Intra-Abdominal Hemorrhagic Catastrophe due to Large Subserous Myomatous Capsular Venous Rupture

Uterine leiomyoma is a common benign uterine tumor of women in the reproductive age group. Although the common symptoms of leiomyoma are menorrhagia and dysmenorrhoea, this patient presenting as a near collapse is a rare finding. The patient presented with abdominal pain and worsening anemia within a span of hours and hypotension, tachycardia, and tachypnoea needing urgent surgical intervention and blood transfusion and intensive care support is relatively rare. Though every effort to know the exact cause of intraperitoneal hemorrhage in this patient was taken, the rarer diagnosis of capsular venous rupture was not identified prior to surgical intervention. Initially, laparoscopy was introduced first to identify the cause of massive hemorrhage; the approach was changed to open myomectomy keeping in mind the general condition of the patient. Hence, for any patient with a prior diagnosis of myoma with hemodynamic instability, the rarer diagnosis of leiomyomatous capsular venous erosion should be a differential diagnosis to aid in the appropriate management of the women. The team of interdisciplinary expertise will definitely improve the outcomes in such cases.

A comparative prospective observational study on the use of ulipristal acetate versus mifepristone in reduction of the size of uterine leiomyoma

Background: Fibroid or uterine leiomyoma is the most common benign tumor of the uterus in the reproductive age group and found in one out of every four women. They are symptomatic in 50% of women, with the peak incidence occurring among women in their 30s or 40s. Fibroid can cause a variety of symptoms which include menstrual disturbances commonly menorrhagia and dysmenorrhea. It is a common indication of hysterectomy in Indians. An effective medical treatment option may reduce hysterectomy-associated morbidity and mortality. This study is undertaken to evaluate the efficacy and safety of medical management of myoma and contribution in the reduction of myoma size comparing the two drugs ulipristal and mifepristone. Aims and Objectives: The study was conducted to compare reduction of menorrhagia (By pictorial blood loss assessment chart score), reduction of fibroid size (using transvaginal ultrasonography), and improvement of hemoglobin (Hb) level. We are also evaluating safety or side effects using these drugs. Materials and Methods: The study includes 210 patients who are divided into two groups. Group A includes 105 patients who are treated with tablet Ulipristal Acetate 5 mg daily for 3 months and Group B includes 105 patients who are treated with tablet mifepristone 25 mg daily for 3 months. Results: Ulipristal and mifepristone both are effective in reduction of menorrhagia and improvement of Hb levels, but Ulipristal is more effective in reduction of size of uterine myoma than mifepristone after 3 months of treatment. Conclusion: Multicentric study over a larger population is required to reach a valid conclusion.

Effects of miRNA-199a-5p on cell proliferation and apoptosis of uterine leiomyoma by targeting MED12

Background/aims Uterine leiomyoma (ULM) is a kind of gene-involved benign tumor, which is located in the front of female reproductive tract. It is one of the most common reproductive tract tumors in women, which leads to abnormal menstruation, repeated pregnancy loss, and other serious gynecological diseases. Recently, microRNAs (miRNAs) have attracted much more attention in the process of exploring the molecular mechanisms of tumorigenesis. Furthermore, the deregulated miRNAs had been reported to play important roles in ULM pathology. Methods In this study, we assessed the expression level of microRNA-199a-5p (miR-199a-5p) in human ULM by quantitative polymerase chain reaction. After that cell counting kit 8, colony formation, 5-ethynyl-20-deoxyuridine, flow cytometry, and Western blot analyses were performed to investigate the effects of miR-199a-5p on ULM cell proliferation and apoptosis. Results We confirmed that miR-199a-5p was significantly downregulated in human ULM. The results of function analyses showed that miR-199a-5p inhibited cell proliferation and induced cell apoptosis in vitro. Bioinformatics tool showed oncogene MED12 was one of the target genes of miR-199a-5p, which mediated the effect of miR-199a-5p on the ULM. Conclusion Our results showed that miR-199a-5p functioned as an antitumor factor in human ULM cells. These findings broaden the current findings on the function of miR-199a-5p into the ULM pathogenesis, and miR-199a-5p may serve as a prognosis and therapeutic target for the ULM and its related diseases.

