High levels of ca125 in a patient with large uterine fibroid.

Uterine leiomyomas, also known as uterine fibroids, are the most common benign tumors of the female genital tract and affect 60 to 80% of women at their reproductive age. Although elevated tumor markers may be measured in benign gynaecological diseases, the association of uterine fibroids with increased levels of serum cancer antigen 125 (CA125) has not been proven to date. In the present case report we present a rare case of a 21-year-old Caucasian woman attended to our outpatient department with hypermenorrhea and pelvic discomfort that was treated for an enlarged intra-abdominal mass with an abnormally high CA-12 (777.3 U/mL).

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High CA-125 in Endometrioma: An Unusual Presentation

KYAMC Journal ◽

10.3329/kyamcj.v9i3.38788 ◽

2018 ◽

Vol 9 (3) ◽

pp. 139-140

Author(s):

Raihana Musawwir ◽

Sheuly Akhter ◽

Fatema Begum

Keyword(s):

Abdominal Mass ◽

Female Genital Tract ◽

High Plasma ◽

Carbohydrate Antigen ◽

Ca 125 ◽

Ovarian Malignancy ◽

Cancer Antigen 125 ◽

Carbohydrate Antigen 125 ◽

Ovarian Endometrioma ◽

Female Genital

CA-125 (cancer antigen 125, carcinoma antigen 125, or carbohydrate antigen 125) also known as mucin 16 or MUC16 is a protein of mucin family glycoprotein that is encoded by the MUC16 gene. It is the most frequently used biomarker for ovarian cancer. It may also be elevated in other cancers, including endometrium, fallopian tube, lung, breast and gastrointestinal cancer and in a number of relatively benign conditions, such as endometriosis, menstruation and pregnancy. High plasma levels of more than 200 U/mL are usually suggestive of malignancy but rarely found in benign conditions of female genital tract, like endometriosis. Very high CA- 125 level is suggestive of ovarian malignancy, was noted in case of ovarian endometrioma. This paper describes a case of a 36 years old lady, mother of 2 children, was admitted with large abdominal mass and abdominal pain. CA-125 was found 3500 U/ML. Ovarian malignancy was suspected. During laparotomy, ruptured endometrioma was noted and it was supported by histopathological report which mentioned," No malignancy seen". Endometrioma can't be excluded in high CA-125 level even without features of endometriosis.KYAMC Journal Vol. 9, No.-3, October 2018, Page 139-140

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Vaginal, Cervical and Uterine pH in Women with Normal and Abnormal Vaginal Microbiota

Pathogens ◽

10.3390/pathogens10020090 ◽

2021 ◽

Vol 10 (2) ◽

pp. 90

Author(s):

Malene Risager Lykke ◽

Naja Becher ◽

Thor Haahr ◽

Ebbe Boedtkjer ◽

Jørgen Skov Jensen ◽

...

Keyword(s):

Pregnant Women ◽

Genital Tract ◽

Quantitative Polymerase Chain Reaction ◽

Female Genital Tract ◽

Uterine Cavity ◽

Vaginal Microbiota ◽

Reproductive Age ◽

Ph Gradient ◽

Increased Risk ◽

Female Genital

Introduction: Healthy women of reproductive age have a vaginal pH around 4.5, whereas little is known about pH in the upper genital tract. A shift in the vaginal microbiota may result in an elevated pH in the upper genital tract. This might contribute to decreased fertility and increased risk of preterm birth. Therefore, we aimed to measure pH in different compartments of the female genital tract in both nonpregnant and pregnant women, stratifying into a normal and abnormal vaginal microbiota. Material and methods: In this descriptive study, we included 6 nonpregnant, 12 early-pregnant, and 8 term-pregnant women. A pH gradient was recorded with a flexible pH probe. An abnormal vaginal microbiota was diagnosed by a quantitative polymerase chain reaction technique for Atopobium vaginae; Sneathia sanguinegens; Leptotrichia amnionii; bacterial vaginosis-associated bacterium 1, 2, 3, and TM7; and Prevotella spp. among others. Results: In all participants we found the pH gradient in the lower reproductive canal to be most acidic in the lower vagina and most alkaline in the upper uterine cavity. Women with an abnormal vaginal microbiota had an increased pH in the lower vagina compared to the other groups. Conclusions: There is a pronounced pH gradient within the female genital tract. This gradient is not disrupted in women with an abnormal vaginal microbiota.

