Adenomyosis and Myomata: Risks, Problems, and...
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Editorial Adenomyosis and Myomata: Risks, Problems, and Complications in Diagnosis and Therapy of Adenomyosis and Myomata Rudy Leon De Wilde , 1 Markus Wallwiener, 2 Attilio Di Spiezio Sardo , 3 Vasilios Tanos , 4 and Sven Becker 5 1 Department of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Oldenburg, Germany 2 Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany 3 Department of Public Health, University of Naples “Federico II”, Naples, Italy 4 St. George’s Medical School, Nicosia University, Aretaeio Hospital, Nicosia, Cyprus 5 Department of Obstetrics and Gynecology, Goethe University Frankfurt, Frankfurt, Germany Correspondence should be addressed to Rudy Leon De Wilde; [email protected] Received 3 June 2018; Accepted 5 June 2018; Published 6 August 2018 Copyright © 2018 Rudy Leon De Wilde et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. e goal of this special issue is to address research concerning risks and problems related to the diagnosis and therapy of adenomyosis and myomata. During the last years, there have been several controversies in the scientific community regarding these topics. e original papers gathered in this special issue highlight and inform the readers about the innovations made in this field. e complex pathogenesis shows that there are multiple biogenetical and multifactorial aspects influencing the etiol- ogy and growth of myomata. Furthermore, the existence of adenomyosis seems to be coupled with molecular differences in myometrial receptors. One of the examples here is the sig- nificant increase in GPER expression in case of adenomyosis (J. Li et al.). Predictive factors that point towards adenomyosis in a clinical set-up make the necessary differential diagnosis between a myoma and an adenomyoma possible. Combining clinical history and symptoms, gynecological examination and MRI (H. Krentel et al.), and sonographical aspects (V. H. Eisenberg et al.) enhance the certainty in the decision- making process. e impact on the reproductive outcome and influence on endometrial receptivity, embryo implantation, and possible “embryotoxicity” as well as anatomical distor- tion may interfere throughout the duration of pregnancy and affect the obstetrical outcome (N. F. Vlahos et al.). Hysteroscopy offers the advantage of visualization of the uterine cavity, giving the option of collecting histological samples under visual control. Possibilities of obtaining diag- nostic criteria and performing transcervical treatment in selected cases are also discussed (A. Di Spiezio Sardo et al.). e hysteroscopic morcellation of submucous myomata seems feasible, even in cases of a location in the uterine wall of more than half of the tumor (S. G. Vitale et al.). Myomas affect, with some variability, all ethnic groups and nearly 50% of all women during their lifetime. While some remain asymptomatic, significant and sometimes life- threatening problems can occur. In most cases surgical therapy cannot be avoided: hysteroscopic or laparoscopic therapy is the gold standard (A. El-Balat et al.). Apart from the routine surgically induced complications, especially in myomata and adenomyosis, there is a risk of injury to the close by organs and a possibility of tissue spilling causing parasitic myoma, endometriosis, or sarcoma spread- ing (V. Tanos et al.). Possibilities to avoid this tumor spilling by contained in-bag morcellation with description of bag- related application techniques are reported (S. Rimbach et al.). Nonsurgical alternatives by high-intensity focused ultra- sound, eventually combined with oxytocin administration (T. Lozinski et al.), and GnRH-agonists and antagonists have Hindawi BioMed Research International Volume 2018, Article ID 5952460, 2 pages https://doi.org/10.1155/2018/5952460
Transcript of Adenomyosis and Myomata: Risks, Problems, and...
EditorialAdenomyosis and Myomata: Risks, Problems, and Complicationsin Diagnosis and Therapy of Adenomyosis and Myomata
Rudy Leon DeWilde ,1 MarkusWallwiener,2 Attilio Di Spiezio Sardo ,3
Vasilios Tanos ,4 and Sven Becker 5
1Department of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology,Pius-Hospital Oldenburg, Oldenburg, Germany
2Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany3Department of Public Health, University of Naples “Federico II”, Naples, Italy4St. George’s Medical School, Nicosia University, Aretaeio Hospital, Nicosia, Cyprus5Department of Obstetrics and Gynecology, Goethe University Frankfurt, Frankfurt, Germany
Correspondence should be addressed to Rudy Leon De Wilde; [email protected]
Received 3 June 2018; Accepted 5 June 2018; Published 6 August 2018
Copyright © 2018 Rudy Leon De Wilde et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.
