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UNASSIGNED: Uterine fibroids, the most common nonmalignant tumors affecting the female genital tract, are a significant medical challenge. This article focuses on the most recent studies that attempted to identify novel non-hormonal therapeutic targets and strategies in UF therapy.
UNASSIGNED: This review covers the analysis of the pharmacological and biological mechanisms of the action of natural substances and the role of the microbiome in reference to UFs. This study aimed to determine the potential role of these compounds in UF prevention and therapy.
UNASSIGNED: While there are numerous approaches for treating UFs, available drug therapies for disease control have not been optimized yet. This review highlights the biological potential of vitamin D, EGCG and other natural compounds, as well as the microbiome, as promising alternatives in UF management and prevention. Although these substances have been quite well analyzed in this area, we still recommend conducting further studies, particularly randomized ones, in the field of therapy with these compounds or probiotics. Alternatively, as the quality of data continues to improve, we propose the consideration of their integration into clinical practice, in alignment with the patient\'s preferences and consent.

Herein, we aimed to examine the diagnostic yield and utility of boring biopsy for subepithelial lesions (SEL) of the stomach and esophagus. A total of 52 patients with SELs of the stomach or esophagus underwent boring biopsy. The diagnostic yield of boring biopsy for gastric and esophageal SELs was 50% (21/42) and 80% (8/10), and for SELs with a diameter of less than 10mm, the diagnostic yield was 67% (6/9) and 83% (5/6), respectively. Forty-three percent (9/21) of the gastric SELs were diagnosed with gastrointestinal stromal tumor (GIST), while all esophageal SELs (8/8) were leiomyomas. Ten percent (4/42) of boring biopsies for the stomach were accompanied by complications:two cases of perforation and two of bleeding.

UNASSIGNED: Focused ultrasound ablation surgery (FUAS) has been widely employed to treat patients with uterine fibroid (UF). This study aimed to estimate myometrial stiffness changes in patients who received FUAS for UFs or myomectomy (ME) and compare the recovery of surrounding myometrium between FUAS and ME groups. Our results may provide more evidence for guiding the proper conception timing in patients with UF.
UNASSIGNED: This study enrolled 173 patients from May 2022 to August 2023. Shear wave elastography (SWE) was used to dynamically monitor myometrial elasticity changes in patients before and after surgery. Moreover, our study monitored and analyzed the stiffness changes in the targeted fibroid after FUAS, as well as in the myometrium around after FUAS or ME.
UNASSIGNED: The stiffness of the myometrium around the resected fibroid was significantly higher than at the preoperative level until 6 months. Conversely, the stiffness of the surrounding myometrium was only temporarily increased 1 day after FUAS. The comparison between FUAS and ME groups regarding the stiffness of the surrounding myometrium showed that nonsignificant differences were detected between the two groups before the treatment. The stiffness of the surrounding myometrium in the ME group was statistically significantly higher than that of the FUAS group 1 day as well as 1, 3, and 6 months after the treatment, respectively.
UNASSIGNED: The FUAS had less impact on the surrounding myometrium than the ME, which may be more conducive to the recovery of myometrial elasticity in patients with UF.

