Pathology and pathophysiology of uterine smooth-muscle tumors (original) (raw)
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The uterine leiomyosarcoma (LMS) is a rare sarcoma arising from the smooth muscle cells found within the myometrium, it is clinically aggressive smooth muscle malignancy, accounting for 2% to 6% of uterine malignancies and an annual incidence of 1.7 per 100,000 women. Although uterine malignancies such as endometrial cancer are common, uterine LMS accounts for only 1% of uterine cancers and is a part of uterine sarcomas' group, who comprises: carcinosarcoma (formerly known as MMMT, malignant mixed Mullerian tumor) (40% to 50%), leiomyosarcoma (30% to 40%) and endometrial stromal sarcoma (10% to 15%). Every group has its own risk factors, presenting symptoms, treatment response and prognosis. 1 Uterine smooth muscle tumors arise from the uterine myometrium and include leiomyomas (or fibroids) and uterine LMS, who exhibits histological features similar to that observed in soft tissue leiomyosarcomas. In fact, smooth muscle cell tumours may be divided into three groups: benign (leiomyoma), malignant (leiomyosarcoma), and tumors of unknown malignant potential. 2
Uterine Leiomyoma: Available Medical Treatments and New Possible Therapeutic Options
The Journal of Clinical Endocrinology & Metabolism, 2013
Context: Uterine leiomyomas (fibroids or myomas) are benign tumors of the uterus and are clinically apparent in up to 25% of reproductive-age women. Heavy or abnormal uterine bleeding, pelvic pain or pressure, infertility, and recurrent pregnancy loss are generally associated with leiomyoma. Although surgical and radiological therapies are frequently used for the management of this tumor, medical therapies are considered the first-line treatment of leiomyoma.
Etiology and Pathogenesis of Uterine Leiomyomas: A Review
Environmental Health Perspectives, 2002
Uterine leiomyomas, or fibroids, represent a major public health problem. It is believed that these tumors develop in the majority of American women and become symptomatic in one-third of these women. They are the most frequent indication for hysterectomy in the United States. Although the initiator or initiators of fibroids are unknown, several predisposing factors have been identified, including age (late reproductive years), African-American ethnicity, nulliparity, and obesity. Nonrandom cytogenetic abnormalities have been found in about 40% of tumors examined. Estrogen and progesterone are recognized as promoters of tumor growth, and the potential role of environmental estrogens has only recently been explored. Growth factors with mitogenic activity, such as transforming growth factor-β 3, basic fibroblast growth factor, epidermal growth factor, and insulin-like growth factor-I, are elevated in fibroids and may be the effectors of estrogen and progesterone promotion. These data offer clues to the etiology and pathogenesis of this common condition, which we have analyzed and summarized in this review.
Clinicopathological Study of Uterine Leiomyomas – A Retrospective Study
Journal of Pharmaceutical Research International
Leiomyomas are benign tumors of the uterus affecting women of the reproductive age group. They are the most common gynaecologic neoplasms in women. The aim of our study was to analyse and correlate the histopathological findings of leiomyomas in 203 hysterectomy specimens received in the department of Pathology at Saveetha Medical College and to further delineate the associated changes and variants that were observed in the leiomyoma specimens. In this study we found that the dominant age group was 31-50 years of age with multiple leiomyomas being more common than solitary ones. The most commonly observed location was intramural. Majority of the hysterectomy specimens showed a proliferative pattern of endometrium. Degenerative changes were observed in 26 cases with hyaline degeneration being the most common secondary change. There were multiple uterine pathologies associated with the uterine leiomyomas of which ovarian cortical cysts were the most frequently noted. The histopatholog...
