Giant Uterine Fibroid in a Low Resources Setting: A Case Report

2020 ◽  
Vol 31 (2) ◽  
pp. 70-78
Author(s):  
Godwin S. Macheku ◽  
Lengarivo Losaru ◽  
Ibreck Msafiri ◽  
Harry Mwerinde ◽  
Anne E. Shuma ◽  
...  
Keyword(s):  
Uterine Fibroid ◽  
Uterine Leiomyoma ◽  
Imaging Modality ◽  
Uterine Leiomyomas ◽  
Female Reproductive Tract ◽  
Advanced Technology ◽  
Laboratory Evaluation ◽  
Benign Tumors ◽  
Abdominal Pressure ◽  
Supracervical Hysterectomy

Background: Uterine leiomyomas represent the most common benign tumors of the female reproductive tract. Giant uterine leiomyomas are exceedingly rare neoplasm and represents a great diagnostic and therapeutic challenge. The aim of this publication is that though the present era is of advanced technology and minimally invasive surgery but this may not be available everywhere and feasible in every case. Diagnosis and management of giant uterine myoma should permit greater management flexibility with safe options, which must be tailored to the individual clinical situation.Case presentation: A 45-year old woman presented with a 12-month history of progressive increasing abdominal size, prolonged menstrual bleeding, menorrhagia, gradual weight gain, vague abdominal pressure sensations, dysmenorrhea, abdominal and pelvic pain, frequent urination, relative constipation and symptom of anemia but not in failure. Physical examination, laboratory evaluation and a trans-abdominal ultrasound were done and findings suggested a giant abdominal-pelvic mass. Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy was performed. Histologically, the specimen was 16.2 Kg uterine leiomyoma measuring 30/24/20 cm, intramural and subserosal myomatous, cellular leiomyoma that occurred without secondary changes, necrosis, cellular atypia, or mitosis.The patient’s postoperative progress was uneventful and she was discharged from the hospital on the seventh postoperative day.Conclusion: In uterine leiomyomas patient, the preferred imaging modality for initial evaluation is ultrasonography because it is the least invasive and most cost effective investigation especially in low resource settings where magnetic resonance imaging (MRI) and computed tomography (CT) Scan are usually not available and majority of the patients cannot afford its cost. The chosen treatment should be individualized, both severity of symptoms and patients desire to preserve fertility are very important. There is no single best approach to uterine fibroid treatment. However, women with giant uterine fibroids are best treated surgically and require adequate pre-operative preparations and an experienced skillful surgeon. Keywords: Giant uterine leiomyoma, diagnosis, supracervical hysterectomy.

Simvastatin inhibits Wnt/β-catenin pathway in uterine leiomyoma

Endocrinology ◽  
2021 ◽  
Author(s):  
Malak El Sabeh ◽  
Subbroto Kumar Saha ◽  
Sadia Afrin ◽  
Mostafa A Borahay
Keyword(s):  
Uterine Leiomyoma ◽  
Reproductive Tract ◽  
Controlled Trial ◽  
Active Form ◽  
Cell Types ◽  
Female Reproductive Tract ◽  
Benign Tumors ◽  
Therapeutic Effects

Abstract The Wnt/β-catenin pathway is upregulated in uterine leiomyomas, the most common benign tumors in the female reproductive tract. Simvastatin is an anti-hyperlipidemic drug, and previous in vitro and in vivo reports showed it may have therapeutic effects in treating leiomyomas. The objective of this study is to examine the effects of simvastatin on the Wnt/β-catenin signaling pathway in leiomyoma. We treated primary and immortalized human leiomyoma cells with simvastatin and examined its effects using RT-qPCR, Western Blotting, and immunocytochemistry. We also examined the effects using human leiomyoma tissues from an ongoing, randomized controlled trial where women with symptomatic leiomyoma received simvastatin (40mg) or placebo for 3 months prior to their surgery. The results of this study reveal that simvastatin significantly reduced the expression of Wnt4 and its co-receptor LRP5. After simvastatin treatment, levels of total β-catenin and its active form, non-phosphorylated β-catenin, were reduced in both cell types. Additionally, simvastatin reduced the expression of Wnt4 and total β-catenin, as well as non-phosphorylated β-catenin protein expression in response to estrogen and progesterone. Simvastatin also inhibited the expression of c-Myc, a downstream target of the Wnt/β-catenin pathway. The effect of simvastatin on non-phosphorylated-β-catenin, the key regulator of the Wnt/β-catenin pathway, was recapitulated in human leiomyoma tissue. These results suggest that simvastatin may have a beneficial effect on uterine leiomyoma through suppressing the overactive Wnt/β-catenin pathway.