On the model of hormonal carcinogenesis on the example of uterine leiomyoma: problems and prospects

The main principles of progesterone hypothesis and the role of auto- and paracrine factors in uterine leiomyoma pathobiology are considered in the article. The necessity of early therapeutic intervention since humor detection is maintained with the aim of reproductive health recovery. The basic features of strategy in case of uterine leiomyoma are defined: measures due to be undertaken since humor detection, determination of limits and possibilities of adjuvant medicamental treatment and optimal time for surgery, conducting patients in peri- and postmenopause and evaluation of oncological risk.

The results of immunohistochemical study of signaling pathways’ markers of proliferation in uterine leiomyoma in women using hormonal contraception.

Objective. To elucidate the influence of various components of hormonal contraception in women with uterine leiomyoma (UL) on the key molecular and cellular mechanisms of its proliferation. Methods. Antigen Ki-67, estrogen receptors (ER) and progesterone receptors (PR) were determined by immunohistochemical methods in 230 samples of UL preparations obtained during myomectomy. Depending on the composition of the components of hormonal contraceptives that women used for 12 months before the operation, 8 study groups were created: Group I - control, without the use of any hormonal contraception; Group II - the use of COCs containing 20 μg of ethinylestradiol and 0.075 mg of gestaden; Group III - COCs (30 μg ethinylestradiol and 0.075 mg gestaden) Group IV - COCs (30 μg ethinylestradiol and 0.15 mg desogestrel) Group V - COCs (30 μg ethinyl estradiol and 0.15 mg levonorgestrel) Group VI - COCs (30 μg ethinyl estradiol and 2 mg dienogest) Group VII - COCs (30 μg ethinylestradiol and 3 mg drospirenone) Group VIII - (intrauterine levonorgestrel releasing system (IUD-LNG). Results. In UL samples from group I, an increase of Ki-67 positive cells in 3.4 times was observed (3.1 ± 0.03%; p <0.04) in comparison with intact myometrium (IM) (0.9 ± 0.06%), which is evidence of a higher cell proliferation in the UL, a 3.1-fold increase in the H-index of ER expression - 39.4 ± 4.3 (p <0.05) versus 12.9 ± 1.6 in the group with IM I and in 2.6 times of PR expression - 21.1 ± 1.7 (p <0.05) compared to IM - 8.2 ± 1.4, which may indicate a greater sensitivity of UL to sex hormones and their promoter role in UL proliferation. Expression of Ki-67 in UL samples in women taking COCs, which included dienogest (1.8 ± 0.03%, p <0.05) - group VI and desogestrel (1.9 ± 0.03%, p <0.05) - group IV, was, 42.0% and 38.8% respectively, what ois less than in group I UL, which can be regarded as the cytoprotective effect of the progestogen component of COC on the mitotic activity of UL cells. A positive trend in the expression of Ki-67 persisted when women used COCs containing gestodene (2.1 ± 0.02%; p <0.05) - group III and levonorgestrel (2.2 ± 0.04%, p <0.05) - group V, in which the expression of Ki-67 was shown by a smaller number of PM cells, respectively, by 32.3% and 25.8% than in group I PM, and also to a lesser extent - in group VIII (COC with droperidone), where the mean value of Ki-67 expression in LM samples was 2.6 ± 0.02% and was 16.9% less than in LM group I. An increase in the dose of ethinyl estradiol in COCs from 20 μg (group II) to 30 μg (group III) did not significantly affect the expression of Ki-67, therefore, the content of estrogens in modern low-dose COCs does not contribute to an increase in proliferation in the LM, and the non-contraceptive antiproliferative effect is associated exclusively with biological and the pharmacological properties of individual gestagens in the composition of COCs. It was proved that the studied COCs did not significantly affect the expression of ER and PGR. There was no significant difference in the expression of the Ki-67 marker (2.9 ± 0.04%, p <0.05) in UL cells in women using LNG-IUD for contraception, compared with group I. Conclusion. The results of the study have shown that when choosing a drug for hormonal contraception in women with UL, preference should be given to combined hormonal drugs that contain progestogens with the most pronounced antiproliferative properties (dienogest, desogestrel and levonorgestrel).

