The management of fibroids based on immunohistochemical studies of their pseudocapsules

Background: We examined the presence of collagen IV and laminin in the pseudocapsule of uterine myomata to clarify different ultra-structural characteristics and their possible role in the management of this condition. Methods: Twenty non-pregnant patients underwent laparoscopic intracapsular myomectomies. Samples of the removed fibroids pseudocapsules were analyzed by immunochemical staining for collagen IV, immunohistochemical location of the vascular membrane-bound laminin and quantitative analysis of their images. Results: In the blood vessels of the pseudocapsules, a reduction in laminin and increase in collagen IV with increasing diameter of fibroids was noted. These proteins are related to loss of the basal membrane and to ageing of the tissue. The increase of collagen IV is linked to the increase of amorphous substance, including glycosaminoglycans and glycoproteins. Conclusion: Based on immunohistochemical findings, the authors propose to remove fibroids in women seeking pregnancy whilst respecting the pseudocapsule by neurofibre sparing in the incision site. This is essential for optimal muscular healing and myometrial function in future pregnancies, and also when fibroids remain under 6 cm diameter, especially in young women wishing pregnancies. Fibroid removal should be performed before the myoma reaches a size causing compression of the surrounding tissues, which results in the loss of regenerative potential.