Clinical and morphological features of leiomyoma of the uterine corpus in reproductive-aged women after previously undergone uterine artery embolization, MRI-guided focused ultrasound ablation, and myomectomy


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Abstract

Due to the introduction of new treatment options, such as uterine artery embolization (UAE), MRI-guided focused ultrasound (MRIgFU) ablation of myoma, in order to evaluate their efficiency, investigators are interested in the impact of the above procedures on the structural and molecular biological features of myomatous nodules. Objective. To investigate the clinical, morphological, and immunohistochemical features of leiomyoma of the uterine corpus in reproductive-aged women after previously undergone UAE, MRIgFU ablation of myoma, and myomectomy. Subjects and methods. The investigation enrolled 85 reproductive-aged women with uterine myoma who needed surgical treatment. Material was obtained from 29 patients after previously undergone UAE (Group 1), 26 patients after previously undergone MRIgFU ablation (Group 2), and 30 patients after previously undergone myomectomy (Group 3). The age range for the women in the compared groups was 22 to 45 years; their mean age was 36.2±5.2 years. Histological and immunohistochemical examinations were performed using the intraoperative myomatous nodule samples obtained during organ-sparing myomectomies in the phase of secretion. The expression of the markers VEGF, HIF-1, IGFR-1, Casp3, and Ki67 was estimated. Results. In Group 1, the expression of VEGF was 2.7 scores in the endothelium and 1.7 scores in the smooth muscle cells; in Groups 2 and 3, this was 1.8 and 0.3 scores and 3.5 and 2.0 scores, respectively. In our investigation, the expression of HIF-1 was much higher in the post-UAE group (10.1%), moderate in the post-myomectomy group (5.0%); and very low in thepost-MRIgFUablation group (0.26%), which was statistically significant (p < 0.05). IGFR-1 was detected in the cytoplasm of smooth muscle cells in the leiomyocytes; In Groups 1, 2, and 3, the expression of IGFR-1 was 1.5, 3.6, and 2.7 scores, respectively (p < 0.05). Its maximum expression was revealed in Group 2. The values of Ki-67 expression as a proliferative process were comparable with the level of apoptosis in the cells, as shown by the obtained date on Casp3, which can judge a relative balance between proliferative and apoptotic processes. Conclusion. Our clinical and morphological evaluation of the leiomyoma after treatment using UAE, MRIgFU ablation, and myomectomy is suggestive of certain molecular biological mechanisms for the development of myoma, as well as the expression of growth factors in the leiomyocytes in relation to the previously performed treatment option. In addition, the inferred causes of myomatous nodular growth could be established.

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About the authors

Irina E. Porotikova

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: irinaevgdoc@gmail.com
PhD student

Tatiana A. Demura

I.M. Sechenov First Moscow State Medical University

Email: demura-t@yandex.ru
MD, professor of department of pathology

Leila V. Adamyan

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation; Moscow State University of Medicine and Dentistry

Email: l_adamyan@oparina4.ru
Academician of the Russian Academy of Sciences, MD, PhD, Professor, Honored Master of Science of the Russian Federation, Head Specialist in Obstetrics and Gynecology of Ministry of Healthcare and Social Development of Russia, Head of the Department of Surgical Gynecology; Head of the Department of Reproductive Medicine and Surgery, Faculty of Postgraduate Education

Tatiana Yu. Gavrilova

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: gavrilova71@mail.ru
MD

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