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Miyashita-Ishiwata M, El Sabeh M, Reschke LD, Afrin S, Borahay MA. Differential response to hypoxia in leiomyoma and myometrial cells. Life Sci 2022; 290:120238. [PMID: 34942165 PMCID: PMC8757389 DOI: 10.1016/j.lfs.2021.120238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 02/03/2023]
Abstract
AIMS Recent evidence suggests that repetitive hypoxia occurs during menstrual cycles due to vasoconstriction and myometrial contraction. It is unknown if hypoxia contributes to the development of uterine leiomyoma, the most common tumor of the female reproductive system. This study aims to characterize the response to hypoxia in leiomyoma and myometrial cells; and determine if an aberrant leiomyoma response to hypoxia may contribute to leiomyomatogenesis. MAIN METHODS Primary and immortalized leiomyoma and myometrial cells were cultured under normoxic and hypoxic conditions. Expression levels of vascular endothelial growth factor-A (VEGF-A), adrenomedullin (ADM), endothelin-1 (ET-1), and hypoxia-inducible factor-1 alpha (HIF-1α) were measured by qRT-PCR, western blotting and ELISA. Cell proliferation was assessed using MTT assay and proliferating-cell-nuclear-antigen (PCNA) expression. KC7F2 (HIF-1α inhibitor) was used to examine the regulating mechanisms. KEY FINDINGS As expected, hypoxia induced HIF-1α expression in both leiomyoma and myometrial cells. However, hypoxia induced VEGF-A, ET-1 and ADM expression and VEGF-A secretion into the culture media in leiomyoma but not myometrial cells. MTT assay and PCNA expression showed that hypoxia induces proliferation in leiomyoma, but not myometrial cells. HIF-1α inhibitor abrogated the hypoxia-induced VEGF-A, ET-1, ADM, and PCNA expression in leiomyoma cells. SIGNIFICANCE This study suggests an aberrant leiomyoma cellular response to hypoxia compared to myometrium. This differential response to menstruation-related repetitive hypoxia episodes may lead to selective proliferation of hypoxia-adaptive leiomyoma cells and contribute to leiomyoma growth. Thus, in addition to adding to our understanding of leiomyoma pathobiology, the study proposes angiogenic factors as a potential leiomyoma therapeutic target.
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Affiliation(s)
- Mariko Miyashita-Ishiwata
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA, Address: 4940 Eastern Ave, Baltimore, MD, USA 21224-2780
| | - Malak El Sabeh
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA, Address: 4940 Eastern Ave, Baltimore, MD, USA 21224-2780
| | - Lauren D Reschke
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA, Address: 4940 Eastern Ave, Baltimore, MD, USA 21224-2780
| | - Sadia Afrin
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA, Address: 4940 Eastern Ave, Baltimore, MD, USA 21224-2780
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA, Address: 4940 Eastern Ave, Baltimore, MD, USA 21224-2780,Correspondence address: Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, 720 Rutland Ave, Baltimore, MD, 21205, USA,
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Ciarmela P, Delli Carpini G, Greco S, Zannotti A, Montik N, Giannella L, Giuliani L, Grelloni C, Panfoli F, Paolucci M, Pierucci G, Ragno F, Pellegrino P, Petraglia F, Ciavattini A. Uterine fibroid vascularization: from morphological evidence to clinical implications. Reprod Biomed Online 2021; 44:281-294. [PMID: 34848152 DOI: 10.1016/j.rbmo.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/10/2021] [Indexed: 01/04/2023]
Abstract
Uterine fibroids are the most common cause of solid pelvic tumours, occurring in 20-30% of fertile women and presenting clinical complications that seriously affect women's health. They commonly cause severe symptoms, such as heavy, prolonged menstrual bleeding and anaemia. The study of microscopic and macroscopic vascular aspects of uterine fibroids is important for understanding the clinical manifestations of uterine fibroids, for predicting the effectiveness of alternative treatments to surgery, i.e. uterine artery embolization, for improving surgery outcomes and for carrying out a differential diagnosis with other benign conditions, e.g. adenomyosis, or malignancy, e.g. leiomyosarcoma, and to develop new therapeutic approaches. In this review, current knowledge of how the vascular network and angiogenesis are implied in the formation of uterine fibroids and in the pathogenesis of related symptoms is explored, and evidence on the role of ultrasound in evaluating fibroid vascularization is summarized. This review combines anatomical, morphological and biomolecular information related to angiogenic mechanisms with diagnostic and clinical information, highlighting the various interconnections. Uterine and fibroid vascularization need further investigation to gain a deeper understanding of the pathogenetic elements that lead to the formation of uterine fibroids and their clinical manifestations.
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Affiliation(s)
- Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy.
| | - Giovanni Delli Carpini
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Stefania Greco
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Alessandro Zannotti
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy; Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Nina Montik
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Luca Giannella
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Lucia Giuliani
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Camilla Grelloni
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Francesca Panfoli
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Michela Paolucci
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Gloria Pierucci
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Federica Ragno
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Pamela Pellegrino
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Careggi University Hospital Florence, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
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Yang F, Zhao J, Liu C, Mao Y, Mu J, Wei X, Jia J, Zhang S, Xin X, Tan J. Superb microvascular imaging technique in depicting vascularity in focal liver lesions: more hypervascular supply patterns were depicted in hepatocellular carcinoma. Cancer Imaging 2019; 19:92. [PMID: 31888768 PMCID: PMC6937684 DOI: 10.1186/s40644-019-0277-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To investigate the capacity of Superb Microvascular Imaging (SMI) to detect microvascular details and to explore the different SMI features in various focal liver lesions (FLLs) and the correlation between SMI and microvessel density (MVD). Method: Eighty-three liver lesions were enrolled in our study, including 35 hepatocellular carcinomas (HCCs) and 48 non-HCCs. All patients underwent color Doppler flow imaging (CDFI) and SMI examination and were categorized into subgroups according to Adler semiquantitative grading (grade 0–3) or the microvascular morphologic patterns (pattern a-f). The correlation between SMI blood flow signal percentage and MVD was assessed. Results Compared with CDFI, SMI detected more high-level blood flow signals (grade 2–3) and more hypervascular supply patterns (pattern e-f) in HCCs (p < 0.05). Furthermore, more hypervascular supply patterns and fewer hypovascular supply patterns were detected in HCC compared with non-HCC (p < 0.05). Based on Adler’s grading or microvascular morphologic patterns, the areas under the receiver operating characteristic curve were 0.696 and 0.760 for SMI, 0.583 and 0.563 for CDFI. The modality of “SMI-microvascular morphologic pattern” showed the best diagnostic performance. There was significant correlation between MVD and the SMI blood flow signal percentage (vascular index, VI) in malignant lesions (r = 0.675, p < 0.05). Conclusion SMI was superior to CDFI in detecting microvascular blood flow signals. More hypervascular supply patterns were depicted in HCC than in non-HCC, suggesting a promising diagnostic value for SMI in the differentiation between HCC and non-HCC. Meanwhile, we were the first to demonstrate that SMI blood flow signal percentage (VI) was correlated with MVD in malignant lesions.
