MyMedR

Fulltext Large lower segment myoma--myomectomy at lower segment caesarean section--a report of two cases

Omar SZ, Sivanesaratnam V, Damodaran P

Singapore Med J, 1999 Feb;40(2):109-10.

Uterine leiomyoma is found in approximately 2% of pregnant women. One in ten women will have complications related to myoma in pregnancy. Myomectomy during pregnancy especially at Caesarean section is much discouraged in the literature. We present here 2 cases of large uterine myoma, situated in the anterior aspect of the lower segment, complicating pregnancy at term. Myomectomy in both instances allowed delivery of the fetus through the lower segment, making vaginal delivery in subsequent pregnancies possible.

Matched MeSH terms: Uterine Neoplasms/surgery*

Fulltext Degenerated uterine fibroid mimicking hydrometra: fallacy in CT

Tok Ch, Bux S, Mohamed S, Lim B

Biomed Imaging Interv J, 2006 Oct;2(4):e42.

PMID: 21614328 MyJurnal DOI: 10.2349/biij.2.4.e42

Fibroids are the commonest uterine neoplasms, occurring in 20% - 30% of women of reproductive age. In women who have pelvic masses of unknown cause, unusual manifestations of fibroids such as necrosis or degeneration may simulate a carcinoma or hydrometra resulting in problems with image interpretation. We report a case of an unsuspected large degenerated uterine fibroid in a lady mistakenly diagnosed as hydrometra on computed tomography scanning.

Matched MeSH terms: Uterine Neoplasms

Uterine leiomyomata in pregnancy

Hasan F, Arumugam K, Sivanesaratnam V

Int J Gynaecol Obstet, 1991 Jan;34(1):45-8.

PMID: 1671020

Sixty cases with uterine leiomyomata in pregnancy are presented. The incidence was 1 in 1033 deliveries. The median age of the patients was 33.4 years. The majority were primigravidae (60%). A significant number of patients gave a history of infertility (43%) and spontaneous abortions (25%). The commonest antenatal complication was malpresentation and in all these patients the myomata were larger than 6 cm. Typical features of red degeneration occurred in 10% of cases. The cesarean section rate was 73%, the commonest indication being obstructed labor. Severe hemorrhage was encountered at cesarean section in 10 patients, 3 of whom needed hysterectomy. There were no perinatal deaths.

Matched MeSH terms: Uterine Neoplasms/complications; Uterine Neoplasms/epidemiology*; Uterine Neoplasms/surgery

Expression of placental proteins in complete and partial hydatidiform moles

Cheah PL, Looi LM

Pathology, 1994 Apr;26(2):115-8.

PMID: 8090580

Examination of routinely stained haematoxylin and eosin sections may sometimes prove inadequate in differentiating partial hydatidiform moles (PHM) from complete hydatidiform moles (CHM). While cytogenetic analysis can aid in the distinction, such facilities are not always available. The possibility of using immunohistochemistry to aid in the differentiation was studied. Twenty-five histologically proven CHM and 11 PHM were studied for their patterns of expression of human chorionic gonadotrophin (hCG), human placental lactogen (hPL) and placental alkaline phosphatase (PIAP). All CHM stained diffusely with hCG and focally with both hPL and PIAP irrespective of gestational age. Of PHM, 63.6% were diffusely positive for hCG, 27.3% for hPL and 54.5% for PIAP; the rest were focally positive. The hCG pattern changed from diffuse to focal with increasing gestational age of PHM, while those of hPL and PIAP became increasingly diffuse with gestational age. While these protein expressions may be applied in differentiating late PHM from CHM, it is not useful in first trimester cases. The most helpful application is that focal expression of hCG and diffuse expressions of hPL and PIAP is not seen in CHM, thereby excluding such a diagnosis. PHM, in contrast, can show either diffuse or focal expression of all 3 antigens.

Matched MeSH terms: Uterine Neoplasms/diagnosis; Uterine Neoplasms/pathology; Uterine Neoplasms/chemistry*

Fulltext Term delivery of a complete hydatidiform mole with a coexisting living fetus followed by successful treatment of maternal metastatic gestational trophoblastic disease

Peng HH, Huang KG, Chueh HY, Adlan AS, Chang SD, Lee CL

Taiwan J Obstet Gynecol, 2014 Sep;53(3):397-400.