OBJECTIVE: This study aims to consolidate existing literature regarding the association between vitamin D and uterine fibroid presence and growth.
METHODS: A comprehensive search across databases including MEDLINE, Embase, CINAHL, Web of Science, ClinicalTrials.gov, and grey literature was conducted from inception to February 2023, using relevant keywords. Authors were contacted for unpublished data.
METHODS: From 9931 studies screened based on title and abstract, those evaluating serum vitamin D levels or vitamin D treatment effects, using ultrasonography for diagnosis, and involving at least 25 pre-menopausal participants were included. Case reports, case series, and reviews were excluded.
METHODS: Data were extracted using a predefined form. Methodological quality was assessed through the Newcastle-Ottawa Scale and the Risk of Bias-2 tools. Evidence quality was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. Data from three randomized controlled trials (n = 328) and 23 observational studies (n = 5650) were meta-analyzed via random effects modeling. Patients receiving oral vitamin D supplementation had a significantly different change in fibroid size (SMD -5.7%, CI -10.63 to -0.76, P = 0.02, I2 = 99%), as measured by percentage change in diameter or volume, compared to controls, over the span of 2-6 months. Those receiving supplementation had vitamin D insufficiency; regimens varied between 50 000 IU weekly for 12 weeks, 50 000 IU weekly for 8 weeks, and 50 000 IU biweekly for 10 weeks. Patients with fibroids exhibited lower serum vitamin D concentrations (MD -5.50 ng/mL, CI 6.99 to -4.01, P < 0.001, I2 = 87%) and higher odds of vitamin D deficiency (OR 3.71, CI 1.90-7.24, P < 0.001, I2 = 80%).
CONCLUSIONS: This review underscores the potential of vitamin D in mitigating fibroid development and growth. While promising, further research is warranted to optimize dosage and treatment duration, potentially offering a non-invasive solution for at-risk patients. Continued exploration of vitamin D\'s role in fibroid treatment is encouraged.
OBJECTIVE: Cette étude vise à consolider la littérature existante concernant l\'association entre la vitamine D et la présence et la croissance des fibromes utérins. SOURCE DES DONNéES: Une recherche exhaustive a été réalisée dans les bases de données MEDLINE, Embase, CINAHL, Web of Science et ClinicalTrials.gov et dans la littérature à l\'aide de mots-clés pertinents pour la période allant de leur création à février 2023. Les auteurs ont été contactés pour obtenir des données non publiées. SéLECTION DES éTUDES: Dans les 9 931 études sélectionnées d\'après leurs titre et résumé, seules celles ayant évalué les taux sériques de vitamine D ou les effets d\'un traitement à la vitamine D, utilisé l\'échographie pour le diagnostic et comptant au moins 25 participantes non ménopausées ont été retenues. Les études de cas, les études de série de cas et les revues n\'ont pas été retenues. EXTRACTION DES DONNéES ET SYNTHèSE: Les données ont été extraites au moyen d\'un formulaire prédéfini. La qualité méthodologique a été évaluée au moyen de l\'échelle de Newcastle-Ottawa et de l\'outil d\'évaluation du risque de biais RoB-2. La qualité des données a été évaluée à l\'aide de la méthodologie GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Les données de trois essais cliniques randomisés (n = 328) et de 23 études observationnelles (n = 5650) ont été méta-analysées à l\'aide d\'une modélisation à effets aléatoires. Les patientes recevant une supplémentation orale en vitamine D ont présenté un changement significativement différent de la taille des fibromes (différence des moyennes standardisées : -5,7 %; IC : -10,63 à -0,76; P = 0,02; I2 = 99 %), tel que mesuré par le changement en pourcentage du diamètre ou du volume, par rapport aux témoins, sur une période de 2 à 6 mois. Les personnes recevant une supplémentation présentaient une insuffisance en vitamine D; les schémas posologiques étaient de 50 000 UI par semaine pendant 12 semaines, 50 000 UI par semaine pendant 8 semaines ou 50 000 UI toutes les deux semaines pendant 10 semaines. Les patientes atteintes de fibromes avaient des concentrations sériques de vitamine D plus faibles (différence moyenne : -5,50 ng/mL; IC : 6,99 à -4,01; P < 0,001; I2 = 87 %) et un risque plus élevé de carence en vitamine D (RC : 3,71; IC : 1,90-7,24; P < 0,001; I2 = 80 %).
CONCLUSIONS: Cette étude souligne le potentiel de la vitamine D dans l\'atténuation du développement et de la croissance des fibromes. Bien que ces conclusions soient prometteuses, la recherche doit se poursuivre afin d\'optimiser le dosage et la durée du traitement, ce qui pourrait constituer une solution non invasive pour les patientes à risque. La poursuite de l\'étude du rôle de la vitamine D dans le traitement des fibromes est encouragée.

