- Perplexing Presentation of Uterine Prolapse and a Prolapsed Pedunculated Leiomyoma. [JOURNAL ARTICLE]
- Am J Obstet Gynecol 2016 Aug 24.
- Locostatin, a disrupter of Raf kinase inhibitor protein, inhibits extracellular matrix production, proliferation, and migration in human uterine leiomyoma and myometrial cells. [JOURNAL ARTICLE]
- Fertil Steril 2016 Aug 23.
To investigate the presence of Raf kinase inhibitor protein (RKIP) in human myometrium and leiomyoma as well as to determine the effect of locostatin (RKIP inhibitor) on extracellular matrix (ECM) production, proliferation, and migration in human myometrial and leiomyoma cells.Laboratory study.Human myometrium and leiomyoma.Thirty premenopausal women who were admitted to the hospital for myomectomy or hysterectomy.Myometrial and leiomyoma tissues were used to investigate the localization and the expression level of RKIP through immunohistochemistry and Western blotting. Myometrial and leiomyoma cells were treated with locostatin (10 μM) to measure ECM expression by real-time polymerase chain reaction, GSK3β expression by Western blotting, cell migration by wound-healing assay, and cell proliferation by MTT assay and immunocytochemistry.The expression of RKIP in human myometrial and leiomyoma tissue; ECM components and GSK3β expression, migration, and proliferation in myometrial and leiomyoma cells.RKIP is expressed in human myometrial and leiomyoma tissue. Locostatin treatment resulted in the activation of the MAPK signal pathway (ERK phosphorylation), providing a powerful validation of our targeting protocol. Further, RKIP inhibition by locostatin reduces ECM components. Moreover, the inhibition of RKIP by locostatin impaired cell proliferation and migration in both leiomyoma and myometrial cells. Finally, locostatin treatment reduced GSK3β expression. Therefore, even if the activation of MAPK pathway should increase proliferation and migration, the destabilization of GSK3β leads to the reduction of proliferation and migration of myometrial and leiomyoma cells.Our results indicate that RKIP may be involved in leiomyoma pathophysiology.
- Increased Speed and Image Quality for Pelvic Single-Shot Fast Spin-Echo Imaging with Variable Refocusing Flip Angles and Full-Fourier Acquisition. [JOURNAL ARTICLE]
- Radiology 2016 Aug 26.:151574.
Purpose To assess image quality and speed improvements for single-shot fast spin-echo (SSFSE) with variable refocusing flip angles and full-Fourier acquisition (vrfSSFSE) pelvic imaging via a prospective trial performed in the context of uterine leiomyoma evaluation. Materials and Methods Institutional review board approval and informed consent were obtained. vrfSSFSE and conventional SSFSE sagittal and coronal oblique acquisitions were performed in 54 consecutive female patients referred for 3-T magnetic resonance (MR) evaluation of known or suspected uterine leiomyomas. Two radiologists who were blinded to the image acquisition technique semiquantitatively scored images on a scale from -2 to 2 for noise, image contrast, sharpness, artifacts, and perceived ability to evaluate uterine, ovarian, and musculoskeletal structures. The null hypothesis of no significant difference between pulse sequences was assessed with a Wilcoxon signed rank test by using a Holm-Bonferroni correction for multiple comparisons. Results Because of reductions in specific absorption rate, vrfSSFSE imaging demonstrated significantly increased speed (more than twofold, P < .0001), with mean repetition times compared with conventional SSFSE imaging decreasing from 1358 to 613 msec for sagittal acquisitions and from 1494 to 621 msec for coronal oblique acquisitions. Almost all assessed image quality and perceived diagnostic capability parameters were significantly improved with vrfSSFSE imaging. These improvements included noise, sharpness, and ability to evaluate the junctional zone, myometrium, and musculoskeletal structures for both sagittal acquisitions (mean values of 0.56, 0.63, 0.42, 0.56, and 0.80, respectively; all P values < .0001) and coronal oblique acquisitions (mean values of 0.81, 1.09, 0.65, 0.93, and 1.12, respectively; all P values < .0001). For evaluation of artifacts, there was an insufficient number of cases with differences to allow statistical testing. Conclusion Compared with conventional SSFSE acquisition, vrfSSFSE acquisition increases 3-T imaging speed via reduced specific absorption rate and leads to significant improvements in perceived image quality and perceived diagnostic capability when evaluating pelvic structures. (©) RSNA, 2016 Online supplemental material is available for this article.
- Outcome and risk factors of cesarean delivery with and without cesarean myomectomy in women with uterine myomatas. [JOURNAL ARTICLE]
- Arch Gynecol Obstet 2016 Aug 24.
