Uterine fibroids

Abstract

Uterine fibroids (also known as leiomyomas or myomas) are common clonal neoplasms of the uterus. Fibroids have both smooth muscle and fibroblast components, in addition to a substantial amount of fibrous extracellular matrix, which all contribute to the pathogenetic process. Fibroids are extremely heterogeneous in their pathophysiology, size, location and clinical symptomatology. They are also a part of a range of disease in which some variants have facets of malignant behaviour but overall are benign. Risk for fibroids is associated with race; black women have a higher risk of developing fibroids earlier in life than their white counterparts and also develop more-severe forms of the disease. Clinically, fibroids account for one-third to half of all hysterectomies and are associated with substantial morbidity and health care costs for women of reproductive age. Indeed, current treatments are primarily surgical and interventional; approximately three-quarters of all fibroid treatments are hysterectomies. However, clinical innovations are emerging in the use of progesterone receptor modulators as a medical therapy. New information is rapidly accumulating about the genetic subgroups that lead to fibroid formation, which might aid further understanding of the clinical heterogeneity of this disease and lead to individualized treatments. This information is a crucial development given the current lack of high-quality evidence on which to base therapeutic decisions.

Subtype-Specific Tumor-Associated Fibroblasts Contribute to the Pathogenesis of Uterine Leiomyoma

“…Uterine leiomyomata (LMs) or fibroids are benign tumors of myometrium (MM), which occur in women of reproductive age with the cumulative incidence of approximately 70% (1–3). Recent comprehensive genome analyses identified at least 4 major LM subtypes with unique genetic alterations (4,5).…”

Endocrine-disrupting chemicals and uterine fibroids

“…Moreover, fibroid tumor size was significantly decreased in response to progesterone withdrawal using the PR antagonist mifepristone (RU486) (80,81). As a result of these and other studies, several selective progesterone receptor modulators (SPRMs) have been shown in clinical trials to inhibit UF growth (49,50,82–87). …”

“…Most of uterine fibroid cases are sporadic in nature, however few rare familial syndromes are associated with development of UFs. In these syndromes, genetic alterations occur in the FH , COL4A5 and COL4A6 genes (49). In sporadic tumors, several recurrent genetic aberrations have been identified, including deletions in 7q, trisomy of chromosome 12, reciprocal translocation of chromosome 12, and monosomy of chromosome 22, among others (50–52).…”

Complications in modern hysteroscopic myomectomy

“…Uterine fibroids (UFs) are common benign tumors of the female genital tract. They are diagnosed in almost one-quarter of women of reproductive age [1]. UFs may cause numerous clinical symptoms, including prolonged or heavy menstrual bleeding, pelvic pressure symptoms or pain, infertility and obstetric complications, but are mostly asymptomatic [1].…”