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Reprod Sci. 2014 Sep;21(9):1177-86. doi: 10.1177/1933719114537719. Epub 2014 May 30.

A combined ultrasound and histologic approach for analysis of uterine fibroid pseudocapsule thickness.

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Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Lecce, Italy
Moscow Institute of Physics & Technology, State University, Moscow, Russia Laboratory of pilot projects Moscow State University of Medicine & Dentistry, Moscow, Russia Department of ObGyn and Reproductive Medicine, Peoples' Friendship University of Russia, Moscow, Russia.
Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University, Hospitals Schleswig-Holstein, Campus Kiel, Germany.
Assisted Reproduction Center, Carolinas Medical Center, Charlotte, NC, USA.
Division of Human Pathology, Vito Fazzi Hospital, Lecce, Italy.
Human Anatomy and Neuroscience Unit, University of Salento, Lecce, Italy.
Department of Obstetrics and Gynecology, University of Ioannina, Ioannina, Greece.
Department of Obstetric & Gynecology, Santa Maria Hospital, Bari, Italy.


Authors investigated 75 patients with uterine myomas, appraising whether fibroid pseudocapsule (FP) thickness varies depending on fibroid location, by a prospective cohort trial (level of evidence II-2) settled in University-affiliated Hospitals. Uteri were scanned via bidimensional and power Doppler ultrasound (US) to map the fibroids and record the FP thickness, prior to hysterectomy for symptomatic uterine fibroids. After hysterectomy, FP specimens were sampled and analyzed by pathologists. Ultrasound and histology data were matched. Pseudocapsule thickness of 108 fibroids was measured: subserosal fibroids (SSFs), intramural fibroids (IMFs), and fibroids near the endometrial cavity (FEC). The FEC's pseudocapsules were considerably thicker than those of IMF and SSF measured by US and histology (P = .001). A clear cutoff existed between FEC pseudocapsule thickness and all other pseudocapsules, with significant differences observed at 2 mm (P = .001). Similarity between histological and US measurements was observed only with IMF pseudocapsules, whereas FEC or SSF showed significant differences. The pseudocapsule of fibroids is considerably thicker near the endometrial cavity when compared to those of both IMFs and SSFs. Since fibroids closest to the endometrial cavity are the most involved in fertility and infertility and FP is considerably thicker near the endometrial cavity, it is possible to hypothesize an involvement of FP of fibroid near the endometrium since FP contains many neuropeptides and neurotransmitters that are physiologically active, even if these data may take on a broader meaning in a study on a larger number of patients.


fibroid; myoma pseudocapsule; myomectomy; thickness; ultrasound; uterine myoma

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