Clinical and morphological features of simple and cellular fibroids

Abstract

Introduction. The current trend of shifting the time of delivery to an older age requires the improvement of methods, algorithms for diagnosis, and choice of management for organ-preserving treatment of uterine fibroids. There are few reports in which data obtained using preoperative imaging methods are compared with the results of histological examination of leiomyomata. The aim of the study was to investigate the features of morphotype and clinical course of the disease in patients with common and cellular uterine leiomyoma. Materials and methods. We divided 80 patients with uterine leiomyoma into 2 groups after comprehensive clinical and morphological examination and treatment. Group 1 involved 50 patients with conventional uterine leiomyoma; group 2 included 30 patients with cellular uterine leiomyoma. All patients had a patient-specific personalized three-dimensional mathematical and graphical model of uterine fibroids built before surgery. Leiomyomata were subjected to a standard pathological examination with hematoxylin and eosin staining, immunohistochemical study with Ki-67 antibody, and Van Gieson picrofucsin to assess fibrosis. Results. The frequency of dysmenorrhea, menorrhagia, primary infertility, and endometrial hyperplastic processes significantly exceeded (p<0.05) those in the group of patients with cellular myoma. In 64.6% of patients of group 2, the indications for surgery were location of myomatous nodes and their enlargement; in group 1, the percentage of such patients was 26.0% (p<0.05). Large uterine fibroids and multiple locations of nodes were detected in more than 50% of patients in group 2, while those in patients of group 1 were determined only in 14%. In patients with conventional leiomyoma, the Ki-67 index was 0–1–2%, whereas in patients with cellular leiomyoma it was 3–4–5%. In group 1, the fibrosis area was 20–40%; in group 2, this indicator reached up to 10%. Conclusion. Uterine cell myoma is characterized by rapid growth, large node sizes, a higher frequency of both submucosal location and infertility, a combination with hyperplastic endometrial processes, uterine bleeding, pronounced pain syndrome, and a younger age. Keywords: uterine leiomyoma, conventional uterine leiomyoma, cellular uterine leiomyoma, 3D modeling, surgical navigation