Deligdisch L, Hirschmann S, Altchek A
Mount Sinai Medical School, New York, New York, USA.
Fertil Steril. 1997 May;67(5):837-41. doi: 10.1016/s0015-0282(97)81394-5.
To define the pathologic changes underlying the mechanism of shrinkage of uterine leiomyomata in patients treated with luprolide acetate.
Retrospective study of pathologic changes seen in leiomyomata removed by hysterectomy or myomectomy in treated and untreated patients, matched by age and size of uteri and leiomyomata.
PATIENT(S): Gross description and histologic slides of 30 treated and 30 untreated patients.
INTERVENTION(S): Histologic examination performed blindly (without knowledge of treatment). Statistical work-up using chi 2 analysis with 1 df.
MAIN OUTCOME MEASURE(S): Degree of hyaline and hydropic degeneration, cellularity, nuclear atypia, necrosis, and obliteration of interface.
RESULT(S): Confluent nodular hyaline degeneration representing a scarlike retraction, geographic hydropic degeneration necrosis and obliteration of the interface between myoma and myometrium were found in higher proportions in the treated patients; differences in cellularity, nuclear atypia, and edema were not statistically significant.
CONCLUSION(S): The decrease in size of the treated leiomyomata occurs as an accelerated postmenopausal shrinkage because of the antiestrogenic effect of the therapy. Obliterated cleavage planes may explain the difficult enucleation of myomatous nodules in some of the treated patients.
明确接受醋酸亮丙瑞林治疗的患者子宫平滑肌瘤缩小机制的病理变化。
对接受治疗和未接受治疗患者经子宫切除术或肌瘤切除术切除的平滑肌瘤的病理变化进行回顾性研究，根据患者年龄、子宫及平滑肌瘤大小进行匹配。
30例接受治疗患者和30例未接受治疗患者的大体描述及组织学切片。
进行盲法组织学检查（不知治疗情况）。采用自由度为1的卡方分析进行统计学处理。
透明样变和水样变性程度、细胞密度、核异型性、坏死及界面消失情况。
在接受治疗的患者中，出现融合性结节状透明样变（表现为瘢痕样收缩）、地图状水样变性坏死及肌瘤与子宫肌层间界面消失的比例更高；细胞密度、核异型性及水肿方面的差异无统计学意义。
由于该治疗的抗雌激素作用，接受治疗的平滑肌瘤体积缩小表现为绝经后加速萎缩。界面消失可能解释了部分接受治疗患者肌瘤结节剥除困难的原因。