PMID: 25286799 DOI: 10.1016/j.tjog.2013.02.005

OBJECTIVE: A twin pregnancy consisting of a complete hydatidiform mole with a coexisting normal fetus is extremely rare with an incidence of 1/22,000 to 1/100,000. The incidence of preterm delivery is high and few pregnancies reach near term with a viable fetus.
CASE REPORT: A 34-year-old woman presented at 20 weeks of gestation with increased levels of serum beta human chorionic gonadotropin (beta-HCG) at 4.74 multiples of the median (310277.7 mIU/mL). Ultrasonography showed a hydatidiform mole together with a normal fetus. Fetal karyotyping revealed 46XY. The serum beta-HCG levels were followed up throughout the remainder of the pregnancy. A male infant weighting 2260 g and the molar tissue were delivered at 37 weeks of gestation. The karyotype of the molar tissue showed 46XX and the histopathological report confirmed our diagnosis. At 4 months postpartum, metastatic gestational trophoblastic disease of the lung was diagnosed in the mother by a computed tomography scan due to increased beta-HCG levels. The patient received three unsuccessful cycles of methotrexate and folinate. Another four cycles of chemotherapy consisting of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) were initiated and the beta-HCG levels returned to normal. There was no evidence of recurrence in the subsequent 5 years of regular follow up.
CONCLUSION: A pregnancy with a complete hydatidiform mole and a living cotwin can be a serious threat to the health of both the mother and the fetus. Early diagnosis depends on a combination of detecting an unusually high level of serum beta-HCG and ultrasound examination. We suggest that continuation of the pregnancy may be an acceptable option and that the pregnancy may continue until term if a normal fetal anatomy is assured and maternal complications are under control. Patients require careful postpartum follow up and any recurrent disease should be managed aggressively.
KEYWORDS: EMA-CO; metastatic gestational trophoblastic disease; twin pregnancy with one complete hydatidiform mole

Matched MeSH terms: Uterine Neoplasms/drug therapy; Uterine Neoplasms/pathology*

Goserelin versus leuprolide before hysterectomy for uterine fibroids

Lim SS, Sockalingam JK, Tan PC

Int J Gynaecol Obstet, 2008 May;101(2):178-83.

PMID: 18164303 DOI: 10.1016/j.ijgo.2007.10.020

To compare goserelin and leuprolide given before hysterectomy for symptomatic large fibroid uteri.

Matched MeSH terms: Uterine Neoplasms/pathology; Uterine Neoplasms/therapy*

Fulltext Hydatidiform molar pregnancy in Malaysian women: a histopathological study from the University Hospital, Kuala Lumpur

Cheah PL, Looi LM, Sivanesaratnam V

Malays J Pathol, 1993 Jun;15(1):59-63.

PMID: 8277792

A review of gestational trophoblastic disease diagnosed at the Department of Pathology, University Hospital, Kuala Lumpur from January 1989 to December 1990 using established histological criteria showed 25 complete hydatidiform moles (CHM), 11 partial hydatidiform moles (PHM), 1 invasive mole and 2 choriocarcinoma. The ages of the patients with CHM ranged from 21 to 43 years (mean = 28.5 years) and PHM 20 to 33 years (mean = 27.5 years). The invasive mole occurred in a 42-year-old Malay woman. The two patients with choriocarcinoma were both Chinese and 41 and 46-years old respectively. During the same period, 1,062 non-molar abortions and 13,115 births, inclusive of livebirths and stillbirths were recorded at the University Hospital. The incidence rate of hydatidiform moles was thus estimated to be 1:384 pregnancies. PHM constituted 30% of all molar pregnancies. Hydatidiform moles occurred among the Malays, Chinese and Indians at the rate of 2.43, 2.66 and 3.29 per 1,000 pregnancies respectively. It appears that hydatidiform molar pregnancy has the highest prevalence among the Indians, a finding similar to an earlier Singapore study.

Matched MeSH terms: Uterine Neoplasms/epidemiology; Uterine Neoplasms/pathology*

Recurrent leiomyomatosis peritonealis disseminata

Ng PH, Mahdy Z, Nik NI

J Obstet Gynaecol, 2004 Feb;24(2):188-9.

