Uterine Leiomyoma

Clinical assessment of the general status of patients with combined uterine pathology (leiomyoma (LM) and adenomyosis) has a practical importance for determining specific therapeutic tactics. The study of the general condition of reproductive aged women with this pathology allows determining of many factors that can affect the clinical course of disease.

Purpose of the study was to investigate the clinical status of reproductive aged women who suffer from combined uterine pathology – LM and adenomyosis.

Materials and methods. 120 women of reproductive age were examined. Group IA united 60 patients with combined uterine pathology – asymptomatic LM and nodal, diffuse, diffuse-focal adenomyosis III, IV degrees of severity with active clinical course; group IB united 60 patients with combined uterine pathology - symptomatic LM and diffuse, diffuse focal adenomyosis I, II degrees of severity with inactive clinical course. Examination was carried out in accordance with the orders of the Ministry of Health of Ukraine.

Results. A study of the general status of reproductive aged women has revealed many factors that can affect the clinical course of disease. The study of nosological forms of extragenital pathology revealed a wide range of different organs and systems diseases, co-morbidities of mainly chronic course, varying severity in 100% of women. A number of somatic diseases can be both a cause and a consequence of gynecological pathology, especially hormonal etiology. Analysis of the anamnestic data on the transferred gynecological diseases showed 100% frequency of the combined and concomitant pathology of the female genital tract.

Conclusions. Completed study involving reproductive aged women with combined uterine pathology (LM and adenomyosis) showed many factors that can affect the clinical course of disease. Obtained data indicate that there are complex metabolic disorders in the women’s body suffering from that combined uterine pathology.

Objective To describe the blood flow velocities and impedance indices changes in the uterine arteries of leiomyomatous uteri using Doppler sonography. Methods This was a prospective, case-control study conducted on 140 premeno-pausal women with sonographic diagnosis of uterine leiomyoma and 140 premeno-pausal controls without leiomyomas. Pelvic sonography was performed to diagnose and characterize the leiomyomas. The hemodynamics of the ascending branches of both main uterine arteries was assessed by Doppler interrogation. Statistical analysis was performed mainly using non-parametric tests. Results The median uterine volume of the subjects was 556 cm 3 , while that of the controls was 90.5 cm 3 (p < 0.001). The mean peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMX), time-averaged mean velocity (Tmean), acceleration time (AT), acceleration index (AI), diastolic/systolic ratio (DSR), diastolic average ratio (DAR), and inverse pulsatility index (PI) were significantly higher in the subjects (94.2 cm/s, 29.7 cm/s, 49.1 cm/s, 25.5 cm/s, 118 ms, 0.8, 0.3, 0.6, and 0.8 respectively) compared with the controls (54.2 cm/s, 7.7 cm/s, 20.0 cm/s, 10.0 cm/s, 92.0 ms, 0.6, 0.1, 0.4, and 0.4 respectively); p < 0.001 for all values. Conversely, the mean PI, resistivity index (RI), systolic/diastolic ratio (SDR) and impedance index (ImI) of the subjects (1.52, 0.70, 3.81, and 3.81 respectively) were significantly lower than those of the controls (2.38, 0.86, 7.23, and 7.24 respectively); p < 0.001 for all values. Conclusion There is a significantly increased perfusion of leiomyomatous uteri that is most likely due to uterine enlargement.

Uterine leiomyomas (ULM), are benign tumors of the smooth muscle cells of the myometrium. They represent a common health problem and are estimated to be present in 30-70% of clinically reproductive women. Abnormal angiogenesis and vascular-related growth factors have been suggested to be associated with ULM growth. The angiotensin-I converting enzyme (ACE) is related with several tumors. The aim of this study was to identify possible correlation between ULM and the ACE I/D polymorphism, to evaluate whether the ACE I/D polymorphism could be a marker for early diagnosis and prognosis. ACE I/D was amplified with specific primer sets recognizing genomic DNA from ULM (n=72) and control (n=83) volunteers and amplicons were separated on agarose gels. The observed genotype frequencies were in agreement with Hardy-Weinberg equilibrium (χ2=2.162, p=0.339). There was no association between allele frequencies and study groups (χ2=0.623; p=0.430 for ACE I allele, χ2=0.995; p=0.339 for ACE D allele). In addition, there were no significant differences between ACE I/D polymorphism genotype frequencies and ULM range in size and number (χ2=1.760; p=0.415 for fibroid size, χ2=0.342; p=0.843 for fibroid number). We conclude that the ACE gene I/D polymorphism is not related with the size or number of ULM fibroids in Turkish women. Thus it cannot be regarded as an early diagnostic parameter nor as a risk estimate for ULM predisposition.

The objective: a study of the condition of the mammary glands in women with uterine leiomyoma on the background of inflammatory diseases of the genital organs.
Materials and methods. At the first stage of the research, a retrospective analysis of histories of 246 women with infertility and uterine leiomyoma on the background of inflammatory diseases and pathology of mamma glands, who were treated in the department of family planning and rehabilitation of reproductive function of State Institution “Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine” named after Academician OM Lukyanova in 2015-2019 was done. In the second stage, a screening ultrasound examination to detect pathology of the breast was performed on the 6th-11th day of the menstrual cycle.
Results. The severity of clinical manifestations of dyshormonal dysplasia of the breast depends on the influence of the most significant risk factors associated with mamma glands diseases: late reproductive age, number of interrupted pregnancies (abortion, miscarriage), genital diseases, age of menarche, the parameters of the menstrual cycle, disorders and duration of menstruations, duration of infertility and lactation, comorbid somatic pathology, especially liver disease, thyroid disease, frequent stress and severe heredity.
Conclusions. The high frequency of combination of uterine leiomyoma and dyshormonal dysplasia of the breast in women with infertility indicates the need for timely diagnosis and adequate correction of this pathology as one of the factors in the development of mamma gland diseases and the earliest use of methods of rehabilitation of reproductive function. This will increase the effectiveness of infertility treatment and prevention of uterine and mammological pathology.

Despite the numerous studies on the factors involved in the genesis and growth of uterine leiomyomas, the pathogenesis of these tumors remains unknown. Intrinsic abnormalities of the myometrium, abnormal myometrial receptors for estrogen, and hormonal changes or altered responses to ischemic damage during the menstrual period may be responsible for the initiation of (epi)genetic changes found in these tumors. Considering these elements, we aimed to offer an overview about epigenetic and genetic landscape of uterine leiomyomas. Narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases. Several studies showed that leiomyomas have a monoclonal origin. Accumulating evidence converges on the risk factors and mechanisms of tumorigenesis: the translocation t (12;14) and deletion of 7q were found in the highest percentages of recurrence; dysregulation of the HMGA2 gene has been mapped within the critical 12q14-q15 locus. Estrogen and progesterone are recognized as promoters of tumor growth, and the potential role of environmental estrogens has been poorly explored. The growth factors with mitogenic activity, such as transforming growth factor-β3, fibroblast growth factor, epidermal growth factor, and insulin-like growth factor-I are elevated in fibroids and may have a role as effectors of the tumor promotion. The new clues on genetics and epigenetics, as well as about the growth factors that control normal and pathological myometrial cellular biology may be of great help for the development of new effective and less invasive therapeutic strategies in the near future.