Identifcation of up-regulated genes in human uterine leiomyoma by sup-pression subtractive hybridization

In searching for differentially expressed genes in human uterine leiomyomas (ULs), suppression sub-tractive hybridization was used to construct an UL up-regulated library, which turned out to represent 88genes. After two rounds of screening by reverse Northern analysis, twenty genes were proved to be up-regulated, including seventeen known genes and three genes with unknown function. All these genes werefirstly associated with UL. Three genes with notable difference were selected for Northern confirmationOur results proved the authenticity of the twenty genes. One gene named Phospholipase A2 (PLA2) showedup-regulation in 4/6 of the patients and investigation of tissue distribution indicated that it had obviousexpression in prostate, testis, liver, heart and skeletal muscle.

Uterine artery embolization combined with percutaneous microwave ablation for the treatment of prolapsed uterine submucosal leiomyoma:A case report

BACKGROUND Vaginal myomectomy is the most common form of radical treatment for prolapsed submucosal leiomyoma and is typically performed under general anesthesia.However,an alternative treatment approach is needed for patients who cannot tolerate general anesthesia.We describe a case with such a patient who was successfully treated via a minimally invasive method under local anesthesia.CASE SUMMARY A 46-year-old female suffered from abnormal uterine bleeding,severe anemia,and a reduced quality of life attributed to a massive prolapsed submucosal leiomyoma.She could not tolerate general anesthesia due to a congenital thoracic malformation and cardiopulmonary insufficiency.A new individualized combined treatment,consisting uterine artery embolization(UAE),percutaneous microwave ablation(PMWA)of the pedicle and the endometrium,and transvaginal removal of the leiomyoma by twisting,was performed.The lesion was completely removed successfully under local anesthesia without any major complications.The postoperative follow-up showed complete symptom relief and a significant improvement in the quality of life.CONCLUSION UAE combined with PMWA can be performed under local anesthesia and is a promising alternative treatment for patients who cannot tolerate general anesthesia.

Identification of up-regulated genes in human uterine leiomyoma by sup-pression subtractive hybridization

In searching for differentially expressed genes in human uterine leiomyomas (ULs), suppression sub-tractive hybridization was used to construct an UL up-regulated library, which turned out to represent 88genes. After two rounds of screening by reverse Northern analysis, twenty genes were proved to be up-regulated, including seventeen known genes and three genes with unknown function. All these genes werefirstly associated with UL. Three genes with notable difference were selected for Northern confirmationOur results proved the authenticity of the twenty genes. One gene named Phospholipase A2 (PLA2) showedup-regulation in 4/6 of the patients and investigation of tissue distribution indicated that it had obviousexpression in prostate, testis, liver, heart and skeletal muscle.

Birth outcomes and pregnancy complications of women with uterine leiomyoma—a population-based case-control study

Objective Uterine leiomyoma is not a rare pathological condition in pregnant women;thus the aim of the study was to evaluate the recent progress in the treatment of these pregnant women on the basis of the association of leiomyoma in pregnancy (LP) with pregnancy complications and birth outcomes including structural birth defects, i.e. congenital abnormalities (CA) in the offspring. Design Cases with CA and matched controls without CA in the population-based Hungarian Case-Control Surveillan- ce System of Congenital Abnormalities (HCC SCA) were evaluated. Only women with prospectively and medically recorded LP in prenatal maternity logbook and medically recorded birth outcomes (gestational age, birth weight, CA) were included to the study. Setting the HCCSCA, 1980-1996 contained 22,843 cases with CA and 38,151 matched controls without CA. Population Hungarian pregnant women and their informative offspring: live births, stillbirths and prenatally diagnosed malformed fetuses. Methods Comparison of birth outcomes of ca- ses with matched controls and pregnancy com- plications of pregnant women with or without LP. Main outcome measures Pregnancy complications, mean gestational age at delivery and birth weight, rate of preterm birth, low birthweight, CA. Results A total of 34 (0.15%) cases had mothers with LP compared to 71 (0.19%) controls. There was a higher incidence of threatened abortion, placental disorders, mainly abruption placentae and anaemia in mothers with LP. There was no significantly higher rate of preterm birth in the newborns of women with LP but their mean birth weight was higher and it associated with a higher rate of large birthweight newborns. A higher risk of total CA was not found in cases born to mothers with LP (adjusted OR with 95% CI = 0.7, 0.5-1.1), the spe- cified groups of CAs were also assessed versus controls, but a higher occurrence of women with LP was not revealed in any CA group. Con- clusions Women with LP have a higher risk of threatened abortion, placental disorders and anaemia, but a higher rate of adverse birth outcomes including CAs was not found in their offspring.