To evaluate the outcome of a cesarean myomectomy (CM) versus a cesarean delivery (CD) alone in women with uterine myomas and the risk factors for adverse outcomes.A retrospective cohort study of all women undergoing CDs with uterine leiomyomatas and singleton pregnancies was performed. Patients with known risk factors for hemorrhage were excluded. Measured adverse outcome parameters included estimated blood loss, drop in hemoglobin levels (pre/postoperatively), operation time, and the use of additional uterotonics. Outcome parameters of women with CM were compared to women with CD alone. Possible risk factors for adverse outcomes were analyzed in a multivariate regression analysis. Evaluated risk factors for CM were according to localization and type of myomatas, the myoma size, BMI ≥30 kg/m(2), age ≥40 years, fetal weight ≥4 kg, repeat CD, and unplanned CD in the first stage of labor. The influence of localization and myoma type were further analyzed in a subgroup analysis.Of the 162 women with uterine myomatas during CD, 48 underwent CM and were analyzed. Overall, CM was not associated with adverse outcomes. Independent of a concomitant myomectomy, a large myoma size of ≥5 cm was associated with an increased blood loss of ≥500 ml (adj. OR 2.7 CI 95 % 1.2-6.2, p = 0.02), and women ≥40 years of age had a significant postoperative drop in hemoglobin (adj. OR 2.4 CI 95 % 1.0-5.4, p = 0.04). In the univariate subgroup analysis, CM of multiple myomatas was associated with an increased blood loss and an increased operation time compared to women with multiple myomatas and CD alone. Prolonged operation times were also observed in women with pedunculated and subserosal myomatas with concomitant myomectomy. There were no cases of hysterectomy or blood transfusions.CM performed by an experienced obstetrician can be safe in selected patients who are without additional preexisting risk factors. Risk factors that are associated with increased blood loss in women with uterine leiomyomatas include a larger size of the leiomyoma (≥5 cm) and a maternal age of ≥40 years.
- 18F-FDG PET/CT Demonstrating Malignant Degeneration of a Uterine Fibroid. [JOURNAL ARTICLE]
- Clin Nucl Med 2016 Aug 24.
Whereas benign leiomyoma of the uterus (fibroid) is very common, malignant degeneration of such fibroids to leiomyosarcoma is rare. Anatomical imaging with CT or MRI cannot differentiate between larger leiomyoma and leiomyosarcoma. Imaging with F-FDG PET/CT can be helpful in differentiating the two. High-grade F-FDG uptake in uterine fibroids is suspected and warrants surgical excision for further evaluation. We present such as case of a 42-year-old premenopausal woman where F-FDG PET/CT helped in making the diagnosis of malignant degeneration of uterine fibroid.
- Gastric inflammatory fibroid polyp mimicking a gastrointestinal stromal tumour. [Journal Article]
- Rev Esp Enferm Dig 2016 Aug; 108(8):497-8.
Inflammatory fibroid polyp of the gastrointestinal tract is a rare, benign neoplasm, most frequently located in the gastric antrum. Symptoms depend on the location and the size of the lesion. Biopsies are limited for the diagnosis of inflammatory fibroid polyps and diagnosis may not be possible until resection. The authors present a case of a 55-year-old woman, presenting with an upper gastrointestinal bleeding due to a large gastric inflammatory fibroid polyp imitating a gastrointestinal stromal tumor.
- Outcomes of uterine sarcoma found incidentally after uterus-preserving surgery for presumed benign disease. [Journal Article]
- BMC Cancer 2016; 16(1):675.
The aims of this study were to evaluate the impact of initial uterus-preserving surgery, such as myomectomy or subtotal hysterectomy, on the recurrence rates of patients with uterine sarcoma found incidentally and to investigate the role of surgical re-exploration in this disease subset.We performed a retrospective chart review for patients who had previously undergone either total hysterectomy or subtotal hysterectomy or myomectomy at the time of initial surgery for presumed benign uterine leiomyoma and were found to have uterine sarcoma on final pathology. Survival analysis was performed comparing patients according to the type of initial surgery.Between 2006 and 2014, 45 patients with uterine sarcoma were identified. Myomectomy or subtotal hysterectomy was performed in 15 patients, and 30 patients underwent total hysterectomy as the initial surgery. Of the patients who underwent myomectomy or subtotal hysterectomy as the initial surgery (n = 15), 14 were re-explored to complete staging. Of the patients who underwent re-exploration (n = 14), five (35.8 %) had remnant sarcoma on the remaining uterus and no patients had disseminated disease. A Kaplan-Meier curve and log-rank test showed no difference in progression-free survival (P = 0.941) between the two groups.Initial uterus-preserving surgery does not appear to be associated with an adverse impact on survival outcomes for unexpected uterine sarcoma when surgical re-exploration was performed immediately. As such, surgical re-exploration may be useful for removing any remnant sarcoma.
