Peritoneal "Pearl" Mystery after Uterine Artery Embolization

Department of Gynecology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Journal of vascular and interventional radiology: JVIR (Impact Factor: 2.41). 10/2011; 22(10):1491-3. DOI: 10.1016/j.jvir.2011.06.024
Source: PubMed
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    ABSTRACT: To study utero-ovarian anastomosis at angiography and its histologic effect on patients who were treated with uterine artery embolization (UAE) with or without ovarian artery embolization (OAE) for symptomatic uterine leiomyomata. Four hundred patients (mean age, 43.6 years +/- 6.34) underwent UAE at the authors' institution from June 1998 to May 2005. Eight of the 400 patients underwent hysterectomy with removal of at least one adnexae after UAE. Five patients received tris-acryl gelatin microspheres and three received polyvinyl alcohol particles. Two patients also underwent OAE with gelatin sponges. Specimens from 16 fallopian tubes and 12 ovaries were reviewed. Histologic slides were prepared and reviewed by two pathologists who were blinded to the angiographic findings. The presence of utero-ovarian anastomoses at angiography, the histologic features of adnexa, the presence of particles in the adnexa, and the size and location of the particles were studied. Utero-ovarian anastomosis was present at angiography in three of the eight patients (38%) and five of the 16 adnexa (31%). Particles were present within the fallopian tube or ovary in all patients who demonstrated utero-ovarian anastomoses at angiography. When utero-ovarian anastomoses were identified bilaterally, particles were found in both adnexae. In cases with particles in the adnexa, the adnexal tissues were histologically viable without evidence of ischemic changes or infarction. Particles were not present in the ovary of patients without utero-ovarian anastomosis at angiography. The angiographic finding of a utero-ovarian anastomosis during UAE appears to correlate with particle embolization in the fallopian tube or ovary. Histologically normal fallopian tubes and ovaries can be expected after UAE with microsphere particles with and without OAE with gelatin sponges.
    Journal of Vascular and Interventional Radiology 02/2007; 18(1 Pt 1):31-9. DOI:10.1016/j.jvir.2006.10.008 · 2.41 Impact Factor
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    ABSTRACT: To determine the long-term outcome of uterine fibroid therapy (UFE) using tris-acryl gelatin microspheres (TAGM). This was a multicenter prospective study of patients undergoing UFE with TAGM, and during this phase of the study, the clinical outcomes 3 years after treatment were assessed. Measures of outcome included the Ruta Menorrhagia Questionnaire, patient self-assessments of symptoms and impact on activities, patient satisfaction and health-related quality of life as measured by the SF-12. Long-term re-intervention rates were also assessed. The data were analyzed at each interval compared to baseline using appropriate statistical tests. Of the 102 patients enrolled, 96 patients had complete baseline data and of these, 69 (72%) had known outcomes at 3 years after treatment. Sixty-one patients (64%) completed long-term follow-up without major intervention. An additional 8 patients (8.3%) underwent fibroid surgery (7 hysterectomies and 1 myomectomy). Among those without intervention, at 3 years after treatment, the mean Ruta Questionnaire Score was 19.3, compared to 47.9 at baseline and 24.5 at 3 months (P <.01). At baseline, 57% of patients had extremely heavy bleeding, while only 2% had that complaint at 36 months. At 36 months, much or moderate improvement in pelvic pain occurred in 83% of patients, pelvic discomfort in 83%, and urinary problems in 69% and 84% were moderately or very satisfied with their outcome. Over the long-term, UFE using TAGM is effective and safe, with high levels of durable symptom control, improved health-related quality of life and patient satisfaction.
    Journal of Vascular and Interventional Radiology 02/2007; 18(2):203-7. DOI:10.1016/j.jvir.2006.12.006 · 2.41 Impact Factor
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    ABSTRACT: Uterine artery embolization (UAE) as an alternative to surgery for the treatment of uterine fibroids and adenomyosis uteri became increasingly popular. While the clinical success of this new treatment strategy is without doubt, there is still considerable uncertainty with respect to the morphologic changes induced by UAE. In this study, a total of 173 women were treated with UAE using tris-acryl gelatin microspheres (TGMS), a new particulate spherical embolic agent, for either symptomatic adenomyosis or leiomyoma. Surgical specimens of 8 women who underwent subsequent myomectomy or hysterectomy were evaluated by conventional histology and immunohistochemistry. TGMS were readily apparent in both macroscopy and routine histology. In patients with fibroids, TGMS accumulated in medium-sized vessels in the direct tumor vicinity, a minor fraction of particles was detected in the outer half of the myometrium and within leiomyomata. In patients with adenomyosis, a random distribution of TGMS was noted throughout the outer half of the myometrium. Freshly infused particles occluded the respective arteries without a significant tissue reaction. In the course of time, a granulomatous foreign body reaction in the vicinity of particles occurred, eventually followed by complete vessel destruction. Leiomyoma treated with UAE showed either hyaline necrosis, coagulative necrosis, or no change at all. Foci of adenomyosis remained unaltered. In conclusion, after UAE with TGMS, particles were identified predominately but not exclusively at the periphery of fibroids. Pathologists must be aware of the morphologic changes induced by UAE in leiomyoma to avoid misinterpretation of induced tissue alterations as signs of malignant tumor growth.
    American Journal of Surgical Pathology 08/2005; 29(7):955-61. DOI:10.1097/01.pas.0000159776.77912.ce · 5.15 Impact Factor