Myomas:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
2006
|
| Series: | Obstetrics and gynecology clinics of North America
33,1 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XVIII, 231 S. Ill. |
| ISBN: | 1416035362 |
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| 650 | 4 | |a Leiomyoma | |
| 650 | 4 | |a Muscles |x Tumors | |
| 650 | 4 | |a Uterine Neoplasms | |
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CONTENTS
Foreword xv
William F. Rayburn
Preface xvii
Aydin Arici
Epidemiology of Myomas 1
Mark Pay son, Phyllis Leppert, and James Segars
About one in four American women experience symptoms from
fibroids in their lifetime. Half of American women have ultrasound
evidence of fibroids by the time of menopause. The prevalence of
fibroid disease varies by race and geography. Fibroids are associated
with hypertension and factors that cause uterine irritation, such as
infection. There may be different types of fibroid disease.
The Genetic Heterogeneity of Uterine Leiomyomata 13
Melissa K. Lobel, Priya Somasundaram, and Cynthia C. Morton
Uterine leiomyomata (UL) are the most common pelvic tumor in
women, and are remarkably heterogeneous in terms of their clini¬
cal, pathologic, and cytogenetic attributes. Despite the major pub¬
lic health impact of this disease, current treatments are largely
invasive and the exact cause of UL remains unknown. Research has
indicated, however, a strong genetic component to tumor develop¬
ment and the heritability of UL by epidemiologic, molecular, and
cytogenetic studies is being investigated actively. Although certain
genes have already been identified as having a role in UL patho
genesis, future research strives to clarify the etiology of these tumors
and eventually to develop less invasive treatment options.
i VOLUME 33 • NUMBER 1 • MARCH 2006 ix
i
i
Cellular Biology of Myomas: Interaction of Sex Steroids with
Cytokines and Growth Factors 41
Ibrahim Sozen and Aydin Arid
Uterine leiomyomata are the most common benign tumors in
women of reproductive age. This article reviews the current evi¬
dence pointing out the pivotal roles of cytokines and growth fac¬
tors in the pathophysiology of leiomyomata at the cellular level,
updating a previous review published in 2002. First discussed are
the two most common mechanisms involved in the pathogenesis
of leiomyomata, and then reviewed are the individual growth fac¬
tors and cytokines that have been implicated in leiomyoma.
Steroid Hormones and Leiomyomas 59
Erica E. Marsh and Serdar E. Bulun
This article reviews and summarizes what is known about the roles
of hormones in leiomyoma growth. Discussed primarily are the
roles of the sex steroid hormones estrogen and progesterone in
leiomyoma pathophysiology and the relationship between these
hormones and known leiomyoma growth factors. Also discussed
are the lessons learned about leiomyoma growth from the sex steroid
receptor modulators and antagonists and their potential thera¬
peutic benefits.
Clinical Features of Myomas 69
Orhan Bukulmez and Kevin J. Doody
Myomas are the most common solid pelvic tumors in women. They
are the primary indication for hysterectomy and the cause of sig¬
nificant morbidity from profuse menstrual bleeding and pelvic
discomfort to reproductive problems. Most uterine myomas cause
no symptoms. The role of uterine myomas as a possible cause of
infertility is still a matter of debate. Myomas may be associated with
miscarriage and obstetric complications in pregnancy. Malignant
transformation of myomas is a very rare event. Several myoma
associated familial syndromes have been defined. More studies are
needed to define natural clinical history of uterine myomas.
Diagnostic Imaging of Myomas 85
Danielle Vitiello and Shirley McCarthy
As treatment options become less invasive and more sophisticated
it is imperative that benign myomas be distinguished from poten¬
tial malignant conditions without falter. The radiologic pathologic
correlations have been integral to our ability to characterize and to
localize uterine leiomyomas with accuracy. Transvaginal ultra¬
sound remains the standard assessment tool. Its usefulness may be
enhanced by sonohysterography or transabdominal ultrasound in
certain circumstances; however, it falls short in its ability to map
x CONTENTS
multiple myomas or those in large volume uteri. MRI has become
ultrasound s complement and far exceeds ultrasound s technical
limitations in precise fibroid mapping and characterization.
