leuprolide and Leiomyomatosis

To evaluate novel hormonal therapies in patients with unresectable benign metastasizing leiomyoma (BML) disease.. Case series.. National Institutes of Health (NIH).. Five subjects with the diagnosis of BML based on imaging and/or histopathologic diagnosis.. Four patients were treated with single or combination therapy of leuprolide acetate and/or an aromatase inhibitor. One patient was treated with an antiprogestin (CDB-2914).. Response to therapy was measured by tumor burden on cross-sectional imaging employing RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 guidelines.. Four patients treated with single or combination therapy of leuprolide acetate and/or an aromatase inhibitor demonstrated stable disease with reduction in tumor burden. The fifth patient treated with antiprogestin (CDB-2914) had degeneration of her tumor, progression of its size, and an improvement in symptoms.. Hormone treatment with GnRH agonist and/or aromatase inhibition may be a therapeutic option to reduce tumor burden in unresectable BML disease or for those patients who wish to avoid surgical intervention. RECIST 1.1 guidelines, while traditionally used to evaluate tumor response to cancer therapeutics, may be useful in evaluating BML tumor burden response to hormone therapy.

Topics: Adult; Antineoplastic Agents, Hormonal; Antineoplastic Combined Chemotherapy Protocols; Aromatase Inhibitors; Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Leiomyomatosis; Leuprolide; Middle Aged; Norpregnadienes; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden; Uterine Neoplasms

Topics: Antineoplastic Agents, Hormonal; Diagnosis, Differential; Drug Therapy, Combination; Estrogen Receptor Modulators; Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Leiomyoma; Leiomyomatosis; Leuprolide; Norpregnenes; Prognosis; Randomized Controlled Trials as Topic; Risk Factors; Uterine Neoplasms

This article is an overview of uterine neoplasms that demonstrate mesenchymal differentiation. Major clinical and pathologic features are described, with a focus on those lesions that cause diagnostic difficulty. Brief discussions on more recent observations made concerning these entities are also included.

Topics: Adenofibroma; Adenomyoma; Antineoplastic Agents, Hormonal; Endometrial Neoplasms; Female; Humans; Leiomyomatosis; Leuprolide; Myometrium; Receptors, Cell Surface; Sarcoma; Stromal Cells; Uterine Neoplasms; Uterus

We investigated the effect of the GnRH agonist (GnRH-a) on the uterine volume and on the immunohistochemical expression of basic fibroblast growth factor (bFGF) and the vasculature of leiomyomas. Twenty-five women were treated with leuprorelin acetate for 3 months; 46 untreated patients were enrolled as a control group. The uterine volume was measured by ultrasonography. After myomectomy or hysterectomy, the immunoexpression of bFGF and the endothelial marker, CD34, was studied and compared in treated and untreated leiomyomas. Uterine volume decreased after therapy. The number of cells expressing bFGF and the vascularity were diminished in treated leiomyomas. Reduction in the blood supply might be responsible, in part, for uterine-volume shrinkage after GnRH-a therapy.

Topics: Adult; Antigens, CD34; Antineoplastic Agents, Hormonal; Female; Fibroblast Growth Factors; Gene Expression Regulation, Neoplastic; Humans; Hysterectomy; Immunohistochemistry; Leiomyomatosis; Leuprolide; Treatment Outcome; Ultrasonography; Uterine Neoplasms

The purpose of this study was to prospectively compare the effectiveness of administering medroxyprogesterone acetate (MPA; 20 mg/d) in either the first (protocol A) or last (protocol B) 12-week period as well as a 6-month course of the GnRH agonist (GnRH-a; leuprolide acetate; 1 mg/d, SC) on calcium (Ca) metabolism.. Prospective, randomized, double-blind, placebo-controlled, crossover trial.. Clinical research center, university hospital.. Twenty women were randomized into protocol A or B, received either MPA or placebo along with GnRH-a, and were then crossed over at 12 weeks to placebo or MPA, for the final 12-week interval of GnRH-a therapy.. Collection of serum and urine samples and measurement of bone density. Sex hormone, calcitropic hormone, and bone density studies were performed at baseline and at 12 and 24 weeks.. In both protocol A and B, LH and E(2) levels declined by 79%-81% and 83%-90% of the baseline, respectively, at 12 and 24 weeks. Serum Ca, phosphorus, alkaline phosphatase, and osteocalcin; 2-h fasting and 24-h urinary Ca excretion; and urinary hydroxyproline levels all increased significantly during GnRH-a treatment alone. Estimated Ca balance decreased significantly during GnRH-a treatment alone. The addition of MPA attenuated the increases in phosphorus, alkaline phosphatase, osteocalcin, and 2-h fasting and 24-h urinary Ca excretion, and the decrease in estimated Ca balance. Comparison of phase order demonstrated that MPA prevented 24-h urinary Ca excretion and urinary hydroxyproline loss and decline in estimated Ca balance when it was added back during the second 12 weeks (protocol B) but not during the first 12 weeks (protocol A). CONCLUSION (S): We conclude that sequential MPA appears to reverse in part the negative effects of GnRH-a on calcitropic hormones and estimated Ca balance.