scholarly journals 5-Hydroxymethylcytosine Promotes Proliferation of Human Uterine Leiomyoma: A Biological Link to a New Epigenetic Modification in Benign Tumors

2014 ◽  
Vol 99 (11) ◽  
pp. E2437-E2445 ◽  
Author(s):  
Antonia Navarro ◽  
Ping Yin ◽  
Masanori Ono ◽  
Diana Monsivais ◽  
Molly B. Moravek ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Uterine Leiomyoma ◽  
Reproductive Tract ◽  
Enzyme Inhibitor ◽  
Malignant Tumors ◽  
Epigenetic Modification ◽  
Uterine Fibroids ◽  
Female Reproductive Tract ◽  
Immunofluorescent Staining ◽  
Benign Tumors

Context: Uterine leiomyoma, or fibroids, represent the most common benign tumors of the female reproductive tract. A newly discovered epigenetic modification, 5-hydroxymethylation (5-hmC), and its regulators, the TET (Ten Eleven Translocation) enzymes, were implicated in the pathology of malignant tumors; however, their roles in benign tumors, including uterine fibroids, remain unknown. Objective: To determine the role of 5-hmC and TET proteins in the pathogenesis of leiomyoma using human uterine leiomyoma and normal matched myometrial tissues and primary cells. Design: 5-hmC levels were determined by ELISA and immunofluorescent staining in matched myometrial and leiomyoma tissues. TET expression was analyzed by quantitative RT-PCR and immunoblotting. TET1 or TET3 were silenced or inhibited by small interfering RNA or 2-hydroxyglutarate to study their effects on 5-hmC content and cell proliferation. Results: We demonstrated significantly higher 5-hmC levels in the genomic DNA of leiomyoma tissue compared to normal myometrial tissue. The increase in 5-hmC levels was associated with the up-regulation of TET1 or TET3 mRNA and protein expression in leiomyoma tissue. TET1 or TET3 knockdown significantly reduced 5-hmC levels in leiomyoma cells and decreased cell proliferation. Treatment with 2-hydroxyglutarate, a competitive TET enzyme inhibitor, significantly decreased both 5-hmC content and cell proliferation of leiomyoma cells. Conclusion: An epigenetic imbalance in the 5-hmC content of leiomyoma tissue, caused by up-regulation of the TET1 and TET3 enzymes, might lead to discovery of new therapeutic targets in leiomyoma.

Profiling of differentially expressed genes in human uterine leiomyomas

2005 ◽  
Vol 15 (1) ◽  
pp. 146-154 ◽  
Author(s):  
E.-J. Lee ◽  
G. Kong ◽  
S.-H. Lee ◽  
S. B. Rho ◽  
C.-S. Park ◽  
...  
Keyword(s):  
Differentially Expressed Genes ◽  
Uterine Leiomyoma ◽  
Uterine Leiomyomas ◽  
Reproductive Age ◽  
Differentially Expressed ◽  
Benign Tumors ◽  
Women Of Reproductive Age ◽  
Polymerase Chain ◽  
Insight Into ◽  
Chip Analysis