A Case Report on Pulmonary Benign Metastasizing Leiomyoma with Recurrent Uterine Fibroids

Pulmonary benign metastasizing leiomyoma(PBML)is a type of benign metastasizing leiomyoma(BML),which metastasizes to lungs.In view of the rarity and nonspecific imaging characteristics of PBML,this condition is easily misdiagnosed as malignant lung cancer.This is a case report of a 39-year-old lady in whom multiple bilateral lung nodules were found during a health checkup and was diagnosed with PBML.The patient had recurrent uterine fibroids and underwent myomectomy twice,7 years and 3 years ago,respectively,before the diagnosis of PBML was made.This patient was asymptomatic,and regular examinations were normal.Her laboratory investigations were all within normal range.Computed tomography(CT)showed multiple nodules in bilateral lungs.In order to confirm the disease,thoracoscopic nodule resection and tissue biopsy were performed.Hematoxylin eosin(HE)staining showed spindle-shaped cells,while immunohistochemical staining revealed positive for desmin,smooth muscle actin(SMA),estrogen receptor(ER),and progesterone receptor(PR),which are all PBML markers.The patient was followed-up without any further treatment.After 8 months of follow-up,CT scan revealed an increased number of nodules.This is unique case because of the recurrence of uterine fibroids,which means that the patient is susceptible to it.Our report may give a new insight to the relationship between the susceptibility of uterine fibroids and the onset and progression of PBML.

子宫肌瘤组织中MMP-2、MLCK、SULT1A3表达及与子宫肌瘤发生的相关性

目的:分析基质金属蛋白酶-2(MMP-2)、肌球蛋白轻链激酶(MLCK)和硫酸基转移酶1A3(SULT1A3)在子宫肌瘤组织中的表达及与子宫肌瘤发生发展的可能关系。方法:收集2019年1月-2021年6月在本院行手术切除治疗的子宫肌瘤患者60例子宫肌瘤组织和正常子宫组织,分别采用RT-PCR技术和免疫组化法测定MMP-2、MLCK、SULT1A3的mRNA及蛋白表达,分析各指标表达与子宫肌瘤发生的相关性。结果:子宫肌瘤组织MMP-2(1.61±0.23)、MLCK(11.87±1.60)的mRNA相对表达量均高于正常子宫组织(1.05±0.09、6.14±1.02),SULT1A3的mRNA相对表达量(0.69±0.11)低于正常子宫组织(1.65±0.44);子宫肌瘤组织中MMP-2蛋白阳性率(68.3%)、MLCK蛋白阳性率(76.7%)均高于正常子宫组织(25.0%、26.7%),子宫肌瘤组织SULT1A3蛋白阳性率(61.7%)低于正常子宫组织(100.0%)(均P<0.05)。mRNA表达,MMP-2与MLCK呈正相关,MMP-2、MLCK与SULT1A3均呈负相关性;蛋白表达,MMP-2与MLCK蛋白表达呈正相关,MMP-2、MLCK与SULT1A3蛋白表达均呈负相关性(均P<0.05)。结论:子宫肌瘤组织中MMP-2、MLCK呈高表达,SULT1A3呈低表达,且各指标具有相关性,这种异常表达可能与子宫肌瘤的发生有关。