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Affiliation(s)
- Fan Yang
- Department of Ultrasound diagnosis and treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, 300060, China
| | - Jing Zhao
- Department of Ultrasound diagnosis and treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, 300060, China
| | - Chunwei Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yiran Mao
- Department of Ultrasound diagnosis and treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, 300060, China
| | - Jie Mu
- Department of Ultrasound diagnosis and treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, 300060, China
| | - Xi Wei
- Department of Ultrasound diagnosis and treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, 300060, China
| | - Jinyan Jia
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Sheng Zhang
- Department of Ultrasound diagnosis and treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, 300060, China
| | - Xiaojie Xin
- Department of Ultrasound diagnosis and treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, 300060, China.
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, 300000, China.
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Doppler sonography of perifibroid and intrafibroid arteries of uterine leiomyomas. Obstet Gynecol Sci 2018; 61:395-403. [PMID: 29780783 PMCID: PMC5956124 DOI: 10.5468/ogs.2018.61.3.395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 08/27/2017] [Accepted: 09/24/2017] [Indexed: 11/08/2022] Open
Abstract
Objective To sonographically evaluate the dominant fibroid nodule vascularity and flow velocity pattern of perifibroid and intrafibroid arteries. Methods We recruited 140 women with uterine fibroids. Their uteri were scanned to determine the vascularity of fibroid nodules and the Doppler indices of the fibroid arteries. Results The median volume of the dominant leiomyoma nodule was 133 cm3 (range=1.5-2,575 cm3). Eighty-three subjects (59.3%) had a dominant leiomyoma nodule volume of ≤200.0 cm3 while the volume of the dominant leiomyoma nodule was >200.0 cm3 in 57 (40.7%) subjects. The dominant fibroid nodule was vascular in 137 (97.9%) subjects and avascular in 3 (2.1%). All the perifibroid artery indices (except the end-diastolic velocity [EDV] and diastolic average ratio [DAR]) are significantly higher than those of the intrafibroid artery. The mean Doppler indices of perifibroid vs. intrafibroid arteries as follows: peak systolic velocity (PSV; 52.1 vs. 45.4 cm/s); EDV (21.1 vs. 22.4 cm/s); time-averaged maximum velocity (TAMX; 31.5 vs. 30.4 cm/s); time- averaged mean velocity (Tmean; 14.3 vs. 13.8 cm/s); pulsatility index (PI; 1.1 vs. 0.8); resistive index (RI; 0.6 vs. 0.5); systolic-diastolic ratio (SDR; 2.7 vs. 2.1); impedance index (ImI; 2.7 vs. 2.1); and DAR (0.66 vs. 0.74); P<0.001 for all indices. Conclusion The predominant pattern of fibroid vascularity is peripheral vascularity and the perifibroid artery indices (except EDV and DAR) are significantly higher than those of the intrafibroid artery. Recurrent fibroids in women with previous myomectomy had significantly higher intrafibroid PI, RI, SDR, and ImI than those without previous myomectomy.
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Kara Bozkurt D, Bozkurt M, Cil AS, Barut MU, Ersahin AA, Çalıskan E. Concomitant use of transvaginal sonography and Doppler indices improve diagnosis of adenomyosis. J OBSTET GYNAECOL 2017; 37:888-895. [DOI: 10.1080/01443615.2016.1256952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Duygu Kara Bozkurt
- Department of Radiology, Kafkas University School of Medicine, Kars, Turkey
| | - Murat Bozkurt
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
| | - Ahmet Said Cil
- Department of Radiology, Universal Hospital Group, Malatya, Turkey
| | - Mert Ulaş Barut
- Department of Obstetrics and Gynecology, Health Woman Research Hospital, Ankara, Turkey
| | - Aynur Adeviye Ersahin
- Department of Obstetrics and Gynecology, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Eray Çalıskan
- Department of Obstetrics and Gynecology, Bahcesehir University Medical Faculty, Istanbul, Turkey
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6
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Nieuwenhuis LL, Keizer AL, Stoelinga B, Twisk J, Hehenkamp W, Brölmann H, Huirne J. Fibroid vascularisation assessed with three-dimensional power Doppler ultrasound is a predictor for uterine fibroid growth: a prospective cohort study. BJOG 2017; 125:577-584. [PMID: 28211610 DOI: 10.1111/1471-0528.14608] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse fibroid vascularisation measured with three-dimensional (3D) power Doppler in relation to absolute fibroid volume change during 12 months of follow up and in relation to fibroid growth rate per year. DESIGN A prospective cohort study was performed between March 2012 and March 2014. SETTING Outpatient clinic of the VU medical centre, Amsterdam. POPULATION OR SAMPLE All premenopausal women diagnosed with a maximum of two fibroids with expectant management were consecutively included. METHODS Three-dimensional ultrasound including power Doppler was performed at baseline, 3, 6 and 12 months. Volume and vascular parameters were calculated using VOCAL software. MAIN OUTCOME MEASURES The relationship between vascular index (VI) at baseline and fibroid volume over time was analysed using linear mixed model analyses for repeated measurements. Second, the relationship between VI at baseline and fibroid growth rate per year was calculated using linear regression analyses. Analyses were adjusted for possible confounders. RESULTS In all, 66 women (mean age 42 years) completed 12 months of follow up without treatment. Baseline fibroid vascularisation (VI) measured with 3D power Doppler is correlated with fibroid volume at 12 months (P = 0.02 ). An increase of 1% in VI at baseline was associated with a 7.00-cm3 larger fibroid volume at 12 months. Furthermore, vascularisation was also associated with fibroid growth rate per year (P = 0.04). CONCLUSION In women with uterine fibroids without therapy, baseline vascularisation (VI) measured with 3D power Doppler is correlated with absolute fibroid volume change at 12 months and with fibroid growth rate per year. TWEETABLE ABSTRACT Fibroid vascularisation correlates with absolute fibroid volume change and fibroid growth rate per year.