OBJECTIVE:  Gastrointestinal stromal tumors are common gastric mesenchymal tumors that are potentially malignant. However, endoscopic ultrasonography is poor in diagnosing gastrointestinal stromal tumors. The study investigated the efficacy of texture features extracted from endoscopic ultrasonography images to differentiate gastrointestinal stromal tumors from gastric mesenchymal tumors.
METHODS:  The endoscopic ultrasonography examinations of 120 patients with confirmed gastric gastrointestinal stromal tumors, leiomyoma, or schwannoma were evaluated. Histology was considered the gold standard. Three feature combinations were extracted from endoscopic ultrasonography images of each lesion: 48 gray-level co-occurrence matrix-based features, 48 gray-level co-occurrence matrix-based features plus 3 global gray features, and 15 gray-gradient co-occurrence matrix-based features. Support vector machine classifiers were constructed by using feature combinations to diagnose gastric gastrointestinal stromal tumors. The area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were used to evaluate the diagnostic performance. The support vector machine model\'s diagnostic performance was compared with the endoscopists.
RESULTS:  The 3 feature combinations had better performance in differentiating gastrointestinal stromal tumors: gray-gradient cooccurrence matrix-based features yielded an area under the receiver operating characteristic curve of 0.90, which was significantly greater than an area under the receiver operating characteristic curve of 0.83 in gray-level co-occurrence matrix-based features and an area under the receiver operating characteristic curve of 0.84 in the texture features plus 3 global features. The support vector machine model (81.67% accuracy, 81.36% sensitivity, and 81.97% specificity) was also better than endoscopists (an average of 69.31% accuracy, 65.54% sensitivity, and 72.95% specificity) Conclusion: Texture features in computer-assisted endoscopic ultrasonography diagnosis are useful to differentiate gastrointestinal stromal tumors from benign gastric mesenchymal tumors and compare favorably with endoscopists. Support vector machine model using gray-gradient co-occurrence matrix-based texture features revealed the best diagnostic performance in diagnosing gastric gastrointestinal stromal tumors.

Evaluating gynecological mass lesions and reviewing their morphological characteristics based on their imaging appearance on magnetic resonance imaging (MRI), and correlating the MRI findings with histopathological findings, was the central theme of our study. This observational cross-sectional study was conducted on 60 female patients with clinically suspected gynecological mass lesions upon physical examination and/or ultrasonography, referred for MRI at a tertiary care hospital over a 1-year period between June 2022 and July 2023. A broad spectrum of differential diagnoses of gynecological masses was observed. In our study, the ratio of benign versus malignant disease was 1.6:1, with 37 benign and 23 malignant masses identified. The most common benign masses were uterine fibroids (n = 14; 23.3%), followed by endometriosis (n = 8; 13.3%), and ovarian dermoid cysts (n = 4; 6.6%). Among the malignant lesions, cervical cancer was the most common (n = 11; 18.3%), followed by endometrial carcinoma (n = 7; 11.6%), ovarian carcinoma (n = 3; 5%), and vaginal carcinoma (n = 2; 3%). Benign lesions mostly appeared hypo- to isointense on T1-weighted imaging and iso- to hyperintense on T2-weighted imaging, while malignant lesions appeared isointense on T1-weighted and hyperintense on T2-weighted imaging. Hemorrhage and fat were well appreciated on MRI and aided in diagnosis. T2 shading was present in 7 out of 8 endometriotic cysts, demonstrating a specificity of 100% and a sensitivity of 83%. For determining parametrial invasion in cervical carcinoma, MRI showed an accuracy of 91%, specificity of 100%, and positive predictive value, negative predictive value, and sensitivity of 100%, 75%, and 88%, respectively. In cases of endometrial carcinoma, MRI demonstrated a sensitivity and specificity of 87% and 91%, respectively, with a positive predictive value of 87% and a negative predictive value of 91% for identifying myometrial invasion greater than 50%. Compared to other modalities, MRI provided substantial information regarding uterine and adnexal masses and surrounding structures, facilitating accurate staging of lesions.

