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

Leiomyoma growth and maintenance are stimulated by sex steroid hormones (2). Since 1980s,
gonadotropin releasing hormone agonists (GnRH-a) have been used for the treatment of uterine
leiomyomas. They reversibly suppress pituitary ovarian function, thus inducing a state of hypo-
estrogenism that allows a temporary control of bleeding and a reduction in uterine and leiomyoma
size. GnRH-a are beneficial in the correction of pre-operative iron deficiency anemia, reduce
intraoperative blood loss and operating time and allow more conservative surgical interventions (1).
Leiomyomas regain their original size within a few weeks after the end of medical therapy. This fact,
together with the menopausal symptoms induced by the low estradiol levels, justify the prevalent use
of GnRH-a as a pre-operative treatment in premenopausal women.
A problem frequently encountered in clinical practice but poorly researched, is that GnRH-a render
surgical planes less distinct and this makes leiomyoma enucleation more difficult. Uterine
leiomyomas are usually defined as well-capsulated benign neoformations. Actually, they are
surrounded by a pseudocapsule, formed by a particular distribution of the bundles of smooth muscle
cells of the more peripheral zone of the myoma and of the surrounding myometrium (3). During the
development of leiomyoma, intense angiogenesis at the periphery leads to the formation of a “vascular
capsule” responsible for blood supply to the growing myoma (4).
The relationship between clinical, surgical and histochemical effects of GnRH-a is well described in
literature (5,6,7,8,9) but, at our knowledge, no report evaluated the specific immunohistochemical
changes of leiomyoma pseudocapsule and their possible relationship with some clinical and surgical
findings.
Aim of the present study was to evaluate the effects of the pre-operative treatment with GnRH-a on
cell proliferation and vascularization of leiomyoma pseudocapsule and speculate if these changes
could influence, at least in part, the modifications of the cleavage plan, the operating time and the
intraoperative blood loss.
96