Role of epidermal growth factor in pathogenesis of uterine leiomyomas

Objective:To investigate the role of epidermal growth factor(EGF) in the pathogenesis of uterine leiomyomas.Methods:Human myometrial smooth muscle cells(HM-SMCs) and smooth muscle cells of human uterine leiomyomas(HL-SMCs) were separated from patients' specimens and cultured.After processed by EGF or PD98059(inhibitor of MKK/MEK) +EGF,the proliferation rate of both SMCs was detected by BrdU method and the phosphorylation level of p44/42 mitogen-activated protein kinase(MAPK) was determined by Western-blot.After different processing time by EGF,the phosphorylation levels of p44/42 MAPK and AKT and p27 expression level in both SMCs were detected by Western-blot.Results:EGF could significantly promote HL-SMCs proliferation and PD98059 could inhibit this effect(P<0.05);besides,PD98059 could inhibit the increase of the phosphorylation level of p44/42 MAPK in both SMCs induced by EGF.When the processing time by EGF was over 15 min,the phosphorylation levels of p44/42 MAPK and AKT in both SMCs decreased sharply and were close to zero:p27 expression in HM-SMCs raised significantly while the upregulation in HL-SMCs was little.Conclusions:EGF could not cause activation of EGFR because of the dephosphorylation of p44/42 MAPK and AKT in HL-SMCs,which caused p27 expression insufficiently and cell cycle dysregulation.

A Systematic Review on Efficacy and Safety of Gasless Laparoscopy in the Management of Uterine Leiomyoma

Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy（GLM） in the management of uterine leiomyoma by comparing GLM with other minimally invasive procedures. Cochrane Library, PubMed, EMBASE, Web of Science, WANFANG database and China National Knowledge Infrastructure（CNKI） were searched for studies published in English or Chinese between January 1995 and May 2015, and related references were traced. Study outcomes from randomized controlled trials and retrospective cohort studies were presented as mean difference（MD） or odds ratio（OR） with a 95% confidence interval（CI）. Seventeen studies（including 1862 patients） meeting the inclusion criteria, including 934 treated with GLM and 928 treated with other minimally invasive procedures were reviewed. The results of meta-analysis revealed that GLM resulted in significantly shorter operating time [MD=–10.34, 95% CI（–18.12, –2.56）, P〈0.00001], shorter hospital stay [MD=–0.47, 95% CI（–0.88, –0.06）], less time to flatus [MD=–2.04, 95% CI（–2.59, –1.48）], less postoperative complications [OR=0.20, 95% CI（0.06, 0.62）] and less blood loss [MD =–30.74, 95% CI（–47.50, –13.98）]. On the other hand, there were no significant differences in duration of post-operative fever [MD=–0.52, 95% CI（–1.46, 0.42）] between the two groups. Additionally, GLM was associated with lower febrile morbidity, lower postoperative abdominal pain, and higher postoperative hemoglobin than other minimally invasive procedures for the treatment of uterine leiomyoma. In conclusion, GLM and other minimally invasive procedures are feasible, safe, and reliable for uterine leiomyoma treatment. However, available studies show that GLM is more effective and safer than other minimally invasive approaches.