Uterine leiomyomas are very common benign tumors resulting in clinically serious gynecological problems in women of reproductive age. Approximately, 1% of leiomyosarcoma was reported to arise in a preexisting leiomyoma. However, the molecular basis of these tumors is poorly understood. To understand the molecular changes during leiomyoma development, we profiled differentially expressed genes in ten paired leiomyoma and normal myometrial tissues using cDNA microarray chip analysis. We identified 67 genes (27 overexpressed and 40 underexpressed) which were scored as differentially expressed at least twofold in at least eight of ten patients. Eighteen of 67 genes have been already reported to be differentially expressed without their established functions in uterine leiomyoma and others have never been reported. Subsequently, the relative expression levels of representative genes from identified 67 genes were confirmed by reverse-transcriptase polymerase chain reaction and immunohistochemistry and were found to be consistent with the microarray data. This study could provide a new insight into the understanding of leiomyoma and leiomyosarcoma.

scholarly journals Development of iRGD-Modified Peptide Carriers for Suicide Gene Therapy of Uterine Leiomyoma

Pharmaceutics ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 202
Author(s):  
Anna Egorova ◽  
Sofia Shtykalova ◽  
Alexander Selutin ◽  
Natalia Shved ◽  
Marianna Maretina ◽  
...  
Keyword(s):  
Gene Therapy ◽  
Uterine Leiomyoma ◽  
Transfection Efficiency ◽  
Chemical Properties ◽  
Suicide Gene ◽  
Suicide Gene Therapy ◽  
Benign Tumors ◽  
Αvβ3 Integrin ◽  
Peptide Carrier ◽  
Plasmid Delivery

Uterine leiomyoma (UL) is one of the most common benign tumors in women that often leads to many reproductive complications. Suicide genetherapy was suggested as a promising approach for UL treatment. In the present study, we describe iRGD ligand-conjugated cysteine-rich peptide carrier RGD1-R6 for targeted DNA delivery to αvβ3 integrin-expressing primary UL cells. The physico-chemical properties, cytotoxicity, transfection efficiency and specificity of DNA/RGD1-R6 polyplexes were investigated. TheHSV-1thymidine kinase encoding plasmid delivery to PANC-1pancreatic carcinoma cells and primary UL cells resulted in significant suicide gene therapy effects. Subsequent ganciclovir treatment decreased cells proliferative activity, induced of apoptosis and promoted cells death.The obtained results allow us to concludethatthe developed RGD1-R6 carrier can be considered a promising candidate for suicide gene therapy of uterine leiomyoma.

scholarly journals Intravenous Carbetocin to decrease blood loss during open myomectomy: a randomized placebo-controlled study

2017 ◽  
Vol 7 (1) ◽  
pp. 27
Author(s):  
Hany F. Sallam ◽  
Nahla W. Shady
Keyword(s):  
Placebo Group ◽  
Blood Loss ◽  
Operative Time ◽  
Uterine Leiomyomas ◽  
Reproductive Age ◽  
Controlled Study ◽  
Benign Tumors ◽  
Operative Blood Loss ◽  
Abdominal Myomectomy ◽  
To Receive

Background: Uterine leiomyomas are benign tumors of the uterus, which represent the most common neoplasms in women of reproductive age, and have a lifetime incidence of approximately 70% in the general population. The objective of this study was to assess the effect of using a single pre-operative dose of IV 100 μg Carbetocin on intra-operative blood loss in abdominal myomectomy surgeries.Methods: In a randomized double-blind placebo-controlled trial, 86 women undergoing abdominal myomectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of pre-operative of IV 100 μg Carbetocin (n = 43) or placebo (n = 43) just before the operation. The primary outcome was intra-operative blood loss.Results: Intra-operative blood loss was significantly lower in those women randomized to receive IV Carbetocin versus the placebo group (714.19±186.27 ml versus 1033.49±140.9 ml), p = 0.0001 The incidence of blood transfusion was increased in placebo group (69.8%) compared with (18.6%) in Carbetocin group, (P = 0.0001). Also, there was a significant reduction in operative time in Carbetocin group (66.35%±10.18) compared with placebo group (95.95±9.16), (P = 0.0001).Conclusions: A single pre-operative dose of IV Carbetocin (100 μg) is a simple applicable method for reducing intra-operative blood loss and operative time in abdominal myomectomy.

