Amid Keshavarzi, M. D. , Shahram Vaezy, Ph. D. , Misty L Noble, B. S

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Treatment of uterine fibroid tumors in an in situ rat model using high-intensity focused ultrasound Amid Keshavarzi, M.D., Shahram Vaezy, Ph.D., Misty L Noble, B.S., Marla K Paun, R.D.M.S., Victor Y Fujimoto, M.D. Fertility and Sterility Volume 80, Pages 761-767 (September 2003) DOI: 10.1016/S0015-0282(03)00783-0

FIGURE 1 A representative uterine fibroid tumor treatment in an Eker rat. (A) The HIFU device (white arrow) is brought in contact with the fibroid tumor (arrowhead). (B) After HIFU treatment, coagulative necrosis can be seen at the targeted regions as indicated by tissue discoloration (arrows). (C) Gross examination of the uterine fibroid tumors showing areas of coagulative necrosis (arrows on 1) on the surface surrounded by a hemorrhagic ring typical of HIFU treatment (arrowhead on 1). The second uterine fibroid tumor also received HIFU treatment. (D) Cross-section of the tumors shows extent of necrosis caused by the HIFU treatment. Keshavarzi. Uterine fibroid treatment using HIFU. Fertil Steril 2003. Fertility and Sterility 2003 80, 761-767DOI: (10.1016/S0015-0282(03)00783-0)

FIGURE 2 Ultrasonic images of a HIFU-treated fibroid tumor in the transverse view. (A) Ultrasound image before HIFU treatment (hypoechogenic area is the fibroid tumor). (B) First week after HIFU treatment, tumor enlarged in volume and shows hyperechoic region within the tumor. (C) Three weeks after treatment, tumor shows shrinkage in size. (D) Five weeks after treatment, more shrinkage of tumor size. (E) Seven weeks after treatment, tumor shows significant shrinkage in size. (F) Eleven weeks after treatment, tumor shows enlargement of the size with the hyperechogenic region in right lower part of the tumor (left side of the picture) with a hypoechogenic region in the right side, which after necropsy, was consistent with newly growing fibroid tumor cells. Keshavarzi. Uterine fibroid treatment using HIFU. Fertil Steril 2003. Fertility and Sterility 2003 80, 761-767DOI: (10.1016/S0015-0282(03)00783-0)

FIGURE 3 Mean of the percent change in tumor volume of HIFU- and sham-treated uterine fibroid tumors in Eker rats is plotted as a function of time. In the HIFU-treatment group, a tumor volume increase was seen initially followed by a gradual reduction in tumor volume until the eighth week after treatment. In the sham treatment group, tumor volume progressively increased until the end of the study. Keshavarzi. Uterine fibroid treatment using HIFU. Fertil Steril 2003. Fertility and Sterility 2003 80, 761-767DOI: (10.1016/S0015-0282(03)00783-0)

FIGURE 4 Representative micrographs of uterine fibroid tumor samples for histological analysis. (A) Sham-treated tumor increased in volume by 500% in 12 weeks after treatment. Fibroid spindles as seen with H & E staining and (B) trichrome staining. (C) HIFU-treated tumor revealed areas of coagulative necrosis indicative of target region (arrow) within normal-appearing uterus (arrowheads) as seen with H & E staining and (D) trichrome staining. Magnification of all slides is ×40. Keshavarzi. Uterine fibroid treatment using HIFU. Fertil Steril 2003. Fertility and Sterility 2003 80, 761-767DOI: (10.1016/S0015-0282(03)00783-0)

FIGURE 5 Ultrasonic representatives of cystic degeneration and calcification of fibroid tumors after HIFU treatment. (A) A fibroid tumor with cystic degeneration (sonolucent region, arrow) after HIFU treatment, a mass of pedunculated necrotic tissue (hyperechogenic region, arrowhead), which was attached to the main tumor. (B) A representative of calcification (arrow) within the fibroid tumor after HIFU treatment. Keshavarzi. Uterine fibroid treatment using HIFU. Fertil Steril 2003. Fertility and Sterility 2003 80, 761-767DOI: (10.1016/S0015-0282(03)00783-0)