Babii Y. Clinico-morphological characteristic of complicated and uncomplicated upper gastrointestinal leiomyoma, their diagnosis and treatment strategy

The dissertation is devoted to the study the pathomorphological structure of complicated and uncomplicated upper gastrointestinal leiomyoma, and to the study of its influence on the clinical manifestation of this disease and on the probability of a gastrointestinal bleeding. In this work, at the first time gastrointestinal leiomyoma was characterized as a pleomorphic neoplasm, the pathomorphological subtypes of which can differ among themselves in the features of the histological structure, as well as the ability to rapidly grow and cause complications. With the help of pathomorphological and immunohistochemical studies, as well as statistical analysis, it was established that the pathohistological subtype of leiomyoma reliably modifies the risk of bleeding, with the lowest risk in the case of ordinary leiomyoma and the highest risk in the case of epithelioid and angioleiomyoma. A clinical and morphological characteristic of leiomyomas of the upper parts of the gastrointestinal tract has been developed, according to which all leiomyomas are divided into two clinical and morphological variants: leiomyomas of a simple clinical and morphological variant are characterized by a low level of proliferation, vascularization, and an asymptomatic course; leiomyomas of the proliferating clinical and morphological variant are characterized by a high level of proliferation, vascularization, and a symptomatic course. After analyzing the results of diagnosis and treatment of leiomyomas complicated by bleeding and developing a diagnostic and treatment algorithm, it was established that in 37.5% of patients, endoscopic hemostasis was ineffective or unstable, which led to extensive surgical interventions. After analyzing the features of diagnosis and operative treatment of uncomplicated leiomyomas and developing a diagnostic and treatment algorithm, it was established that for leiomyomas < 2 cm, the best preoperative methods of diagnosis are repeated esophagogastroduodenoscopy and endoscopic ultrasonography. For leiomyomas ≥ 2 cm, these diagnostic methods can be supplemented with contrast-enhanced computed tomography and fine-needle biopsy if necessary.