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Painless spontaneous haemoperitoneum secondary to a uterine leiomyoma/fibroid: unusual presentation of a life-threatening differential

BMJ Case Reports ◽

10.1136/bcr-2021-243465 ◽

2021 ◽

Vol 14 (10) ◽

pp. e243465

Author(s):

Chiamaka Maduanusi ◽

Sathiyaa Balachandran ◽

Sahathevan Sathiyathasan ◽

Kazal Omar

Keyword(s):

Uterine Leiomyoma ◽

Rare Complication ◽

Abdominal Mass ◽

Uterine Fibroids ◽

Reproductive Age ◽

Haemodynamic Instability ◽

Hypovolaemic Shock ◽

Important Differential Diagnosis ◽

Life Threatening ◽

Definitive Management

This is a case of a 47-year-old woman with a spontaneous haemoperitoneum secondary to uterine leiomyomas (fibroids), an important differential diagnosis in patients with uterine fibroids and hypovolaemic shock. Uterine fibroids are very common in women of reproductive age, yet little is taught about their potential to cause hypovolaemic shock. Although it is a rare complication, given the prevalence of fibroids, it is important to bear this life-threatening differential in mind to optimise the care for these women. Presentation typically involves abdominal pain, syncope, haemodynamic instability and an intra-abdominal mass. CT of the abdomen and pelvis can be helpful in identifying the source of the haemoperitoneum, but should not delay surgery, which is the definitive management.

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Fibroids and infertility

International Journal of Infertility & Fetal Medicine ◽

10.5005/jp-journals-10016-1071 ◽

2014 ◽

Vol 5 (1) ◽

pp. 1-7

Author(s):

Harpreet Kaur

Keyword(s):

Female Genital Tract ◽

Uterine Cavity ◽

Reproductive Function ◽

Benign Tumors ◽

Hysteroscopic Myomectomy ◽

Final Treatment ◽

Unpublished Studies ◽

Cochrane Database ◽

Intramural Fibroids ◽

Female Genital

ABSTRACT Fibroids are the commonest benign tumors of female genital tract. Though fibroids may not be a sole cause for infertility in majority of cases, but it has been seen that there is an improvement in pregnancy rates after myomectomy. Fibroids that distort the uterine cavity and large intramural fibroids are shown to be associated with adverse effects on reproductive function. Available evidence suggests that submucosal, intramural, and subserosal .broids interfere with fertility in decreasing order of importance. In infertile women and those with recurrent pregnancy loss, myomectomy should be considered only after a thorough evaluation has been completed. Medical management of fibroids has no role in treatment of fertility rather it might lead to delay in the final treatment for infertility. Preoperative medical treatment with a GnRH agonist should be considered for women who are anemic and those undergoing hysteroscopic myomectomy. Subserosal fibroids have least effect on fertility, so they do not need removal before infertility treatment. Keymessage Fibroids are important cause of infertility; Removal of submucousal fibroids is warranted before IVF. Search methodology Data were sourced from the electronic database PubMed, MEDLINE, OVID, Cochrane Database of systematic reviews and published guidelines on fibroids and infertility. Abstracts from papers and posters presented at the international meetings, published and unpublished studies, and expert opinion was considered. How to cite this article Kaur H, Rao KA. Fibroids and infertility. Int J Infertil Fetal Med 2014;5(1):1-7

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Increased expression of neurogenic factors in uterine fibroids

Human Reproduction ◽

10.1093/humrep/dez182 ◽

2019 ◽

Author(s):

Alice Luddi ◽

Camilla Marrocco ◽

Laura Governini ◽

Bianca Semplici ◽

Valentina Pavone ◽

...

Keyword(s):

