Evidence of Biomechanical and Collagen Heterogeneity in Uterine Fibroids

PLoS One. 2019 Apr 29;14(4):e0215646. doi: 10.1371/journal.pone.0215646. eCollection 2019.


Objective: Uterine fibroids (leiomyomas) are common benign tumors of the myometrium but their molecular pathobiology remains elusive. These stiff and often large tumors contain abundant extracellular matrix (ECM), including large amounts of collagen, and can lead to significant morbidities. After observing structural multiformities of uterine fibroids, we aimed to explore this heterogeneity by focusing on collagen and tissue stiffness.

Methods: For 19 fibroids, ranging in size from 3 to 11 centimeters, from eight women we documented gross appearance and evaluated collagen content by Masson trichrome staining. Collagen types were determined in additional samples by serial extraction and gel electrophoresis. Biomechanical stiffness was evaluated by rheometry.

Results: Fibroid slices displayed different gross morphology and some fibroids had characteristics of two or more patterns: classical whorled (n = 8); nodular (n = 9); interweaving trabecular (n = 9); other (n = 1). All examined fibroids contained at least 37% collagen. Tested samples included type I, III, and V collagen of different proportions. Fibroid stiffness was not correlated with the overall collagen content (correlation coefficient 0.22). Neither stiffness nor collagen content was correlated with fibroid size. Stiffness among fibroids ranged from 3028 to 14180 Pa (CV 36.7%; p<0.001, one-way ANOVA). Stiffness within individual fibroids was also not uniform and variability ranged from CV 1.6 to 42.9%.

Conclusions: The observed heterogeneity in structure, collagen content, and stiffness highlights that fibroid regions differ in architectural status. These differences might be associated with variations in local pressure, biomechanical signaling, and altered growth. We conclude the design of all fibroid studies should account for such heterogeneity because samples from different regions have different characteristics. Our understanding of fibroid pathophysiology will greatly increase through the investigation of the complexity of the chemical and biochemical signaling in fibroid development, the correlation of collagen content and mechanical properties in uterine fibroids, and the mechanical forces involved in fibroid development as affected by the various components of the ECM.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomechanical Phenomena
  • Collagen / chemistry
  • Collagen / metabolism*
  • Collagen Type I / metabolism
  • Collagen Type III / metabolism
  • Collagen Type V / metabolism
  • Elasticity
  • Female
  • Humans
  • Leiomyoma / pathology*
  • Leiomyoma / physiopathology*
  • Uterine Neoplasms / pathology*
  • Uterine Neoplasms / physiopathology*


  • Collagen Type I
  • Collagen Type III
  • Collagen Type V
  • Collagen

Grant support

This research was partially supported by the Charles B. Hammond, MD, Research Fund of the Department of Obstetrics and Gynecology, Duke University School of Medicine (F.L.J) and by an investigator initiated unrestricted grant from BioSpecifics Technologies Corporation (P.C.L., F.L.J.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.