Frontiers in medicine · 2026
Clinical and pathological characteristics, diagnosis, and surgical treatment of uterine angioleiomyoma: a retrospective cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Li Ruirui, Guo Wenping, Wubulikasimu Zibaguli, Yang Huaxin, Song Juan, Song Zhaoli, Lin Li
Аннотация
OBJECTIVE: Uterine angioleiomyoma (ALM) is a rare benign mesenchymal tumor. Its clinical management poses challenges due to difficulties in preoperative diagnosis, an increased risk of intraoperative bleeding due to its highly vascular nature, and unclear mechanisms and predictive factors for postoperative recurrence. This study aims to describe the clinical and pathological characteristics of uterine ALM, elucidate diagnostic and surgical strategies, and evaluate the safety and efficacy of surgical treatment.
METHODS: We conducted a retrospective analysis of 20 patients who were pathologically diagnosed with uterine ALM and underwent surgical treatment at our hospital between August 2015 and August 2023. Data collected included clinical manifestations and signs, imaging findings, surgical procedures, pathological subtypes, and follow-up results. The primary endpoints were symptom relief, intraoperative blood loss, and recurrence.
RESULTS: Only one case was preoperatively suspected as ALM on ultrasound; the remaining cases were diagnosed postoperatively. The median intraoperative blood loss was 15 mL in the 10 patients who underwent hysteroscopy (FIGO type 0-2 submucosal myomas), 300 mL in the 5 patients who underwent open surgery (myoma diameter ≥ 10 cm), and 17 mL in the 5 patients who underwent laparoscopy (myoma diameter < 10 cm). Pathological analysis identified 14 cases of the common type, 3 cases of the degenerative type, and 3 cases of the cellular type. Among the 19 patients who completed follow-up, with a median follow-up duration of 33.5 months, 1 case of the cellular type recurred, and 2 patients achieved spontaneous pregnancy.
CONCLUSION: The preoperative diagnosis of uterine ALM remains challenging. We recommend a standardized diagnostic workflow: transvaginal ultrasound screening, followed by MRI evaluation, intraoperative assessment, and pathological confirmation. Surgical treatment should be individualized based on lesion location, size, and the patient's fertility needs. Surgeons should anticipate the potential for significant intraoperative bleeding due to highly vascularized lesions, and complete resection may be important for reducing recurrence based on our observations which requires validation in larger cohorts.
METHODS: We conducted a retrospective analysis of 20 patients who were pathologically diagnosed with uterine ALM and underwent surgical treatment at our hospital between August 2015 and August 2023. Data collected included clinical manifestations and signs, imaging findings, surgical procedures, pathological subtypes, and follow-up results. The primary endpoints were symptom relief, intraoperative blood loss, and recurrence.
RESULTS: Only one case was preoperatively suspected as ALM on ultrasound; the remaining cases were diagnosed postoperatively. The median intraoperative blood loss was 15 mL in the 10 patients who underwent hysteroscopy (FIGO type 0-2 submucosal myomas), 300 mL in the 5 patients who underwent open surgery (myoma diameter ≥ 10 cm), and 17 mL in the 5 patients who underwent laparoscopy (myoma diameter < 10 cm). Pathological analysis identified 14 cases of the common type, 3 cases of the degenerative type, and 3 cases of the cellular type. Among the 19 patients who completed follow-up, with a median follow-up duration of 33.5 months, 1 case of the cellular type recurred, and 2 patients achieved spontaneous pregnancy.
CONCLUSION: The preoperative diagnosis of uterine ALM remains challenging. We recommend a standardized diagnostic workflow: transvaginal ultrasound screening, followed by MRI evaluation, intraoperative assessment, and pathological confirmation. Surgical treatment should be individualized based on lesion location, size, and the patient's fertility needs. Surgeons should anticipate the potential for significant intraoperative bleeding due to highly vascularized lesions, and complete resection may be important for reducing recurrence based on our observations which requires validation in larger cohorts.