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Affiliation(s)
- L L Nieuwenhuis
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - A L Keizer
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - B Stoelinga
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jwr Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Wjk Hehenkamp
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Ham Brölmann
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jaf Huirne
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
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O'Shea T, Bamber J, Fontanarosa D, van der Meer S, Verhaegen F, Harris E. Review of ultrasound image guidance in external beam radiotherapy part II: intra-fraction motion management and novel applications. Phys Med Biol 2016; 61:R90-137. [PMID: 27002558 DOI: 10.1088/0031-9155/61/8/r90] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Imaging has become an essential tool in modern radiotherapy (RT), being used to plan dose delivery prior to treatment and verify target position before and during treatment. Ultrasound (US) imaging is cost-effective in providing excellent contrast at high resolution for depicting soft tissue targets apart from those shielded by the lungs or cranium. As a result, it is increasingly used in RT setup verification for the measurement of inter-fraction motion, the subject of Part I of this review (Fontanarosa et al 2015 Phys. Med. Biol. 60 R77-114). The combination of rapid imaging and zero ionising radiation dose makes US highly suitable for estimating intra-fraction motion. The current paper (Part II of the review) covers this topic. The basic technology for US motion estimation, and its current clinical application to the prostate, is described here, along with recent developments in robust motion-estimation algorithms, and three dimensional (3D) imaging. Together, these are likely to drive an increase in the number of future clinical studies and the range of cancer sites in which US motion management is applied. Also reviewed are selections of existing and proposed novel applications of US imaging to RT. These are driven by exciting developments in structural, functional and molecular US imaging and analytical techniques such as backscatter tissue analysis, elastography, photoacoustography, contrast-specific imaging, dynamic contrast analysis, microvascular and super-resolution imaging, and targeted microbubbles. Such techniques show promise for predicting and measuring the outcome of RT, quantifying normal tissue toxicity, improving tumour definition and defining a biological target volume that describes radiation sensitive regions of the tumour. US offers easy, low cost and efficient integration of these techniques into the RT workflow. US contrast technology also has potential to be used actively to assist RT by manipulating the tumour cell environment and by improving the delivery of radiosensitising agents. Finally, US imaging offers various ways to measure dose in 3D. If technical problems can be overcome, these hold potential for wide-dissemination of cost-effective pre-treatment dose verification and in vivo dose monitoring methods. It is concluded that US imaging could eventually contribute to all aspects of the RT workflow.
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Affiliation(s)
- Tuathan O'Shea
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, London SM2 5NG, UK
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Haugen G, Novakovic Z, Kirste U, Husby H, Dorenberg E. Uterine artery Doppler flow velocity waveform analysis following uterine fibroid embolisation. J OBSTET GYNAECOL 2014; 35:316-7. [PMID: 25058042 DOI: 10.3109/01443615.2014.940298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective was to evaluate the relation of uterine artery Doppler flow pulsatility index (PI) with total uterine volume reduction following bilateral embolisation of uterine fibroids by injection of polyvinyl alcohol particles. Doppler flow velocity was examined before and within 8 days after embolisation (n = 13). Uterine size was assessed by magnetic resonance imaging (MRI) before, and at 3 and 6 months after, the procedure. Mean PI values (mean of right and left side) obtained before embolisation were negatively related to uterine size (r = -0.68, p = 0.010) but not to uterine volume reduction after the procedure. Mean PI values after the procedure were related to the percentage decrease in uterine volume both at 3 (r = 0.74, p = 0.004) and 6 months (p = 0.73, p = 0.005). Doppler ultrasound measures of the uterine arteries may be used to evaluate reduction of uterine size following fibroid embolisation.
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Tal R, Segars JH. The role of angiogenic factors in fibroid pathogenesis: potential implications for future therapy. Hum Reprod Update 2013; 20:194-216. [PMID: 24077979 DOI: 10.1093/humupd/dmt042] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND It is well established that tumors are dependent on angiogenesis for their growth and survival. Although uterine fibroids are known to be benign tumors with reduced vascularization, recent work demonstrates that the vasculature of fibroids is grossly and microscopically abnormal. Accumulating evidence suggests that angiogenic growth factor dysregulation may be implicated in these vascular and other features of fibroid pathophysiology. METHODS Literature searches were performed in PubMed and Google Scholar for articles with content related to angiogenic growth factors and myometrium/leiomyoma. The findings are hereby reviewed and discussed. RESULTS Multiple growth factors involved in angiogenesis are differentially expressed in leiomyoma compared with myometrium. These include epidermal growth factor (EGF), heparin-binding-EGF, vascular endothelial growth factor, basic fibroblast growth factor, platelet-derived growth factor, transforming growth factor-β and adrenomedullin. An important paradox is that although leiomyoma tissues are hypoxic, leiomyoma feature down-regulation of key molecular regulators of the hypoxia response. Furthermore, the hypoxic milieu of leiomyoma may contribute to fibroid development and growth. Notably, common treatments for fibroids such as GnRH agonists and uterine artery embolization (UAE) are shown to work at least partly via anti-angiogenic mechanisms. CONCLUSIONS Angiogenic growth factors play an important role in mechanisms of fibroid pathophysiology, including abnormal vasculature and fibroid growth and survival. Moreover, the fibroid's abnormal vasculature together with its aberrant hypoxic and angiogenic response may make it especially vulnerable to disruption of its vascular supply, a feature which could be exploited for treatment. Further experimental studies are required in order to gain a better understanding of the growth factors that are involved in normal and pathological myometrial angiogenesis, and to assess the potential of anti-angiogenic treatment strategies for uterine fibroids.
