Multiple Myoma: Intramural and Subserous and Bilateral Serous Cyst

Myoma

• Other names
o Uterine Fibroid
o Leiomyoma
o Fibroids
• The most common benign (not harmful; not malignant) gynecological tumor (abnormal growth of tissues that may
or may not be cancerous) in premenopausal women
Etiology

• Research to determine the etiology on going

• Comprised of monoclonal cells arising from the myometrium.
o Monoclonal cells
▪ refer to a line of cells that have been derived from a single clonal origin
▪ derived from a single cell and all have the same genotype
▪ a cell line that originates from a single progenitor
• