日本産科婦人科学会/日本産婦人科医会編：産婦人科診療ガイドライン 産科編2020、p279-280、日本産科婦人科学会、2020.
Malcolm G Munro, Hilary O D Critchley, Ian S Fraser, FIGO Menstrual Disorders Committee
The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions.
Int J Gynaecol Obstet. 2018 Dec;143(3):393-408. doi: 10.1002/ijgo.12666. Epub 2018 Oct 10.
Abstract/Text
BACKGROUND: The International Federation of Gynecology and Obstetrics (FIGO) systems for nomenclature of symptoms of normal and abnormal uterine bleeding (AUB) in the reproductive years (FIGO AUB System 1) and for classification of causes of AUB (FIGO AUB System 2; PALM-COEIN) were first published together in 2011. The purpose was to harmonize the definitions of normal and abnormal bleeding symptoms and to classify and subclassify underlying potential causes of AUB in the reproductive years to facilitate research, education, and clinical care. The systems were designed to be flexible and to be periodically reviewed and modified as appropriate.
OBJECTIVES: To review, clarify, and, where appropriate, revise the previously published systems.
METHODOLOGY AND OUTCOME: To a large extent, the process has been an iterative one involving the FIGO Menstrual Disorders Committee, as well as a number of invited contributions from epidemiologists, gynecologists, and other experts in the field from around the world between 2012 and 2017. Face-to-face meetings have been held in Rome, Vancouver, and Singapore, and have been augmented by a number of teleconferences and other communications designed to evaluate various aspects of the systems. Where substantial change was considered, anonymous voting, in some instances using a modified RAND Delphi technique, was utilized.
© 2018 International Federation of Gynecology and Obstetrics.
日本産科婦人科学会/日本産婦人科医会編：産婦人科診療ガイドライン 婦人科外来編2020、p64-65、日本産科婦人科学会、2020.
Yoshikazu Kitahara, Osamu Hiraike, Hiroshi Ishikawa, Koji Kugu, Yasushi Takai, Osamu Yoshino, Masanori Ono, Ryo Maekawa, Ikuko Ota, Akira Iwase
National survey of abnormal uterine bleeding according to the FIGO classification in Japan.
J Obstet Gynaecol Res. 2023 Jan;49(1):321-330. doi: 10.1111/jog.15464. Epub 2022 Oct 18.
Abstract/Text
AIM: To investigate the status of abnormal uterine bleeding (AUB) in Japan using the International Federation of Gynecology and Obstetrics (FIGO) classification (AUB system 1 and 2; PALM-COEIN) and to clarify the relationship between AUB symptoms and the diseases causing AUB.
METHODS: In a nationwide study, we enrolled first-time patients who visited target facilities during two consecutive weeks from December 1, 2019 to January 31, 2020. The FIGO classification was used to investigate patients with symptoms and causative diseases of AUB. Based on the proportion of patients in the nationwide study, 373 cases were included in the detailed survey. Survey items included symptoms of AUB according to AUB system 1, examination details, and causative diseases according to the PALM-COEIN classification.
RESULTS: Within the study period, we encountered 61 740 first-time patients, of which 8081 (13.1%) were diagnosed with AUB. Among them, 39.9% had abnormal menstrual cycles and 56.9% had abnormal menstrual bleeding. In the survey, PALM had the highest percentage of AUB-L and COEIN had the highest percentage of AUB-O. Correspondence analysis showed that COEIN was strongly associated with abnormal menstrual cycles and PALM with abnormal menstrual bleeding.
CONCLUSION: We conducted the first nationwide survey of AUB in Japan. The FIGO classification was a useful tool for the diagnosis of AUB, with a strong correlation between symptoms of AUB by AUB system 1 and the causative disease of AUB by PALM-COEIN. Conversely, a high percentage of AUB-N and AUB-E suggests that AUB system 1 and PALM-COEIN are ambiguous as diagnostic tools.
© 2022 The Authors. Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.
Qiwei Yang, Michal Ciebiera, Maria Victoria Bariani, Mohamed Ali, Hoda Elkafas, Thomas G Boyer, Ayman Al-Hendy
Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment.
Endocr Rev. 2022 Jul 13;43(4):678-719. doi: 10.1210/endrev/bnab039.
Abstract/Text
Uterine fibroids are benign monoclonal neoplasms of the myometrium, representing the most common tumors in women worldwide. To date, no long-term or noninvasive treatment option exists for hormone-dependent uterine fibroids, due to the limited knowledge about the molecular mechanisms underlying the initiation and development of uterine fibroids. This paper comprehensively summarizes the recent research advances on uterine fibroids, focusing on risk factors, development origin, pathogenetic mechanisms, and treatment options. Additionally, we describe the current treatment interventions for uterine fibroids. Finally, future perspectives on uterine fibroids studies are summarized. Deeper mechanistic insights into tumor etiology and the complexity of uterine fibroids can contribute to the progress of newer targeted therapies.
© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.
Hiroshi Ishikawa, Kazutomo Ishi, Vanida Ann Serna, Rafael Kakazu, Serdar E Bulun, Takeshi Kurita
Progesterone is essential for maintenance and growth of uterine leiomyoma.
Endocrinology. 2010 Jun;151(6):2433-42. doi: 10.1210/en.2009-1225. Epub 2010 Apr 7.
Abstract/Text
Uterine leiomyomata (ULs) represent the most common tumor in women and can cause abnormal uterine bleeding, large pelvic masses, and recurrent pregnancy loss. Although the dependency of UL growth on ovarian steroids is well established, the relative contributions of 17beta-estradiol and progesterone are yet to be clarified. Conventionally, estradiol has been considered the primary stimulus for UL growth, and studies with cell culture and animal models support this concept. In contrast, no research model has clearly demonstrated a requirement of progesterone in UL growth despite accumulating clinical evidence for the essential role of progesterone in this tumor. To elucidate the functions of ovarian steroids in UL, we established a xenograft model reflecting characteristics of these tumors by grafting human UL tissue beneath the renal capsule of immunodeficient mice. Leiomyoma xenografts increased in size in response to estradiol plus progesterone through cell proliferation and volume increase in cellular and extracellular components. The xenograft growth induced by estradiol plus progesterone was blocked by the antiprogestin RU486. Furthermore, the volume of established UL xenografts decreased significantly after progesterone withdrawal. Surprisingly, treatment with estradiol alone neither increased nor maintained the tumor size. Although not mitogenic by itself, estradiol induced expression of progesterone receptor and supported progesterone action on leiomyoma xenografts. Taken together, our findings define that volume maintenance and growth of human UL are progesterone dependent.
Netta Mäkinen, Miika Mehine, Jaana Tolvanen, Eevi Kaasinen, Yilong Li, Heli J Lehtonen, Massimiliano Gentile, Jian Yan, Martin Enge, Minna Taipale, Mervi Aavikko, Riku Katainen, Elina Virolainen, Tom Böhling, Taru A Koski, Virpi Launonen, Jari Sjöberg, Jussi Taipale, Pia Vahteristo, Lauri A Aaltonen
MED12, the mediator complex subunit 12 gene, is mutated at high frequency in uterine leiomyomas.
Science. 2011 Oct 14;334(6053):252-5. doi: 10.1126/science.1208930. Epub 2011 Aug 25.
Abstract/Text
Uterine leiomyomas, or fibroids, are benign tumors that affect millions of women worldwide and that can cause considerable morbidity. To study the genetic basis of this tumor type, we examined 18 uterine leiomyomas derived from 17 different patients by exome sequencing and identified tumor-specific mutations in the mediator complex subunit 12 (MED12) gene in 10. Through analysis of 207 additional tumors, we determined that MED12 is altered in 70% (159 of 225) of tumors from a total of 80 patients. The Mediator complex is a 26-subunit transcriptional regulator that bridges DNA regulatory sequences to the RNA polymerase II initiation complex. All mutations resided in exon 2, suggesting that aberrant function of this region of MED12 contributes to tumorigenesis.
Koichi Nagai, Ryoko Asano, Futoshi Sekiguchi, Mikiko Asai-Sato, Yohei Miyagi, Etsuko Miyagi
MED12 mutations in uterine leiomyomas: prediction of volume reduction by gonadotropin-releasing hormone agonists.
Am J Obstet Gynecol. 2023 Feb;228(2):207.e1-207.e9. doi: 10.1016/j.ajog.2022.09.024. Epub 2022 Sep 20.
Abstract/Text
BACKGROUND: Gonadotropin-releasing hormone agonists are used to treat premenopausal uterine leiomyomas; however, leiomyoma volume reduction is not always achieved. The reduction rate after this treatment varies for each leiomyoma, even in the same patient. Therefore, an effective method for predicting uterine leiomyoma volume reduction is required to reduce the adverse hypoestrogenic effects and drug-related economic burden related to gonadotropin-releasing hormone agonists.
OBJECTIVE: This study aimed to determine the predictive use of MED12 mutations for evaluating the effect of gonadotropin-releasing hormone agonist treatment concerning reducing uterine leiomyoma volume and to predict the MED12 mutation status based on the findings of magnetic resonance imaging performed before treatment.
