Myomas, An Issue of Obstetrics and Gynecology Clinics (The Clinics: Internal Medicine)

Cover......Page 1
Foreword......Page 2
Preface......Page 4
Epidemiology of Myomas......Page 6
Prevalence in different populations......Page 7
Prevalence in different race and ethnic groups......Page 8
Are there different types of fibroid disease?......Page 9
Incidence at different ages and progression......Page 10
Hormones and fibroids......Page 11
Hypertension......Page 12
Smoking, alcohol, and caffeine......Page 13
Summary......Page 14
References......Page 15
The Genetic Heterogeneity of Uterine Leiomyomata......Page 17
Epidemiologic aspects of genetic liability......Page 19
Heritable diseases related to uterine leiomyomata......Page 20
Clonality studies: glucose-6-phosphate-dehydrogenase analysis......Page 21
Clonality studies: AR gene analysis......Page 22
Genotypic and phenotypic correlations of uterine leiomyomata......Page 23
The t(12;14) subgroup......Page 24
The 6p21 rearrangement subgroup......Page 27
Comparison of HMGA2 and HMGA1......Page 28
The del(7q) subgroup......Page 29
Chromosome 1 rearrangements and fumarate hydratase......Page 30
Cytogenetic characteristics of heritable diseases related to uterine leiomyomata......Page 31
Minor cytogenetic subgroups in uterine leiomyomata......Page 32
Future direction of uterine leiomyomata research......Page 33
Summary......Page 34
References......Page 35
Cellular Biology of Myomas: Interaction of Sex Steroids with Cytokines and Growth Factors......Page 44
Cell proliferation......Page 45
Extracellular matrix accumulation......Page 46
Transforming growth factor-beta......Page 47
Epidermal growth factor......Page 50
Basic fibroblast growth factor......Page 51
Prolactin......Page 52
Monocyte chemotactic protein-1......Page 53
Human chorionic gonadotropin......Page 54
Summary......Page 55
References......Page 56
Steroid Hormones and Leiomyomas......Page 62
Estrogen, selective estrogen receptor modulators, and leiomyomas......Page 63
Aromatase and leiomyomas......Page 65
Progesterone, progestins, antiprogestins, and leiomyomas......Page 66
References......Page 67
Clinical Features of Myomas......Page 71
Abnormal uterine bleeding......Page 72
Pelvic mass symptoms......Page 73
Infertility......Page 76
Pregnancy and the growth of myomas......Page 79
Obstetric complications......Page 80
Malignancy......Page 81
Rare associations......Page 82
Summary......Page 83
References......Page 84
Diagnostic Imaging of Myomas......Page 87
Transvaginal ultrasonography......Page 88
MRI......Page 90
Summary......Page 95
References......Page 96
Options for Medical Treatment of Myomas......Page 98
Estrogen and progestin therapy......Page 99
Gonadotropin-releasing hormone agonists......Page 100
Gonadotropin-releasing hormone antagonists......Page 102
Selective estrogen receptor modulators......Page 103
Mifepristone......Page 105
Androgen therapy......Page 106
Progestin-containing intrauterine contraceptive devices......Page 107
Future directions......Page 108
References......Page 111
Conservative Surgical Management of Uterine Myomas......Page 115
Abdominal myomectomy......Page 116
Laparoscopic myomectomy......Page 118
Myolysis......Page 121
Uterine artery ligation and occlusion......Page 122
References......Page 123
Technical overview of uterine artery embolization......Page 125
Clinical outcomes for uterine artery embolization......Page 127
Submucous and subserosal myomas......Page 130
Uterine artery embolization as a surgical adjuvant......Page 131
Risks of uterine artery embolization for uterine myomas......Page 132
Pregnancy outcome after uterine artery embolization......Page 133
Alternatives to uterine artery embolization......Page 136
Summary: collaborative management of symptomatic leiomyomata......Page 138
References......Page 140
Myomas and Assisted Reproductive Technologies: When and How to Act?......Page 145
Myomas and assisted reproduction......Page 146
Abdominal myomectomy......Page 148
Laparoscopic myomectomy......Page 149
Summary......Page 150
References......Page 151
Prevalence of fibroids in pregnancy......Page 153
Natural history of fibroids in pregnancy......Page 154
Complications of fibroids in pregnancy......Page 155
Pregnancy loss......Page 156
Preterm labor and birth......Page 157
Placental abruption......Page 158
Pain......Page 159
Preeclampsia......Page 160
Malpresentation......Page 161
Cesarean delivery......Page 162
Other complications......Page 163
Preconception myomectomy......Page 164
Antepartum myomectomy......Page 165
Summary......Page 166
References......Page 167
Borderline Smooth Muscle Tumors of the Uterus......Page 170
Evaluation of smooth muscle tumors with standard differentiation......Page 173
Mitotically active leiomyoma (leiomyoma with increased mitotic index)......Page 174
Tumors of uncertain malignant potential......Page 175
Myxoid differentiation......Page 176
Summary......Page 177
References......Page 178
Malignant Transformation of Myomas: Myth or Reality?......Page 181
Can asymptomatic rapidly growing fibroids be observed or must they routinely be removed?......Page 182
Can diagnostic imaging distinguish leiomyosarcomas from uterine leiomyomas?......Page 183
Can a leiomyosarcoma be identified preoperatively using gonadotropin-releasing hormone analogues?......Page 184
Are frozen section examinations at the time of surgery reliable in diagnosing uterine leiomyosarcoma?......Page 185
Can fertility be preserved following a myomectomy for a leiomyosarcoma?......Page 186
Does morcellation of a leiomyosarcoma influence management?......Page 188
Is it always necessary surgically to stage patients with leiomyosarcomas?......Page 189
Can molecular biology be used to determine the biologic aggressiveness of leiomyosarcomas?......Page 190
Should all women with stage I uterine leiomyosarcomas receive postoperative adjuvant chemotherapy?......Page 191
Can hormone-replacement therapy be safely given to a woman following treatment for a leiomyosarcoma?......Page 192
References......Page 193
Future Directions in Myoma Research......Page 197
Risk factors......Page 198
Sex steroids......Page 200
Cytokines, growth factors, and growth factor receptors......Page 203
Extracellular matrix......Page 206
Gonadotropin-releasing hormone agonists......Page 208
Uterine artery embolization......Page 209
Hysterectomy......Page 211
Myomectomy......Page 212
MRI-guided focused ultrasound therapy......Page 213
Somatostatin analogues......Page 214
Aromatase inhibitors......Page 215
Future directions in myoma research......Page 216
References......Page 217