HEALTHY AND PATHOLOGICAL CHANGES OF MYOMETRIUM: PREGNANT MYOMETRIUM, UTERINE FIBROIDS AND LEIOMYOSARCOMA. Cambios normales y patológicos del miometrio: miometrio del embarazo, fibrosis uterina y leiomiosarcoma


  • Pasquapina Ciarmela Department of Experimental and Clinical Medicine, Faculty of Medicine, Polytechnic University of Marche, Ancona
  • Soriful Islam Department of Experimental and Clinical Medicine, Faculty of Medicine, Polytechnic University of Marche, Ancona
  • Pasquale Lamanna Obstetrics and Gynaecology Unit, Profili Hospital, Fabriano
  • Andrea Tranquilli Woman’s Health Sciences Department, Polytechnic University of Marche, Ancona
  • Mario Castellucci Department of Experimental and Clinical Medicine, Faculty of Medicine, Polytechnic University of Marche, Ancona,


Palabras clave:

Pregnant myometrium, leiomyoma, leiomyosarcoma, miometrio gravídico, leiomioma, leiomiosarcoma


El miometrio, la pared muscular del útero, puede modificar su misma masa y las propiedades celulares en el embarazo y también en los tumores como el leiomioma y el leiomiosarcoma. El leiomioma, dicho también fibroma, es un tumor benigno del útero y se considera como  una de las causas más frecuentes de infertilità en el período reproductivo femenino. El leiomiosarcoma, en cambio, es un tumor maligno y agresivo de la musculatura lisa uterina. La presente revisión discute las características generales del leiomioma y el leiomiosarcoma y los relativos tratamientos clínicos actualmente usados y además describe las características del miometrio normal en el embarazo. 


The myometrium, the muscular wall of the uterus, can modify its mass and cellular properties in pregnancy as well as in tumor conditions such as leiomyoma and leiomyosarcoma. Leiomyomas, also known as fibroids, are benign tumors of the uterus, considered to be one of the most frequent causes of infertility in reproductive years of women. Leiomyosarcomas in turn, are rare aggressive malignant uterine smooth-muscle tumors. The present review is discussing the general features of leiomyoma and leiomyosarcoma with their current treatments and also discussing the characteristics of normal pregnant myometrium and compare with leiomyoma.


Los datos de descargas todavía no están disponibles.


Abramson S, Gilkeson RC, Goldstein JD, Woodard PK, Eisenberg R, Abramson N. 2001. Benign metastasizing leiomyoma: clinical, imaging, and pathologic correlation. AJR Am J Roentgenol 176: 1409-13.

Ahmadi F, Zafarani F, Niknejadi M, Vosough A. 2008. Uterine Leiomyoma: Hysterosalpingo-graphic Appearances. International Journal of Fertility and Sterility 1: 137-144.

Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. 2005. Endometrial cancer. The Lancet 366: 491-505.

Andersen J, Barbieri RL. 1995. Abnormal gene expression in uterine leiomyomas. J Soc Gynecol Investig 2: 663-72.

Andersen J, Grine E, Eng CL, Zhao K, Barbieri RL, Chumas JC, Brink PR. 1993. Expression of connexin-43 in human myometrium and leiomyoma. Am J Obstet Gynecol 169: 1266-76.

Avritscher R, Iyer RB, Ro J, Whitman G. 2001. Lipoleiomyoma of the uterus. AJR Am J Roentgenol 177: 856.

Brölmann H, Huirne J. 2008. Current Treatment Options and Emerging Strategies for Fibroid Management. The Internet Journal of Gynecology and Obstetrics 10 (1).

Burroughs KD, Fuchs-Young R, Davis B, Walker CL. 2000. Altered hormonal responsiveness of proliferation and apoptosis during myometrial maturation and the development of uterine leiomyomas in the rat. Biol Reprod 63: 1322-30.

Catherino WH, Malik M, Driggers P, Chappel S, Segars J, Davis J. 2010. Novel, orally active selective progesterone receptor modulator CP8947 inhibits leiomyoma cell proliferation without adversely affecting endometrium or myometrium. J Steroid Biochem Mol Biol 122: 279-86.

Cesen-Cummings K, Houston KD, Copland JA, Moorman VJ, Walker CL, Davis BJ. 2003. Uterine leiomyomas express myometrial contractile-associated proteins involved in pregnancy-related hormone signaling. J Soc Gynecol Investig 10: 11-20.

Ceyhan K, Simsir C, Dolen I, Calyskan E, Umudum H. 2002. Multinodular hydropic leiomyoma of the uterus with perinodular hydropic degeneration and extrauterine extension. Pathol Int 52: 540-3.

Ciarmela P, Islam MS, Reis FM, Gray PC, Bloise E, Petraglia F, Vale W, Castellucci M. 2011. Growth factors and myometrium: biological effects in uterine fibroid and possible clinical implications. Hum Reprod Update 17: 772-90.

Coard KC, Fletcher HM. 2002. Leiomyosarcoma of the uterus with a florid intravascular component ("intravenous leiomyosarcoma-tosis"). Int J Gynecol Pathol 21: 182-5.