STUDY DESIGN: MED12 exon 2 mutation and erythropoietin expression in uterine leiomyomas were evaluated concerning volume reduction, as measured using magnetic resonance imaging. We developed a system for classifying leiomyomas according to T2-weighted magnetic resonance imaging signals to noninvasively predict the presence or absence of MED12 mutations in leiomyomas. Leiomyoma samples (>5 cm) were obtained from 168 patients during surgery (hysterectomy or myomectomy) between 2005 and 2021 at Yokohama City University Hospital. To analyze the rate of leiomyoma volume reduction, 41 patients had been preoperatively administered the gonadotropin-releasing hormone agonist (leuprorelin acetate 3.75 mg, monthly subcutaneous injection) for 3 months; magnetic resonance imaging was performed before and after treatment without contrast material.
RESULTS: Patients with MED12 exon 2 mutations had smaller volume reduction after treatment with the gonadotropin-releasing hormone agonist (P<.001, Mann-Whitney U test) and displayed lower signal intensity on T2-weighted images than those with leiomyomas expressing wild-type MED12 exon 2. The newly proposed magnetic resonance imaging-based classification system showed that MED12 exon 2 mutations were more frequent in the low-signal group than in the high-signal group, with nearly equal proportions of mutated and wild-type MED12 exon 2 leiomyomas noted in the intermediate group. The low-signal group had significantly lower erythropoietin expression levels than the high-signal group (P<.001, Kruskal-Wallis test with the Dunn posthoc analysis).
CONCLUSION: MED12 mutation status can be a candidate marker for predicting the effect of gonadotropin-releasing hormone agonists on uterine leiomyoma reduction. Magnetic resonance imaging findings can be used to determine MED12 mutation status as a noninvasive strategy to select patients who will most likely benefit from gonadotropin-releasing hormone agonist treatment.
Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.
Kamal Khademvatani, Yousef Rezaei, Abdollah Kerachian, Mir Hossein Seyyed-Mohammadzad, Ramin Eskandari, Alireza Rostamzadeh
Acute pulmonary embolism caused by enlarged uterine leiomyoma: a rare presentation.
Am J Case Rep. 2014;15:300-3. doi: 10.12659/AJCR.890607. Epub 2014 Jul 13.
Abstract/Text
PATIENT: Female, 42.
FINAL DIAGNOSIS: Acute pulmonary embolism.
SYMPTOMS: Chest pain • dyspnea.
MEDICATION: Streptokinase • Warfarin.
CLINICAL PROCEDURE: .-
SPECIALTY: Cardiology and Neoplasm.
OBJECTIVE: Management of emergency care.
BACKGROUND: Deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) caused by pelvic vein compression are rare and life-threatening complications of leiomyoma of the uterus.
CASE REPORT: We report a 42-year-old virgin woman with a history of leiomyoma who presented to the emergency department with complaints of dyspnea and pleuritic chest pain with transient spotting. On physical examination, she had a non-tender abdomen with a 20-week size uterus. Imaging investigations revealed an acute DVT in her left leg and a huge uterine-derived mass compressing the common iliac veins. Transesophageal echocardiography (TEE) demonstrated an echogenic mass in her right pulmonary artery consistent with thrombosis. The patient was completely cured using thrombolytic therapy and myomectomy, and was well at 1 year after thrombolysis.
CONCLUSIONS: PE caused by pelvic vein compression is a rare complication of leiomyoma, which should be considered. Thrombolytic therapy associated with myomectomy can be implemented for treating such cases, and TEE can be used for diagnosing suspected high-risk PE.
日本鉄バイオサイエンス学会治療指針作成委員会 編：鉄剤の適正使用による貧血治療指針 改定[第3版]、p22-26、日本鉄バイオサイエンス学会、2015.
佐藤 友美【画像!-エキスパート直伝 産婦人科画像診断-】(第4章)腫瘍 子宮肉腫 産科と婦人科(0386-9792)88巻Suppl. Page320-328(2021.03).
Abolfazl Mehdizadehkashi, Kobra Tahermanesh, Samaneh Rokhgireh, Vahideh Astaraei, Zahra Najmi, Mehrnoosh Rakhshande, Leila Allahqoli, Mahin Ahmadi Pishkuhi, Ibrahim Alkatout, Shahla Chaichian
Uterine Isthmus Tourniquet during Abdominal Myomectomy: Support or Hazard? A Randomized Double-Blind Trial.
Gynecol Obstet Invest. 2020;85(5):396-404. doi: 10.1159/000510512. Epub 2020 Sep 16.
Abstract/Text
BACKGROUND AND OBJECTIVES: A tourniquet has been suggested as a useful means of reducing massive hemorrhage during myomectomy. However, it is not clear whether the restricted perfusion affects the ovaries. In the present study, we examined the effect of a tourniquet on ovarian reserve and blood loss during myomectomy.
MATERIALS AND METHODS: In a randomized double-blind clinical trial, fertile nonobese patients scheduled for abdominal myomectomy at Rasool-e-Akram Hospital from February 2018 to June 2019 were randomized to a tourniquet (n = 46) or a non-tourniquet group (n = 35). Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured before and 3 months after surgery, blood loss was recorded during surgery, and serum levels of hemoglobin (Hb) were recorded before surgery, 6 h and 3 days after surgery. SPSS version 21 was used for statistical analysis.
