Background: Uterine leiomyomas (fibroids) are now known to be highly variable in their clinical behavior and biologic basis. However, the approach to leiomyomas and their effect on fertility, miscarriage and pregnancy complications has been based on location alone.Materials and Methods: This talk with bring together published information on the effect of leiomyomas on reproductive performance and newer literature on growth, regression and genetics of uterine fibroids. In addition, we will discuss the effects of treatments for fibroids on reproductive performance.Results: Location within the uterus remains the most predictive clinical factor in determining the impact of uterine fibroids on fertility. Submucosal fibroids have the greatest fertility impairment. Moreover, removal of submucosal fibroids is associated with an improvement in fertility potential. In contrast, intramural fibroids also have a measurable inhibitory effect on fertility potential, but show no attenuation of that impairment with conventional surgical removal. However, it is not clear whether it is biologic differences in the two or the adverse effects of surgical myomectomy which makes a difference.Conclusion: Further work is necessary to understand genotype/phenotype relationships in uterine fibroids. Less invasive treatment options may also benefit women with leiomyomas who desire pregnancy.

Uterine sarcomas, accounting for only 1% of malignant genital system tumors, present significant diagnostic and therapeutic challenges due to their rarity, small size, and diverse clinical manifestations. Leiomyosarcoma, a subtype of uterine sarcoma, is particularly difficult to differentiate from benign leiomyomas, as there are no distinct clinical or radiological criteria. The study aimed to identify specific structural changes in leiomyocytes of uterine leiomyomas that may indicate a high risk of developing leiomyosarcoma. Through histological and immunohistochemical analyses, including hematoxylin and eosin staining and markers such as Ki67, vimentin, and desmin, a detailed examination of operative materials from a single patient at two different times (2017 and 2023) was conducted. The initial histological diagnosis in 2017 suggested a leiomyoma with low malignant potential, but subsequent follow-up in 2023 revealed leiomyosarcoma with invasion into the sigmoid colon. This case emphasizes the diagnostic complexity of leiomyosarcoma, particularly when structural changes in leiomyocytes are present, and highlights the need for continuous monitoring of patients postoperatively, even in cases initially deemed to have low malignant potential. The study concludes that prognosis depends not on tumor size but on the degree of malignancy, with poorly differentiated sarcomas demonstrating a poor prognosis. These findings underscore the importance of histopathological evaluation and long-term follow-up to improve patient outcomes in uterine sarcoma cases.

Introduction: Uterine leiomyomas arise from the proliferation of smooth muscle cells. ACE gene encodes a convertase enzyme mainly secreted in vascular endothelial cells which is involved in the renin–angiotensin system and blood pressure controlling. This gene has an insertion/deletion (I/D) polymorphism correlates to serum and tissue ACE levels. The aim of this study is to elucidate the relationship between ACE gene variation and the development of myom.Methods: The samples of 55 uterine leiomyoma patients and 78 healthy women were studied. After obtaining informed consent, blood samples were collected and DNA extraction was performed by Salting-out method. Genotyping was performed using PCR reaction. The amplified products were two bands of 190 and 490 bp, which represents D allele and I allele, respectively. Statistical analysis was done using Chi-square test.Results: The D allele frequency was 0.55 in the patient group and 0.51 in the control group. The I allele frequencies in the two groups were 0.45 and 0.49, respectively. The results showed that taking the II genotype into account as reference genotype; homozygous DD individuals were at increased risk of uterine myoma (Odds ratio: 1.37). However, heterozygous ID showed a similar risk with the II genotype as the reference group.Conclusion: High blood pressure is significantly associated with uterine fibroids. It has been shown that atherosclerotic damage of uterine blood vessels and the inflammatory process caused by it may play an important role in the development of uterine myoma. This study indicates a positive relationship between the ACE (I/D) polymorphism and the risk of uterine myoma. This finding is evidence of the important role of the renin–angiotensin system in the pathogenesis of myoma.

Background: Uterine myomas are common pelvic masses during pregnancy. The pain and rapid growth of myomas are among the most common complications during pregnancy. We evaluate management of painful cystic degeneration of myomas during pregnancy.Case: A 27-year-old primigravida had a pelvic mass. We have managed a case in which the diagnosis of cystic degeneration of uterine myomas could not be easily differentiated from an ovarian torsion or carcinoma. Differentiation between degenerative pain of the myoma and an ovarian malignancy or torsion was necessary. A complete aspiration of the cystic changes of the uterine myoma was performed without performing a myomectomy.Conclusion: We report a good result of aspiration of a cystic uterine myoma during pregnancy with a review of the literature published for twenty years since 1 January 1988.

The most common mesenchymal tumours of the uterine corpus originate from smooth muscle cells. Leiomyomas are commonly found in women of child bearing age; however, leiomyosarcomas occur later in life (50-55 years of age). Most uterine leiomyosarcomas occur de novo, but rare cases of leiomyosarcomas that arise from leiomyomas have been reported. We present two cases of fertile women with submucosal leiomyomas that became malignant and discuss their pathologic features and immunohistochemistry studies for P16, P53 and Ki67.