Myomas

Myomas......Page 1
Myomas......Page 3
Epidemiology of Myomas......Page 5
Prevalence in different populations......Page 6
Prevalence in different race and ethnic groups......Page 7
Are there different types of fibroid disease?......Page 8
Incidence at different ages and progression......Page 9
Hormones and fibroids......Page 10
Hypertension......Page 11
Smoking, alcohol, and caffeine......Page 12
Summary......Page 13
References......Page 14
The Genetic Heterogeneity of Uterine Leiomyomata......Page 16
Epidemiologic aspects of genetic liability......Page 18
Heritable diseases related to uterine leiomyomata......Page 19
Clonality studies: glucose-6-phosphate-dehydrogenase analysis......Page 20
Clonality studies: AR gene analysis......Page 21
Genotypic and phenotypic correlations of uterine leiomyomata......Page 22
The t(12;14) subgroup......Page 23
The 6p21 rearrangement subgroup......Page 26
Comparison of HMGA2 and HMGA1......Page 27
The del(7q) subgroup......Page 28
Chromosome 1 rearrangements and fumarate hydratase......Page 29
Cytogenetic characteristics of heritable diseases related to uterine leiomyomata......Page 30
Minor cytogenetic subgroups in uterine leiomyomata......Page 31
Future direction of uterine leiomyomata research......Page 32
Summary......Page 33
References......Page 34
Cellular Biology of Myomas: Interaction of Sex Steroids with Cytokines and Growth Factors......Page 43
Cell proliferation......Page 44
Extracellular matrix accumulation......Page 45
Transforming growth factor-beta......Page 46
Epidermal growth factor......Page 49
Basic fibroblast growth factor......Page 50
Prolactin......Page 51
Monocyte chemotactic protein-1......Page 52
Human chorionic gonadotropin......Page 53
Summary......Page 54
References......Page 55
Steroid Hormones and Leiomyomas......Page 61
Estrogen, selective estrogen receptor modulators, and leiomyomas......Page 62
Aromatase and leiomyomas......Page 64
Progesterone, progestins, antiprogestins, and leiomyomas......Page 65
References......Page 66
Clinical Features of Myomas......Page 70
Abnormal uterine bleeding......Page 71
Pelvic mass symptoms......Page 72
Infertility......Page 75
Pregnancy and the growth of myomas......Page 78
Obstetric complications......Page 79
Malignancy......Page 80
Rare associations......Page 81
Summary......Page 82
References......Page 83
Diagnostic Imaging of Myomas......Page 86
Transvaginal ultrasonography......Page 87
MRI......Page 89
Summary......Page 94
References......Page 95
Options for Medical Treatment of Myomas......Page 97
Estrogen and progestin therapy......Page 98
Gonadotropin-releasing hormone agonists......Page 99
Gonadotropin-releasing hormone antagonists......Page 101
Selective estrogen receptor modulators......Page 102
Mifepristone......Page 104
Androgen therapy......Page 105
Progestin-containing intrauterine contraceptive devices......Page 106
Future directions......Page 107
References......Page 110
Conservative Surgical Management of Uterine Myomas......Page 114
Abdominal myomectomy......Page 115
Laparoscopic myomectomy......Page 117
Myolysis......Page 120
Uterine artery ligation and occlusion......Page 121
References......Page 122
Technical overview of uterine artery embolization......Page 124
Clinical outcomes for uterine artery embolization......Page 126
Submucous and subserosal myomas......Page 129
Uterine artery embolization as a surgical adjuvant......Page 130
Risks of uterine artery embolization for uterine myomas......Page 131
Pregnancy outcome after uterine artery embolization......Page 132
Alternatives to uterine artery embolization......Page 135
Summary: collaborative management of symptomatic leiomyomata......Page 137
References......Page 139
Myomas and Assisted Reproductive Technologies: When and How to Act?......Page 144
Myomas and assisted reproduction......Page 145
Abdominal myomectomy......Page 147
Laparoscopic myomectomy......Page 148
Summary......Page 149
References......Page 150
Prevalence of fibroids in pregnancy......Page 152
Natural history of fibroids in pregnancy......Page 153
Complications of fibroids in pregnancy......Page 154
Pregnancy loss......Page 155
Preterm labor and birth......Page 156
Placental abruption......Page 157
Pain......Page 158
Preeclampsia......Page 159
Malpresentation......Page 160
Cesarean delivery......Page 161
Other complications......Page 162
Preconception myomectomy......Page 163
Antepartum myomectomy......Page 164
Summary......Page 165
References......Page 166
Borderline Smooth Muscle Tumors of the Uterus......Page 169
Evaluation of smooth muscle tumors with standard differentiation......Page 172
Mitotically active leiomyoma (leiomyoma with increased mitotic index)......Page 173
Tumors of uncertain malignant potential......Page 174
Myxoid differentiation......Page 175
Summary......Page 176
References......Page 177
Malignant Transformation of Myomas: Myth or Reality?......Page 180
Can asymptomatic rapidly growing fibroids be observed or must they routinely be removed?......Page 181
Can diagnostic imaging distinguish leiomyosarcomas from uterine leiomyomas?......Page 182
Can a leiomyosarcoma be identified preoperatively using gonadotropin-releasing hormone analogues?......Page 183
Are frozen section examinations at the time of surgery reliable in diagnosing uterine leiomyosarcoma?......Page 184
Can fertility be preserved following a myomectomy for a leiomyosarcoma?......Page 185
Does morcellation of a leiomyosarcoma influence management?......Page 187
Is it always necessary surgically to stage patients with leiomyosarcomas?......Page 188
Can molecular biology be used to determine the biologic aggressiveness of leiomyosarcomas?......Page 189
Should all women with stage I uterine leiomyosarcomas receive postoperative adjuvant chemotherapy?......Page 190
Can hormone-replacement therapy be safely given to a woman following treatment for a leiomyosarcoma?......Page 191
References......Page 192
Future Directions in Myoma Research......Page 196
Risk factors......Page 197
Sex steroids......Page 199
Cytokines, growth factors, and growth factor receptors......Page 202
Extracellular matrix......Page 205
Gonadotropin-releasing hormone agonists......Page 207
Uterine artery embolization......Page 208
Hysterectomy......Page 210
Myomectomy......Page 211
MRI-guided focused ultrasound therapy......Page 212
Somatostatin analogues......Page 213
Aromatase inhibitors......Page 214
Future directions in myoma research......Page 215
References......Page 216