Uterine Fibroids ◽

Reproductive Age ◽

In Vivo Studies ◽

Pcr Analysis ◽

Benign Tumors ◽

Endometrial Stromal Cells ◽

Eutopic Endometrium ◽

Qrt Pcr ◽

Fertility Sparing

Abstract STUDY QUESTION Are selective markers for the neuronal differentiation such as microtubule-associated protein 2 (MAP-2) and synaptophysin (SYP) as well as the nerve growth factor (NGF) expressed by fibroids, myometrium and eutopic endometrium? SUMMARY ANSWER Neuronal markers NGF, MAP-2 and SYP are highly expressed in fibroids compared with matched myometrium, and this neurogenic pathway is upregulated by tumor necrosis factor (TNF) alpha in cultured smooth muscle cells (SMCs). WHAT IS KNOWN ALREADY Uterine fibroids or leiomyomas are the most common benign tumors, accounting for approximately one-third of hysterectomies. The present trend is to improve the medical treatment avoiding surgery, also for fertility sparing; hence, the pathogenic mechanisms are investigated, aiming to develop new therapeutic strategy. STUDY DESIGN, SIZE, DURATION This laboratory-based case–control study is focused on fibroids and myometrial specimens obtained between 2015 and 2017 from 15 women of reproductive age at the proliferative phase of the menstrual cycle. Leiomyomas, matched myometrium and endometrium from each woman were analyzed. Control endometrium was obtained from women undergoing surgery for ovarian cyst (n = 15). PARTICIPANTS/MATERIALS, SETTING, METHODS qRT-PCR, western blotting and immunostaining were applied to evaluate the expression of neurogenic markers; the effects of TNF on NGF, MAP-2 and SYP expression in cultured SMCs from leiomyomas and matched myometrium were analyzed. MAIN RESULTS AND THE ROLE OF CHANCE qRT-PCR analyses using tissues from clinical patients showed that the levels of NGF, MAP-2 and SYP mRNA were significantly higher in uterine leiomyomas compared with their matched myometrium (P < 0.05), whereas only NGF was significantly increased in eutopic endometrium compared with healthy endometrium. In primary SMCs, isolated from fibroids or from the adjacent myometrium, NGF, MAP-2 and SYP mRNA expression were significantly increased by TNF treatment (P < 0.05). Finally, human endometrial stromal cells prepared from the endometrium of patients affected by uterine fibroids display higher TNF expression (P < 0.001). LIMITATIONS, REASONS FOR CAUTION qRT-PCR analysis and immunofluorescence validation are robust methods demonstrating a clear upregulation of neurogenic factors in leiomyomas, even though additional studies are needed to establish a correlation between increased neuronal gene expression and degree of pain, as well as the involvement of inflammation mediators in the development of the neurogenic unhinge. Therefore, more in vivo studies are needed to confirm the results achieved from primary cultured SMCs. WIDER IMPLICATIONS OF THE FINDINGS The increased expression of neurogenic factors in uterine fibroids and endometrium may contribute to explain the painful stimuli. Accordingly, these neurogenic pathways may represent potential therapeutic avenues to treat the fibroid-related disorders. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by research grants from the University of Siena. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

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Prevalence of fibroids: a study in a semiurban area in Telangana, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175059 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5247 ◽

Cited By ~ 1

Author(s):

Juvvadi Srilatha ◽

Verabelly Malathi

Keyword(s):

Ultrasound Examination ◽

Female Genital Tract ◽

Uterine Fibroids ◽

Benign Neoplasm ◽

Medical Advice ◽

The Body ◽

Age Group ◽

Normal Range ◽

Early Management ◽

Female Genital

Background: Uterine fibroids, also known as Leiomyoma, are the most common benign neoplasm in the female genital tract and originate from the myometrium´s smooth muscle. Although the uterine fibroids are diagnosed frequently, the prevalence of it in the local populations is unknown. Therefore, this study was done to observe the prevalence of the fibroids in our geographic area.Methods: 4487 women aged between 18-50 years who came to our gynec OPD out of which 522 were positive for the presence of fibroids, were included into the study. Ultrasound examination was done for all the patients. During this examination, the uterine dimensions and the structure were assessed. The number of the fibroids were counted and noted. Biopsy sample was taken from the fibroids and sent to pathology lab for further histological examination.Results: Out of the 4487 patients included into the study, 11.6% had fibroids. The predominant age group which was positive the presence of fiberoids was 40-59 years. 59.8% of them were married while 40.2% were either unmarried or divorced or widowed. The body mass index for most of them was within the normal range (60.3%), while some were slightly overweight. The most common cause of the patients to seek medical advice was menstrual disorder (37.7%) which included heavy, irregular or no periods.Conclusions: Fibroids was significantly associated with age, married marital status, overweight, pregnancy, menopause, childbirth and the presence of menorrhagia. Early detection would help in early management and thereby reduce the morbidity.

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Clinicopathological analysis of ovarian tumours: a 10 year retrospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183320 ◽

2018 ◽

Vol 7 (8) ◽

pp. 3216

Author(s):

Sahana N. Naik ◽

Sunil Kumar K. S. ◽

Girija B.