PMID: 14766471

Matched MeSH terms: Uterine Neoplasms/pathology*; Uterine Neoplasms/surgery

Laparoscopic versus abdominal myomectomy: trend and pattern of practice among reproductive age population in Kedah, Malaysia

Ahmad MF, Sheng KL, Kathirgamanathan S, Kannaiah K

Minerva Ginecol, 2018 10;70(5):644-645.

PMID: 29464941 DOI: 10.23736/S0026-4784.18.04183-7

Matched MeSH terms: Uterine Neoplasms/pathology; Uterine Neoplasms/surgery*

Fulltext Lipoleiomyoma of the uterus

Karikalan B, Pasupathi T

Indian J Pathol Microbiol, 2017 Jan-Mar;60(1):128-129.

PMID: 28195112 DOI: 10.4103/0377-4929.200052

Matched MeSH terms: Uterine Neoplasms/diagnosis; Uterine Neoplasms/pathology*

Incidence of acute atherosis in complete molar pregnancy

Hayati AR, Azizah A, Wahidah A

Malays J Pathol, 1998 Dec;20(2):113-4.

PMID: 10879273

A clinicohistological study of acute atherosis in molar pregnancy was undertaken. Maternal decidual vessels in currettage samples of 38 histologically confirmed complete hydatidiform moles were examined histologically for acute atherosis, recognised as fibrinoid necrosis of the smooth muscle wall with a perivascular mononuclear cell infiltrate, with or without lipophages. Acute atherosis was detected in eight of 38 cases, an incidence of 18.4%. All the patients were normotensive. The significance of acute atherosis in molar pregnancy remains to be clarified.

Matched MeSH terms: Uterine Neoplasms/complications; Uterine Neoplasms/pathology*

Fulltext Hydatidiform mole and post-evacuation regression patterns of serum beta human chorionic gonadotrophin

Kamariah K, Satgunasingam N, Nasri NM, Ng KY

Med J Malaysia, 1993 Mar;48(1):40-5.

PMID: 7688063

Eighty-nine patients who had hydatidiform moles evacuated at the General Hospital, Kuala Lumpur, were followed with serum beta hCG determinations from October 1988 to June 1991. A regression curve for serum beta hCG, as measured by RIA, was derived from the results of 47 of the patients who demonstrated spontaneous regression of serum beta hCG titres. All 47 patients had normal serum titres at 135 days after evacuation. The mean time taken to reach normal level was 82.6 days, while the range was 39 to 135 days (5 to 19 weeks).

Matched MeSH terms: Uterine Neoplasms/blood*; Uterine Neoplasms/therapy

Fulltext Anti-Uterine Fibroid Effect of Standardized Labisia Pumila Var. Alata Extracts In Vitro and in Human Uterine Fibroid Cancer Xenograft Model

Zakaria N, Mohd KS, Ahmed Saeed MA, Ahmed Hassan LE, Shafaei A, Al-Suede FSR, et al.

Asian Pac J Cancer Prev, 2020 Apr 01;21(4):943-951.

PMID: 32334454 DOI: 10.31557/APJCP.2020.21.4.943

BACKGROUND: Uterine fibroids are a common type of solid tumor presenting in women of reproductive age. There are very few alternative treatment available from conventional treatment involving surgeries. Labisia pumila var. alata or locally known as 'Kacip Fatimah' was widely used as traditional medicine in Malaysia. This plant has been used to maintain a healthy female reproductive system. The present study aimed to evaluate anti fibroid potential of L. pumila extracts through in vitro apoptosis activity against uterine leiomyoma cells (SK-UT-1) and in uterine leiomyoma xenograft model. Evaluation of bioactive markers content were also carried out.

METHODS: Apoptotic induction of the extracts was determined by morphological examination of AO/PI dual staining assay by flourescent microscopy and flow cytometry analysis on Annexin V-FITC/PI stained cells. In vivo study was done in immune-compromised mouse xenograft model. HPLC analysis was employed to quantify marker compounds.

RESULTS: Morphological analysis showed L. pumila induced apoptosis in a dose dependent manner against SK-UT-1 cells. In vivo study indicated that L. pumila significantly suppressed the growth of uterine fibroid tumor. All tested extracts contain bioactive marker of gallic acid and cafeic acid.

CONCLUSION: This work provide significant data of the potential of L. pumila in management of uterine fibroids.
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Matched MeSH terms: Uterine Neoplasms/drug therapy*; Uterine Neoplasms/pathology

Fulltext Molar pregnancy with normal viable fetus presenting with severe pre-eclampsia: a case report

Atuk FA, Basuni JBM

J Med Case Rep, 2018 May 21;12(1):140.