Options for Medical Treatment of Myomas 97
Beth W. Rackow and Aydin Arici
Uterine myomas are a prevalent issue for women of reproductive
age. For patients who desire future fertility or conservative man¬
agement of myomas, medical therapies can be an effective manage¬
ment option. Estrogen and progesterone impact myoma growth
and development, and current medical therapies manipulate these
steroid hormones to affect myoma size and abnormal bleeding.
Future therapies are likely to target more specific hormone regula¬
tion, growth factors, or gene regulation.
Conservative Surgical Management of Uterine Myomas 115
David L. Olive, Steven R. Lindheim, and Elizabeth A. Pritts
Given the increasing demand for a more conservative approach to
the patient who has uterine leiomyomata, it is incumbent upon the
practicing gynecologist to be aware of the many treatment alterna¬
tives to hysterectomy. Therapeutic options are available that pre¬
serve the uterus in situ, and allow an attempt at conception if the
patient so desires. This article focuses upon the surgical options
that are available to preserve the uterus in the face of symptomatic
uterine fibroids.
Uterine Artery Embolization as a Treatment Option for
Uterine Myomas 125
Paul B. Marshburn, Michelle L. Matthews, and Bradley S. Hurst
Results from clinical series indicate that uterine artery emboliza¬
tion (UAE) improves pelvic symptoms and excessive uterine bleed¬
ing that are caused by uterine leiomyomata. Randomized controlled
trials have not been conducted to provide data on the long term effi¬
cacy and risks of UAE compared with conventional surgical options.
Even without controlled studies, demand for this procedure has
increased rapidly. UAE may be considered an alternative to hysterec¬
tomy, or perhaps myomectomy in well selected cases. Posttreatment
hospitalization and recovery tend to be shorter after UAE compared
with hysterectomy. UAE should not be recommended routinely for
women who desire future fertility. Collaborative efforts between
gynecologists and interventional radiologists are necessary to opti¬
mize the safety and efficacy of UAE.
CONTENTS *i
Myomas and Assisted Reproductive Technologies: When
and How to Act? 145
Aytug Kolankaya and Aydin Arid
Myomas are the most common benign neoplasms in women of
reproductive age and may be associated with infertility. The deci¬
sion to treat myomas actively before initiating assisted reproduc¬
tive techniques (ART) depends mainly on the location, rather than
the size, of the myomas. Consensus exists for surgical removal of
submucous myomas, preferably by hysteroscopic resection, and
for no intervention for subserous myomas. Surgical treatment for
intramural myomas that deform the endometrial cavity also is rec¬
ommended, especially if there is a history of failed ART cycles. The
approach for intramural myomas away from the endometrium is
still an issue of debate.
Obstetric Complications of Fibroids 153
David W. Ouyang, Katherine E. Economy, and Errol R. Norwitz
Uterine fibroids (leiomyomas) are common benign tumors of uter¬
ine smooth muscle. They vary widely in number, size, and location.
The effect of uterine fibroids on fecundity and pregnancy outcome
remains controversial. In general, the literature tends to underesti¬
mate the prevalence of myomas in pregnancy and overestimate the
complications that are attributed to them. This article reviews in
detail the current literature regarding the effect of uterine fibroids on
pregnancy outcome, the mechanisms by which fibroids may com¬
plicate pregnancy, and the usefulness of medical and surgical inter¬
ventions that are used to prevent and treat such complications.
Borderline Smooth Muscle Tumors of the Uterus 171
Naciye Mulayim and Fatih Gucer
Intermediate or borderline uterine smooth muscle tumors can be
challenging even for the most experienced pathologist. Tumor cell
necrosis, atypia, and mitotic index enable classification into prog¬
nostic categories in most cases. The clinician is faced with the fact
that clinical outcome does not always correlate with morphologic
features. In rare tumors, determination of prognosis is impossible
because of limited clinical experience. Studies on molecular mark¬
ers of prognosis hold promise for the future.
