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      TGF-β1 role in uterine leiomyoma and endometrial polyp: an insight to drug-based treatment instead of surgical techniques

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          Abstract

          Objective

          Considering the high prevalence of leiomyoma and endometrial polyps, investigating the contributing factors and determining the pathophysiology of these lesions are essential. Target therapy is now an acceptable method for the treatment of some diseases. We aimed to determine the expression of transforming growth factor (TGF)-β1 in endometrial polyps and leiomyomas to discover a drug-based method to overcome surgical treatments.

          Methods

          In this cross-sectional study, 55 patients with leiomyoma and 55 patients with polyps were included. Prepared slides from leiomyoma and adjacent myometrium or polyp lesions and adjacent endometrium were obtained and investigated for TGF-β1. Then, data were collected and analyzed using SPSS version 22.

          Results

          The mean age of participants was 40.6±5.8 years. Based on their reports, 88.2% (n=97) of patients in the study population had abnormal uterine bleeding with similar distributions among both groups. In contrast, 63.5% of the leiomyoma group did not express TGF-β1. However, in normal myometrium, 23.6% had the highest degree of TGF-β1 expression. Polyp tissue did not show staining for TGF-β1 in any patients. Additionally, 89.1% of non-polypoid endometrium did not express TGF-β1. Normal tissue had a significantly greater amount of TGF-β1 compared to leiomyoma and endometrial polyps.

          Conclusion

          TGF-β1 is expressed more prominently in normal myometrium with mostly high-intensity features compared to leiomyoma. Additionally, polyps showed no staining for TGF-β1, while normal endometrium showed a low-density staining pattern.

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          Most cited references26

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          Uterine fibroids

          Uterine fibroids (also known as leiomyomas or myomas) are common clonal neoplasms of the uterus. Fibroids have both smooth muscle and fibroblast components, in addition to a substantial amount of fibrous extracellular matrix, which all contribute to the pathogenetic process. Fibroids are extremely heterogeneous in their pathophysiology, size, location and clinical symptomatology. They are also a part of a range of disease in which some variants have facets of malignant behaviour but overall are benign. Risk for fibroids is associated with race; black women have a higher risk of developing fibroids earlier in life than their white counterparts and also develop more-severe forms of the disease. Clinically, fibroids account for one-third to half of all hysterectomies and are associated with substantial morbidity and health care costs for women of reproductive age. Indeed, current treatments are primarily surgical and interventional; approximately three-quarters of all fibroid treatments are hysterectomies. However, clinical innovations are emerging in the use of progesterone receptor modulators as a medical therapy. New information is rapidly accumulating about the genetic subgroups that lead to fibroid formation, which might aid further understanding of the clinical heterogeneity of this disease and lead to individualized treatments. This information is a crucial development given the current lack of high-quality evidence on which to base therapeutic decisions.
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            Etiology, symptomatology, and diagnosis of uterine myomas.

            To review the currently available literature regarding the biology, etiology, symptoms, and diagnosis of uterine myomas. Literature review of 220 articles pertaining to uterine myomas. Although uterine myomas presently are not well understood, many advances have been made in the understanding of the hormonal factors, genetic factors, growth factors, and molecular biology of these benign tumors. Prospective, longitudinal studies are underway to characterize the risk factors for their development. When needed, the position of myomas can be best imaged by sonohysterography or magnetic resonance imaging. Evidence suggests that only submucous myomas appear to interfere with fertility, and only very rarely do myomas effect pregnancy outcome. A summary of the available literature regarding the biology, etiology, symptomatology, and diagnosis of myomas shows that, although they are still not well understood, much has been learned about uterine myomas.
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              Extracellular matrix in uterine leiomyoma pathogenesis: a potential target for future therapeutics.

              Uterine leiomyoma (also known as fibroid or myoma) is the most common benign tumor of the uterus found in women of reproductive age. It is not usually fatal but can produce serious clinical symptoms, including excessive uterine bleeding, pelvic pain or pressure, infertility and pregnancy complications. Due to lack of effective medical treatments surgery has been a definitive choice for the management of this tumor.
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                Author and article information

                Journal
                Obstet Gynecol Sci
                Obstet Gynecol Sci
                OGS
                Obstetrics & Gynecology Science
                Korean Society of Obstetrics and Gynecology
                2287-8572
                2287-8580
                January 2021
                30 November 2020
                : 64
                : 1
                : 107-113
                Affiliations
                [1 ]Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
                [2 ]Departments of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
                [3 ]Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
                Author notes
                Corresponding author: Niloofar Namazi, MD, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Fars Province, Shiraz, Iran, E-mail: namazin68@ 123456gmail.com , https://orcid.org/0000-0002-9993-6209
                Article
                ogs-20191
                10.5468/ogs.20191
                7834754
                33238661
                95ce1a52-9c94-48ce-bbd5-4f2373b464f8
                Copyright © 2021 Korean Society of Obstetrics and Gynecology

                Articles published in Obstet Gynecol Sci are open-access, distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 1 July 2020
                : 19 September 2020
                : 8 October 2020
                Categories
                Original Article
                General Gynecology

                cytokines,polyps,leiomyoma,transforming growth factor beta,uterus

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