PMID: 29779493 DOI: 10.1186/s13256-018-1689-9

BACKGROUND: While gestational trophoblastic disease is not rare, hydatidiform mole with a coexistent live fetus is a very rare condition occurring in 0.005 to 0.01% of all pregnancies. As a result of the rarity of this condition, diagnosis, management, and monitoring will remain challenging especially in places with limited resources and expertise. The case we report is an interesting rare case which presented with well-described complications; only a few similar cases have been described to date.

CASE PRESENTATION: We report a case of a 21-year-old local Sarawakian woman with partial molar pregnancy who presented with severe pre-eclampsia in which the baby was morphologically normal, delivered prematurely, and there was a single large placenta showing molar changes.

CONCLUSION: Even though the incidence of this condition is very rare, recognizing and diagnosing it is very important for patient care and it should be considered and looked for in patients presenting with pre-eclampsia.

Matched MeSH terms: Uterine Neoplasms/complications*; Uterine Neoplasms/pathology

Management of the pregnant mother with malignant conditions

Sivanesaratnam V

Curr Opin Obstet Gynecol, 2001 Apr;13(2):121-5.

PMID: 11315864

A malignancy discovered in pregnancy is often difficult to manage; the optimal maternal therapy has to be balanced with the fetal well-being. Generally, the cancer is managed as though the patient is not pregnant. For the various site-specific cancers, surgery is the main modality of treatment; this should be individualized. Chemotherapeutic agents are highly teratogenic in the first trimester, with some adverse effects when used after 12 weeks' gestation. The overall survival rate for pregnancy-associated breast cancer is poor; the reasons for this are discussed. For cervical cancer, delivery by caesarean section appears to be the method of choice, with significantly better survival rates compared with those who deliver vaginally. Other gynaecological and non-gynaecological malignancies are discussed.

Matched MeSH terms: Uterine Neoplasms/diagnosis; Uterine Neoplasms/therapy

FZD1 activates protein kinase C delta-mediated drug-resistance in multidrug-resistant MES-SA/Dx5 cancer cells

Hung TH, Chen CM, Tseng CP, Shen CJ, Wang HL, Choo KB, et al.

Int J Biochem Cell Biol, 2014 Aug;53:55-65.

PMID: 24814288 DOI: 10.1016/j.biocel.2014.04.011

Multidrug-resistant (MDR) cancer is a major clinical problem in chemotherapy of cancer patients. We have noted inappropriate PKCδ hypomethylation and overexpression of genes in the PKCδ/AP-1 pathway in the human uterus sarcoma drug-resistant cell line, MES-SA/Dx5 cells, which also overexpress p-glycoprotein (ABCB1). Recent studies have indicated that FZD1 is overexpressed in both multidrug-resistant cancer cell lines and in clinical tumor samples. These data have led us to hypothesize that the FZD1-mediated PKCδ signal-transduction pathway may play an important role in drug resistance in MES-SA/Dx5 cells. In this work, the PKCδ inhibitor Rottlerin was found to reduce ABCB1 expression and to inhibit the MDR drug pumping ability in the MES-SA/Dx5 cells when compared with the doxorubicin-sensitive parental cell line, MES-SA. PKCδ was up-regulated with concurrent up-regulation of the mRNA levels of the AP-1-related factors, c-JUN and c-FOS. Activation of AP-1 also correlated with up-regulation of the AP-1 downstream genes HGF and EGR1. Furthermore, AP-1 activities were reduced and the AP-1 downstream genes were down-regulated in Rottlerin-treated or PKCδ shRNA-transfected cells. MES-SA/Dx5 cells were resensitized to doxorubicin-induced toxicity by co-treatment with doxorubicin and Rottlerin or PKCδ shRNA. In addition, cell viability and drug pump-out ability were significantly reduced in the FZD1 inhibitor curcumin-treated and FZD1 shRNA-knockdown MES-SA/Dx5 cells, indicating involvement of PKCδ in FZD1-modulated ABCB1 expression pathway. Taken together, our data demonstrate that FZD1 regulates PKCδ, and the PKCδ/AP-1 signalling transduction pathway plays an important role in drug resistance in MES-SA/Dx5 cells.