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Affiliation(s)
- Reshef Tal
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA
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10
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Istre O. Uterine artery occlusion for the treatment of symptomatic fibroids: Endoscopic, radiological and vaginal approach. MINIM INVASIV THER 2009; 14:167-74. [PMID: 16754159 DOI: 10.1080/13645700510033976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Uterine fibroids are the most common solid pelvic tumors in women. Although many fibroids seem to cause no symptoms, for some women they can have serious adverse effects and impact on quality of life. Common symptoms associated with fibroids include abnormal uterine bleeding, pelvic pressure and reproductive dysfunction. The past decade has witnessed highly sophisticated diagnostic and therapeutic technology for fibroids. The tools currently at our disposal permit greater management flexibility, which must be tailored to the individual clinical situation. Nonsurgical treatments include medical therapy and treatments interfering with the blood supply to the uterus or the fibroid; among the latest introduced are uterine artery embolization performed by the interventional radiologist and laparoscopic uterine occlusion performed by the gynaecologist. Even simpler is the non-incision temporary uterine clamp directed with Doppler and placed in the side fornices in the vagina.
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Affiliation(s)
- Olav Istre
- Department of Gynecology and Obstetrics, Endoscopic Unit, Ullevaal University Hospital, Oslo, Norway.
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Fleischer R, Weston GC, Vollenhoven BJ, Rogers PA. Pathophysiology of fibroid disease: angiogenesis and regulation of smooth muscle proliferation. Best Pract Res Clin Obstet Gynaecol 2008; 22:603-14. [DOI: 10.1016/j.bpobgyn.2008.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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12
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Smith J, Kontermann RE, Embleton J, Kumar S. Antibody phage display technologies with special reference to angiogenesis. FASEB J 2005; 19:331-41. [PMID: 15746176 DOI: 10.1096/fj.04-2863rev] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The presence of blood vessels is a prerequisite for normal development, tissue growth, and tissue repair. However, its abnormal occurrence or absence can also potentiate disease processes. Angiogenic therapies have been used to stimulate blood vessel growth in ischemic conditions such as severe end-stage peripheral vascular disease, ischemic heart disease and stroke and for inhibition of angiogenesis in tumors. The targeting and identification of novel endothelial cell (EC) markers that can ultimately be used in angiogenic strategies is an expanding field but is limited by the availability of reagents. For instance repeated injection of mouse monoclonal antibodies (Mabs) against angiogenic EC, can result in the production of autoantibodies. Therefore, these mouse Mabs cannot be used for therapeutic purposes. Phage display technology was employed in this context to select antibodies, proteins, and peptides against known or novel EC antigens. Furthermore, technologies have been developed that enable the specific targeting of epitopes on cells including the endothelium with high-affinity/avidity antibodies. The focus for these antibody targeting strategies are markers that are unique or up-regulated on angiogenic EC including the vascular endothelial growth factor receptor (VEGFR) KDR, endoglin (CD105), and the extracellular domain B (ED-B) domain of fibronectin (FN). These markers are reviewed herein.
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Affiliation(s)
- Julia Smith
- University of Manchester, Stopford Building, Oxford Rd, Manchester, M13 9PT, UK.
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13
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Poncelet C, Fauvet R, Feldmann G, Walker F, Madelenat P, Darai E. Prognostic value of von Willebrand factor, CD34, CD31, and vascular endothelial growth factor expression in women with uterine leiomyosarcomas. J Surg Oncol 2004; 86:84-90. [PMID: 15112250 DOI: 10.1002/jso.20055] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES To compare uterine leiomyosarcomas (LMS) and leiomyomas (LM) with normal myometrium in terms of microvessel density (MVD), and to correlate this parameter with vascular endothelial growth factor (VEGF) expression and clinical/pathological parameters. METHODS An immunohistochemical technique, using antibodies against von Willebrand factor (FvW), CD34, CD31, and VEGF, was applied to formalin-fixed paraffin-embedded samples of 32 normal myometria, 32 uterine LM, and 12 LMS. MVD was calculated by a digital image analyzer. RESULTS Using anti-FvW, mean +/- SD MVD in myometrium, LM, and LMS was 107.0 +/- 53.6, 66.2 +/- 55.4, and 64.4 +/- 44.2, respectively (P = 0.001). MVD was lower in LMS (P = 0.021) and in LM (P = 0.0004) than in normal myometrium. Using anti-CD34, mean +/- SD MVD in myometrium, LM, and LMS was 187.6 +/- 91.2, 106.1 +/- 55.5, and 114.2 +/- 98.8, respectively (P = 0.001). MVD was lower in LMS (P = 0.012) and LM (P = 0.0004) than in normal myometrium. No such differences were found using anti-CD31 and anti-VEGF. No correlation was found between MVD and VEGF expression. In women with uterine LMS, low MVD (assessed with anti-FvW) correlated with recurrence (P = 0.04) and poor overall survival (P = 0.03). CONCLUSIONS Uterine smooth muscle tumors exhibit a lower MVD than normal myometrium, as assessed using anti-FvW or anti-CD34 antibodies. A reduced MVD, as assessed by FvW staining, has prognostic value in uterine LMS.
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Affiliation(s)
- Christophe Poncelet
- Service d'Histologie et de Biologie Cellulaire, Faculté de Medecine Xavier Bichat, Paris Cedex, France.