Dobashi Y, Iwabuchi K, Nakahata J, Yanagimoto K, Kameya T. 1999. Combined clear and granular cell leiomyoma of soft tissue: evidence of transformation to a histiocytic phenotype. Histopathology 34: 526-31.ç

Echt G, Jepson J, Steel J, Langholz B, Luxton G, Hernandez W, Astrahan M, Petrovich Z. 1990. Treatment of uterine sarcomas. Cancer 66: 35-39.

Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, Murray GD. 2007. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. The New England journal of medicine 356: 360.

Emoto M, Iwasaki H, Ishiguro M, Kikuchi M, Horiuchi S, Saito T, Tsukamoto N, Kawarabayashi T. 1999. Angiogenesis in carcinosarcomas of the uterus: differences in the microvessel density and expression of vascular endothelial growth factor between the epithelial and mesenchymal elements. Hum Pathol 30: 1232-41.

Evans P, Brunsell S. 2007. Uterine fibroid tumors: diagnosis and treatment. Am Fam Physician 75: 1503-8.

Farquhar CM, Steiner CA. 2002. Hysterectomy rates in the United States 1990-1997. Obstet Gynecol 99: 229-34.

Frishman GN, Jurema MW. 2005. Myomas and myomectomy. J Minim Invasive Gynecol 12: 443-56.

Hardman MP, Roman JJ, Burnett AF, Santin AD. 2007. Metastatic uterine leiomyosarcoma regression using an aromatase inhibitor. Obstetrics & Gynecology 110: 518.

Hensley ML, Blessing JA, Mannel R, Rose PG. 2008. Fixed-dose rate gemcitabine plus docetaxel as first-line therapy for metastatic uterine leiomyosarcoma: a Gynecologic Oncology Group phase II trial. Gynecologic oncology 109: 329-334.

Hensley ML, Ishill N, Soslow R, Larkin J, Abu-Rustum N, Sabbatini P, Konner J, Tew W, Spriggs D, Aghajanian CA. 2009. Adjuvant gemcitabine plus docetaxel for completely resected stages I-IV high grade uterine leiomyosarcoma: Results of a prospective study. Gynecologic oncology 112: 563-567.

Hock YL, Goswami P, Rollason TP. 2000. Mitotically active haemorrhagic cellular (apoplectic) leiomyoma. Eur J Gynaecol Oncol 21: 28-9.

Johansson B. 1984. Different types of smooth muscle hypertrophy. Hypertension 6: III64-8.

Kennedy S, Bergqvist A, Chapron C, D´Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E. 2005. ESHRE guideline for the diagnosis and treatment of endometriosis. Human reproduction 20: 2698-2704

Kim MJ, Park YK, Cho JH. 2002. Cotyledonoid dissecting leiomyoma of the uterus: a case report and review of the literature. J Korean Med Sci 17: 840-4.

Kondi-Pafiti A, Grapsa D, Kairi-Vassilatou E, Kontogianni-Katsarou K, Koliopoulos C, Botsis D. 2006. Mesenchymal tumors of the uterine corpus with heterologous and hematopoietic components: a study of ten cases and review of the literature. Eur J Gynaecol Oncol 27: 73-7.

Krysiewicz S. 1992. Infertility in women: diagnostic evaluation with hysterosalpingo-graphy and other imaging techniques. American Journal of Roentgenology 159: 253-61.

Lethaby A, Vollenhoven B, Sowter M. 2002. Efficacy of preoperative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology 109: 1097-1108.

Lethaby AE, Vollenhoven BJ. 2008. An evidence-based approach to hormonal therapies for premenopausal women with fibroids. Best Practice & Research Clinical Obstetrics & Gynaecology 22: 307-31


Luo X, Yin P, Coon VJ, Cheng YH, Wiehle RD, Bulun SE. 2010. The selective progesterone receptor modulator CDB4124 inhibits proliferation and induces apoptosis in uterine leiomyoma cells. Fertil Steril 93: 2668-73.

Lye SJ, Bernstein P, Oskamp M. 1998. Is the attenuation of beta-adrenergic agonist efficacy during labor caused by elevated prostaglandin E levels? Am J Obstet Gynecol 179: 1168-74.

Marsh EE, Bulun SE. 2006. Steroid hormones and leiomyomas. Obstet Gynecol Clin North Am 33: 59-67.

Matsuo H, Kurachi O, Shimomura Y, Samoto T, Maruo T. 1999. Molecular bases for the actions of ovarian sex steroids in the regulation of proliferation and apoptosis of human uterine leiomyoma. Oncology 57: 49-58.

Matta WHM, Shaw RW, Nye M. 1989. Long term follow-up of patients with uterine fibroids after treatment with the LHRH agonist buserelin. BJOG: An International Journal of Obstetrics & Gynaecology 96: 200-6.

Mayerhofer K, Obermair A, Windbichler G, Petru E, Kaider A, Hefler L, Czerwenka K, Leodolter S, Kainz C. 1999. Leiomyosarcoma of the uterus: a clinicopathologic multicenter study of 71 cases. Gynecologic oncology 74: 196-201.

