Uterine Fibroid Pseudocapsule

The study aim was to evaluate management of myomas during cesarean section, the pro and cons and the outcomes of cesarean myomectomy. Moreover, we tried to investigate the long-term outcomes of cesarean myomectomy. The authors conducted a literature review using scientific databases, focusing on the benefits and outcomes of cesarean myomectomy and the recent trends regarding this topic, and identified relevant articles, related references and other papers citing them. Despite the demonstrated advantages of cesarean myomectomy, postponed myomectomy after cesarean section was recommended in some instances. Apart from recent reports on the safety and feasibility of cesarean myomectomy, the current literature also describes serious complications of cesarean myomectomy, including even maternal death. This poses a question about the reported rate of complications: whether it is underestimated in common practice. Although some studies strongly suggest the safety of cesarean myomectomy, data on the long-term outcomes of cesarean myomectomy in women are lacking. The risk-benefit ratio of cesarean myomectomy should be re-evaluated in the new century, given the increasing patient age, incidence of myoma in pregnancy, and the wide use of assisted reproductive techniques.

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“…There is also a large amount of data in the literature on myoma pseudocapsule . As one outcome, Tinelli et al .…”

Section: Future Of CMmentioning

confidence: 99%

Cesarean myomectomy in modern obstetrics: More light and fewer shadows

Sparić

Kadija

Stefanović

et al. 2017

J of Obstet and Gynaecol

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“…Concerning intramural LMs, studies have already been published that highlight the importance of intracapsular technique to preserve the myometrium integrity during enucleation of LMs, sparing pseudocapsule ( Figure 4 ) [ 5 , 31 ]. At the light of the study results and of previous report [ 38 ], the authors affirmed that the FP should be always preserved, as much as possible, during the myomectomy procedure, to have a better myometrial cicatrization and a better outcome on successive fertility [ 17 , 31 ].…”

Section: Discussionmentioning

confidence: 59%

“…FP growth of submucous LMs could reduce and adversely affect the overlying endometrium, becoming atrophic. What is not clear is whether increasing of the FP thickness should increase also the amount of normal quota of neuroendocrine fibers [ 17 ]. Normally, both protein gene product 9.5 (PGP9.5) and oxytocin demonstrated no significant differences in the density between the FP and adjacent normal myometrium, regardless of the fibroid location in the uterus.…”

Section: Discussionmentioning

confidence: 99%

“…Trying to understand the correlation between LMs and fertility, some authors deeply studied the LMs anatomical and biological structure, in order to develop even more conservative and effective treatments [ 15 , 16 ]. From the LMs anatomy studies, the neuroendocrine-biological role of the fibroid pseudocapsule (FP), a sort of neurovascular bundle surrounding LM, on myometrial physiology emerged [ 17 ]. Several studies have highlighted a new endocrine function of such structure, which may have a potential role in the uterine healing and fertility, especially after myomectomy [ 18 – 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…The FP is a well-known anatomical entity, which can be sonographically [ 17 , 25 ] and histologically evaluated [ 26 ]. In a previous preliminary report [ 27 ], authors examined the pseudocapsule thickness according to uterine location of LMs, detecting a high correspondence between ultrasound (US) and the histological measurement.…”

Section: Introductionmentioning

confidence: 99%

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Submucous Fibroids, Fertility, and Possible Correlation to Pseudocapsule Thickness in Reproductive Surgery

Tinelli

Kosmas

Mynbaev

et al. 2018

BioMed Research International

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Background and Objectives Fibroids are related to infertility. Fibroid pseudocapsule is a neurovascular bundle surrounding leiomyomas rich of neurofibers involved in myometrial biology. Authors evaluated, by a case-control study, the fibroid pseudocapsule (FP) thickness by ultrasound (US) and the histological measurements, according to uterine location of fibroids. Methods 137 consecutive patients undergoing hysterectomy for uterine myomas were enrolled and 200 myomas were evaluated. Before surgery, patients underwent an ultrasound (US) investigation to evaluate the number, the size, and the location of fibroids. After surgery, myoma-pseudocapsule-myometrium specimens were measured and evaluated by a single expert pathologist. Both US and histological data were collected and statistically analyzed. Results Our results confirm the relevant difference of FP thickness, particularly represented under the endometrium for submucous LMs. FPs near the endometrial cavity were considerably thicker than those of both intramural fibroids and subserous fibroids measured by US (P=0.0001) and histology (P=0.0001). A clear cut-off measurement at 2 mm (P=0.0001) was found between endometrial FPs and all other FPs for either US or histology measurements. Conclusion The thickness of FP is considerably higher near the endometrial cavity when compared to those of both intramural and subserous LMs, suggesting a potential role either in fertility or in myometrial healing.

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