Topics: Adult; Bone Density; Calcium; Cross-Over Studies; Double-Blind Method; Endometriosis; Female; Gonadotropin-Releasing Hormone; Homeostasis; Humans; Leiomyomatosis; Leuprolide; Medroxyprogesterone Acetate; Placebos; Uterine Neoplasms

To compare the effects of two different doses of a monthly depot injection of a GnRH agonist (GnRH-a) on uterine cavity area in patients with uterine leiomyomata.. Prospective, randomized study.. Hospital department of obstetrics and gynecology.. Thirty-six premenopausal women, 25 to 52 years of age, with uterine leiomyomata.. Leuprolide acetate (LA) depot, 1.88 or 3.75 mg, was administered SC every 4 weeks for 24 weeks.. Uterine cavity area before and after treatment was assessed by hysterosalpingography.. The 1.88- and 3.75-mg LA depots significantly reduced uterine cavity area by 40.8% and 40.2%, respectively. No significant difference was observed between the two groups.. Monthly injection of 1.88 or 3.75 mg LA depots appears to reduce uterine cavity area to a similar extent in patients with uterine leiomyomata.

Topics: Adult; Delayed-Action Preparations; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Injections, Subcutaneous; Leiomyomatosis; Leuprolide; Middle Aged; Prospective Studies; Uterine Neoplasms; Uterus

It has been amply demonstrated that uterine leiomyoma possess estrogen receptors. On the basis of this presupposition, it is considered logical to use GnRH-agonists which, by reducing the level of estrogen, also reduce the volume of the leiomyoma, although to a varying extent. The maximum reduction which can be obtained occurs, according to published data, between 3 and 6 months of treatment, attaining mean values of approximately 50%. In the author's experience the treatment period was shortened even further by administering only 2 vials of leuprolide depot each month to women who subsequently underwent hysterectomy. The sample group comprised 30 women with uterine leiomyomatosis, of whom 15 were treated with a GnRH analogue and 15 with placebo. The reduction of uterine volume was evaluated by echography and was found to be 40% in the treated group, whereas non change was detected in the "placebo-group".

Topics: Adult; Combined Modality Therapy; Delayed-Action Preparations; Female; Humans; Hysterectomy; Leiomyomatosis; Leuprolide; Middle Aged; Premedication; Time Factors; Uterine Neoplasms

Alport syndrome with diffuse leiomyomatosis (ASDL) is a complex combination that doesn't have a specific course of treatment. In this case report, we present a 44-year-old woman with ASDL and detail her treatment. The patient presented at the emergency room (ER) with symptoms of anemia, bronchial asthma, and abnormal uterine bleeding (AUB). The patient had diffuse myomas in different areas of her body, including the esophagus and genital tract. She was treated by a multidisciplinary team that included members from the hematology/oncology, pulmonary, interventional radiology, anesthesia, surgery, and gynecology services. A physician from interventional radiology performed an embolization of the uterine arteries to treat the patient's AUB. Surgery was done in May 2011 to remove the esophageal leiomyomas to improve her pulmonary function. Surgery included a distal esophagectomy, a proximal gastrostomy, and the resection of the leiomyomatous mass. In order to shrink the tumor in her genito pelvic region so that it could be extirpated with the highest likelihood of success, the patient was treated with gonadotropin-releasing hormone agonist (leuprolide acetate, 3.75 mg/month for 4 months). In May 2012, the patient had a total abdominal hysterectomy (TAH), with a bilateral salpingo-ophorectomy (BSO), the excision of a leiomyoma, and a posterior colporrhaphy.

Topics: Adult; Antineoplastic Agents, Hormonal; Case Management; Child; Combined Modality Therapy; Embolization, Therapeutic; Esophageal Neoplasms; Esophagectomy; Female; Gastrostomy; Genital Neoplasms, Female; Humans; Hysterectomy; Leiomyomatosis; Leuprolide; Male; Nephritis, Hereditary; Ovariectomy; Patient Care Team; Radiography, Interventional

To describe a case report of diffuse uterine leiomyomatosis who had successful pregnancy twice following conservative management.. Retrospective report.. Private general hospital.. A nulliparous woman 25 years of age presented with menorrhagia and infertility. She had innumerable small fibroids of 4-42 mm size throughout the myometrium. Size of the symmetrically enlarged uterus was 131×80×60 mm, clinically corresponding to that of 12 weeks of gestation.. She received a GnRH analogue (GnRHa; leuprolide acetate) 3.75 mg per month for 6 months.. Reduction of uterus size, menstrual amount, conception, pregnancy outcome.. Enlarged uterus reduced to almost normal size after 3 doses of GnRHa. She did not experience heavy bleeding during menstruation. She conceived spontaneously in the first cycle after discontinuation of GnRHa. Antenatal course was uneventful. A healthy male baby of 2.5 kg was delivered by cesarean section at 39 weeks. The placenta weighed 330 g. There was no postpartum hemorrhage. She conceived spontaneously for the second time in the first cycle after resumption of menses. Antenatal, intranatal (cesarean section), and postnatal courses of the second pregnancy were uneventful. The second neonate weighed 3.0 kg and the placenta 400 g.. Conservative treatment may help to achieve successful pregnancy in case of diffuse uterine leiomyomatosis.