Mentzel T, Fletcher CD. 1994. Malignant mesenchymomas of soft tissue associated with numerous osteoclast-like giant cells mimicking the so-called giant cell variant of "malignant fibrous histiocytoma". Virchows Arch 424: 539-45.

Miettinen M, Fetsch JF. 2006. Evaluation of biological potential of smooth muscle tumours. Histopathology 48: 97-105.

Murase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW. 1999. Uterine Leiomyomas: Histopathologic Features, MR Imaging Findings, Differential Diagnosis, and Treatment1. Radiographics 19: 1179-97.

Myatt L, Lye SJ. 2004. Expression, localization and function of prostaglandin receptors in myometrium. Prostaglandins Leukot Essent Fatty Acids 70: 137-48.

Nam JH. 2011. Surgical treatment of uterine sarcoma. Best Practice & Research Clinical Obstetrics & Gynaecology.

O'Cearbhaill R, Zhou Q, Iasonos A, Soslow RA, Leitao MM, Aghajanian C, Hensley ML. 2010. Treatment of advanced uterine leiomyo-sarcoma with aromatase inhibitors. Gynecologic oncology 116: 424-9.

Olufowobi O, Sharif K, Papaionnou S, Neelakantan D, Mohammed H, Afnan M. 2004. Are the anticipated benefits of myomectomy achieved in women of reproductive age? A 5-year review of the results at a UK tertiary hospital. J Obstet Gynaecol 24: 434-40.

Rackow BW, Arici A. 2006. Options for medical treatment of myomas. Obstetrics and gynecology clinics of North America 33: 97-113.

Sankaran S, Manyonda IT. 2008. Medical management of fibroids. Best Pract Res Clin Obstet Gynaecol 22: 655-76.

Sayed GH, Zakherah MS, El-Nashar SA, Shaaban MM. 2010. A randomized clinical trial of a levonorgestrel-releasing intrauterine system and a low-dose combined oral contraceptive for fibroid-related menorrhagia. Int J Gynecol Obstet 112: 126-30.

Shynlova O, Tsui P, Jaffer S, Lye SJ. 2009. Integration of endocrine and mechanical signals in the regulation of myometrial functions during pregnancy and labour. Eur J Obstet Gynecol Reprod Biol 144 Suppl 1: S2-10.

Shynlova O, Oldenhof A, Dorogin A, Xu Q, Mu J, Nashman N, Lye SJ. 2006. Myometrial apoptosis: activation of the caspase cascade in the pregnant rat myometrium at midgestation. Biol Reprod 74: 839-49.

Soysal S, Soysal ME. 2005. The efficacy of levonorgestrel-releasing intrauterine device in selected cases of myoma-related menorrhagia: a prospective controlled trial. Gynecologic and obstetric investigation 59: 29-35.

Starczewski A, Iwanicki M. 2000. [Intrauterine therapy with levonorgestrel releasing IUD of women with hypermenorrhea secondary to uterine fibroids]. Ginekologia polska 71: 1221.

Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T. 2005. MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls1. Radiographics 25: 21-40.

Taran FA, Weaver AL, Gostout BS, Stewart EA. 2010. Understanding cellular leiomyomas: a case-control study. Am J Obstet Gynecol 203: 109 e1-6.

Toledo G, Oliva E. 2008. Smooth muscle tumors of the uterus: a practical approach. Arch Pathol Lab Med 132: 595-605.

Walker CL, Stewart EA. 2005. Uterine fibroids: the elephant in the room. Science 308: 1589-92.

Wallach EE, Vlahos NF. 2004. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol 104: 393-406.

Wildemeersch D, Schacht E. 2002. The effect on menstrual blood loss in women with uterine fibroids of a novel. European Journal of Obstetrics & Gynecology and Reproductive Biology 102: 74-9.

Wu TI, Hsu KH, Huang HJ, Hsueh S, Chou HH, Tsai CS, Ho KC, Chao A, Chang TC, Lai CH. 2008. Prognostic factors and adjuvant therapy in uterine carcinosarcoma. European journal of gynaecological oncology 29: 483-8

Wu X, Blanck A, Olovsson M, Moller B, Favini R, Lindblom B. 2000. Apoptosis, cellular proliferation and expression of p53 in human uterine leiomyomas and myometrium during the menstrual cycle and after menopause. Acta Obstet Gynecol Scand 79: 397-404.

Yu D, Wong YM, Cheong Y, Xia E, Li TC. 2008. Asherman syndrome-one century later. Fertility and sterility 89: 759-79.




Cómo citar

Ciarmela, P., Islam, S., Lamanna, P., Tranquilli, A., & Castellucci, M. (2016). HEALTHY AND PATHOLOGICAL CHANGES OF MYOMETRIUM: PREGNANT MYOMETRIUM, UTERINE FIBROIDS AND LEIOMYOSARCOMA. Cambios normales y patológicos del miometrio: miometrio del embarazo, fibrosis uterina y leiomiosarcoma. Revista Argentina De Anatomía Clínica, 4(1), 7–13.



Temas en Revisión