leuprolide and Leiomyosarcoma

Leuprolide acetate has been used to decrease uterine size and shrink leiomyomata. In carefully selected patients, its treatment benefits are well recognized. However, if leuprolide acetate is inadvertently given to a patient with an unsuspected leiomyosarcoma, complications may occur.. A patient presumed to have leiomyomata was treated with monthly injections of leuprolide acetate. In the third month of treatment, unusual manifestations, including increased bleeding, aborting mass, urinary retention, and severe pain, occurred suggesting a possible malignancy and requiring immediate operation.. The use of leuprolide acetate can delay the diagnosis and treatment of leiomyosarcoma and thus may increase the risk of morbidity and affect the treatment outcome of patients with leiomyosarcoma. The histologic changes ascribed to leuprolide acetate treatment in leiomyomata also were seen in this leiomyosarcoma.

Topics: Antineoplastic Agents, Hormonal; Female; Humans; Leiomyoma; Leiomyosarcoma; Leuprolide; Middle Aged; Uterine Neoplasms

To describe the effectiveness in the clinical use of a new bipolar needle for performing laparoscopic coagulation of symptomatic uterine myomas, and to compare it with the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser.. Observational, comparative.. Voluntary community hospital.. Three hundred women, 150 in the Nd:YAG laser group and 150 in the bipolar needle group, who had symptomatic myomas no larger than 10 cm, responded to pretreatment with depot leuprolide, and were no longer interested in childbearing.. Myomas were pierced repeatedly with the bipolar needle to produce numerous cores of coagulation. An average of 30 to 50 passes were made.. Myoma size and location were assessed by endovaginal ultrasound before preoperative treatment with depot leuprolide. The coagulating effect of the bipolar needle devascularized the myomas, and the resulting shrinkage was comparable with that produced by the Nd:YAG laser. Complications were infrequent, with no evidence of myoma regrowth 6 months after the procedure.. The bipolar needle was as effective as the Nd:YAG laser in coagulating symptomatic subserosal and intramural uterine myomas and achieving reduction in size of 50% to 70%, with no regrowth.

Topics: Aluminum Silicates; Antineoplastic Agents, Hormonal; Delayed-Action Preparations; Electrocoagulation; Endometrium; Equipment Design; Female; Follow-Up Studies; Humans; Laparoscopes; Laparoscopy; Laser Coagulation; Leiomyoma; Leiomyosarcoma; Leuprolide; Needles; Neodymium; Preoperative Care; Ultrasonography; Uterine Neoplasms; Yttrium

Recurrence of heavy vaginal bleeding and massive necrosis of a uterine leiomyosarcoma are reported in a 41-year-old female who was being treated with GnRH-a for a presumed uterine fibroid. The pathogenic mechanisms of such an event are reviewed and discussed in light of the available literature on the subject of GnRH-a and the treatment of uterine smooth muscle neoplasms.

Topics: Adult; Female; Humans; Leiomyosarcoma; Leuprolide; Necrosis; Uterine Hemorrhage; Uterine Neoplasms; Uterus

We present a case of a 46-year-old woman evaluated for abnormal uterine bleeding and an enlarged uterus, with normal endometrial sampling. Three months of leuprolide acetate injections resulted in a nonenlarging uterus and resolution of iron deficiency anemia and menorrhagia. Intraoperative examination suggested leiomyosarcoma, which was confirmed by postoperative permanent histologic sections. Residual uterine sarcomatous disease was confirmed on reexploration. Similar cases will continue to raise arguments against conservative hormonal intervention in the perimenopausal woman with an enlarged uterus. As the gynecologist gains familiarity with the use of gonadotropin-releasing hormone analogue therapy in the treatment of myomatous uteri, the criteria for hysterectomy will become less rigid and the potential for delay in the diagnosis and treatment of sarcomatous disease will become more common. Physicians must be cognizant of this potential complication of conservative therapy of leiomyomata uteri.

Topics: Antineoplastic Agents; Female; Gonadotropin-Releasing Hormone; Humans; Leiomyosarcoma; Leuprolide; Middle Aged; Uterine Neoplasms