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Surrey ES. Impact of intramural leiomyomata on in-vitro fertilization-embryo transfer cycle outcome. Curr Opin Obstet Gynecol 2003; 15:239-42. [PMID: 12858112 DOI: 10.1097/00001703-200306000-00005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The effect of leiomyomata on implantation and pregnancy rates resulting from in-vitro fertilization-embryo transfer has not been clearly defined. Submucosal and intramural leiomyomata which distort the endometrial cavity clearly affect outcome. However, the impact and possible mechanism of action of intramural lesions, which do not clearly alter the contour of the endometrial cavity, remain controversial. This review evaluates recent literature addressing these issues. RECENT FINDINGS Several recent studies have evaluated the impact of leiomyomata on the uterine environment. Alterations in uterine artery blood flow may have an impact on implantation, although conflicting results have been reported. Other recent studies have evaluated alterations in gene expression and local cytokine release which may also play a role. Five recently published clinical case-controlled trials provide conflicting information regarding the impact of these lesions on in-vitro fertilization-embryo transfer cycle outcome as measured by clinical pregnancy and implantation rates. Results varied from no effect to a highly significant and deleterious impact on cycle outcomes. These differences may be partly attributable to differences in patient inclusion criteria and inconsistencies in analyses of precise fibroid location and size. SUMMARY Intramural leiomyomata, which impinge upon the uterine cavity, negatively affect in-vitro fertilization-embryo transfer cycle outcome. Myomectomy should be beneficial in these circumstances despite an absence of data in this regard. No definitive statements can be made regarding intramural leiomyomata, which do not distort the cavity due to differing outcomes from currently available investigations. In the absence of more clear cut data, no recommendation can be made to support routine myomectomy in these cases. Rather, clinical management should be individualized.
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Affiliation(s)
- Eric S Surrey
- Colorado Center for Reproductive Medicine, Englewood, Colorado 80110, USA.
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Poncelet C, Madelenat P, Feldmann G, Walker F, Darai E. Expression of von Willebrand's factor, CD34, CD31, and vascular endothelial growth factor in uterine leiomyomas. Fertil Steril 2002; 78:581-6. [PMID: 12215337 DOI: 10.1016/s0015-0282(02)03301-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the vascular parameters of uterine leiomyomas and normal myometrium, to correlate these parameters with vascular endothelial growth factor (VEGF) expression and clinical/pathological parameters, and to compare vascular parameters according to the endothelial markers used. DESIGN An immunohistochemical technique was applied to formalin-fixed paraffin-embedded tissue samples, using antibodies against von Willebrand's factor (FvW), CD34, CD31, and VEGF. The intratumoral vascular area (VA), microvessel density (MVD), and vascular luminal area (VLA) were determined with an image analyser. SETTING University teaching hospital. PATIENT(S) Thirty-two patients with uterine leiomyomas underwent conservative surgery. Twenty leiomyoma-free patients undergoing hysterectomy were the controls. INTERVENTION(S) Immunohistochemical and morphometrical analysis. MAIN OUTCOME MEASURE(S) Measurements of VA, MVD, and VLA. RESULT(S) The CD34 labeling showed decreased VA in myomas compared with myometrium. Decreased MVD and an increased VLA in myomas were found with FvW and CD34 labeling. The VA, MVD, and VLA were not related to VEGF expression or to clinical/pathological parameters. Similar results for VA and MVD were obtained with FvW and CD34 labeling. CONCLUSION(S) Leiomyomas have a smaller vascular area, a lower microvessel density, and a higher vascular luminal area than normal myometrium.
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Affiliation(s)
- Christophe Poncelet
- Service de Gynécologie-Obstétrique, Hôpital Bichat-Claude Bernard, Paris, France.
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deSouza NM, Williams AD. Uterine arterial embolization for leiomyomas: perfusion and volume changes at MR imaging and relation to clinical outcome. Radiology 2002; 222:367-74. [PMID: 11818601 DOI: 10.1148/radiol.2222010584] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To monitor changes in perfusion and volume of uterus and leiomyomas after bilateral uterine artery embolization (UAE) and to correlate immediate perfusion changes with subsequent reduction in leiomyoma volume and clinical outcome. MATERIALS AND METHODS Eleven consecutive women underwent magnetic resonance (MR) imaging before UAE, immediately after, and at 1 and 4 months. Reduction in maximal enhancement above baseline at 90 seconds (ME(90)) after injection of the dominant leiomyoma immediately after embolization was correlated with its volume reduction at 4 months and with clinical response at 12 months. RESULTS Forty-five leiomyomas were noted (mean, four per patient). Myometrium enhanced briskly (ME(90) of 110%), with a reduction in ME(90) to 26% immediately after embolization. Initial leiomyoma ME(90) was lower (P <.001), but it suppressed to baseline levels immediately after embolization. At 1 and 4 months, myometrial perfusion returned to normal, but leiomyoma perfusion remained suppressed (P <.001). Immediate reduction in leiomyoma ME(90) correlated with clinical response (Spearman rho = 0.64). Leiomyomas initially high in SI on T2-weighted images showed significantly greater volume reduction than those low in SI (P =.006). Well-perfused leiomyomas did not show greater volume reduction than those that were poorly perfused. Volume reduction did not correlate with improvement in clinical symptom score. CONCLUSION Immediate reduction in leiomyoma perfusion after bilateral UAE correlates with clinical response, whereas leiomyomas initially high in SI on T2-weighted images indicate a likely greater volume reduction.
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Affiliation(s)
- Nandita M deSouza
- Robert Steiner Magnetic Resonance Unit, Department of Imaging, Faculty of Medicine at Imperial College, Hammersmith Hospital, DuCane Rd, London W12 0HS, England.