Prominent Uterine Leiomyoma in a Post Menopause Women- A Case Report
Krishna Kumar Dhakchinamoorthi et al., Sch Acad J Pharm, Nov, 2020; 9(11): 315-317, 2020
Case Report Uterine fibroids are the type of benign tumors that occurs on the uterine smooth muscles also one of the most common causes and lead to hospitalization in women. Uterine fibroids developed among women during or over the age of 50 years. Many cases are asymptomatic. Pelvic examination and ultrasound can be used to diagnose the uterine fibroids. Medical therapy, surgical interventions such as hysterectomy are the treatment of choices involved in the uterine fibroids. In the present case report, a 50-year-old female patient was admitted with complaints of abdominal distension and swelling for the past two years. On physical examination, the uterus was enlarged to 36 weeks and firm inconsistency. To remove the fibroid tumor, she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. The uterus mass was removed totally. It was measured around 5.5kg in weight. She was further managed with post-operative care. Early diagnosis and providing alert and warning to the women who all are at risk can prevent the risk of developing uterine fibroid.
CLINICOPATHOLOGICAL STUDY OF UTERINE LEIOMYOMAS IN HYSTERECTOMY SPECIMENS; A RETROSEPTIVE STUDY.
Introduction: Leiomyomas are the commonly encountered benign uterine neoplasms in women of reproductive age group accounting for 5-20%. We reported 100 cases of women who underwent who hysterectomy for uterine leiyomayomas which was diagnosed by clinically and sonologically. Methods: This is a retrospective study of 100 cases who underwent hysterectomy for uterine leiyomayomas which was diagnosed by clinically and sonologically between March 2016 to March 2017.Women who underwent hysterectomy with an indication other than for uterine leiyomayomas were excluded in the study. Data including age, parity, symptoms and clinical indication for hysterectomy were collected. Hysterectomy specimens clinically diagnosed as uterine leiomyomas were subjected to histopathological examination. Results: Age range of the patients with leiomyoma was 24-50years. Majority of the patients were between 41-50 years (51% cases). Menorrhagia was the commonest symptom constituting 38% cases and fibroid uterus was the most common clinical diagnosis provided (54%). Most common location of leiomyoma?s was intramural (66.66%) followed by subserosal (20.37%) 59% leiomyoma?s were single and 41% were multiple. Degenerative changes were observed in 16.46% cases, amongst which hyaline change was the most common (6.33%). Histopathological patterns showed proliferative endometrium in 66% and cystic granular hyperplasia in least of 2% Cystic ovaries were seen in 11% of the patients, adenomyosis in 19 %. Conclusion: Fibromyoma is the most common benign tumor commonly affects the women of child-bearing age, mostly in the third decade. The most common presentation is menstrual disturbances. Intramural fibroid is the most common variety. The proliferative endometrium, followed by secretary endometrium was commonly reported.
Clinical Presentation & Operative Treatment of Leiomyoma of Uterus and its Outcome
Chattagram Maa-O-Shishu Hospital Medical College Journal, 2014
Introduction: Uterine leiomyoma is remarkably common, however only a subset of women have their fibroids clinically detected, symptomatic, or warrant surgical treatment. Mode of treatment depends on age of the patients, number, size and site of the myoma and also fertility status of the patients. Materials & methods: To evaluate the sociodemographic, clinical characteristics, management outcome and its determinants in BSMMU, Dhaka, Bangladesh, the study was carried out. 50 patients of diagnosed leiomyoma admitted in the BSMMU, Dhaka was selected for the study. Clinical profile, type of surgery and postoperative follow up findings were noted. Data was analyzed by computer based software SPSS -18. Results: The common complaints among the 50 patients were progressive menorrhagia (70%), abdominal swelling (50%), infertility (24%), weight in pelvis (38%), weakness/dizziness or syncopal attack after menstrual period (26%) and recurrent miscarriages (12%). The average uterine size at presentation was 15±9.7 weeks. The majority (70%) of the women presented with multiple leiomyomata. The commonest anatomical position of the myomas were multiple positions and intramural(80%). Total abdominal hysterectomy with or without bilateral sulphingo ophorectomy according to age was the commonest surgical procedure performed in thirty two (64%) cases. Myomectomy was done in 12(24%) cases and laparoscopic assisted vaginal hysterectomy was done in also 6(12%) of patients. Postoperative complications occurred in 24%(12) of the women. The most common complications were postoperative pyrexia 12%, blood loss warranting transfusion 8%, wound infection 10% and prolonged hospital stay 6%. Conclusion: Uterine fibroid is common in our environment and most of the patients had regular menstrual cycle with progressive menorragia. Its removal is commonly associated with post-operative pyrexia, blood loss, and anemia and wound infection. Preoperative correction of anemia appropriate use of antibiotics and strict hemostasis and asepsis can reduce these complications.
