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№4' 2017
ONCOLOGYInternational Medical Journal, Vol. 23., Iss. 4, 2017, P. 57−61.
EPIDEMIOLOGY OF LEIOMYOMA, ADENOMYOSIS AND UTERINE SARCOMA (literature review)
S. P. Grigoriev Institute for Medical Radiology (NAMS of Ukraine), Kharkiv, Ukraine
The literature review contains modern data on the epidemiology of benign myometrium tumors −− leiomyomas and adenomyosis, which are among the most common diseases of the female genitals, as well as rare malignant non−epithelial tumors of the uterus −− sarcomas. Over the past decades, a marked increase in the incidence of benign and malignant tumors in the female sexual sphere has been observed. In Ukraine, in the context of birthrate reduction and a high level of overall mortality of the population, the problem of prevention, early diagnosis and effective treatment of such patients acquires special significance. To develop preventive measures, it is important to study the epidemiology of tumors of various locations. In the structure of female genital diseases, uterine leiomyoma ranks second after inflammation in this organ and its appendages, accounting for 15−20 % of cases. The results of epidemiological studies conducted in the world showed an increase in the frequency of detection of leiomyasis as the age of women increased. Numerous scientific sources report that there are differences in the frequency of the tumor detection, depending on the residence of women in different climatic and geographical areas; the tumors are more common in black people than the representatives of the white race. Differences in the incidence of leiomyoma detection among urban and rural populations have been described, in urban dwellers their rates are much higher. The patients with uterine leiomyoma have a high rate of surgical interventions −− up to 50−70 % of all operations performed in gynecological hospitals. The search for the ways to preserve the uterus in such patients is one of the most important tasks of modern gynecology and is based on the improvement of differential diagnosis of benign, borderline and malignant myometrial tumors even at the stage of examination, since it is the false suspicion of oncopathology that becomes an indication for unjustified operative interventions. Adenomyosis, or internal genital endometriosis, is a dyshormonal immune−dependent pathological process characterized by benign invasive growth of the endometrial glands in the muscular layer of the uterus and is accompanied by hyperplasia and hypertrophy of smooth muscle tissue. Adenomyosis is called a «missed» disease, because on an average interval between the moment of appearance of its first symptoms and before diagnosis is 7−8 years, which requires the timeliness and improvement of the quality of diagnosis of this pathology. At present, many researchers note an increase in the frequency of combined development of hyperplastic processes of endo− and myometrium, according to some data, from 63 to 73 % of cases, which is explained by common morphological, immunohistochemical features. Sarcoma of the uterus is more common in women aged 40−60. Similar deviations at this age are explained by changes in metabolic and hormonal processes, a decrease in local tissue resistance with the appearance of inferior connective tissue and atrophic phenomena in the genital organs. The risk factors for uterine sarcoma in pre− and postmenopausal women are uterine leiomyoma, especially fast−growing, late menarche, late first birth, multiple and spontaneous abortions, primary infertility, i.e. endocrine metabolic disorders manifested by hyperestrogenism. The theory that mutations of certain genes increase the likelihood of risk of sarcoma incidence has been features by a number of authors who say that retinoblastoma can have one genetic locus with leiomyosarcoma, and carcinosarcoma, being a hormone−dependent tumor, with carcinoma of the breast. Modern knowledge of the epidemiology of leiomyomas, adenomyosis and sarcomas in women of different ages and nationalities in the presence of certain risk factors will allow to develop a set of diagnostic and preventive measures for timely diagnosis and treatment tactics in the presence of this pathology and avoid unnecessary medical and surgical interventions.
Key words: epidemiology, leiomyoma, adenomyosis, uterine sarcoma.