scholarly journals Effect of Dose, Timing and Delivery of Tumor Necrosis Factor Alpha as an Adjuvant in Cryosurgery of ELT-3 Uterine Leiomyoma (Fibroid) Tumor

2009 ◽  
Vol 3 (2) ◽  
Author(s):  
J. Jiang ◽  
J. Bischof
Keyword(s):  
Tumor Growth ◽  
Uterine Fibroid ◽  
Tumor Size ◽  
Uterine Leiomyoma ◽  
Mode Of Delivery ◽  
Growth Delay ◽  
Tumor Growth Delay ◽  
Tnf Α ◽  
Pre Treatment

Uterine leiomyoma (fibroid or myoma) is the most common indication for hysterectomy in premenopausal women. Cryomyolysis is a uterus sparing procedure in which a myoma is frozen by a cryoprobe, thereby causing tissue necrosis upon thawing and eventual reduction in myoma size. Unfortunately, although the iceball is readily visualized (by ultrasound-US or magnetic resonance-MR), the tissue at the periphery of the iceball is not completely destroyed. One potential solution to this problem is the use of cryosurgical adjuvants that increase cryosurgical image guidance and efficacy. Previous work in our lab has shown that TNF-α (native or as the nanodrug, CYT-6091, Cytimmune Sciences, Inc.) can act synergistically with cryosurgery to destroy all prostate cancer within an iceball. Building on this work, the current study was designed to test TNF-α as an adjuvant in an in vivo model of uterine fibroid (ELT-3) in a nude mouse. The aims of this study are to characterize in vivo: 1) the destruction of the uterine fibroid over time after cryosurgery; 2) the effect of TNF-α pre-treatment on enhancement of cryosurgery; 3) the effect of TNF-α dose, pre-treatment time and mode of delivery on the above and to note any toxicities. ELT–3 rat uterine fibroid cells were grown in the hind limb of female nude mice. TNF-α at various dose (2μg and 5μg) was administered at 1, 2 and 4 hours before cryotreatment in native or CYT-6091. Native TNF-α was injected either intra-tumorally or peri-tumorally. Injecting TNF-α solution into the center of the tumor comprised the intra-tumoral approach. For peri-tumoral injection, TNF-α solution was injected at each one of eight evenly distributed points spanning the circumference of the tumor base. CYT-6091 was administered by i.v. injection only. Cryosurgery was performed with a modified 1 mm diameter cryoprobe tip (−120°C). Freezing was allowed to continue to the visible edge of the tumor. Injury was assessed by measuring tumor-growth delay. Baseline tumor size was measured on day 0; fold-changes in tumor size are reported relative to size at day 0. Toxicity was evaluated by survival rate. Groups were 4–6 animals in each group. The data suggests that pre-treatment with TNF-α before cryosurgery significantly enhances visually guided destruction of uterine leiomyoma, and that the dose, timing and mode of delivery are important variables in optimization of this combination treatment. First, it was observed that at least four hours pretreatment with TNF-α is required to obtain the synergistic effect of TNF-α and cryoinjury. Second, peri-tumoral injection of native TNF-α, was the most effective delivery method to enhance cryoinjury at low dose (2μg), however it was also the most toxic method at high dose (5μg). On the other hand, CYT-6091, although less effective than peri-tumoral injection at 2μg, was the safest delivery mode (0% lethality at 2μg; 33% at 5μg). Finally, CYT-6091 delivery at 5μg with cryosurgery resulted in a dramatic tumor growth delay compared with cryosurgery alone. Therefore, i.v. injection of CYT-6091 followed by cryosurgery allowed the highest dose of TNF-α, the least toxicity and the best overall myoma reduction. Funding: R01 CA075284, American Medical Systems, Inc. TNF-α and CYT-6091: Cytimmune Sciences, Inc.

scholarly journals Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Mohamed A. Satti ◽  
Carmen Paredes Saenz ◽  
Rubin Raju ◽  
Sierra Cuthpert ◽  
Abed Kanzy ◽  
...  
Keyword(s):  
Literature Review ◽  
Uterine Leiomyoma ◽  
Medical Center ◽  
Rare Complication ◽  
Abdominal Mass ◽  
Uterine Fibroids ◽  
Case Series ◽  
Thromboembolic Disease ◽  
Uterine Leiomyomas ◽  
Prophylactic Anticoagulation

Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE.Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015.Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma.

