Director

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• Director
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• September 15, 2006

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Ultrasonic Characteristics Differential
Diagnosis on Leiomyoma, Adenomyosis and
AdenomyomaReview of the Literature
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What is Leiomyomata?

• The elephant in the room

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• Uterine leiomyomas are benign myometrial
  neoplasms enriched in extracellular matrix.

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• Uterine leiomyomas are the most
• common gynecologic disease of the
• corpus uteri and are readily detected
• by trans-vaginal sonography.
• They are the primary indication for hysterectomy,
  over
• 200000 cases annually in US. Science June, 2005

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• Tumors occur in 77 women and approximately 25
  of Caucasians have clinical significant lesions.
• In African-American women, clinical disease is
  more severe more and concordant with prevalence.
  
• Science June, 2005

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Risk Factors Prevalence

• The prevalence of clinical significant fibroids
  peaks in the perimenopausal years and declines
  after menopause.
• Increased Risk obesity early menarche, race
• Decreased Risk old age of the last child birth.
• 
  (COX-2, PGE)
• Science June, 2005

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Genetics of Uterine Leiomyoma

• Approximately 40 display cytogenetic
  alternations, frequently involving chromosome 12,
  t(1214). (HMGA2)
• Hereditary leiomyomatosis and RCC (HLRCC)
• Fumarate hydratase gene (FH).
• Tuberous sclerosis complex gene (TSC) BHD.
• CYP19 CYP17 (black African women).
• Deletions of 7q, 3q and 1p rearrangements of 6p,
  10q and 13q.
  
• 
  Science. June 2005 Obs Gyn. April 2006

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Obesity Parity Race
Genetic Alter FH BHD TSC2 HMG2A
Autocrine TGF?.etc
Estrogen Progesterone
Tumor Growth ECM
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Leiomyomata ? Leiomyosarcoma?

• However, it appears that a subset of myomas with
  a deletion of a specific portion of chromosome 1
  have both a specific cellular morphology and gene
  transcription profiles akin to those of
  leiomyosarcomas.
• Christacos NC. Genes Chromosomes Cancer
  200645304