Leiomyoma pseudocapsule after pre-surgical treatment with gonadotropin-releasing hormone agonists: Relationship between clinical features and immunohistochemical changes

Abstract 

Objective

To evaluate if pre-operative GnRH-a modify uterine leiomyoma pseudocapsule and the possible clinical effects of these changes.

Study design

The study was performed at the University Federico II of Naples on 33 premenopausal patients submitted to laparotomic myomectomy after treatment with triptorelin depot. 29 untreated patients formed the control group. The operating time, the intraoperative bleeding and the prompt identification of the cleavage plan between myoma and myometrium were evaluated. The pseudocapsule features and the immunoexpression of PCNA and CD34 in this area were studied.

Results

Treated patients showed lower blood loss and not clearly identifiable cleavage plan, but without any significant increase in the operating time. Treated lesions showed less evident border between myoma and myometrium and lower PCNA and CD34 pseudocapsule immunoexpression than untreated ones.

Conclusion

We propose the changes of leiomyoma pseudocapsule as partial explanations of the reported clinical and surgical findings after pre-operative GnRH-a.

Keywords: Cleavage plan, GnRH-a therapy, Intraoperative blood loss, Leiomyoma pseudocapsule, Myomectomy