Mechanical Signaling and Extracellular Matrix in Uterine Fibroids

2017 ◽  
Vol 35 (06) ◽  
pp. 487-493 ◽  
Author(s):  
Saima Rafique ◽  
James Segars ◽  
Phyllis Leppert
Keyword(s):  
Gene Expression ◽  
Extracellular Matrix ◽  
Reproductive Tract ◽  
Critical Role ◽  
Uterine Fibroids ◽  
Female Reproductive Tract ◽  
Benign Tumors ◽  
Mechanical Signaling ◽  
Abnormal Cells ◽  
Fibroid Growth

AbstractFibroids (uterine leiomyomas) are the most common benign tumors of the female reproductive tract. Steroid hormones, growth factors, and cytokines have long been implicated in fibroid growth; however, research suggests that changes in the extracellular matrix and mechanical signaling play a critical role in fibroid growth and differentiation. Studies have shown that growth of fibroids is related to the change in the volume and composition of extracellular matrix with increased deposition of abnormal collagen, glycoproteins, laminins, fibronectins, and an increased osmotic stress. These changes generate mechanical stress which is converted to chemical signals in the cells through mechanotransduction and eventually affects gene expression and protein synthesis. Current studies also suggest that mechanical signaling in fibroid cells is abnormal as evidenced by decreased apoptosis of abnormal cells and deposition of a stiff extracellular matrix promoting fibrosis. Understanding and defining these mechanisms could help design new therapies for the treatment of fibroids.

scholarly journals Intracardiac Masses I-Mass Study Single Center Experience Within 12 Years

2021 ◽  
Author(s):  
Zehra Bugra ◽  
Samim Emet ◽  
Berrin Umman ◽  
Pelin Karaca Ozer ◽  
Murat Sezer ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Malignant Tumors ◽  
Thrombus Formation ◽  
Imaging Modality ◽  
Benign Tumors ◽  
Cardiac Tumors ◽  
Cross Sectional ◽  
Lung Cancers ◽  
Intracardiac Masses ◽  
Cardiac Masses

Abstract Objective : The aim of this cross-sectional, retrospective, descriptive study was to review and classify cardiac masses systematically and to determine their frequencies.Methods : The medical records of 64,862 consecutive patients were investigated within 12 years. Every patient with a cardiac mass imaged by transthoracic echocardiography (TTE) and confirmed with an advanced imaging modality such as transesophageal echocardiography (TEE), computed tomography (CT) and / or cardiac magnetic resonance imaging (CMR) was included. Acute coronary syndromes triggering thrombus formation, vegetations, intracardiac device and catheter related thrombi were excluded.Results : Data demonstrated 127 (0.195 %) intracardiac masses consisting of 33 (0.050 %) primary benign, 3 (0.004 %) primary malignant, 20 (0.030 %) secondary tumors, 3 (0.004 %) hydatid cysts and 68 (0.104 %) thrombi respectively. The majority of primary cardiac tumors were benign (91.67 %), predominantly myxomas (78.79 %), and the less malignant (8.33 %). Secondary cardiac tumors were common than the primary malignant tumors (20:3), with male dominancy (55 %), lymphoma and lung cancers were the most frequent. Intracardiac thrombi was the majority of the cardiac masses, thrombi accompanying malignancies were in the first range (n=17, 25%), followed by autoimmune diseases (n=13, 19.12 %) and ischemic heart disease with low ejection fraction (n=12, 17.65 %).Conclusion: This retrospective analysis identified 127 patients with cardiac masses. The majority of benign tumors were myxoma, the most common tumors that metastasized to the heart were lymphoma and lung cancers, and the thrombi associated with malignancies and autoimmune diseases were the most frequent.

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