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Gregoriou O, Konidaris S, Botsis D, Papadias C, Makrakis E, Creatsas G. Long term effects of Tibolone on postmenopausal women with uterine myomas. Maturitas 2001; 40:95-9. [PMID: 11684378 DOI: 10.1016/s0378-5122(01)00234-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of the present study is to evaluate the long term effects of Tibolone (Livial) on uterine myomas volume as well as on uterine arteries pulsatility index (PI) in postmenopausal women. METHODS This study included 66 naturally menopausal women. Twenty of them (group A) had no uterine myomas; 23 of them (group B) had a single, asymptomatic, intramural or subserous myoma of a maximum diameter less or equal than 2 cm; 23 of them (group C) had a single, asymptomatic, intramural or subserous myoma of a maximum diameter between 2 and 5 cm. The volume of the myomas as well as the pulsatility index of the uterine arteries was assessed by transvaginal ultrasonography every 6 months after administration of Tibolone (2.5 mg daily). RESULTS No statistically significant difference on myomas volume was found after a 3-year period of Tibolone administration. The uterine artery basal PI was significantly higher in group A compared to that of groups B and C. After 6 months of Tibolone administration the PI in group A was significantly lower compared to the basal one whereas in groups B and C was significantly higher compared to the basal value. CONCLUSIONS Our results suggest that treating postmenopausal woman with Tibolone on a long-term basis: (a) does not increase the volume of uterine myomas and (b) has an early effect on uterine haemodynamics (decrease of PI in women without myomas and increase of PI in women with myomas).
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Affiliation(s)
- O Gregoriou
- 2nd Department of Obstetrics and Gynecology, University of Athens, Areteion Hospital, 76 Vas Sophias Ave, Athens 115 28, Greece.
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Surrey ES, Lietz AK, Schoolcraft WB. Impact of intramural leiomyomata in patients with a normal endometrial cavity on in vitro fertilization-embryo transfer cycle outcome. Fertil Steril 2001; 75:405-10. [PMID: 11172848 DOI: 10.1016/s0015-0282(00)01714-3] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Assess the impact of intramural uterine leiomyomata and a normal endometrial cavity on IVF-ET cycle outcome. DESIGN Retrospective case-controlled analysis. SETTING Tertiary-care-assisted reproductive technology program. PATIENT(S) Three hundred ninety-nine consecutive fresh IVF-ET cycles were performed in patients with a normal precycle diagnostic hysteroscopy; patients were divided into four groups. Group 1: positive leiomyomata, age <40 years (n = 51 cycles); group 2: negative leiomyomata, age <40 years (n = 57 cycles); group 3: positive leiomyomata, age > or =40 years (n = 22 cycles); group 4: negative leiomyomata, age > or =40 years (n = 59 cycles). A subgroup of all group 2 patients aged 35-39 (group 2A, n = 113 cycles) was also evaluated as an additional control. INTERVENTION(S) Controlled ovarian hyperstimulation, IVF-ET. MAIN OUTCOME MEASURE(S) Implantation (IR), live birth (LBR) rates. RESULT(S) There were no significant differences in LBR among age-matched controls: group 1 (49%) versus 2 (57.5%) or 2A (57%) and group 3 (40.9%) versus 4 (32.2%). IR was significantly lower in group 1 (21.4%) versus 2 (33.3%) or 2A (33.9%) but not in group 3 (17.5%) versus 4 (11.6%). Implantation did not correlate with either mean leiomyoma diameter or volume. CONCLUSION(S) [1] LBR was not affected by the presence of intramural leiomyoma in IVF-ET patients with hysteroscopically normal endometrial cavities. [2] A significant decrease in IR was only noted in patients <40 years old. [3] Given the relatively high LBR in all groups, prophylactic surgical intervention cannot be justified, but precycle hysteroscopy evaluation is recommended.
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Affiliation(s)
- E S Surrey
- Colorado Center for Reproductive Medicine, 799 E. Hampden Avenue, Suite #300, Englewood, Colorado 80110, USA.
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Abstract
This study aimed to compare vascular parameters between fibroid and myometrium. From 10 uteri, specimens were taken from small fibroids (<0.5 cm), from the inner and outer parts of large fibroids (>3 cm), and from myometrium. Antibodies to endothelial cell markers CD31, CD34, factor VIII-related antigen (FVIII), and Ulex europaeus lectin were used in routine immuno- and lectin chemistry protocols. Parameters calculated were vascular area (VA), microvascular density (MD) and vascular luminal diameter. VA measures showed that myometrium had a greater area stained than small fibroids (P = 0.03) using CD31 and both inner (P = 0.04) and outer (P = 0.01) regions of large fibroids using FVIII, and than all groups (small, P = 0.02; inner, P = 0.02; outer, P = 0.006) using the lectin U. europaeus. MD was higher in myometrium than all uterine fibroid groups (small, P = 0.009; inner, P = 0.01; outer, P = 0.01) using U. europaeus lectin, than both regions of large (inner, P = 0.04; outer, P = 0.02) fibroids using FVIII, and than outer regions of large fibroids using CD31 (P < 0.05). There were significantly larger diameter vessels in myometrium and large fibroids compared with small fibroids using CD34, FVIII and the lectin U. europaeus (P </= 0.04). These differences in vasculature may represent differences in angiogenesis and vascular remodelling.