Malignant Transformation of Myomas: Myth or Reality? 183
Peter E. Schwartz and Michael G. Kelly
The possibility that a fibroid may actually be a smooth muscle
tumor of uncertain malignant potential or a leiomyosarcoma often
dictates the clinical management of rapidly growing fibroids. This
article provides a clinicopathologic background regarding uterine
xii CONTENTS
leiomyosarcomas and answers common questions that obstetricians
and gynecologists have about the management of rapidly growing
fibroids and leiomyosarcoma. The clinician must be aware that the
infrequent occurrence of uterine leiomyosarcomas makes it difficult
to establish absolutely firm recommendations for the diagnosis and
management of this disease, particularly with regard to fertility
preservation. Nevertheless, this article addresses major issues that a
clinician might face in the evaluation of a smooth muscle tumor of
the uterus that clinically may be malignant.
Future Directions in Myoma Research 199
Pavna K. Brahma, Kristina M. Martel, and
Gregory M. Christman
This article highlights our current knowledge of fibroids and
addresses future directions for fibroid research and treatment over
the next decade. The available data on cytogenetics are discussed, in
addition to discoveries into signaling pathways and second mes¬
senger molecules in leiomyomas. Current medical management,
surgical trends and the barriers to transition to minimally invasive
procedures are summarized. Innovations in genetic diagnosis and
intervenrional radiologic aided therapies may revolutionize therapy
for certain populations of patients who have fibroids. From tissue
specific medical management, to minimally invasive surgical tech¬
niques, to pharmacogenetics, the current directions of fibroid
research are leading us to an exciting new frontier.
Index 225
; CONTENTS xiii
|
| adam_txt |
\no\i\s
CONTENTS
Foreword xv
William F. Rayburn
Preface xvii
Aydin Arici
Epidemiology of Myomas 1
Mark Pay son, Phyllis Leppert, and James Segars
About one in four American women experience symptoms from
fibroids in their lifetime. Half of American women have ultrasound
evidence of fibroids by the time of menopause. The prevalence of
fibroid disease varies by race and geography. Fibroids are associated
with hypertension and factors that cause uterine irritation, such as
infection. There may be different types of fibroid disease.
The Genetic Heterogeneity of Uterine Leiomyomata 13
Melissa K. Lobel, Priya Somasundaram, and Cynthia C. Morton
Uterine leiomyomata (UL) are the most common pelvic tumor in
women, and are remarkably heterogeneous in terms of their clini¬
cal, pathologic, and cytogenetic attributes. Despite the major pub¬
lic health impact of this disease, current treatments are largely
invasive and the exact cause of UL remains unknown. Research has
indicated, however, a strong genetic component to tumor develop¬
ment and the heritability of UL by epidemiologic, molecular, and
cytogenetic studies is being investigated actively. Although certain
genes have already been identified as having a role in UL patho
genesis, future research strives to clarify the etiology of these tumors
and eventually to develop less invasive treatment options.
i VOLUME 33 • NUMBER 1 • MARCH 2006 ix
i
i
Cellular Biology of Myomas: Interaction of Sex Steroids with
Cytokines and Growth Factors 41
Ibrahim Sozen and Aydin Arid
Uterine leiomyomata are the most common benign tumors in
women of reproductive age. This article reviews the current evi¬
dence pointing out the pivotal roles of cytokines and growth fac¬
tors in the pathophysiology of leiomyomata at the cellular level,
updating a previous review published in 2002. First discussed are
the two most common mechanisms involved in the pathogenesis
of leiomyomata, and then reviewed are the individual growth fac¬
tors and cytokines that have been implicated in leiomyoma.
Steroid Hormones and Leiomyomas 59
Erica E. Marsh and Serdar E. Bulun
This article reviews and summarizes what is known about the roles
of hormones in leiomyoma growth. Discussed primarily are the
roles of the sex steroid hormones estrogen and progesterone in
leiomyoma pathophysiology and the relationship between these
hormones and known leiomyoma growth factors. Also discussed
are the lessons learned about leiomyoma growth from the sex steroid
receptor modulators and antagonists and their potential thera¬
peutic benefits.