- Endocrine-disrupting chemicals and uterine fibroids. [REVIEW, JOURNAL ARTICLE]
- Fertil Steril 2016 Aug 20.
Uterine fibroids are the most frequent gynecologic tumor, affecting 70% to 80% of women over their lifetime. Although these tumors are benign, they can cause significant morbidity and may require invasive treatments such as myomectomy and hysterectomy. Many risk factors for these tumors have been identified, including environmental exposures to endocrine-disrupting chemicals (EDCs) such as genistein and diethylstilbestrol. Uterine development may be a particularly sensitive window to environmental exposures, as some perinatal EDC exposures have been shown to increase tumorigenesis in both rodent models and human epidemiologic studies. The mechanisms by which EDC exposures may increase tumorigenesis are still being elucidated, but epigenetic reprogramming of the developing uterus is an emerging hypothesis. Given the remarkably high incidence of uterine fibroids and their significant impact on women's health, understanding more about how prenatal exposures to EDCs (and other environmental agents) may increase fibroid risk could be key to developing prevention and treatment strategies in the future.
- Pathological Features and Clinical Associations of 58 Small Incidental Angiomyolipomas of the Kidney. [JOURNAL ARTICLE]
- Hum Pathol 2016 Aug 17.
Although angiomyolipoma of the kidney is a well-described and broadly studied neoplasm, little is known about clinical and morphological features of small incidental tumors occurring sporadically. Sections from 58 small angiomyolipomas found in 37 patients from 402 consecutive unselected autopsies were studied. A female predominance and a bimodal age distribution (30-50 and >70 years) were observed. No angiomyolipoma was found in a prepubertal patient. Six patients had multiple and bilateral angiomyolipomas (2-8 tumors per patient). Overall, the tumors ranged in size from 0.1 mm to 10 mm (mean 1.5 mm) and were variably composed of smooth muscle and fat. Abnormal blood vessels were seen in only 4 tumors (7%). Most angiomyolipomas were located just beneath the renal capsule or at the corticomedullary junction. Pure leiomyoma-like (25 tumors) and lipoma-like (1 tumor) angiomyolipomas were found in patients younger than those with angiomyolipomas consisting of a mixture of components (P=.03). Angiomyolipomas located in the subcapsular and cortical parenchyma were mainly composed of smooth muscle (P=.004) while fat predominated in angiomyolipomas in the medulla and corticomedullary junction (P=.004). No correlation between morphology and size was found. In summary, this study demonstrates that 9% of an unselected population had angiomyolipomas. Their frequent location just beneath the capsule and in the corticomedullary junction suggests that these areas might promote their development. Finally, the proportions of smooth muscle and fat appear to be associated with their location in the renal parenchyma and with the patients' ages.
- Disseminated leiomyoma cells can be identified following conventional myomectomy. [JOURNAL ARTICLE]
- BJOG 2016 Aug 17.
Uncontained morcellation of leiomyomas during laparoscopic surgery has recently been discouraged, as undetected malignant tumours, namely leiomyosarcomas, could be fragmented which may result in upstaged disease. However, enucleating leiomyomas per se may be inappropriate from an oncological perspective because complete, radical resection of malignant tumours to prevent further tumour growth or recurrence is not achieved. Thus, the aim of this study was to determine whether spillage of leiomyoma cells occurs during laparotomic myomectomy.Observational study.Tertiary academic centre in the Netherlands.Women undergoing laparotomic myomectomy were included in the study.Peritoneal abdominal washings were obtained on two occasions during the myomectomy procedure; the first one immediately after opening the abdomen and the second one after resection of the leiomyoma(s). Cytological evaluation of the fluids was performed.The presence of leiomyoma cells in any of the washings.Five patients were included in this pilot study. All first washings were negative for leiomyoma cells. However, cytology positive for the presence of leiomyoma cells was found in three of the five second, post-myomectomy washings.Tissue spillage from leiomyoma(s) occurs during conventional open myomectomy. The clinical relevance of tissue dissemination after myomectomy is unclear but it cannot be excluded that this may negatively affect the patient's outcome if there is malignant change within the enucleated leiomyoma(s). Therefore, it is questionable whether morcellation in specially designed containment bags after laparoscopic myomectomy, guarantees any additional oncological safety.Even during conventional myomectomy, tissue spillage occurs during resection of leiomyoma(s).