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Medicina
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Uterine Smooth-Muscle Tumors
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Uterine Smooth-Muscle Tumors

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 9306

Special Issue Editor

Dr. Radmila Sparić

E-Mail Website
Guest Editor
Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Višegradska 26, 11000 Belgrade, Serbia
Interests: myoma; cesarean myomectomy; HRQoL; reproductive endocrinology; PCOS; cervical cancer screening; infertility; menopause

Special Issue Information

Dear Colleagues,

Uterine fibroids (myomas, leiomyomas) are the most common benign tumors of the female reproductive organs. They affect women throughout almost the entirety of their lifespan, causing significant morbidity and health-related quality of life impairments. On the other hand, uterine leiomyosarcomas represent a rare malignant and aggressive uterine cancer with an unfavorable prognosis and the highest prevalence in pre- and peri-menopause women. In women of a reproductive age, they are frequently accidentally diagnosed during a pathological analysis of removed tissue, such as the uterus or uterine fibroids for benign uterine diseases. Data on rare tumors, such as uterine smooth-muscle tumors of uncertain malignant potential (STUMP) and leiomyomatosis peritonealis generalisata, are lacking.

The aim of this Special Issue of Medicina is to explore the current advances covering these topics. In this Special Issue, we aim to provide an overview of the latest achievements in the field. The spectrum of topics ranges from epidemiology, genetics, environmental factors, pathophysiology, clinical presentation and complications, imaging modalities, diagnosis, surveillance, prognosis and therapy. Recent evidence for myoma-associated infertility and pregnancy outcomes in women with myomas are expected. Manuscripts investigating the health-related quality of life impairment are also welcome. Studies addressing less common conditions or outcomes are encouraged.

Dr. Radmila Sparić
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • myoma
  • leiomyoma
  • fibroid
  • leiomyosarcoma
  • myomectomy
  • hysterectomy
  • cesarean myomectomy
  • quality of life
  • infertility
  • obstetric complications

Published Papers (5 papers)

