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• W2000398524 abstract "Uterine myomas generally develop in women during their childbearing years. Nonsurgical treatment of uterine myoma has focused primarily on use of the GnRH agonist, which produces temporary menopause. However, clinical application of GnRH agonist therapy has been limited because uterine volume often increases after discontinuation of treatment, insufficient volume reduction is achieved in some patients, and most leiomyomas return to their pretreatment size after cessation of treatment. Whole-body positron emission tomography (PET) is a form of computer-assisted imaging that produces images reflecting the biochemistry of tissue (1Wang P.H. Liu R.S. Li Y.F. Ng H.T. Yuan C.C. Whole-body PET with (fluorine-18)-2-deoxyglucose for detecting recurrent primary serous peritoneal carcinoma.Gynecol Oncol. 2000; 77: 44-47Crossref PubMed Scopus (29) Google Scholar). We used whole-body PET to elucidate the biology of myoma during GnRH agonist treatment. In this study, we included women who needed surgical management of polymenorrhea with resultant severe anemia (hemoglobin < 6.0 g/dL), but who wished to preserve their fertility, were younger than 30 years of age, and were able to bear children. To facilitate scanning accuracy, eligible women had a single intramural leiomyoma 6–8 cm in diameter on ultrasonography, no previous abdominal surgery or history of pelvic inflammatory disease, and no previous or coexisting medical or surgical illness. The study was approved by the ethics committee of the Department of Obstetrics and Gynecology of Veterans General Hospital—Taipei, and each patient gave written informed consent. Two patients fulfilled the eligibility criteria and received a depot formulation of goserelin acetate (3.6 mg subcutaneously in the early follicular phase of the cycle) monthly for 4 months before surgical resection of intramural leiomyomas. Both patients underwent regular follow-up that included monthly detailed physical examination, laboratory testing, serum E2 measurement, and ultrasonography. The volume of the total uterus and myomas were calculated by using a sector scanner (GateWay; Diasonics, Milpitas, CA) to measure the three largest dimensions (A, B, and C) and applying the formula for a prolate ellipsoid (0.5233 × A × B × C). After the third dose of GnRH agonist, patients underwent (18F)-2-deoxyglucose (FDG) PET, which is described in detail elsewhere (1Wang P.H. Liu R.S. Li Y.F. Ng H.T. Yuan C.C. Whole-body PET with (fluorine-18)-2-deoxyglucose for detecting recurrent primary serous peritoneal carcinoma.Gynecol Oncol. 2000; 77: 44-47Crossref PubMed Scopus (29) Google Scholar), at the National PET/Cyclotron Center. At that time, ultrasonography showed that the volumes of the myomas had decreased by 43% in one patient and 53% in the other, and the respective hemoglobin values returned to 10.2 g/dL and 9.3 g/dL. Both patients underwent myomectomy after the fourth dose of GnRH agonist. Pathologic examination confirmed the presence of leiomyomas. In both patients, PET images demonstrated increased FDG uptake, with a distribution that correlated with the uterine leiomyoma area (Figure 1, Figure 2). Figure 2Transverse section of a pelvic (18F)-2-deoxyglucose positron emission tomographic scan in patient 2. Enhanced uptake of (18F)-2-deoxyglucose by the uterine myoma is visible (yellow and orange areas).View Large Image Figure ViewerDownload (PPT) Because PET scans obtained before, during, and after GnRH agonist treatment were not available in both patients, we enrolled two volunteers who met the above inclusion criteria and underwent PET before surgery. Enrollment of these women having informed consent was approved by the ethics committee. Neither the whole uterus nor the myomas of both women showed increased accumulation of FDG. Although molecular biologic and genetics techniques have advanced knowledge about myomas, current treatment of these neoplasms was shaped by classic principles and response to the gonadal steroids estrogen and progesterone (2Stewart E.A. Nowak R.A. New concepts in the treatment of uterine leiomyomas.Obstet Gynecol. 1998; 92: 624-627Crossref PubMed Scopus (44) Google Scholar). The advantage of GnRH agonist is that it represents a noninvasive medical treatment. However, the effects of GnRH agonist therapy are often transient. Myomas recur after discontinuation of treatment and grow more rapidly than in untreated patients. Use of PET in oncologic diagnosis has rekindled interest in this technique (1Wang P.H. Liu R.S. Li Y.F. Ng H.T. Yuan C.C. Whole-body PET with (fluorine-18)-2-deoxyglucose for detecting recurrent primary serous peritoneal carcinoma.Gynecol Oncol. 2000; 77: 44-47Crossref PubMed Scopus (29) Google Scholar). The enhanced glycolytic rate of tumor cells makes tumor detection with PET possible because of the increased accumulation of FDG (1Wang P.H. Liu R.S. Li Y.F. Ng H.T. Yuan C.C. Whole-body PET with (fluorine-18)-2-deoxyglucose for detecting recurrent primary serous peritoneal carcinoma.Gynecol Oncol. 2000; 77: 44-47Crossref PubMed Scopus (29) Google Scholar). Based on observation of the increased rate of glucose metabolism in uterine myomas, we hypothesized that uterine myomas treated with GnRH agonist still had relatively high energy consumption and cellular activity. We therefore used PET to study the effect of GnRH agonist treatment of myomas. Some researchers have tried to evaluate the effect of GnRH agonist treatment by using results of histologic examination (3Crow J. Gardner R.L. McSweeney G. Morphological changes in uterine leiomyomas treated by GnRH agonist goserelin.Int J Gynecol Pathol. 1995; 14: 235-242Crossref PubMed Scopus (57) Google Scholar, 4Wang P.H. Yang A.H. Yuan C.C. Ng H.T. Chao H.T. Uterine myoma after cessation of gonadotropin-releasing hormone agonist ultrasound and histopathologic findings.Chin Med J (Taipei). 1998; 61: 625-629Google Scholar), with conflicting results. Crow et al. (3Crow J. Gardner R.L. McSweeney G. Morphological changes in uterine leiomyomas treated by GnRH agonist goserelin.Int J Gynecol Pathol. 1995; 14: 235-242Crossref PubMed Scopus (57) Google Scholar) found marked variability in the ultrastructural features of treated myomas on electron microscopy, which included shrinkage of intact cells to disrupted cell membranes and disruption of some organelles. In contrast, Wang et al. (4Wang P.H. Yang A.H. Yuan C.C. Ng H.T. Chao H.T. Uterine myoma after cessation of gonadotropin-releasing hormone agonist ultrasound and histopathologic findings.Chin Med J (Taipei). 1998; 61: 625-629Google Scholar) used electron morphometry and found focal loss of myofibrillar structure but well-preserved cell membranes and lack of cellular damage in treated myoma smooth-muscle cells, which indicated transient shrinkage of cells. This absence of cellular damage and the increased glycolysis and energy consumption of treated uterine myomas seen in the current study may contribute to regrowth of treated uterine myomas after cessation of therapy. However, further work is needed to substantiate this hypothesis." @default.
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• W2000398524 title "Relationship between gonadotropin-releasing hormone agonist and myoma cellular activity: preliminary findings on positron emission tomography" @default.
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