Histological findings in resected leiomyomas following MR-HIFU treatment, single-institution data from seven patients with unfavorable focal therapy

Figures & data

Table 1. Patient characteristics.

	Age	Myoma	Funaki (T2) classification	Mindjuk (T1gd+) classification	Symptoms	Medication
Case 1	46 y	898 ml Submucosal	Type II, homogeneous	Type II, heterogeneous	Pain and pressure at lower abdomen	–
Case 2	38 y	95 ml Subserosal	Type II, homogeneous	Type III, heterogeneous	Abdominal pressure, urinary frequency	–
Case 3	32 y	21 ml Intramural	Type II, heterogeneous	Type III, homogeneous	Infertility, deformation of the uterine cavity due to leiomyoma	Ulipristal acetate prior HIFU
Case 4	40 y	59 ml Intramural	Type II, homogeneous	Type II homogeneous (venous phase) Type III homogeneous (arterial phase)	Hypermenorrhea leading to anemia	Combined oral contraceptive post HIFU
Case 5	41 y	242 ml Intramural	Type II, homogeneous	Type II, homogeneous	Hypermenorrhea, urinary urgency	Ulipristal acetate prior HIFU, hormonal IUD prior and post HIFU
Case 6	38 y	170 ml Intramural	Type II, homogeneous	Type III, homogeneous	Hypermenorrhea	Ulipristal acetate prior HIFU
Case 7	41 y	361 ml Intramural	Type II, homogeneous	Type II, homogeneous	Urinary frequency	Ulipristal acetate post HIFU

Figure 1. Pretreatment MR-images. Histological samples are from the regions of the remaining leiomyoma tissue. CD: collagen% and CD31% show heterogeneous histology. Scale bar applies for all histological images.

Table 2. Procedural outcomes.

	HIFU procedure	Initial NPV	Leiomyoma volume change post-therapy	Reason for surgery	Surgery
Case 1	Poor tissue heating at therapy time, response varied at different areas	37% (after two HIFU procedures)	−9% at 3 months	Insufficient clinical response	13 months post HIFU, laparoscopic hysterectomy
Case 2	NPV limited by surrounding bowel loops	9%	−48% at 6 months	Insufficient clinical response	7 months post HIFU, hysterectomy
Case 3	Heats well	36%	−38% at 10 months	Continued uterine cavity deformation and infertility, appearance of new leiomyomata	10 months post HIFU, laparoscopic myomectomy
Case 4	Highly vascularized leiomyoma, poor heating despite using maximum power 300 W	3%	Follow-up imaging not done	Low NPV	1 months post HIFU, hysterectomy
Case 5		50%	−24% at 12 months	Insufficient clinical response	29 months post HIFU, laparoscopic hysterectomy using morcellation
Case 6	Heats well	54%	−22% at 3 months	Insufficient clinical response	19 months post HIFU, laparoscopic myomectomy
Case 7		45%	−42% at 3 months	Symptom recurrence at one year	16 months post HIFU, laparoscopic hysterectomy with morcellation

Figure 2. (a) Samples from regions with dense scarred tissue. Organized collagen bundles mixed sparsely with basophilic nuclei are seen. Few blood vessels are present in case 7. Scale bar applies for all images. (b) Samples from regions with non-organized coagulative necrosis. Original tissue architecture is preserved, empty cell compartments and unorganized collagen bundles are seen. Hematoidin deposits and remnants of blood vessels are present. Scale bar applies for all images.

Figure 3. Boundary of remaining leiomyoma tissue and dense scarred tissue. No increase of Mib-1+, CD31+ or MMP-2+ cells is seen at the boundary. In Herovici, staining collagen appears mature.

Data availability statement

Data are made available on reasonable request.