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Affiliation(s)
- R Casey
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Victoria 3168, Australia
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Colacurci N, De Franciscis P, Cobellis L, Nazzaro G, De Placido G. Effects of hormone replacement therapy on postmenopausal uterine myoma. Maturitas 2000; 35:167-73. [PMID: 10924843 DOI: 10.1016/s0378-5122(00)00115-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the effects of sequential continuous hormone replacement therapy (HRT) on myoma size and on pulsatility index (PI) of uterine arteries and to verify the correlation between uterine artery flow impedance and the growth rate of myoma in women receiving HRT. METHODS In a prospective 1-year study 60 postmenopausal women were enrolled into three study-groups to receive continuous transdermal 17beta-oestradiol 0.05 mg/day plus nomegestrolo acetate 5 mg/day sequentially added: 20 patients (group A) unaffected by uterine myomas, 20 patients (group B) with single asymptomatic myoma <3 cm/14 cm3, 20 patients (group C) with single asymptomatic myoma >3 cm/14 cm3. The changes in myoma volume and in PI were assessed by means of transvaginal ultrasonographic scan every 3 months. The patients with myoma were divided into two subgroups: quiescent myoma (B1, C1) and growing myoma (B2, C2). RESULTS No significant increase of uterine fibroids volume was found after 1-year HRT (24.14+/-20.02-->28.81+/-30.02 cm3). Six out of eight myomas growing during HRT belonged to group C. The uterine artery basal PI value of group A was significantly higher (P<0.01) than the corresponding PI in group B and C. At 3 months follow-up, uterine artery PI was significantly higher (P<0.01) than the basal value in both group B (1.70+/-0.22-->1.88+/-0.16) and C (1.59+/-0.28-->1.92+/-0.21). The baseline PI values in group B1 and C1 were significantly higher than the baseline values observed in group B2 and C2 (1.76+/-0.17 vs. 1.32+/-0.02, 1.76+/-0.16 vs. 1.24+/-0.08) and significantly lower than those observed in group A (2.39+/-0.47). After 3 months of HRT, the PI values were not significantly higher than the baseline values in groups B1 and C2 (1.76+/-0.17-->1.90+/-0.17; 1.24+/-0.08-->1.74+/-0.16), while they were significantly higher in group C1 (1.76+/-0.16-->2.01+/-0.17). CONCLUSIONS Sequential continuous HRT does not increase the volume of the uterine myoma. The findings of very low resistance index in the uterine arteries of women with growing myoma may indicate the risk of growth of the neoplasia during HRT. The assessment of PI in the uterine arteries could be helpful in predicting the growth rate of the myomas before starting HRT.
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Affiliation(s)
- N Colacurci
- Outpatient Menopausal Clinic, Institute of Gynaecology and Obstetrics, School of Medicine, Second University of Naples, Largo Madonna delle Grazie 1, 80134, Naples, Italy.
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Chiang CH, Chang MY, Hsu JJ, Chiu TH, Lee KF, Hsieh TT, Soong YK. Tumor vascular pattern and blood flow impedance in the differential diagnosis of leiomyoma and adenomyosis by color Doppler sonography. J Assist Reprod Genet 1999; 16:268-75. [PMID: 10335475 PMCID: PMC3455709 DOI: 10.1023/a:1020371614069] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Our objective was to evaluate the differences between leiomyoma and adenomyosis by color Doppler sonography with new criteria. METHODS A total of 78 patients with symptomatic uterine nodularities who were sonographically suspected to have leiomyoma or adenomyosis without other coexisting pathologic conditions was enrolled in the study. All patients underwent transvaginal color Doppler sonography (7.0-MHz vaginal probe) or transabdominal color Doppler sonography (5.0 MHz) during the early follicular phase. The morphology, tumor vascular pattern, and blood flow impedance of the uterine tumors were measured. All of the patients underwent surgery and the pathologic reports were used as references. RESULTS The mean age was not statistically significant in patients with adenomyosis versus leiomyoma (P > 0.05). The morphologic criteria for adenomyosis and leiomyoma by sonography detected 79% of adenomyosis and 84% of leiomyoma. Adenomyosis had 87% randomly scattered vessels or intratumoral signals and 88% of leiomyomas showed peripheral scattered vessels or outer feeding vessels. Eighty-two percent of adenomyosis had a pulsitility index (PI) of arteries within or around uterine tumors > 1.17 and 84% of leiomyomas had a PI < or = 1.17. The reliability test of tumor vascular pattern and blood flow impedance were better than that of using morphological criteria alone. CONCLUSIONS With the aid of color Doppler sonography, tumor vascular pattern and blood flow impedance of the arteries within or around uterine tumors could more accurately diagnose adenomyosis and leiomyoma in addition to the morphologic criteria on transvaginal sonography.
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Affiliation(s)
- C H Chiang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital 199, Taipei, Taiwan, Republic of China
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Peters-Engl C, Medl M, Mirau M, Wanner C, Bilgi S, Sevelda P, Obermair A. Color-coded and spectral Doppler flow in breast carcinomas--relationship with the tumor microvasculature. Breast Cancer Res Treat 1998; 47:83-9. [PMID: 9493979 DOI: 10.1023/a:1005992916193] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The phenomenon of tumor angiogenesis is an important aspect of understanding tumor biology. Studies in breast carcinoma have shown microvessel density (MVD) assessed by immunohistochemistry to be of prognostic importance in primary breast cancer. On the other hand, recently developed highly sensitive color-coded Doppler techniques offer a noninvasive method to examine neovascularisation in breast tumors. The purpose of this study was to determine the relationship between Doppler flow parameters and microvessel count assessed by immunohistochemistry. Fifty-three patients with primary breast cancer were examined preoperatively with color-coded Doppler ultrasound. The obtained Doppler frequency spectra were analyzed for peak systolic flow velocity (Vmax). Following surgery, paraffin-embedded microsections were immunohistochemically stained for factor VIII-related antigen. Tumor angiogenesis was assessed by microvessel count under light microscopy. Undifferentiated tumors correlated with high MVD (p=0.009) whereas other clinicopathological parameters were not associated with MVD. Color Doppler signals were detected in 50 out of 53 breast tumors. Evaluation of tumor flow velocity with various clinicopathological parameters showed a significant correlation with tumor size (p=0.0001) and lymph node metastasis (p=0.02). However, there was no significant correlation between MVD and intratumoral blood flow velocity assessed by color-coded Doppler. Our findings showed that Doppler flow measurement did not correlate with the extent of tumor angiogenesis of breast cancer. The present data give circumstantial evidence that microvessel count assessed by immunohistochemistry reflects the microvascular network, whereas tumor vasculature documented by Doppler ultrasound supplies information on the macrovasculature.