Diagnostic Accuracy of Ultrasound in Differentiation Uterine Leiomyosarcoma from Uterine Leiomyoma: A Systematic Review

Background: Uterine leiomyosarcoma is a rare malignant pathology of smooth muscle of uterus which is mostly asymptomatic with a wide range of late onset of symptoms such as post-menopausal bleeding and severe abdominal pelvic pain and abnormal vaginal discharge. Uterine leiomyosarcoma characteristically has structural and clinical similarities with giant uterine leiomyoma because both originate from the smooth muscle cells of the uterus. The diagnosis of uterine leiomyosarcoma through ultrasound is very different difficult due to indistinguishable sonographic features of uterine leiomyoma and leiomyosarcoma but there are certain sonological features which can prove the reliability of ultrasound as the diagnostic tool for differentiating uterine leiomyosarcoma from uterine leiomyoma. Aim: To access the accuracy of ultrasound in differentiating uterine leiomyosarcoma from uterine leiomyoma. Methods: An electronic database search was performed (PubMed, Science direct, Google Scholar) with the data range from 2000 to 2021. All studies included in the research was in English language. Articles which had descriptive studies related to sonographic features of uterine leiomyosarcoma and uterine leiomyoma. Results: Total 15 articles were found regarding the prevalence, clinical manifestation and sonographic findings of uterine leiomyosarcoma and uterine leiomyoma ,10 articles were included in the introduction and technique where as 6 articles were selected for systemic review with the sample size ranging from 20-200 in all different articles and age criteria of the participant in the selected articles was above 40 years with most candidates were investigated in the post menopause period. Conclusion: We identified certain sonographic patterns that can accurately differentiate uterine leiomyoma sarcoma from uterine leiomyoma with moderate sensitivity and specificity. Keywords: Transvaginal ultrasonography, leiomyoma, leiomyosarcoma

Results of combined treatment of uterine leiomyoma in women of reproductive age

The purpose of the work. To study the effectiveness of the combined treatment of uterine leiomyoma (UL), taking into account the possibility of realizing reproductive function.Material and methods. The total number of women of reproductive age examined with a large UL (a dominant node more than 50 mm in diameter) was 94. At the first stage, all patients received preoperative preparation. At the first stage all patients received preoperative preparation. 35 patients with concomitant endometrial hyperplasia and/or with the presence of the progesterone receptor gene polymorphism PGR progins received aGn-RH in an average therapeutic dose once in 28 days, 3 injections. 59 patients with the reference genotype without endometrial pathology received mifepristone 50 mg daily for 3 months. After preoperative preparation, the patients underwent conservative myomectomy by laparotomy. Menstrual function, pelvic pain syndrome, size of leiomatous nodules, drug tolerance, frequency of pregnancy and recurrence were assessed. Statistical data processing was performed using Microsoft Excel software. The main statistical indicators such as frequency, mean and standard deviation were taken into account. The results were considered significant at p < 0.05.Results. Excessive menstruation and AUB occurred in 81.9% of patients. Amenorrhea occurred in 79.8% of patients after 1 month of therapy and in all patients after 3 months. Recovery of menstruation was noted in 10.6% of patients a month after the operation, in 59.6% of patients after two months and on the third cycle menstruation resumed in all patients. The frequency of pain syndrome unrelated to the menstrual cycle decreased from 52.1% to 9.6%, dyspareunia from 12.8% to 4.3%, dysmenorrhea from 47.9% to 8.5%. According to ultrasound data, after 1 month in the group of women receiving aGn-RH the size of the nodules decreased by an average of 22.9%, and after mifepristone by 16.9%, and after 3 months by 51.4% and 45.8%. The uterine volume decreased by 28.6% and 30.5%. Starting from the second month of treatment, symptoms caused by estrogen deficiency were noted in 39.4% of patients treated with aGn-RH and 20.3% in the mifepristone group. Overall, the treatment was defined as effective in 88.6% of the women treated with aGn RH and 93.2% of those treated with mifepristone. Relapse occurred in 11.4% of women after aGn-RH and in 5.1% of those in the mifepristone group. Pregnancy occurred in 69.2% of patients and resulted in delivery in 90.8% of cases.Conclusions. The use of preoperative hormonal preparation and a differentiated approach to medication selection leads to normalization of the patient's condition and a reduction in the size of the nodules, which allows organ-preserving surgical treatment with minimal uterine trauma. Preference should be given to anti-gestagens because, with equal efficiency compared to aGn-RH, they are better tolerated by patients and have a more pronounced positive effect on process stabilization and disease recurrence. This combined approach improves treatment efficiency to 91.5%, preserves the uterus in reproductive-age women and promotes pregnancy in 69.2% of cases.