Ishikawa Hiroshi, Yao Erika, Kaneko Meika, Ota Masayuki, Takada Akiyo, Koga Kaori
Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan.
J Obstet Gynaecol Res. 2025 May;51(5):e16312. doi: 10.1111/jog.16312.
Large uterine fibroids that grow rapidly over a short period should be differentiated from uterine leiomyosarcoma, and their treatment remains controversial in women seeking to conceive. Here, we report two cases of uterine fibroids treated with short-term relugolix administration followed by myomectomy. Needle biopsy specimens obtained before relugolix administration showed no malignancy, and significant tumor shrinkage was observed following treatment. Both patients subsequently underwent myomectomy. One patient achieved a live birth 14 months after myomectomy, whereas the other experienced improvement in severe anemia, allowing her to prepare for pregnancy. Histological examination after relugolix administration revealed atrophic changes in spindle cells within the fibroids, characterized by nuclear crowding and decreased immunoreactivity for desmin and α-smooth muscle actin. The significant fibroid shrinkage observed after the short-term administration of relugolix provided a rationale for myomectomy, improved anemia, and facilitated appropriate uterine reconstruction, ensuring structural integrity for future pregnancies in women of reproductive age.
短期内迅速生长的大型子宫肌瘤应与子宫平滑肌肉瘤相鉴别，对于有生育需求的女性，其治疗方案仍存在争议。在此，我们报告两例子宫肌瘤患者，先接受短期瑞卢戈利治疗，随后进行肌瘤切除术。在给予瑞卢戈利之前获取的穿刺活检标本未显示恶性特征，治疗后观察到肿瘤显著缩小。两名患者随后均接受了肌瘤切除术。一名患者在肌瘤切除术后14个月成功分娩，而另一名患者的严重贫血状况得到改善，使其能够为妊娠做准备。给予瑞卢戈利后的组织学检查显示肌瘤内梭形细胞出现萎缩性改变，其特征为核拥挤以及结蛋白和α平滑肌肌动蛋白的免疫反应性降低。短期给予瑞卢戈利后观察到的肌瘤显著缩小为肌瘤切除术提供了理论依据，改善了贫血状况，并有助于进行适当的子宫重建，确保育龄期女性未来妊娠时子宫结构的完整性。
