Fibroid degeneration in a postmenopausal woman presenting as an acute abdomen

Shrestha, Rajendra; Khanal, Raju; Aryal, Madan Raj; Pathak, Ranjan; Karmacharya, Paras; Naqi, Muniba; Murukutla, Srujitha; Bhatt, Vijaya Raj; Gottesman, Aaron

doi:10.3402/jchimp.v5.25917

Cited by 9 publications

(10 citation statements)

References 6 publications

(7 reference statements)

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“…In postmenopausal women with obesity, peripheral aromatization of adrenal-derived androstenedione into estrone might be responsible for the increase in size. As the fibroids enlarge, they outgrow their blood supply or cause mechanical compression of feeder arteries and undergo degenerative changes [ 9 ]. Hyaline degeneration (63%) is the most common, followed by myxomatous (13%), calcareous (8%), mucoid (6%), cystic (4%), carneous (3%), and fatty changes (3%).…”

Section: Discussionmentioning

confidence: 99%

“…Hyaline degeneration (63%) is the most common, followed by myxomatous (13%), calcareous (8%), mucoid (6%), cystic (4%), carneous (3%), and fatty changes (3%). The exact pathogenesis for degeneration of fibroids in postmenopausal women remains unclear, however, increased production of growth factors (epidermal or insulin like) from the fibroid might explain this condition [ 9 ]. Rarely, it may undergo malignant degeneration to become leiomyosarcoma in less than 1% of cases [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Neglected case of a huge leiomyoma in an elderly postmenopausal woman: a case report

Garg

Bansal

2022

J Med Case Reports

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Background Fibroids are benign tumors of the female reproductive tract originating from the myometrial smooth muscle cells. They are a frequent occurrence in women of childbearing age but their incidence is rare after menopause. In addition, there is a remote possibility of malignant transformation to leiomyosarcoma in less than 1% of cases. Case presentation We hereby report a case of large fibroid in a postmenopausal Indian female with rapid growth, raising the suspicion of malignant transformation into leiomyosarcoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology report confirmed it to be benign leiomyoma without any evidence of neoplasia. Conclusion Sudden enlargement of leiomyoma in postmenopausal women should not be ignored due to possible malignant transformation and is to be dealt immediately with hysterectomy followed by histopathology.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neglected case of a huge leiomyoma in an elderly postmenopausal woman: a case report

Garg

Bansal

2022

J Med Case Reports

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“…Degenerative changes are also likely to occur when GnRH agonists are used [19] and during pregnancy [20,21], when there are changes in hormonal dynamics. Leiomyomas rarely grow after menopause; therefore, only a few cases of leiomyomas have been reported in postmenopausal women [22][23][24][25]. An age-related decrease in blood supply to the uterus causes circulatory disorders in leiomyomas, resulting in vitrification of the extracellular matrix and accumulation of fluid and gelatin in leiomyomas [25].…”

Section: Discussionmentioning

confidence: 99%

Possible significance of degeneration and decreased expression of progesterone receptor in postmenopausal uterine leiomyoma

et al. 2022

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Background The growth of uterine leiomyomas is dependent on the levels of sex steroid hormones, and they usually shrink after menopause. However, there are cases in which leiomyomas continue to grow and/or surgery is required after menopause. In addition to estrogen, progesterone has recently been implicated in leiomyoma enlargement, but its relevance to postmenopausal leiomyoma remains unknown. Therefore, we investigated whether hormone receptor expression is associated with postmenopausal leiomyoma enlargement and characterized pathological findings of postmenopausal leiomyoma, which have not been clarified yet. Methods Nine cases that required total hysterectomy for leiomyomas after menopause were examined. Surgeries were conducted because of pelvic pressure, pelvic pain, suspected malignancy, or growing leiomyoma. Six cases of leiomyomas being incidentally found during total hysterectomy for postmenopausal uterine prolapse, and six patients who underwent hysterectomy for leiomyomas before menopause, were examined as controls. We evaluated the expression of estrogen receptor, progesterone receptor B, and progesterone receptor AB by immunohistochemical staining among the cases. We also analyzed the pathological findings of leiomyomas. Results In postmenopausal leiomyomas, the expression of progesterone receptor was higher than that in the adjacent myometrium. Compared with premenopausal leiomyomas, the expression of progesterone receptor decreased. Postmenopausal leiomyomas that required surgery did not show elevated sex steroid hormone receptor expression, compared with the leiomyomas that did not require surgery. The degeneration frequency of leiomyomas was 92% in the group that underwent surgery for postmenopausal leiomyomas, 65% in the group that underwent surgery for reasons other than the presence of leiomyomas after menopause, and 47% in the group operated for leiomyomas before menopause. Conclusions These results suggest that sex steroid hormones are unlikely to be associated with the growth of leiomyomas after menopause. Since leiomyoma degeneration with increased extracellular matrix is likely to occur in postmenopausal women, the degeneration of leiomyomas may be the main mechanism for the growth of postmenopausal leiomyomas.

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“…This size is found to regress in the postmenopausal women. 9 So, the present study will be a cross-sectional study which will be undertaken to know the association of uterine leiomyoma with BMI and parity in the women of coastal Karnataka.…”

Section: Introductionmentioning

confidence: 99%

Association between uterine leiomyoma with body mass index and parity in the women of coastal Karnataka, India

Shetty

Pawaskar

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: Fibroid is the commonest benign tumor of the uterus and also commonest benign solid tumor in females. Fibroids are found to be 2-3 times more prevalent in obese women, specially the one’s with central obesity and in those with BMI > or = 35. Epidemiologic data also shows pregnancy is associated with reduced risk of fibroids. So, the present study will be a cross-sectional study which will be undertaken to know the association of uterine leiomyoma with BMI and parity in the women of coastal Karnataka.Methods: An analytical cross-sectional study was performed among the 100 patients attending OPD at the department of obstetrics and gynecology, Karwar institute of medical sciences from June 2018 to August 2018. Women suspected to have fibroid based on their symptoms were made to undergo ultrasonography. Comparison was made between the parity, body mass index of the patient and the size of the uterine fibroid visualized.Results: Out of 100 women studied 63 were nulliparous and 37 women were multiparous. Incidence of fibroid is inversely proportional to parity. When BMI < 18 only 6 women had fibroid, when BMI > 25, 57 women had fibroids and between 18-25 group 37 women were diagnosed with fibroid.Conclusions: The fibroid showed directly proportional association with BMI. Greater the BMI, more was the risk of fibroids. The fibroid showed inversely proportional association with parity. Greater the parity of the women lesser was her chances of being at risk of having fibroid.

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Fibroid degeneration in a postmenopausal woman presenting as an acute abdomen

Cited by 9 publications

References 6 publications

Neglected case of a huge leiomyoma in an elderly postmenopausal woman: a case report

Neglected case of a huge leiomyoma in an elderly postmenopausal woman: a case report

Possible significance of degeneration and decreased expression of progesterone receptor in postmenopausal uterine leiomyoma

Association between uterine leiomyoma with body mass index and parity in the women of coastal Karnataka, India

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