Pathologic Changes in Uterine Leiomyomas After Extended Treatment With Ulipristal Acetate

Ulipristal acetate is a selective progesterone receptor modulator that acts on progesterone receptors in uterine muscle and endometrium. It is effective in reducing the size of uterine leiomyomas (fibroids) and in managing associated menorrhagia. Although ulipristal acetate–associated pathologic changes have been previously documented in the endometrium, it is unclear what morphology can be expected in posttreatment fibroids. We herein report 2 cases in which patients underwent hysterectomy, after at least two 3-mo courses of ulipristal acetate. The fibroids demonstrated some pathologic changes that have previously been described associated with gonadotropin-releasing hormone agonist treatment and other progestogens. In addition, both cases demonstrated plexiform/“patchwork” fibrosis and vascular medial myxoid degeneration. Mitotic activity was absent; however, the presence of ischemic necrosis and mild nuclear atypia may mimic a more aggressive neoplasm in some areas. Awareness of these histopathologic patterns is important in the setting of ulipristal acetate treatment, to avoid over-diagnosis of “uncertain malignant potential” or malignant smooth muscle tumors.
Source: International Journal of Gynecological Pathology - Category: Pathology Tags: Pathology of the Corpus: Case Reports Source Type: research

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(Abstracted from J Minim Invasive Gynecol 2019;26:1234–1252) Almost 70% of white and more than 80% of black premenopausal women are affected by uterine leiomyomas. Medical or conservative procedures can manage many leiomyoma-related symptoms.
Source: Obstetrical and Gynecological Survey - Category: OBGYN Tags: GYNECOLOGY: OPERATIVE GYNECOLOGY Source Type: research
A woman in her thirties presented with a 7.5 cm renal mass and a 12 cm pelvic mass. She underwent a hysterectomy which showed a large uterine leiomyoma, and a nephrectomy which showed a papillary renal cell carcinoma. A representative image of the papillary renal cell carcinoma is depicted.
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Path to patient image quiz Source Type: research
Background: Leiomyomas are common in women of reproductive age, for whom treatment-stratification can be challenging. We assessed factors influencing pre-operative selection of surgical intervention and compare outcomes. Patients and Methods: A literature review was performed and surgical interventions for fibroids at a London hospital (2015-2018) were retrospectively examined. Outcomes assessed were estimated blood loss, length of stay (LOS) and complications. Data were analysed using univariate non-parametric inferential statistics. Results: A total of 258 cases were identified. Estimated blood loss was statistically sig...
Source: In Vivo - Category: Research Authors: Tags: Clinical Studies Source Type: research
Conclusion: Serum levels of cox2 and wnt3a exhibited diagnostic value for endometrial cancer. Cox2 serum levels and β-catenin expression also showed potential value of prognostic prediction. Cox2 serum levels might be a potential marker for early diagnosis and prognosis prediction in endometrial cancer.
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Abstract“Benign” metastatic leiomyomas (BML) are indolently growing metastatic tumors which mostly associate with uterine leiomyomas in women in reproductive ages. The reason to define these lesions as “benign” despite metastasis is their pathological features with low mitotic counts, lack of or min imal nuclear atypia, pseudocyst formation, and coagulative necrosis unlike leiomyosarcomas. Despite lack of pathological malignant features, they may cause significant morbidity and even mortality. Here, we describe a BML case with metastases to vertebrae and skull bones. Vertebral and skull metasta ses ...
Source: Neurosurgical Review - Category: Neurosurgery Source Type: research
Uterine leiomyomas are the most common benign tumors of the uterus with a premenopausal cumulative clinically relevant incidence of 50% in black and 35% in white women [1]. The standard treatment for symptomatic fibroids is hysterectomy, but there has been a shift towards less invasive approaches like myomectomy, high intensity focused ultrasound and UFE [1 –3]. Mid- and long-term studies evaluating therapy effectiveness after UFE suggest freedom from treatment failure between 70%-90%, based on follow-up times between 1 and 10 years [2,3,5–9]; however, follow-up data longer than 10 years after UFE...
Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology - Category: OBGYN Authors: Tags: Review article Source Type: research
Publication date: Available online 30 January 2020Source: European Journal of Obstetrics &Gynecology and Reproductive BiologyAuthor(s): Meritxell Gracia, Francisco CarmonaAbstractUterine myomas (fibroids, leiomyomas) are the most common benign myometrial tumors in women of reproductive age. They are present in 5-70% of women (depending on different series), with at least one fibroid identified in 70% of women aged 40 to 60 years. Symptoms are present in 20-50% of women with uterine fibroids and include Abnormal Uterine Bleeding (AUB), pelvic pain, Bulk-pressure symptoms and fertility problems depending on the size and ...
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
Uterine fibroids (UFs; leiomyoma) are the most common benign neoplastic threat that arise in the myometrium of women of reproductive age. These monoclonal tumors occur in about 77% of women by the age of 50 years and are clinically manifest in 25% –50% of women. Although benign, nonetheless these tumors are associated with significant morbidity including abnormal uterine bleeding, anemia, pelvic pain, subfertility, and obstetric complications. In addition, they are the primary indication for hysterectomy, and a major source of reproductive dysfunction.
Source: Fertility and Sterility - Category: Reproduction Medicine Authors: Tags: Reflections Source Type: research
Uterine fibroids (UFs), also known as leiomyomas, are benign pelvic tumors that occur in nearly 70% of all reproductive-aged women (1, 2). Some of these women will develop severe symptoms associated with the presence of these tumors. Annually, UFs account for over 200,000 hysterectomies in the U.S. This is due to the lack of long-term effective medical therapies (3). Tumor growth is characterized by slow proliferation with increased deposition of extracellular matrix (proteoglycans and collagens), which participates in the fibrotic phenotype of UFs (3).
Source: Fertility and Sterility - Category: Reproduction Medicine Authors: Tags: Reflections Source Type: research
Conclusion: In this case, lung and mediastinal metastasis of uterine fibroids was observed. However, depending on only a postoperative histological analysis is insufficient for the diagnosis of PBML. Histological analysis combined with an evaluation of the expression levels of ER and PR is crucial for the diagnosis and treatment of PBML.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
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