Clinical Features of Myomas 69
Orhan Bukulmez and Kevin J. Doody
Myomas are the most common solid pelvic tumors in women. They
are the primary indication for hysterectomy and the cause of sig¬
nificant morbidity from profuse menstrual bleeding and pelvic
discomfort to reproductive problems. Most uterine myomas cause
no symptoms. The role of uterine myomas as a possible cause of
infertility is still a matter of debate. Myomas may be associated with
miscarriage and obstetric complications in pregnancy. Malignant
transformation of myomas is a very rare event. Several myoma
associated familial syndromes have been defined. More studies are
needed to define natural clinical history of uterine myomas.
Diagnostic Imaging of Myomas 85
Danielle Vitiello and Shirley McCarthy
As treatment options become less invasive and more sophisticated
it is imperative that benign myomas be distinguished from poten¬
tial malignant conditions without falter. The radiologic pathologic
correlations have been integral to our ability to characterize and to
localize uterine leiomyomas with accuracy. Transvaginal ultra¬
sound remains the standard assessment tool. Its usefulness may be
enhanced by sonohysterography or transabdominal ultrasound in
certain circumstances; however, it falls short in its ability to map
x CONTENTS
multiple myomas or those in large volume uteri. MRI has become
ultrasound's complement and far exceeds ultrasound's technical
limitations in precise fibroid mapping and characterization.
Options for Medical Treatment of Myomas 97
Beth W. Rackow and Aydin Arici
Uterine myomas are a prevalent issue for women of reproductive
age. For patients who desire future fertility or conservative man¬
agement of myomas, medical therapies can be an effective manage¬
ment option. Estrogen and progesterone impact myoma growth
and development, and current medical therapies manipulate these
steroid hormones to affect myoma size and abnormal bleeding.
Future therapies are likely to target more specific hormone regula¬
tion, growth factors, or gene regulation.
Conservative Surgical Management of Uterine Myomas 115
David L. Olive, Steven R. Lindheim, and Elizabeth A. Pritts
Given the increasing demand for a more conservative approach to
the patient who has uterine leiomyomata, it is incumbent upon the
practicing gynecologist to be aware of the many treatment alterna¬
tives to hysterectomy. Therapeutic options are available that pre¬
serve the uterus in situ, and allow an attempt at conception if the
patient so desires. This article focuses upon the surgical options
that are available to preserve the uterus in the face of symptomatic
uterine fibroids.
Uterine Artery Embolization as a Treatment Option for
Uterine Myomas 125
Paul B. Marshburn, Michelle L. Matthews, and Bradley S. Hurst
Results from clinical series indicate that uterine artery emboliza¬
tion (UAE) improves pelvic symptoms and excessive uterine bleed¬
ing that are caused by uterine leiomyomata. Randomized controlled
trials have not been conducted to provide data on the long term effi¬
cacy and risks of UAE compared with conventional surgical options.
Even without controlled studies, demand for this procedure has
increased rapidly. UAE may be considered an alternative to hysterec¬
tomy, or perhaps myomectomy in well selected cases. Posttreatment
hospitalization and recovery tend to be shorter after UAE compared
with hysterectomy. UAE should not be recommended routinely for
women who desire future fertility. Collaborative efforts between
gynecologists and interventional radiologists are necessary to opti¬
mize the safety and efficacy of UAE.
CONTENTS *i
Myomas and Assisted Reproductive Technologies: When
and How to Act? 145
Aytug Kolankaya and Aydin Arid
Myomas are the most common benign neoplasms in women of
reproductive age and may be associated with infertility. The deci¬
sion to treat myomas actively before initiating assisted reproduc¬
tive techniques (ART) depends mainly on the location, rather than
the size, of the myomas. Consensus exists for surgical removal of
submucous myomas, preferably by hysteroscopic resection, and
for no intervention for subserous myomas. Surgical treatment for
intramural myomas that deform the endometrial cavity also is rec¬
ommended, especially if there is a history of failed ART cycles. The
approach for intramural myomas away from the endometrium is
still an issue of debate.
Obstetric Complications of Fibroids 153
David W. Ouyang, Katherine E. Economy, and Errol R. Norwitz
Uterine fibroids (leiomyomas) are common benign tumors of uter¬
ine smooth muscle. They vary widely in number, size, and location.
