Clinical characteristics of patients with leiomyoma who undergo surgery after high intensity focused ultrasound (HIFU)

Proteasome inhibitor MG132 modulates signal transduction pathways in ELT3 uterine leiomyoma cells

Uterine leiomyomas, or fibroids, are common benign tumors that affect a significant percentage of women, with treatment options ranging from medication to surgery. Carbobenzoxyl-L-leucyl-L-leucyl-L-leucine (MG132), a proteasome inhibitor, has exhibited potential in treating various cancers by disrupting key cellular processes such as apoptosis and cell cycle regulation. The present study aimed to evaluate the effects of MG132 on the viability, proliferation, apoptosis, and the production of reactive oxygen species (ROS) in Eker leiomyoma tumor-3 (ELT3) uterine leiomyoma cells and to elucidate the underlying molecular mechanisms involved. Cell viability was evaluated using an MTT assay, while cytotoxicity was assessed using a lactate dehydrogenase (LDH) release assay. Colony formation assays assessed the long-term effects of MG132. Apoptosis and cell cycle distribution were analyzed using flow cytometry with Annexin V staining, and ROS production was also measured by flow cytometry. Western blot analysis was performed to examine key proteins related to the cell cycle and apoptosis. The findings of the present study revealed that MG132 significantly reduced the cell viability and impaired colony formation in ELT3 cells, as evidenced by decreased cell viability and increased LDH activity. MG132 treatment significantly increased apoptosis and induced cell cycle arrest at the G2/M phase. Additionally, MG132 increased the levels of ROS, which contributed to ROS-mediated apoptosis. Western blot analysis revealed that MG132 modulated key proteins involved in cell proliferation and apoptosis, including p21, p27, ERK, and caspase-3. Furthermore, MG132 treatment induced autophagy, as indicated by the increased conversion of LC3 I to LC3 II. Overall, MG132 was revealed to exert potent cytotoxic effects on ELT3 uterine leiomyoma cells by inducing ROS-mediated apoptosis and cell cycle arrest, and triggering autophagy. These findings suggest that MG132 provides a proof of concept for targeting the proteasome in uterine leiomyomas.

Histological findings in resected leiomyomas following MR-HIFU treatment, single-institution data from seven patients with unfavorable focal therapy

PURPOSE

Magnetic resonance - high-intensity focused ultrasound (MR-HIFU) is a noninvasive treatment option for symptomatic uterine leiomyomas. Currently, pretreatment MRI is used to assess tissue characteristics and predict the most likely therapeutic response for individual patients. However, these predictions still entail significant uncertainties. The impact of tissue properties on therapeutic outcomes remains poorly understood and detailed knowledge of the histological effects of ultrasound ablation is lacking. Investigating these aspects could aid in optimizing patient selection, enhancing treatment effects and improving treatment outcomes.

METHODS AND MATERIALS

We present seven patients who underwent MR-HIFU treatment for leiomyoma followed by second-line surgical treatment. Tissue samples obtained during the surgery were stained with hematoxylin and eosin, Masson's trichrome and Herovici to evaluate general morphology, fibrosis and collagen deposition of leiomyomas. Immunohistochemical CD31, Ki-67 and MMP-2 stainings were performed to study vascularization, proliferation and matrix metalloproteinase-2 protein expression in leiomyomas, respectively.

RESULTS

The clinical characteristics and radiological findings of the leiomyomas prior to treatment as well as qualitative histological findings after the treatment are presented and discussed in the context of current literature. A tentative model for volume reduction is presented.

CONCLUSION

These findings provide insights into potential factors contributing to suboptimal therapeutic outcomes and the variability in histological changes following treatment.

Ventral hernia after high-intensity focused ultrasound ablation for uterine fibroids treatment: A case report

BACKGROUND

High-intensity focused ultrasound (HIFU) ablation is a minimally invasive approach in gynecology that is used to manage uterine fibroids. Although this procedure is safe and effective, adverse outcomes are becoming a major problem.

CASE SUMMARY

We present a case of ventral hernia that occurred as a rare and delayed complication of HIFU ablation for uterine fibroids treatment. The patient came to the hospital with abdominal bloating that occurred 6 mo after ultrasound-guided HIFU ablation for managing uterine fibroids. The ventral hernia, which occurred due to atrophied muscle layers following the procedure, was confirmed by imaging studies and intraoperative findings. She required a hernia repair with mesh and hysterectomy for definitive treatment of uterine fibroid.

CONCLUSION

High-intensity ultrasound ablation should be performed only on appropriate candidates. Patients should be educated about potential complications of the procedure and the possibility of subsequent treatment. Post-procedural long-term follow-up for detecting delayed adverse effects is important.