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Review

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13 pages, 4639 KiB  
Review
Cesarean Myomectomy: Reflections on Clinical and Surgical Controversies between a New Trans-Decidual Technique vs. Traditional Method
by Radmila Sparić, Luka Andrić, Oguz Guler, Antonio Malvasi, Ivana Babović, Safak Hatirnaz, Miriam Dellino and Andrea Tinelli
Medicina 2024, 60(4), 609; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60040609 - 8 Apr 2024
Viewed by 742
Abstract
Up to 70–80% of women of reproductive age may be affected with the most common uterine tumors, known as fibroids or myomas. These benign tumors are the second most prevalent cause of surgery among premenopausal women. Predictions show that the occurrence of myomas [...] Read more.
Up to 70–80% of women of reproductive age may be affected with the most common uterine tumors, known as fibroids or myomas. These benign tumors are the second most prevalent cause of surgery among premenopausal women. Predictions show that the occurrence of myomas in pregnancy will increase, and that the risk of having myomas during pregnancy increases with advanced maternal age. Although most women with fibroids do not experience any symptoms during pregnancy, up to 30% of women experience problems during pregnancy, childbirth, and the puerperium. The viability of myoma excision during cesarean surgery (CS) is a contentious issue raised by the rising incidence of myomas in pregnancy and CS rates. A new surgical procedure for removing fibroids using a trans-endometrial approach, which involves making an incision through the decidua itself, has put into doubt the long-standing practice of cesarean myomectomy (CM) with a trans-serosal approach. Some authors have recently advocated for this last approach, highlighting its advantages and potential uses in real-world situations. The purpose of this paper is to critique the present approach to cesarean myomectomy by analyzing the clinical and surgical distinctions between the two approaches and providing illustrations of the CM methods. Full article
(This article belongs to the Special Issue Uterine Smooth-Muscle Tumors)
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35 pages, 2589 KiB  
Review
Uterine Tumors Resembling Ovarian Sex Cord Tumors (UTROSCTs): A Scoping Review of 511 Cases, Including 2 New Cases
by Rafał Watrowski, Mario Palumbo, Serena Guerra, Alessandra Gallo, Brunella Zizolfi, Pierluigi Giampaolino, Giuseppe Bifulco, Attilio Di Spiezio Sardo and Maria Chiara De Angelis
Medicina 2024, 60(1), 179; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60010179 - 19 Jan 2024
Viewed by 1432
Abstract
Uterine Tumors Resembling Ovarian Sex Cord Tumors (UTROSCTs) are rare uterine mesenchymal neoplasms with uncertain biological potential. These tumors, which affect both premenopausal and postmenopausal women, usually have a benign clinical course. Nevertheless, local recurrences and distant metastases have been described. By analyzing [...] Read more.
Uterine Tumors Resembling Ovarian Sex Cord Tumors (UTROSCTs) are rare uterine mesenchymal neoplasms with uncertain biological potential. These tumors, which affect both premenopausal and postmenopausal women, usually have a benign clinical course. Nevertheless, local recurrences and distant metastases have been described. By analyzing 511 cases retrieved from individual reports and cases series, we provide here the most comprehensive overview of UTROSCT cases available in the literature, supplemented by two new cases of UTROSCTs. Case 1 was an asymptomatic 31-year-old woman who underwent a laparoscopic resection of a presumed leiomyoma. Case 2 was a 58-year-old postmenopausal woman with abnormal vaginal bleeding who underwent an outpatient hysteroscopic biopsy of a suspicious endometrial area. In both cases, immunohistochemical positivity for Calretinin and Inhibin was noted, typical for a sex cord differentiation. In both cases, total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed. In light of the available literature, no pathognomonic clinical or imaging finding can be attributed to UTROSCT. Patients usually present with abnormal uterine bleeding or pelvic discomfort, but 20% of them are asymptomatic. In most cases, a simple hysterectomy appears to be the appropriate treatment, but for women who wish to become pregnant, uterus-preserving approaches should be discussed after excluding risk factors. Age, tumor size, lymphovascular space invasion, nuclear atypia, and cervical involvement are not reliable prognostic factors in UTROSCT. The current research suggests that aggressive cases (with extrauterine spread or recurrence) can be identified based on a distinct genetic and immunohistochemical phenotype. For instance, UTROSCTs characterized by GREB1::NCOA1-3 fusions and PD-L1 molecule expression appear to be predisposed to more aggressive behaviors and recurrence, with GREB1::NCOA2 being the most common gene fusion in recurrent tumors. Hence, redefining the criteria for UTROSCTs may allow a better selection of women suitable for fertility-sparing treatments or requiring more aggressive treatments in the future. Full article
(This article belongs to the Special Issue Uterine Smooth-Muscle Tumors)
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14 pages, 5220 KiB  
Review
Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Comprehensive Multidisciplinary Update
by Andrea Tinelli, Ottavia D’Oria, Emanuela Civino, Andrea Morciano, Atif Ali Hashmi, Giorgio Maria Baldini, Radomir Stefanovic, Antonio Malvasi and Giovanni Pecorella
Medicina 2023, 59(8), 1371; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59081371 - 27 Jul 2023
Cited by 1 | Viewed by 5579
Abstract
Background and Objectives: The uterine smooth muscle tumors of uncertain malignant potential (STUMP) are tumors with pathological characteristics similar to leiomyosarcoma, but that do not satisfy histological criteria for leiomyoma. These are problematic lesions with intermediate morphologic features; thus, diagnosis and treatment [...] Read more.
