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Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1650
THE DESTINY OF MYOMAS
Andrea TINELLI 1, 2, Radmila SPARIĆ 3, 4, Saša KADIJA 3, 4, Ivana BABOVIĆ 3, 4, Raffaele TINELLI 5, Ospan A. MYNBAEV 2, Antonio MALVASI 2, 6
1 Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology, “Vito Fazzi” Hospital, Lecce, Italy; 2 International Translational Medicine and Biomodeling Research Group, Laboratory of Human Physiology, Department of Informatics and Applied Mathematics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Russia; 3 Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia; 4 Medical Faculty, University of Belgrade, Belgrade, Serbia; 5 Department of Obstetrics and Gynecology, “A. Perrino” Hospital, Brindisi, Italy; 6 Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy
Myomas are the most common disorder of the female genital organs, occurring more frequently throughout women’s reproductive years. Myomas are a major health issue all over the world. They develop as a monoclonal tumor from cells influenced by ovarian steroids, and mediated by surrounding myometrial cells by paracrine mechanisms. During its growth, a myoma compresses the surrounding tissue, causing the formation of a pseudocapsule, encapsulating the myoma. The mechanical properties of myomas are a key factor which can contribute to their growth. While myomas are essentially rigid, their pseudocapsule is more elastic, and this allows uterine adaptation to the growing myoma. Hence, the pseudocapsule induces displacement on the myometrium, which is not destructive since the integrity and contractility of uterine structure is maintained. Extensive research conducted on the myoma and its pseudocapsule has produced important data. Scientific research is still trying to clarify some of the evidence regarding the influence of myomas on infertility, especially in the case of intramural myomas. During fertility-sparing myoma surgery, data suggest that during myoma removal the pseudocapsule should be preserved. However, unsolved issues still exist on the cesarean myomectomy technique, since the age of pregnancy has been increasing in the new millennium, so patients present with myomas which should be removed before and during the cesarean section, or prior to applying for medically-assisted reproduction.