Keyword(s):

Malignant Tumors ◽

Female Genital Tract ◽

Germ Cell Tumors ◽

Mucinous Cystadenoma ◽

Ovarian Tumors ◽

Reproductive Age ◽

Benign Tumors ◽

Age Group ◽

Epithelial Tumors ◽

Neoplastic Lesions

Background: Ovarian tumors account for 30% of all cancers of female genital tract which represents the sixth most common cancer and fourth leading cause of death in women. The present study was done with an objective to determine the frequency and distribution of various ovarian tumors and to study their clinical and histopathological presentations.Methods: It is a retrospective observational study of patients with ovarian tumors subjected to surgery in the department of obstetrics and gynecology, SDM College of Medical Sciences and Hospital from January 2005 to December 2015.Results: There were 642 cases comprising of 77.7% of neoplastic lesions and 22.3% of non-neoplastic lesions. Majority of the ovarian tumors (83%) were seen in the age group of 20 to 50 years. Mean age for ovarian tumors was 38 years. Among the neoplastic lesions 84% were benign, 14.2% were malignant and 1.8% were borderline tumors. Surface epithelial tumors were the commonest tumors (60.9%) followed by germ cell tumors (12.8%). Serous cystadenoma was the most common benign tumors (47.1%) followed by mucinous cystadenoma (18.4%). Among the ovarian malignant tumors; serous cystadenocarcinoma was the most common (4.5%) followed by mucinous cystadenocarcinoma (2.6%). Chocolate cysts were the most common among the non-neoplastic lesions (36.4%).Conclusions: Ovarian neoplastic lesions were more common than non-neoplastic lesions. Benign ovarian tumors were common in reproductive age group. The mean age of occurrence for ovarian tumor was 38 years. The most common neoplasm was surface epithelial tumors, of which serous tumors was the commonest. Chocolate cysts were the most frequently encountered histopathological finding among the non-neoplastic lesions.

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Myomectomy during cesarean section

Serbian Journal of Anesthesia and Intensive Therapy ◽

10.5937/sjait2104073s ◽

2021 ◽

Vol 43 (3-4) ◽

pp. 73-80

Author(s):

Radmila Sparić ◽

Đina Tomašević ◽

Mladen Anđić ◽

Miljan Pupovac ◽

Aleksandra Pavić ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Perioperative Complications ◽

Uterine Fibroids ◽

Surgical Site Infections ◽

Reproductive Age ◽

Benign Tumors ◽

Uterine Torsion ◽

Perioperative Bleeding ◽

Increased Risk

Myomas (fibroids, leiomyomas) are the most common benign tumors of genital organs in women of reproductive age and represent a significant problem in women's health care. The frequency of cesarean section is higher in women with uterine fibroids. Absolute indications for myomectomy during caesarean section are: fibroids that prevent hysterotomy during caesarean section, impede uterine incision suture, hamper safe fetal extraction and cause uterine torsion. Relative indications for myomectomy during caesarean section are: subserous and pedunculated fibroids, anterior uterine wall fibroids, fibroids that can cause immediate perioperative, and puerperal complications, the patient's desire, fibroids that can cause complications in subsequent pregnancies, and fibroids that can be enucleated without additional hysterotomy. Myomectomy during caesarean section is a complex surgical procedure, associated with the possibility of considerable complications, and defining their actual frequency and risk factors for their occurrence requires further research. Myomectomy during caesarean section is associated with an increased risk of perioperative bleeding. Other perioperative complications of myomectomy during cesarean section are: disseminated intravascular coagulation, paralytic ileus, surgical site infections, sepsis, postoperative febrile morbidity, increased incidence of blood transfusions, and prolonged hospitalization.

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Mullerian adenosarcoma of the cervix: case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20164690 ◽

2016 ◽

Vol 6 (1) ◽

pp. 335

Author(s):

Akinfenwa T. Atanda ◽

Osondu C. Agu ◽

Abubakar K. Modu K. Modu

Keyword(s):

Genital Tract ◽

Clinical Presentation ◽

Female Genital Tract ◽

Reproductive Age ◽

Age Group ◽

Rare Tumours ◽

Histopathological Evaluation ◽

Optimum Management ◽

Reproductive Age Group ◽

Female Genital

Mullerian adenosarcomas are rare tumours that may be found in any part of the female genital tract including cervix. They are more common in the reproductive age group and rare among blacks. When they present in the cervix they may be clinically misdiagnosed as an endocervical polyp and histologically as an adenofibroma. Clinical presentation is mostly as irregular vagina bleeding and as a mass in the vagina. Meticulous histopathological evaluation is crucial for its optimum management.

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