Diffuse uterine leiomyomatosis: A case report and review of literature

BACKGROUND Diffuse uterine leiomyomatosis(DUL)is a benign uterine smooth muscle neoplasm with unknown etiology.Since DUL is rarely reported,knowledge regarding it is limited.The rate of early diagnosis is low,and DUL is often misdiagnosed as common multiple uterine leiomyomas before surgery.CASE SUMMARY A 27-year-old patient with no sexual activity presented to the Emergency Department of our hospital complaining of heavy vaginal bleeding.She had a history of uterine fibroids and menorrhagia.Pelvic examination showed a regularly enlarged uterus,similar in size to that associated with a 4-mo pregnancy.Pelvic magnetic resonance imaging(MRI)revealed numerous multiple uterine fibroids,and a transabdominal myomectomy(TM)was performed.Intraoperative exploration revealed that the myometrium was full of myoma nodules of variable sizes.Over 50 leiomyomas were removed.The pathology report confirmed leiomyoma.The patient was discharged and received a gonadotropin-releasing hormone analog(3.75 mg)for 6 mo.Ten months after surgery,the patient presented to the hospital again for abnormal uterine bleeding.MRI showed an irregular mass with a diameter of 5.2 cm without sharp demarcation in the uterine cavity.Submucosal leiomyoma was considered first,and the patient underwent a hysteroscopic myomectomy plus hymen repair.Intraoperative exploration showed that there were several leiomyomatosis masses in the cavity.Postoperative pathological exam-ination confirmed submucosal leiomyoma and necrotic and generative tissue.Although the menstrual cycle was still irregular,the patient did not have symptoms of menorrhagia for a period of 28 mo after the second surgery.CONCLUSION Individuals with DUL are easily misdiagnosed due to the lack of specific manifestations of this disease.MRI is helpful for early identification and preoperative evaluation.There is currently no unified method of diagnosis.For women who want to preserve fertility,conservative surgery should be made an option.When TM is chosen,a modified new myomectomy should be considered to avoid the drawbacks of traditional TM.

Identification of differentially expressed genes in human uterine leiomyomas using differential display

In searching of differentially expressed genes in human uterine leiomyomas, differential display was used with twelve pairs of primers to compare human uterine leiomyomas with matched myometrium. False positives were eliminated by reverse Northern analysis. Positives were confirmed by Northern blot analysis. RESULTS: Four of 69 cDNA fragments (3 up-regulated named L1, L2 and L3 and 1 down-regulated named M1 in leiomyoma) were confirmed by Northern analysis. Sequence comparison and Northern analysis proved that L1 is exactly the human ribosomal protein S19. It was present ubiquitously in 13 tissues tested but in various levels and even in different size. L1 was highly expressed in parotidean cystadenocarcinoma, pancreatic cancer and breast cancer examined. No mutations have been found in human uterine leiomyomas (n=6). CONCLUSIONS: hRPS19 overexpression might be a universal signal in rapid cell growth tissues.

Effects of Fuke Qianjin Formula on hormones and their receptors and metabonomics study in uterine fibroids model rats

Objective To investigate the effects of different fractions from Fuke Qianjin Formula(妇科千金方,FKQJF)on uterine leiomyoma(UL)to determine the best fraction.Methods FKQJF was extracted and isolated to obtain polysaccharides(FKP),flavonoids(FKF),and grease(FKG).140 female SPF SD rats were divided into 14 groups[model(MOD),normal control(NC),Gouliuqing(GLQ),Mifepristone(MFST),FKQJF,low,medium,and high dose of polysaccharides(l-FKP,m-FKP,and h-FKP),low,medium,and high dose of flavonoids(l-FKF,m-FKF,and h-FKF),low,medium,and high dose of grease(l-FKG,m-FKG,and h-FKG)],and uterine fibroids model rats were treated with drugs for four weeks.Serum levels of estrogen and progesterone were measured using enzyme-linked immunoassay assay(ELISA)kits.The expression of estrogen receptor(ER-α,ER-β)and progesterone receptor(PR)in the uterus was observed using immunohistochemistry(IHC).Serum metabolite profiles and FKG were analyzed using gas chromatography-mass spectrometry(GC-MS).Results FKQJF,h-FKF,m-FKG,and h-FKG significantly downregulated the estrogen level in the uterine fibroid model rats(P<0.01).FKQJF,h-FKF,and h-FKG significantly reduced the level of progesterone in the uterine fibroid model rats(P<0.01).The levels of ER-α,ER-β,and PR in uterine fibroid model rats were significantly decreased by FKQJF and h-FKG(P<0.01).The levels of ER-α,ER-β,and PR in the fibroid model rats were decreased by m-FKG(P<0.05).Additionally,serum metabolism results revealed that h-FKG and FKQJF could regulate related endogenous metabolites and make the pathological indices of uterine fibroids in rats close to the normal group.Forty-six components were identified in the oil,accounting for 91.97%of the total oil components.Conclusion FKQJF and h-FKG showed a significant anti-myoma activity and significantly improved the pathological state of the uterus in rats with hysteromyoma.The mechanism of action may be related to the regulation of estrogen progesterone and its receptor in uterine fibroid model animals.These findings proved the effect of FKQJF on uterine leiomyoma and provided an experimental basis for its clinical research and application.

