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

Comment
Uterine leiomyomas are surrounded by a pseudocapsule formed by a particular distribution of the
peripheral bundles of smooth muscle cells (3). A vascular capsule, formed by larger vessels entering
the capsule from the periphery and a high density of capillaries, has also been described using electron
microscopy (4).
Frequently, surgeons observe that the pre-operative GnRH-a makes myomectomy more difficult,
because the cleavage plan between leiomyoma and its pseudocapsule becomes less distinct. Some
Authors (10,11,12) believe that the pre-operative use of GnRH-a may increase difficulties in
identifying and dissecting the cleavage plan between leiomyoma and its pseudocapsule, both in
abdominal and laparoscopic myomectomy. This conclusion is conflicting with a study of Vercellini et
al (7), that does not support the idea that pre-operative administration of GnRH-a makes myomectomy
more difficult or reduces the intraoperative blood loss.
For the first time in literature, we investigated if the finding of a less distinct cleavage plan between
myoma and myometrium could be put in relationship with some morphological and
imunohistochemical changes of the pseudocapsule.
All the patients enrolled in the present study underwent laparotomic myomectomy, both due to the
myoma location and size (intramural lesions, with a mean diameter of about 6 cm) and to the specific
skill of the surgical team.
We report that the cleavage plan between myoma and surrounding myometrium was not clearly
identifiable in the majority of pre-treated patients, but this finding did not represent an additional
difficulty for the surgeons: as a matter of fact, we did not observe any significant increase in the total
operating time and demonstrated a reduced intraoperative bleeding. The skill and the cooperation of
the surgeons probably influenced these results.
Then, we tried to evaluate the possible relationship between these clinical and surgical findings and
some histological and immunohistochemical features of the leiomyoma pseudocapsule.
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