The effect of uterine fibroids on fecundity and pregnancy outcome
remains controversial. In general, the literature tends to underesti¬
mate the prevalence of myomas in pregnancy and overestimate the
complications that are attributed to them. This article reviews in
detail the current literature regarding the effect of uterine fibroids on
pregnancy outcome, the mechanisms by which fibroids may com¬
plicate pregnancy, and the usefulness of medical and surgical inter¬
ventions that are used to prevent and treat such complications.
Borderline Smooth Muscle Tumors of the Uterus 171
Naciye Mulayim and Fatih Gucer
Intermediate or borderline uterine smooth muscle tumors can be
challenging even for the most experienced pathologist. Tumor cell
necrosis, atypia, and mitotic index enable classification into prog¬
nostic categories in most cases. The clinician is faced with the fact
that clinical outcome does not always correlate with morphologic
features. In rare tumors, determination of prognosis is impossible
because of limited clinical experience. Studies on molecular mark¬
ers of prognosis hold promise for the future.
Malignant Transformation of Myomas: Myth or Reality? 183
Peter E. Schwartz and Michael G. Kelly
The possibility that a fibroid may actually be a smooth muscle
tumor of uncertain malignant potential or a leiomyosarcoma often
dictates the clinical management of rapidly growing fibroids. This
article provides a clinicopathologic background regarding uterine
xii CONTENTS
leiomyosarcomas and answers common questions that obstetricians
and gynecologists have about the management of rapidly growing
fibroids and leiomyosarcoma. The clinician must be aware that the
infrequent occurrence of uterine leiomyosarcomas makes it difficult
to establish absolutely firm recommendations for the diagnosis and
management of this disease, particularly with regard to fertility
preservation. Nevertheless, this article addresses major issues that a
clinician might face in the evaluation of a smooth muscle tumor of
the uterus that clinically may be malignant.
Future Directions in Myoma Research 199
Pavna K. Brahma, Kristina M. Martel, and
Gregory M. Christman
This article highlights our current knowledge of fibroids and
addresses future directions for fibroid research and treatment over
the next decade. The available data on cytogenetics are discussed, in
addition to discoveries into signaling pathways and second mes¬
senger molecules in leiomyomas. Current medical management,
surgical trends and the barriers to transition to minimally invasive
procedures are summarized. Innovations in genetic diagnosis and
intervenrional radiologic aided therapies may revolutionize therapy
for certain populations of patients who have fibroids. From tissue
specific medical management, to minimally invasive surgical tech¬
niques, to pharmacogenetics, the current directions of fibroid
research are leading us to an exciting new frontier.
Index 225
; CONTENTS xiii |
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| series | Obstetrics and gynecology clinics of North America |
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| spelling | Myomas guest ed. Aydin Arici Philadelphia [u.a.] Saunders 2006 XVIII, 231 S. Ill. txt rdacontent n rdamedia nc rdacarrier Obstetrics and gynecology clinics of North America 33,1 Myoma gtt Leiomyoma Muscles Tumors Uterine Neoplasms Uterine fibroids Uterus Uterus Diseases Arici, Aydin Sonstige oth Obstetrics and gynecology clinics of North America 33,1 (DE-604)BV000617486 33,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014763287&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Myomas Obstetrics and gynecology clinics of North America Myoma gtt Leiomyoma Muscles Tumors Uterine Neoplasms Uterine fibroids Uterus Uterus Diseases |
| title | Myomas |
| title_auth | Myomas |
| title_exact_search | Myomas |
| title_exact_search_txtP | Myomas |
| title_full | Myomas guest ed. Aydin Arici |
| title_fullStr | Myomas guest ed. Aydin Arici |
| title_full_unstemmed | Myomas guest ed. Aydin Arici |
| title_short | Myomas |
| title_sort | myomas |
| topic | Myoma gtt Leiomyoma Muscles Tumors Uterine Neoplasms Uterine fibroids Uterus Uterus Diseases |
| topic_facet | Myoma Leiomyoma Muscles Tumors Uterine Neoplasms Uterine fibroids Uterus Uterus Diseases |
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