%0 Journal Article
%T Uterine Fibroids: Pathogenesis and Interactions with Endometrium and Endomyometrial Junction
%A Andrea Ciavattini
%A Jacopo Di Giuseppe
%A Piergiorgio Stortoni
%A Nina Montik
%A Stefano R. Giannubilo
%A Pietro Litta
%A Md. Soriful Islam
%A Andrea L. Tranquilli
%A Fernando M. Reis
%A Pasquapina Ciarmela
%J Obstetrics and Gynecology International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/173184
%X Uterine leiomyomas (fibroids or myomas) are benign tumors of uterus and clinically apparent in a large part of reproductive aged women. Clinically, they present with a variety of symptoms: excessive menstrual bleeding, dysmenorrhoea and intermenstrual bleeding, chronic pelvic pain, and pressure symptoms such as a sensation of bloatedness, increased urinary frequency, and bowel disturbance. In addition, they may compromise reproductive functions, possibly contributing to subfertility, early pregnancy loss, and later pregnancy complications. Despite the prevalence of this condition, myoma research is underfunded compared to other nonmalignant diseases. To date, several pathogenetic factors such as genetics, microRNA, steroids, growth factors, cytokines, chemokines, and extracellular matrix components have been implicated in the development and growth of leiomyoma. This paper summarizes the available literature regarding the ultimate relative knowledge on pathogenesis of uterine fibroids and their interactions with endometrium and subendometrial myometrium. 1. Introduction Leiomyomas are benign uterine tumors of unknown aetiology. These kinds of lesions seem to arise from myometrial transformation as a result of specific physiological and pathological conditions. The majority of these monoclonal estrogen-dependent uterine neoformations [1] afflict mostly women during reproductive age, and 80% of them suffer from this during their whole lifetime [2]. In the past, most women with fibroids remained undiagnosed, because they were asymptomatic. Analyses based on clinical diagnosis or diagnostic tests underestimate the true incidence; in fact, they take only into account symptomatic patients. Cramer and Patel [3] estimated the prevalence of uterine fibroids based on clinical assessment at 33%, ultrasound scan at 50%, and histological examination of hysterectomy specimens at 77%. The reported frequency of the disease varies widely due to differences in study design. In fact, to determine the exact prevalence of fibroids, a correct clinical research should apply ultrasound scanning in a randomly sampled population [4]. Nowadays, conflicting data about the pathogenesis of leiomyomas coexist in the literature. The development of uterine myomas can be linked to predisposing risk factors, initiators and genetic mechanisms, promoters, and effectors. The aim of this work is to discuss the latest knowledge on the pathogenesis of uterine fibroids and their interactions with the endometrium and subendometrial myometrium. 2. Pathogenesis of Uterine Leiomyoma 2.1. Risk
%U http://www.hindawi.com/journals/ogi/2013/173184/