Terapia prechirurgica della fibromatosi uterina - FedOA - Università ...

Results
According with previous evaluations, treated patients showed significantly improved hematochemical
parameters and reduced myoma volume after pre-surgical medical treatment (table 1).
The mean diameter of removed myomas resulted 6.06±0.80 [SD] cm in the GnRH-a group.
Surgeons stated that the cleavage plan between leiomyomas and surrounding myometrium was clearly
identifiable in 25 (86.2%) untreated patients and in 14 (42.4%) GnRH-a treated patients.
Anyway, no significant difference in the operating time was found among the two groups (untreated
group: 60.93±22.01 [SD] minutes, range 35-100 min; GnRH-a group: 68.82±17.78 [SD] min, range
40-110 min).
In the untreated group, the mean intraoperative blood loss was 213.79±139.47 [SD] ml (range 30-550
ml). It resulted significantly higher than in GnRH-a group (142.35±97.73 [SD] ml, range 20-350 ml).
The hematoxylin and eosin staining on the retrospectively recruited samples showed, in uteri from
untreated patients, a distinct border between myoma and surrounding myometrium. This border
became not so clean and evident after pre-surgical treatment with GnRH-a (Figure 1).
An immunopositivity for PCNA ranging from ++ to +++ was detected in all untreated leiomyomas
unrespect to the topography (pseudocapsule or centre) (Figure 2a). In treated cases, the expression of
PCNA resulted lower in comparison with untreated ones, with an immunopositivity ranging between
+ and ++ at the periphery of myomas (Figure 2b).
In untreated myomas, CD34 immunostaining showed a prominent vascularization, constituted by
anastomosing blood vessels, more evident in the pseudocapsule zone (mean vessel count: 51.28±6.67
[SD] (range 40-60) (Figure 2c). In the same area, treated leiomyomas showed significantly reduced
vascularization (mean count: 40.41±5.66 [SD] (range 30-48) (Figure 2d), with decreased number and
size of blood vessels.
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