The management of uterine leiomyomas
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2015
The aim of this guideline is to provide clinicians with an understanding of the pathophysiology, prevalence, and clinical significance of myomata and the best evidence available on treatment modalities. The areas of clinical practice considered in formulating this guideline were assessment, medical treatments, conservative treatments of myolysis, selective uterine artery occlusion, and surgical alternatives including myomectomy and hysterectomy. The risk-to-benefit ratio must be examined individually by the woman and her health care provider. Implementation of this guideline should optimize the decision-making process of women and their health care providers in proceeding with further investigation or therapy for uterine leiomyomas, having considered the disease process and available treatment options, and reviewed the risks and anticipated benefits. Published literature was retrieved through searches of PubMed, CINAHL, and Cochrane Systematic Reviews in February 2013, using appropr...
Uterine leiomyoma in a 19-year-old girl: Case report and literature review Case presentation
A previously healthy 19-year old female presented to the gynaecological clinic with gradual abdominal distension for six months, associated with progressive abdominal discomfort. There was no history of nausea, vomiting, weight loss, or anorexia. She reported no changes in bowel habits and denied genitourinary symptomatology. Menarche occurred at 14 years of age, and her menstrual periods had always been regular. She denied recent sexual activity and was not currently taking oral contraceptives. The remainder of the patient's history, including a focused family history, was non-contributory. Physical examination revealed the presence of a somewhat firm, irregular, nontender, and mobile mass arising from the pelvis, corresponding in size to a pregnant uterus of 24 weeks' gestation. Laboratory analysis showed a blood haemoglobin concentration of 12.6 g/dL. The remainder of her laboratory results were within physiological parameters, and pregnancy was excluded. Transabdominal ultrasonography revealed globular uterine enlargement and a hypoechoic mass measuring 18 cm × 14 cm. The ovaries and adnexa were not visualized because they were obscured by the enlarged, bulky uterus. Neither ascites nor hydronephrosis was noted. The patient was counselled about the diagnosis of uterine fibroid and underwent exploratory laparotomy after proper counselling and written informed consent. Intraoperatively, the uterus was grossly enlarged by a large fibroid measuring 16 cm x 10 cm and ). Both ovaries and fallopian tubes were normal. Figure 1: Intraoperative image of the exteriorized uterus, showing the large fundal leiomyoma
Clinicopathological assessment of leiomyoma uterus
Background: Uterine Leiomyoma are benign neoplasm composed of smooth muscle with variable amount of connective tissue 1 , is the commonest visceral neoplasm affecting females in reproductive age group 2. They are noted clinically in 20-30% of women over 30 years of age. Aim: To analyze the clinicopathologic spectrum of uterine leiomyomas with regards to their clinical and histopathological presentation, associated changes and variants. Methods: All hysterectomy and myectomy specimen received at Nalanda Medical College, Patna over a period of one year from Dec. 2018 to Nov. 2019,provisionally diagnosed as leiyomyoma clinically or/and sonologically .Clinical data obtained on a proforma after informed consent to patients. Specimens were fixed in 10% formalin, processed and embedded in paraffin blocks. Sections of 4-6 micron thickness were taken and stained with routine H&E stain and studied. Results: A total of 108 case of leiyomyoma were studied. Majority of the patients were between 41-50 years (45.37% cases). Menorrhagia was the commonest symptom constituting 38.88%. majority of cases were multiparous (87.03). Most common location of leiomyoma was intramural (57.40%) followed by subserosal (16.66%). 62.96% leiomyomas were single and 38.04% were multiple. Degenerative changes were observed in 15.74% cases, amongst which hyaline change was the most common (5.55%). Proliferative endometrium was most common endometrial finding (47.22%). Adenomyosis was associated with leiomyoma in 20.37% cases. Conclusions: Uterine leiomyoma is associated with degenerative changes and coexistent patholologies. Histopathological examination of hysterectomy specimens should be done to confirm the diagnosis for its proper management and rule out other pathologies, especially malignant lesions.