The goal of this special issue is to address research concerningrisks and problems related to the diagnosis and therapyof adenomyosis and myomata. During the last years, therehave been several controversies in the scientific communityregarding these topics. The original papers gathered in thisspecial issue highlight and inform the readers about theinnovations made in this field.
The complex pathogenesis shows that there are multiplebiogenetical and multifactorial aspects influencing the etiol-ogy and growth of myomata. Furthermore, the existence ofadenomyosis seems to be coupled with molecular differencesin myometrial receptors. One of the examples here is the sig-nificant increase in GPER expression in case of adenomyosis(J. Li et al.).
Predictive factors that point towards adenomyosis ina clinical set-up make the necessary differential diagnosisbetween a myoma and an adenomyoma possible. Combiningclinical history and symptoms, gynecological examinationand MRI (H. Krentel et al.), and sonographical aspects (V.H. Eisenberg et al.) enhance the certainty in the decision-making process.The impact on the reproductive outcome andinfluence on endometrial receptivity, embryo implantation,and possible “embryotoxicity” as well as anatomical distor-tion may interfere throughout the duration of pregnancy andaffect the obstetrical outcome (N. F. Vlahos et al.).
Hysteroscopy offers the advantage of visualization of theuterine cavity, giving the option of collecting histologicalsamples under visual control. Possibilities of obtaining diag-nostic criteria and performing transcervical treatment inselected cases are also discussed (A. Di Spiezio Sardo etal.). The hysteroscopic morcellation of submucous myomataseems feasible, even in cases of a location in the uterine wallof more than half of the tumor (S. G. Vitale et al.).
Myomas affect, with some variability, all ethnic groupsand nearly 50% of all women during their lifetime. Whilesome remain asymptomatic, significant and sometimes life-threatening problems can occur. In most cases surgicaltherapy cannot be avoided: hysteroscopic or laparoscopictherapy is the gold standard (A. El-Balat et al.).
Apart from the routine surgically induced complications,especially in myomata and adenomyosis, there is a risk ofinjury to the close by organs and a possibility of tissue spillingcausing parasitic myoma, endometriosis, or sarcoma spread-ing (V. Tanos et al.). Possibilities to avoid this tumor spillingby contained in-bag morcellation with description of bag-related application techniques are reported (S. Rimbachet al.).
Nonsurgical alternatives by high-intensity focused ultra-sound, eventually combinedwith oxytocin administration (T.Lozinski et al.), and GnRH-agonists and antagonists have
HindawiBioMed Research InternationalVolume 2018, Article ID 5952460, 2 pageshttps://doi.org/10.1155/2018/5952460
2 BioMed Research International
been used in the treatment of symptomatic uterine fibroidswith long-lasting effects (M. Safrai et al.). Selective proges-terone receptor modulators add perspectives and open newmedication-based treatment options (T. Rabe et al.). In allcontinuously applied medications, not only early drug relatedcomplications, but also problems due to the total dosage ofthe medication should be taken into account.
As this special issue deals with the most frequent diseasestreated by gynaecologists, it clearly should be seen as afurther step to engage in research and optimizing treatmentmodalities. The authors, as key opinion leaders in their field,have shared their thoughts and knowledge with only onepurpose: to reach a next level in the standard of care dealingwith myomata and adenomyosis.
Acknowledgments
The guest editors would like to thank all the authors, whocontributed to this special issue.This high quality publicationwould not have been possible without the participation ofthe expert reviewers, who provided feedback and criticismthroughout the review process.
Rudy Leon De WildeMarkus Wallwiener
Attilio Di Spiezio SardoVasilios TanosSven Becker
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