Efficacy of patient-controlled hydromorphone analgesia in those undergoing uterine fibroid artery embolization via the right radial artery

Objective: To evaluate the efficacy and safety of patient-controlled analgesia(PCA) with hydromorphone as perioperative analgesia during uterine artery embolization(UAE) via the right radial artery.Patients and methods: A total of 33 patients with uterine fibroids, who underwent UAE at the authors’ hospital between June 2021 and March 2022, were selected. Hydromorphone(10 mg) was dispensed into a 100 ml PCA pump with normal saline. Pump administration was initiated 15 min before the start of the procedure, and the intraoperative dose was adjusted according to patient pain level. A numerical rating scale was used to evaluate pain immediately after embolization, 5 min after embolization, at the end of the procedure, and 6, 12, 24, 48, and 72 h after the procedure. Side effects were also observed.Results: Thirty-three patients underwent uterine artery embolization via the right radial artery. Patient pain was well controlled at all time points surveyed, and patients reported satisfaction with analgesia. The median length of hospital stay was 5 days. There were 7 cases of adverse reactions, but no serious side effects were observed.Conclusion: Patients reported positive experiences with arterial embolization of uterine fibroids via the right radial artery. Hydromorphone PCA effectively controlled pain. The PCA pump is easy to operate, has a low incidence of adverse reactions, and offers economic benefits at the patient and institutional levels.

IDENTIFICATION OF DIFFERENTIAL PROTEINS IN UTERINE LEIOMYOMA BY TWO-DIMENSIONAL ELECTROPHORESIS

Objective： To establish and optimize the two-demensional electrophoresis maps of uterine leiomyoma and to study the difference of global protein patterns between uterine leiomyoma and normal myometrium. Methods： Using Two-dimensional electrophoresis followed by computer-assisted image analysis, the differential proteins between uterine leiomyoma and normal myometrium were compared. Results： The well-resolved and reproducible two-dimensional gel electrophoresis patterns of uterine leiomyoma and normal myometrium were established. Totally 1085±108 and 1103±151 protein spots were obtained by using the pH 4-7 IPG strips in uterine leiomyoma and normal myometrium map, respectively, of which 7 spots increased and 15 spots decreased in quantity in uterine leiomyoma compared with normal myometrium. Conclusion： The differentially expressed proteins are useful for studying the mechanism of the cause of uterine leiomyoma.

Candidate Molecules and ki-67/MIB1 as Novel Diagnostic Biomarker for Human Uterine Mesenchymal Tumors

Human uterine leiomyosarcoma (LMS) develops more often in the muscle tissue layer of the uterine body than in the uterine cervix. The development of gynecologic tumors is often correlated with female hormone secretion;however, the development of uterine LMS is not substantially correlated with hormonal conditions, and the risk factors are not yet known. Importantly, a diagnostic-biomarker, which distinguishes malignant uterine LMS from benign tumor leiomyoma (LMA), is yet to be established. Accordingly, it is necessary to analyze risk factors associated with uterine LMS, to establish a clinical treatment method. Protea some β-ring subunit LMP2/β1i-deficient mice spontaneously develop uterine LMS, with a disease prevalence of ~40% by 14 months of age. We found LMP2/β1i expression to be absent in human uterine LMS, but present in human LMA. Therefore, defective-LMP2/β1i expression may be one of the risk factors for human uterine LMS. LMP2/β1i is a potential diagnostic-biomarker under the combination of candidate molecules, for instance cyclin B1, cyclin E and calponin h1 and ki-67/MIB1 counts for uterine mesenchymal tumors, especially human uterine LMS, and may be a targeted-molecule for a new therapeutic approach.