Topics: Adult; Antineoplastic Agents, Hormonal; Cesarean Section; Female; Gestational Age; Humans; Infant, Newborn; Leiomyomatosis; Leuprolide; Live Birth; Male; Parity; Pregnancy; Treatment Outcome; Ultrasonography, Prenatal; Uterine Neoplasms

The aim of this study was to report an exceptional case of a patient presenting with intracaval and intracardiac leiomyomatosis treated by combined surgical and medical treatment.. A 48-year-old presented with intracaval and intracardiac leiomyomatosis (IL) discovered 6 years following a total hysterectomy with ovarian conservation for myomas. Surgical resection of the pelvic myomas and intracaval leiomyomatosis was performed during the same surgical procedure. Given the presence of a small tumor residuum in the pelvic cavity, postoperative medical treatment based on a gonadotropin-releasing hormone (GnRH) agonist was delivered for 1 year. The patient was followed-up using clinical examination and systematic CT scan. Ten months following the end of medical treatment, she is still in good health and the pelvic residuum has stabilized.. Patients with pelvic tumor combined with IL could be treated using a one-stage surgical procedure. In cases of incomplete surgical resection, medical treatment based on GnRH agonist could be successfully delivered.

Topics: Angiomyoma; Antineoplastic Agents, Hormonal; Female; Heart Neoplasms; Humans; Hysterectomy; Leiomyomatosis; Leuprolide; Middle Aged; Pelvic Neoplasms; Vascular Neoplasms

Topics: Female; Humans; Leiomyomatosis; Leuprolide; Mitosis; Uterine Neoplasms

Intravenous leiomyomatosis with cardiac extension is an extremely rare disease.. We recently treated a case of intravenous leiomyomatosis with extension from the inferior vena cava into the right atrium. Three operations--exploratory laparotomy, debulking of the pelvic mass and resection of the intracardiac leiomyoma--were performed. Since cells of the resected leiomyomatosis were estrogen receptor positive, we postoperatively administered GnRH agonist (leuprorelin acetate) for six months to prevent regrowth of the residual mass in the pelvis. The residual mass began to enlarge immediately after cessation of leuprorelin acetate. The same medication was readministered, and regrowth of the residual mass was completely inhibited for 15 months, until this writing.. Intravenous leiomyomatosis seems to be hormone dependent, as in the case of uterine leiomyomas. In the absence of total resection, functioning ovarian tissue may remain. Therefore, long-term treatment with GnRH agonist may be useful in preventing recurrence of this disease.

Topics: Adult; Antineoplastic Agents, Hormonal; Female; Gonadotropin-Releasing Hormone; Heart Atria; Heart Neoplasms; Humans; Leiomyomatosis; Leuprolide; Recurrence; Treatment Outcome; Vena Cava, Inferior

Intravascular leiomyomatosis is an uncommon uterine tumor characterized by grossly visible intravascular proliferation of benign smooth muscle. Based on its role in reducing the size of leiomyomas, leuprolide acetate was given as induction therapy for extensive inoperable intravascular leiomyomatosis.. A 44-year-old woman, gravida 1, para 1-0-0-1, presented in July 1992 with abnormal uterine bleeding. Pelvic examination and ultrasonography revealed the presence of a large irregular pelvic mass. At laparotomy, uterine and bilateral adnexal masses were noted extending up to the pelvic inlet and into the broad and infundibulopelvic ligaments. This tumor was not resectable. Based on histologic and immunoperoxidase studies, the lesion was interpreted as a plexiform epithelioid smooth-muscle tumor of uncertain malignant potential. Leuprolide acetate depot therapy (7.5 mg every 4 weeks) was begun in September 1992 and continued for a total of 20 months. Maximal tumor regression was achieved after 9 months. Subsequent reexploration at 20 months revealed a resectable tumor. Resection was accomplished successfully, leaving no apparent residual disease.. Leuprolide acetate induced tumor regression and rendered debulking surgery feasible in a patient with previously unresectable, widespread, retroperitoneal intravascular leiomyomatosis. Primary hormone therapy may provide alternative therapeutic options for certain cases of intravascular leiomyomatosis.

Topics: Adult; Female; Humans; Leiomyomatosis; Leuprolide; Preoperative Care; Uterine Neoplasms