Matched MeSH terms: Uterine Neoplasms/drug therapy; Uterine Neoplasms/genetics*; Uterine Neoplasms/pathology

Ovarian and uterine leiomyosarcoma: which one is the primary?

Shafiee MN, Kah Teik C, Md Zain RR, Kampan N

Horm Mol Biol Clin Investig, 2019 Aug 09;41(2).

PMID: 31398145 DOI: 10.1515/hmbci-2019-0037

Uterine leiomyosarcoma (LMS) is rare but primary ovarian LMS is even rarer constituting less than 0.1% of all gynecologic disorders. Neither histologic features nor immunohistochemistry could be utilized to distinguish between uterine or ovarian origin. We illustrate a clinical case of metastatic LMS to the ovary in a woman with underlying uterine fibroid presenting with anemia with heavy menses.

Matched MeSH terms: Uterine Neoplasms/diagnosis*; Uterine Neoplasms/etiology; Uterine Neoplasms/therapy

Cerebral metastases from choriocarcinoma. Results of chemotherapy

Sen DK, Sivanesaratnam V, Chuah CY, Ch'ng SL, Singh J, Paramsothy M

Acta Obstet Gynecol Scand, 1987;66(5):425-8.

PMID: 3425244

Of 36 cases of choriocarcinoma treated at the University Hospital Kuala Lumpur during 1980-84 inclusive, 6 patients were found to have cerebral metastases. Intrathecal methotrexate and combination chemotherapy were started in all cases, with monitoring of tumor growth by serial beta-HCG assays and CT scanning of brain and lung. Chemotherapy was reduced because of severe toxicity in 2 patients, one of whom received radiotherapy to the brain. Four patients (66%) have now been in remission for 2.5-6 years. Two did not respond to therapy and died. The factors involved in therapy and response are discussed.

Matched MeSH terms: Uterine Neoplasms/blood; Uterine Neoplasms/drug therapy*; Uterine Neoplasms/mortality

Fulltext Endometrial stromal sarcoma with Cd56 expression: a case report

Azizan, N., Hayati, F., Madatang, A., Abu Seman, F.

Journal of Surgical Academia, 2018;8(1):36-38.

MyJurnal

Endometrial stromal sarcoma (ESS) is a rare malignant tumour of the endometrium, accounts for less than 1% of all
uterine malignancies. Routinely, it is diagnosed morphologically, supported by immunomarkers of CD10 and
vimentin. CD56 is used widely in neuroendocrine tumour. In our current practice, CD56 is not used to support the
diagnosis of ESS. We present a case of a postmenopausal lady with advanced ESS who had expression of CD56
upon immunohistochemical study

Matched MeSH terms: Uterine Neoplasms

All-trans retinoic acid (atra) inhibits telomerase expression of BeWo choriocarcinoma cell (ATCC CCL-98)

Tatit NS, Kevin P

Med J Malaysia, 2019 12;74(6):504-508.

PMID: 31929476

INTRODUCTION: Choriocarcinoma is malignant cancer originating from placental trophoblast. The incidence of this cancer is estimated at 0.57-1.1 per 1000 births in the United States of America, Australia, Europe, and New Zealand. The rate is much higher in South East Asia and Japan with two occurrences per a thousand births. Telomerase activity is an important part of the apoptotic process. Increased telomerase activity will result in cellular immortality and poor prognosis in cancer. Vitamin A possess an essential role in cell proliferation and differentiation. One of the active metabolites of vitamin A is All-Trans Retinoic Acid (ATRA).

METHODS: In this study, we examined the role of ATRA against telomerase activity in choriocarcinoma cell. This cell was derived from BeWo cell line (ATCC CCL-98) and were given different doses of ATRA.

RESULTS: From this study, Choriocarcinoma cell that was given ATRA in dosage of 50μg/ml inhibit telomerase activity by extending the cycle time of 39.51±0.09, compared to the control group with a cycle time of 37.62±0.43. Cycle length change consistently with higher dose of ATRA.

CONCLUSION: This study has proven that ATRA could inhibit telomerase activity by lengthening the cycle. Changes in the increase of ATRA doses in this experimental test need to be studied further on experimental animals, either administered as a single agent or as an addition to standard treatment of trophoblastic disease.

Matched MeSH terms: Uterine Neoplasms/drug therapy*; Uterine Neoplasms/metabolism; Uterine Neoplasms/pathology

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