Investigation of amyloid deposition in uterine leiomyoma patients

Objects: To investigate the pathogenesis of amyloid presented in uterine leiomyoma. Methods: 36 uterine leiomyoma patients were recruited and divided into two groups according to Congo red staining results. 6 cases are Congo red staining-positive, and 30 cases Congo red staining-negative which represented amyloid positive and amyloid negative respectively. All patients’ serum total protein (TP), albumin (Alb) and prealbumin (PA) levels were measured as well as blood hemoglobin (Hb), cell counts of white blood cell (WBC), neutrophils (NEU) and lymphocyte (LYM). Glycogen in tissue was compared between amyloid accumulated and amyloid negative sections with periodic acid schiff staining (PAS) in leiomyoma patients. Results: All of blood Hb concentration, WBC, NEU and LYM have not been found significant differences between two groups. Also no obvious infiltration of inflammatory cells was observed in tissue with amyloid deposition in uterine leiomyoma patients. And levels of TP, Alb and prealbumin have not been found significant differences between two groups. The amyloid was negative in leiomyoma entity cells range by Congo red staining, while small blood vessels in myoma tissues were positively detected with high rate. Amyloid was found in normal tissue around myoma as well as in blood vessel of pseudo-capsule. Increased PAS-positive material induced by leiomyoma was not correlated with amyloid deposition. Conclusions: Metabolic changes in the setting of functional alterations of cell in local microenvironment with uterine leiomyoma, may be related to the amyloid deposition.

Study of 41 Cases of Pregnancy after Uterine Leiomyoma Treatment by Uterine Artery Embolization (UAE)

Uterine leiomyoma, a benign tumor, may be treated with hormone therapy, conventional surgical resection and uterine artery embolization (UAE): this paper reports the study on safety after UAE treatment. Pregnancy processes and prognoses of a total of 41 cases from 39 patients (two women were pregnant twice) who succeeded to pregnancy after UAE treatment in our clinic were studied. The average age of patients was 34.5 (29 - 40). Patients included 24 cases of multiple uterine leiomyoma and 14 cases of solitary leiomyoma;the average size of leiomyoma was 388.3 cm3 (15 - 1059 cm3) and the average period between UAE operation and pregnancy was 26.5 months (1 - 120). Causes of pregnancy were 29 cases of natural pregnancy and 12 cases of infertility treatment: 28 cases succeeded in delivery, 7 cases resulted in spontaneous abortion, and 6 cases are ongoing. Premature birth, placental abnormality and low-weight babies were observed in 3, 3, and 1 cases, respectively;the latter 1 case was of triplets. Although the incidence of placental abnormality was a little high, no other serious complications were observed, suggesting that pregnancy after UAE has no problem from the obstetric point of view. In the future, UAE is considered to be worthwhile if carefully done for cases who want to become pregnant.

Guinea Pig Model of Uterine Leiomyoma Established by Intragastric Administration of Estrogen

[Objective] The paper was to establish the guinea pig model of uterine leiomyoma by intragastric administration of estrogen and to discuss the effect of different doses and administration cycles on formation of uterine leiomyoma. [Method] Mature female guinea pigs were divided into short term model group and long term model group, and intragastrically administrated with estradiol valerate at the dose of 0.1 mg/100 g body weight twice a week for 6 and 8 weeks respectively. Guinea pigs intragastrically administrated with equal volume of normal saline were set as con- trol. After 6 or 8 weeks, the guinea pigs were sacrificed. The serum levels of estrogen and progesterone were measured by ELISA and the leiomyoma formation rate was measured. Histological changes were compared between treatment group and control group with HE staining. [Results] The leiomyoma formation rate was 30% in short term model group and 40% in long term model group. The overall leiomyoma formation rate was 35%. The serum level of estrogen in model animals increased significantly and the progesterone level decreased in long term model group. Histopathological examination confirmed that the guinea pig model of uterine leiomyoma was established successfully. [Conclusions] Intragastric administration of estrogen is a simple and effective method for establishing guinea pigs model of uterine leiomyoma.

