; severe symptoms develop in 15 to 30% of these women. 1,2 Uterine fibroids in black women are significantly larger at diagnosis than those in white women, are diagnosed at an earlier age, and are characterized by more severe symptoms and a longer period of sustained growth. 3-5 Approximately 200,000 hysterectomies, 30,000 myomectomies, and thousands of selective uterineartery embolizations and high-intensity focused ultrasound procedures are performed annually in the United States to remove or destroy uterine fibroids. The annual economic burden of these tumors is estimated to be between $5.9 billion and $34.4 billion. 6 There may be one predominant uterine fibroid or a cluster of many fibroids (Fig. 1). Very large fibroids can cause the uterus to expand to the size reached at 6 or 7 months of pregnancy. The location and size of the fibroid in the uterus are critical determinants of its clinical manifestations. As compared with other fibroids, submucous fibroids that extend into the uterine cavity are the most disruptive to endometrial integrity, implantation, and the capacity of the myometrium to contract and stop menstrual bleeding from the endometrial blood vessels; thus, even small submucous fibroids are associated with excessive or irregular bleeding, infertility, and recurrent pregnancy loss. In contrast, subserous fibroids that grow out into the peritoneal cavity can exert pressure that is sensed by the patient as pelvic discomfort only if they reach a certain size. Intramural fibroids that reside in the myometrial wall represent an intermediary group. Regardless of their size or location, fibroids may have paracrine molecular effects on the adjacent endometrium that are extensive enough to cause excessive uterine bleeding or defective implantation. 7 Uterine fibroids are monoclonal tumors that arise from the uterine smoothmuscle tissue (i.e., the myometrium). 8 Histologically, fibroids are benign neoplasms composed of disordered smooth-muscle cells buried in abundant quantities of extracellular matrix (Fig. 1). The cells proliferate in vivo at a modest rate. Formation of the extracellular matrix also accounts for a substantial portion of tumor expansion. Uterine fibroids are almost always benign. 9 A striking feature of uterine fibroids is their dependency on the ovarian steroids estrogen and progesterone. 10 Ovarian activity is essential for fibroid growth, and most fibroids shrink after menopause. The sharp elevations and declines in the production of estrogen and progesterone that are associated with very early pregnancy and t...

Uterine Smooth Muscle Tumors of Uncertain Malignant Potential (STUMP): Review of Pathophysiology, Classification, Diagnosis, Treatment, and Surveillance

“…Mutations influencing regulated genetic processes then cause unregulated self-renewal and proliferation. Several observations support the notion that a single somatic mutation arises in a myometrial cell that then alters normal cellular mechanisms involving regulation, signaling, growth, and destruction [8,12,13]. There are a spectrum of outcomes to include benign leiomyoma vs leiomyosarcoma growth.…”

“…Normal myometrial tissue contains stem cells responsible for its own proliferation and self-renewal under regulated processes. Smooth muscle cells will undergo multiple cycles of growth and involution from physiologic ovarian hormone stimulation under estrogen and progesterone in the reproductive age female [8,10,11]. These cells also receive indirect paracrine signaling from stem cells to create a regulated physiologic process on the uterine myometrium.…”

“…These cells also receive indirect paracrine signaling from stem cells to create a regulated physiologic process on the uterine myometrium. Repeated physiologic stimulation of hormonal and paracrine signals have the potential to create genetic mutations and chromosomal rearrangements in myometrial stem cells [8]. Mutations influencing regulated genetic processes then cause unregulated self-renewal and proliferation.…”

“…Various manuscripts classify STUMP with leiomyoma variants as they share histologic criteria, however others strictly separate these groups due to the unknown malignant potential of STUMP tumors. STUMP tumors therefore create a dilemma from the standpoint of histologic diagnosis, classification, and appropriate treatment [5][6][7][8][9][10]. Research is ongoing with clinical management guidelines and post-operative surveillance remaining elusive.…”

Sėkmingas 4 400 Gramų Svėrusio Gimdos Kūno Pašalinimas Laparoskopiniu Būdu – Pasiekimas, Vertas Guinnesso Rekordų Knygos? Klinikinis Atvejis

“…Apie 20-50 proc. vaisingo amžiaus moterų diagnozuotos gimdos miomos, iš jų 1/3 pasireiškia klinikiniai simptomai, todėl reikia medikamentinio arba operacinio gydymo [1]. Tiksli lejomiomų etiologija nėra aiški, manoma, kad jų atsiradimą ir augimą lemia autokrininiai ir parakrininiai augimo hormonai, genetika, rasė, rūkymas, nutukimas ir estrogenų poveikis, susijęs su mėnesinių ciklu [2,3].…”