Myoma of Uterus

Xu Hong

2003-11-3

Synonyms
leiomyoma of uterus leiomyomas fibromyomas myofibromas fibroids fibromas myomas
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Incidence
Most common solid pelvic tumors

Develop in 2025% of women during reproductive years

3050 years old

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Correlative Factors
An estrogenic milieu may be necessary Progesterone function
estrogen progesterone puberty menopause

Growth factor and their receptor epithelial growth factorEGF Insulin-like growth factorIGF platelet-derived growth factor
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Pathology

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Gross Appearance
Rare only a singleusually many exist Well-circumscribednonencapsulated pseudocapsule A pseudocapsule is present. The consistency is usually firm or even hard except when degeneration or hemorrhage has occurred. colorlight gray or pinkish white cut sectionan intertwining pattern or a whorl-like arrangement bulgy
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Smooth muscle tumors of the uterus are often multiple. Seen here are submucosal, intramural, and subserosal leiomyomata of the uterus.
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Microscopic Appearance
Compositionsmooth muscle connective tissue The nonstriated muscle fibers are arranged in bundles of various sizes that run in multiple directions.

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Classification1
According to growth location Myomas on the body of uterus90% Myomas on the cervix of uterus10%

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Classification2
According to the relation to uterine muscle
Submucous10 15% Intramural60 70% Subserosal20%
Few leiomyomas are actually of a single pure type.

hybrids
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Clinical Manifestation

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Symptoms
menorrhagia and prolonged menstrual period menorrhagia common Pelvic pain occurs in pregnancy if undergoing degeneration pedunculated or torsion of a pedunculated myoma Pelvic pressureurinary frequency bowel difficultyconstipation spontaneous abortion Spontaneous abortion Infertility infertility

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Signs
A palpable abdominal tumour

Pelvic examination uterus enlarged and irregular hard

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Degeneration
Result from the diminished Hyaline degeneration vascularity of the Cystic degeneration connective-tissue element Red degeneration Sarcomatous change The othersfat degeneration calcification the secondary infection
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Red Degeneration
Occasionally seen as a complication of pregnancy
during pregnancy or immediate postpartum period

The pathogenesis is unknownmay be the result of the accumulation of blood in the tumour because of venous obstruction. The cut surface resembles raw meat. Clinical featuresa cause of painacute fever rapid growthtender
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Here is a very large leiomyoma of the uterus that has undergone degenerative change and is red (so-called "red degeneration"). Such an appearance might make you think that it could be malignant. Remember that malignant tumors do not generally arise from benign tumors.
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Sarcomatous Change
Rare0.4% 0.8% More common at 40 50 years old Usually occur in intramural fiboids grow quickly vaginal bleeding

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Diagnosis
History Bimanual examination Ultrasonography
Bultrasound examination

Hysteroscopy Laparoscopy Hysterography

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hysteroscopy laparoscopy

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Differential Diagnosis
Pregnancy Ovarian tumour Adenomyosis Malignant tumors of uterus sarcoma of uterus endometrial carcinoma cervical cancer
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Treatment

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Observation and Follow Up

Smallasymptomatic fibroids need not be treatedespecially near menopause. Interval36 months

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Medical Treatment
Androgenic agentstestosterone propionate
GnRH-a induce a hypoestrogenic pseudomenopausal state not recommended for longer than 6 months add-back regimens
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Surgery Treatment1
Indications greater than 10 weeks gestational size menorrhagialead to anemia have pressure symptoms grows rapidly failure of medical treatment
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Surgery Treatment2
Method Myomectomyconservative therapy myomectomy preserve fertility significant risk of recurrence
Hysterectomy radical therapy
hysterectomy

Only true cure for leiomyomas

Subtotal hysterectomy

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Surgery Treatment3
Approach trans-abdominal trans-vaginal laparoscopic or hysteroscopic

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It is important to individualize the choice of therapy.

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Uterine Leiomyomas Complicating Pregnancy

impact on pregnancyabortion impact on deliverypremature labour fetal malpresentation retained placenta placenta previa need for operative delivery birth canal obstruction postpartum hemorrhage Conservative treatment
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Critical Points
May be related to superabundant estrogen. Well-circumscribednonencapsulated. Have a pseudocapsule. Can be classified into submucosalintramural and subserosal types. Different types have different features. Menorrhagia is common. Four degeneration types Individualized treatmentinclude observation medical treatment and surgical treatment.
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