Spontaneous Uterine Perforation Secondary to Leiomyosarcoma Arising in a Uterine Leiomyoma

Histogenesis of uterine leiomyosarcoma has been controversial. It is generally believed that uterine leiomyosarcomas arise de novo, rather than from any precursor lesions. We report an unusual case of spontaneous rupture of leiomyosarcoma arising in pre-existing calcified uterine leiomyoma, which has been monitored over the years after menopause. This case also suggests that spontaneous intraperitoneal hemorrhage associated with malignant transformation of uterine leiomyoma, although rare, should be considered in postmenopausal women presenting with rapid growing uterine mass.

Giant cellular leiomyoma in the broad ligament of the uterus:A case report

BACKGROUND The treatment of large pelvic masses in postmenopausal women is a challenge in clinical practice.Although ultrasound or magnetic resonance imaging can be used to determine the size and location of the mass,it is still difficult to achieve a preoperative diagnosis.The majority of cellular leiomyomas are diagnosed by histopathology after surgery.We report the differential diagnosis and surgical management of a rare case of cellular leiomyoma in the broad ligament of the uterus.CASE SUMMARY A 52-year-old Chinese woman without sexual history was admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine for the first time.The patient had a 1-year history of progressive abdominal enlargement as well as a 2-year history of menopause,and complained of frequent abdominal pain and low-grade fever.Computed tomography of the abdomen showed a solid cystic mass(29.4 cm×18.8 cm×37.7 cm)in the pelvis and abdomen.Moreover,routine blood test results indicated a baseline cancer antigen 125(CA-125)level of 187.7 U/mL and C-reactive protein of 109.58 mg/L.Subsequently,retrograde hysterectomy and bilateral adnexectomy were performed in this patient.On histopathologic examination of the surgical specimen,a rare cellular leiomyoma in the broad ligament was diagnosed.CONCLUSION Clinicians need to constantly improve diagnosis and treatment for the challenges posed during clinical assessment,differential diagnosis,and surgical management.

Uterine Leiomyomas Surgery: Assessment of Five Years in the Gynecology Department of Hôpital du Mali

Uterine leiomyomas (myomas) are the most common benign tumors of the female genital tract. They affect 20% to 25% of women of childbearing age and are 3 to 9 times more common in black women. We initiated this study in order to report the socio-demographic aspects and the indications for leiomyomas surgery at Hôpital du Mali. This was a retro-prospective descriptive study, conducted in the gynecology department of Hôpital du Mali from January 1, 2015 to December 31, 2019. Any patients, regardless of their age, in whom a leiomyomas had been detected and surgically treated were included. We had collected 180 cases of surgery for leiomyomas out of 950 surgical procedures, with a frequency of 18.94%. The 36 - 45 age group represented 45% of our patients with an average age of 35 years. Nulligravida accounted for 48.9% and nulliparous (60%). The main reason for consultation was the desire to become pregnant (53.33%). A history of myomectomy was found out in 15.55% of patients. Pelvic ultrasound figured out 64.44% interstitial myomas. Myomectomy was performed in 88.88% of cases and hysterectomy in 11.12% of cases. Among our patients 39.37% had become pregnant. Operative complications were dominated by anemia 14.44%. Leiomyoma was the histological tissue found in all cases of myomectomy. The average duration of hospitalization was 3 days. Conclusion: Leiomyomas surgery is the first scheduled gynecological surgical activity. Laparotomy remains the primary route of entry. The indications are dominated by the desire for pregnancy.