Background and Objectives: The uterine smooth muscle tumors of uncertain malignant potential (STUMP) are tumors with pathological characteristics similar to leiomyosarcoma, but that do not satisfy histological criteria for leiomyoma. These are problematic lesions with intermediate morphologic features; thus, diagnosis and treatment are difficult. This narrative review aims to review data in the literature about STUMPs, particularly focusing on management and therapeutic options and strategies for women who desire to preserve fertility. Material and Methods: authors searched for “uterine smooth muscle tumor of uncertain malignant potential” in PubMed and Scopus databases, from 2000 to March 2023. Pertinent articles were obtained in full-text format and screened for additional references. Only articles in English language were included. Studies including full case description of patients with histopathological diagnosis of STUMP in accordance with Stanford criteria were included. Results: The median age was 43 years old. Symptoms are similar to those of leiomyomas, with a mean diameter of 8.0 cm. Total hysterectomy with or without bilateral salpingo-oophorectomy is the standard care for women if fertility desire is satisfied. Myomectomy alone can be considered for young patients. Although these tumors have not a high malignant potential, several studies described recurrence and metastases. Conclusions: STUMPs are complex uterine smooth muscle tumors, with a rare but reasoned clinical–diagnostic management. Considering the high clinical and histological complexity of these tumors, high level of expertise is mandatory. Full article
(This article belongs to the Special Issue Uterine Smooth-Muscle Tumors)
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9 pages, 2281 KiB  
Case Report
Uterine Leiomyomas with Specific Histology Features of Two Fumarate Hydratase/Succinate Dehydrogenase-Deficient Tumors: A Double Case Report
by Ljubiša Jovanović, Svetlana Milenković, Luka Andrić, Radomir Stefanović, Branislav Milošević, Jelena Micić, Igor Pilić, Aleksandra Beleslin, Olga Mihaljević and Milan Dokić
Medicina 2024, 60(5), 825; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60050825 - 17 May 2024
Viewed by 244
Abstract
Background and Objectives: Mutations in succinate dehydrogenase (SDH) and fumarate hydratase (FH) give rise to various familial cancer syndromes, with these alterations being characteristic of certain types of histomorphologically specific leiomyomas that hold significant predictive value. Materials and Methods: This study [...] Read more.
Background and Objectives: Mutations in succinate dehydrogenase (SDH) and fumarate hydratase (FH) give rise to various familial cancer syndromes, with these alterations being characteristic of certain types of histomorphologically specific leiomyomas that hold significant predictive value. Materials and Methods: This study presents two cases of uterine leiomyomas exhibiting rare histomorphological and genetic characteristics, which are crucial for prognosis and further treatment. Results: Distinct histopathological features such as marked nuclear atypia, intracellular eosinophilic globules, and abnormal intratumoral vessels raise suspicion for specific leiomyoma subtypes, which carry predictive significance for additional hereditary cancer syndromes. Immunohistochemical analysis confirmed FH/SDH deficiency in both patients, who underwent careful follow-up. Conclusions: This study describes two cases involving unusual leiomyomas, the histopathological characteristics of which may easily go unrecognized. These features hold predictive significance because their specific mutations point to additional hereditary cancer syndromes, highlighting the need for further examinations. Full article
(This article belongs to the Special Issue Uterine Smooth-Muscle Tumors)
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10 pages, 7065 KiB  
Case Report
Reflections on Postpartum Hysterectomy as a Possible Complication of Cesarean Myomectomy: A Long Debate
by Nikoleta Tabakova, Radmila Sparić and Andrea Tinelli
Medicina 2024, 60(4), 594; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60040594 - 4 Apr 2024
Viewed by 662
Abstract
Uterine fibroids are common benign tumors found in fertile women. Numerous obstetrical issues, such as dystocia during labor, fetal hypotrophy, a ruptured amniotic sac, early labor, low-birth-weight newborns, etc., are associated with fibrous pregnant uteri. Cesarean myomectomy is not a common procedure because [...] Read more.
Uterine fibroids are common benign tumors found in fertile women. Numerous obstetrical issues, such as dystocia during labor, fetal hypotrophy, a ruptured amniotic sac, early labor, low-birth-weight newborns, etc., are associated with fibrous pregnant uteri. Cesarean myomectomy is not a common procedure because of the possibility of postpartum hysterectomy or a potentially lethal hemorrhage. For the chosen topic, we present two instances of emergency postpartum hysterectomies following cesarean myomectomy. After a cesarean myomectomy, two women experienced a perioperative hemorrhage that required a postpartum hysterectomy without a salpingo-oophorectomy. A postpartum hysterectomy was required in every instance due to the failure of additional hemostatic techniques to control the bleeding after the cesarean myomectomy. In every case, the location and number of fibroids—rather than their size—were the primary factors leading to the postpartum hysterectomy. In order to ensure that the patient is safe and that the advantages outweigh the dangers, the current trends in cesarean myomectomy include aiming to conduct the procedure either electively or when it offers an opportunity. The treatment is still up for debate because it is unknown how dangerous a second hysterectomy is for people who have had a cesarean myomectomy. Full article
(This article belongs to the Special Issue Uterine Smooth-Muscle Tumors)
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