RESULTS: Demographic, obstetric, and myoma characteristics were similar in the 2 groups (p > 0.05). The mean baseline values of AMH and FSH did not differ between groups (p > 0.05). After surgery, only FSH was higher in the control group (p = 0.043). Despite the time taken to fasten and open the tourniquet, the mean operating time was shorter in the tourniquet group (p < 0.001). Blood loss was higher in the control group (p = 0.005). The drop in Hb levels at 6 h after surgery was higher in the non-tourniquet group (p = 0.002). Blood loss was significantly associated with the duration of surgery (r = 0.523, p < 0.001).
CONCLUSION: The use of a tourniquet during abdominal myomectomy significantly reduced the mean volume of blood loss compared to the non-tourniquet group, while it did not prolong the duration of surgery, nor reduced the ovarian reserve. A tourniquet is a safe and efficient measure during abdominal myomectomy.
© 2020 S. Karger AG, Basel.
Osama Alomar, Ahmed Abu-Zaid, Mohammed Ziad Jamjoom, Abdullah Ama Almubarki, Saud Owaimer Alsehaimi, Safa Alabdrabalamir, Saeed Baradwan, Mohammed Abuzaid, Majed Saeed Alshahrani, Khalid Khadawardi, Ehab Badghish, Hanadi Bakhsh, Maha Al Baalharith, Ibtihal Abdulaziz Bukhari, Afnan Baradwan, Hany Salem, Ismail A Al-Badawi
Prophylactic vasopressin to reduce intraoperative blood loss and associated morbidities during myomectomy: A systematic review and meta-analysis of 11 controlled trials.
J Gynecol Obstet Hum Reprod. 2022 Dec;51(10):102485. doi: 10.1016/j.jogoh.2022.102485. Epub 2022 Oct 12.
Abstract/Text
OBJECTIVE: To collate evidence from randomized controlled trials (RCTs) and nonrandomized controlled trials (NCTs) on the efficacy and safety of vasopressin versus passive control (placebo/no treatment) during myomectomy.
METHODS: Six information sources were screened until 25-June-2022. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to evaluate the risk of bias. Data were summarized as mean difference or risk ratio with 95% confidence interval in a random-effects model.
RESULTS: Eleven studies, comprising 1067 patients (vasopressin=567 and control=500) were analyzed. For RCTs (n = 8), the overall quality included 'high risk' (n = 4), 'low risk' (n = 2), and 'some concerns' (n = 2). For NCTs (n = 3), the overall quality included 'good' (n = 2) and 'fair' (n = 1). The mean intraoperative blood loss, mean difference in hemoglobin level, mean difference in hematocrit level, rate of perioperative blood transfusion, and mean operative time were significantly reduced in favor of the vasopressin group compared with the control group. However, there was no significant difference between both groups regarding the mean hospital stay. Pertaining to safety endpoints, after omission of an outlier study, the rate of drug-related cardiovascular adverse events did not significantly differ between both groups. There was no quantitative evidence of publication bias for the endpoint of intraoperative blood loss.
CONCLUSION: Among patients undergoing myomectomy, prophylactic administration of vasopressin was largely safe and correlated with significant reductions in intraoperative blood loss and associated morbidities compared with a passive control intervention. Nonetheless, the conclusions should be cautiously interpreted owing to the low-evidence quality and the used doses varied greatly between studies.
Copyright © 2022 Elsevier Masson SAS. All rights reserved.
日本産科婦人科内視鏡学会編：産婦人科内視鏡手術ガイドライン2019年版、p90-95、日本産科婦人科内視鏡学会、2019.
日本産科婦人科学会/日本産婦人科医会編：産婦人科診療ガイドライン 婦人科外来編2020、p62-63、日本産科婦人科学会、2020.
日本産科婦人科内視鏡学会編：産婦人科内視鏡手術ガイドライン2019年版、p170-174、日本産科婦人科内視鏡学会、2019.
日本産科婦人科内視鏡学会編：産婦人科内視鏡手術ガイドライン2019年版、p160-168、日本産科婦人科内視鏡学会、2019.
日本産科婦人科内視鏡学会編：産婦人科内視鏡手術ガイドライン2019年版、p77-81、日本産科婦人科内視鏡学会、2019.
日本産科婦人科内視鏡学会編：産婦人科内視鏡手術ガイドライン2019年版、p82-87、日本産科婦人科内視鏡学会、2019.
日本産科婦人科学会/日本産婦人科医会編：産婦人科診療ガイドライン 婦人科外来編2020、p66-67、日本産科婦人科学会、2020.
日本産科婦人科学会/日本女性医学学会編：ホルモン補充療法ガイドライン 2017年度版、p64-65、2017.