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Affiliation(s)
- C Peters-Engl
- Department of Gynecology and Obstetrics, Lainz Medical Center, Vienna, Austria
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Huang SC, Chou CY, Lin YS, Tsai YC, Hsu KF, Liu CH, Huang KE. Enhanced deoxyribonucleic acid damage and repair but unchanged apoptosis in uterine leiomyomas treated with gonadotropin-releasing hormone agonist. Am J Obstet Gynecol 1997; 177:417-24. [PMID: 9290461 DOI: 10.1016/s0002-9378(97)70208-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Our purpose was to investigate the histopathologic changes in uterine leiomyomas in cell proliferation, proliferating cell nuclear antigen expression, angiogenesis, and apoptosis after treatment with gonadotropin-releasing hormone agonist. STUDY DESIGN Fifteen consecutive patients who had undergone gonadotropin-releasing hormone agonist treatment before surgery and 44 patients who did not were studied. The volumes of myomas were determined ultrasonographically, and in patients receiving gonadotropin-releasing hormone agonist therapy measurements were done again after administration of the gonadotropin-releasing hormone agonist to evaluate the response to treatment. Paraffin sections were stained with hematoxylin and eosin, PC 10 for proliferating cell nuclear antigen expression, MIB 1 for measurement of cell proliferation, ApopTag for apoptosis, and factor VIII for quantitation of microvessel density. A deoxyribonucleic acid fragmentation test was also done on nine cases with available frozen tissues. RESULTS Most of the leiomyomas showed substantial expression of proliferating cell nuclear antigen. Gonadotropin-releasing hormone agonist therapy further induced significant overexpression of proliferating cell nuclear antigen (p = 0.0004, chi 2 test). All three leiomyomas that failed to respond to therapy showed less proliferating cell nuclear antigen staining compared with the good responders. In contrast, data from MIB 1 immunostaining showed that < 0.3% of leiomyoma cells were proliferating. However, positive-staining cells were more frequently detected in the treatment group (0.075% +/- 0.091% vs 0.002% +/- 0.010%, p = 0.0002, Mann-Whitney U test). Apoptosis developed spontaneously in leiomyoma cells independent of gonadotropin-releasing hormone agonist therapy. No significant change in apoptosis but a significant increase in microvessel density was observed in the treatment group compared with the control group. CONCLUSION Enhanced deoxyribonucleic acid damage or repair with cell growth arrest may be responsible for the action of gonadotropin-releasing hormone agonist in shrinking uterine leiomyomas. Moreover, the extent of proliferating cell nuclear antigen expression seems to be associated with the response to gonadotropin-releasing hormone agonist therapy.
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Affiliation(s)
- S C Huang
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan
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Chou CY, Hsu KF, Wang ST, Huang SC, Tzeng CC, Huang KE. Accuracy of three-dimensional ultrasonography in volume estimation of cervical carcinoma. Gynecol Oncol 1997; 66:89-93. [PMID: 9234927 DOI: 10.1006/gyno.1997.4714] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the accuracy of a three-dimensional (3D) ultrasound system in volume estimation of cervical carcinoma. STUDY DESIGN Transvaginal 3D and two-dimensional (2D) scans on cervical carcinoma volumes were performed 1 day before surgery. The volume of cervical carcinoma measured from each surgical specimen was compared with the corresponding volume of the cervical tumor measured by a 3D ultrasound and with the conventional 2D ultrasound volume measurement calculated using the formula pi/6 x(R1 x R2 x R3), where R1, R2, and R3 were the maximal transverse, anteroposterior, and longitudinal length of tumor, respectively. Limits of agreement and 95% confidence intervals were calculated and systemic bias between the methods was analyzed. The Klotz test was also used to assess the statistical significance of the degree of dispersion. RESULTS A total of 61 cases, 55 with exophytic tumors and 6 with endocervical tumors, were examined in this study. The limits of agreement between the volume measured from specimen and tumor volume determined by ultrasound were +6.68 to -6.10 mL for 3D measurements and +12.46 to -10.98 mL for 2D measurements. The Klotz test showed the discrepancy in the degree of dispersion between 3D and 2D ultrasound measurements was statistically significant (P = 0.01). CONCLUSION The true volume of cervical carcinoma is measured more accurately by a 3D ultrasound system than 2D ultrasound.
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Affiliation(s)
- C Y Chou
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan, Taiwan.
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Chou CY, Huang SC, Tsai YC, Hsu KF, Huang KE. Uterine leiomyosarcoma has deregulated cell proliferation, but not increased microvessel density compared with uterine leiomyoma. Gynecol Oncol 1997; 65:225-31. [PMID: 9159329 DOI: 10.1006/gyno.1997.4634] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the differences of biological aggressiveness in terms of proliferating cell nuclear antigen (PCNA) expression, cell proliferation, and microvessel density between uterine leiomyosarcoma and leiomyoma. STUDY DESIGN All patients with uterine leiomyosarcoma undergoing surgery at National Cheng Kung University Hospital were eligible. Forty-four patients with uterine myoma were also studied as the benign counterpart. The paraffin-embedded slides were stained with hematoxylin and eosin to confirm the presence of tumor and to quantitate mitoses, PC 10 for measurement of PCNA expression, MIB 1 for measurement of cell proliferation, and factor VIII for quantitation of microvessel density. The immunohistochemical findings of the slides were correlated with clinocopathologic findings of the patients, and the data were analyzed by either chi2 or unpaired t test. RESULTS Six patients with uterine leiomyosarcoma and 44 patients with uterine leiomyoma were studied. Statistically significant higher mean levels of PCNA and MIB 1 were observed in uterine leiomyosarcoma compared with those of uterine myoma (for PCNA expression, P = 0.0001; for MIB 1, 11.61 +/- 11.42% vs 0.45 +/- 0.21%, P < 0.0001). No significant difference of microvessel density was observed between these two groups (65.73 +/- 48.62 vs 41.97 +/- 28.20, P = 0.084). Among the six patients with leiomyosarcoma, two patients with a higher percentage of MIB 1-positive tumor cells died of recurrent disease. In contrast, two patients with lower MIB 1 counts were disease-free for 3 years or more. CONCLUSION Deregulated cell growth in uterine leiomyosarcoma may account for the biological aggressiveness of this tumor. Furthermore, the percentage of MIB 1-positive tumor cells seems to be associated with the prognosis or extent of uterine leiomyosarcoma.
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Affiliation(s)
- C Y Chou
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan, Taiwan.
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