Laboratory of Experimental Pathology and Biostatistics Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina 27709, USA.
To determine the associations of race, age and body mass index (BMI) with the gross pathology parameters of uterine leiomyomas in premenopausal women undergoing hysterectomy or myomectomy.
Participants (N = 107) were recruited from surgical rosters of the George Washington University (GWU) Medical Center Gynecology Department as part of the National Institute of Environmental Health Sciences Fibroid Study. Tumor data and patient demographics were obtained from clinical reports, pathology forms and interviews.
Surgical cases consisted of 78% African Americans, 13% Caucasians and 9% others (non-African American, non-Caucasian or race unknown). This proportion of African Americans was significantly higher than the distribution of GWU health plan participants. Fibroids were localized predominantly within the intramural region. Subserosal tumors were more common in patients with more than 9 tumors. African Americans had the highest mean BMI and mean myomatous uterine weight.
African Americans were the disproportionate majority coming to surgery for fibroids. The average BMI and uterine weight were greater in African Americans than in Caucasians, although these differences were marginal. Race did not influence the size, location or number of fibroids in these surgical cases. Subserosal tumors were more common in patients with more than 9 tumors.
"Fibroid tumor specimens were obtained by consent from women undergoing hysterectomy or myomectomy at the George Washington University Medical Center between June, 1996 and April, 1999, as part of the NIEHS Uterine Fibroid Study. Details of patient recruitment, demographics, and collection of gross pathology data have been previously reported . "
[Show abstract][Hide abstract] ABSTRACT: We propose, and offer evidence to support, the concept that many uterine leiomyomas pursue a self-limited life cycle. This cycle can be arbitrarily divided on the basis of morphologic assessment of the collagen content into 4 phases: (1) proliferation, (2) proliferation and synthesis of collagen, (3) proliferation, synthesis of collagen, and early senescence, and (4) involution. Involution occurs as a result of both vascular and interstitial ischemia. Interstitial ischemia is the consequence of the excessive elaboration of collagen, resulting in reduced microvascular density, increased distance between myocytes and capillaries, nutritional deprivation, and myocyte atrophy. The end stage of this process is an involuted tumor with a predominance of collagen, little to no proliferative activity, myocyte atrophy, and myocyte cell death. Since many of the dying cells exhibit light microscopic and ultrastructural features that appear distinct from either necrosis or apoptosis, we refer to this process as inanosis, because it appears that nutritional deprivation, or inanition, is the underlying cause of cell death. The disposal of myocytes dying by inanosis also differs in that there is no phagocytic reaction, but rather an apparent dissolution of the cell, which might be viewed as a process of reclamation as the molecular contents are reclaimed and recycled.
Obstetrics and Gynecology International 11/2013; 2013:528376. DOI:10.1155/2013/528376
"Informed consent was obtained, and the study was approved by the institutional review boards at the NIEHS and GWU. Details of patient recruitment, demographics, and collection of gross pathology data have been previously reported . "
[Show abstract][Hide abstract] ABSTRACT: Based upon our morphologic observations, we hypothesize and also provide morphometric evidence for the occurrence of progressive developmental changes in many uterine fibroids, which can be arbitrarily divided into 4 phases. These developmental phases are related to the ongoing production of extracellular collagenous matrix, which eventually exceeds the degree of angiogenesis, resulting in the progressive separation of myocytes from their blood supply and a condition of interstitial ischemia. The consequence of this process of slow ischemia with nutritional and oxygen deprivation is a progressive myocyte atrophy (or inanition), culminating in cell death, a process that we refer to as inanosis. The studies presented here provide quantitative and semiquantitative evidence to support the concept of the declining proliferative activity as the collagenous matrix increases and the microvascular density decreases.
Obstetrics and Gynecology International 09/2013; 2013:285103. DOI:10.1155/2013/285103
[Show abstract][Hide abstract] ABSTRACT: According to the National Health and Social Life Survey, the prevalence of sexual dysfunction among women in the United States is 43%. Despite findings that nearly 50% of all female patients have complaints related to sexuality, only 18% of practitioners report routinely obtaining a sexual history. To further complicate this issue, when sexual dysfunction is present, patients are often unwilling to address the subject with their respective physicians. As primary reasons for avoiding the subject of sexual dysfunction, patients cite fear that the clinician will dismiss their concerns, the clinician will be uncomfortable discussing sexuality, or no effective treatment will be available to treat the problem. Over the past decade, significant strides have been made in the field of sexual dysfunction. Clinicians have developed a better understanding of the psychological and physical mechanisms contributing to this array of disorders. Effective pharmacologic therapy for the treatment of male sexual dysfunction is readily available. Development of comparable therapy for women is under investigation. Given the recent dynamic nature of the field, as well as the large number of affected patients, it behooves the astute practitioner to be well versed in understanding disease mechanisms related to sexual dysfunction, their diagnosis, and possible treatment modalities.
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