UNASSIGNED: The diagnosis of chronic uterine inversion occurs after birth or secondary to pathologies of the pelvic region organs. Especially, the diagnosis and treatment of isolated chronic inversion rapidly under appropriate conditions seem to reduce maternal morbidity and mortality.
UNASSIGNED: Chronic uterine inversion is a rare clinical diagnosis and difficult to diagnose and treat. This is a 22-year-old patient with no particular history known for a month for uterine fibroid with a polyp, who gave birth through the cervix in the context of subfertility for a year. Non puerperal uterine inversion is a rare clinical condition, and it should be kept in mind that this may be uterine inversion when mass lesions causing clinical complaints are detected, especially in the vulva, vagina, and cervix uteri region. The quality of life of the patients is increased by reducing the morbidity and mortality rates by making a diagnosis with a good clinical and ultrasonographic evaluation.

OBJECTIVE: To assess the efficacy of mechanical resection through TruClear™ hysteroscopy in patients with endometrial polyps and submucosal fibroids.
METHODS: Descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Shifa International Hospital, Islamabad, Pakistan, from June 2018 to 2022.
METHODS: Patients diagnosed with endometrial polyps and submucosal fibroids confirmed by abdominal or transvaginal ultrasonography were included. Patients having a history of congestive cardiac failure, chronic kidney disease, and bleeding diathesis were excluded from the study. Data about the complete removal of pathology (endometrial polyps and submucosal fibroids), mean operating time, and postoperative complications such as bleeding and perforation were extracted. The follow-up was set up to 6 months after the procedure.
RESULTS: The average age of the 45 patients was 35.62 ± 7.46 years. Heavy menstrual bleeding was the most prevalent symptom, seen in 73.3% of cases, followed by irregular vaginal bleeding (IVB) in 11.1% of cases. The most frequent disease identified by sonography was a polyp in 21 (47%) instances, followed by submucosal fibroids in 12 (27%) cases, mixed pathology in 10 (22%), and malignancy in 2 (4%) cases. The overall average operative time was 36.46 ± 24.94 minutes. A hundred percent removal of lesions was observed in this study. Persistent symptoms were observed in 13% of patients after the surgery so they were treated with other interventions. The most common intervention was an intrauterine hormonal device. Intraoperative bleeding was observed in only one patient and was managed by intraoperative intrauterine balloon insertion. The recurrence rate was 8.9% (4/45).
CONCLUSIONS: TruClear™ hysteroscopy showed a major advantage in the successful and complete removal of the pathology, low operation time, and complications.
BACKGROUND: Fibroids, Hysteroscopy, Polyps, Endometrial resection, Menstrual bleeding.

Pseudo-Meigs syndrome is a rare syndrome characterized by hydrothorax and ascites associated with pelvic masses, and patients occasionally present with elevated serum cancer antigen-125 (CA125) levels. Hydropic leiomyoma (HLM) is an uncommon subtype of uterine leiomyoma characterized by hydropic degeneration and secondary cystic changes. Rapidly enlarging HLMs accompanied by hydrothorax, ascites, and elevated CA125 levels may be misdiagnosed as malignant tumors. Here, we report a case of HLM in a 45-year-old Chinese woman who presented with ascites and hydrothorax. Preoperative abdominopelvic CT revealed a giant solid mass in the fundus uteri measuring 20 × 15 × 12 cm. Her serum CA125 level was elevated to 247.7 U/ml, while her hydrothorax CA125 level was 304.60 U/ml. The patient was initially diagnosed with uterine malignancy and underwent total abdominal hysterectomy and adhesiolysis. Pathological examination confirmed the presence of a uterine hydropic leiomyoma with cystic changes. After tumor removal, the ascites and hydrothorax subsided quickly, with no evidence of recurrence. The patient\'s serum CA125 level decreased to 116.90 U/mL on Day 7 and 5.6 U/mL on Day 40 postsurgery. Follow-up data were obtained at 6 months, 1 year, and 2 years after surgery, and no recurrence of ascites or hydrothorax was observed. This case highlights the importance of accurate diagnosis and appropriate management of HLM to achieve successful outcomes.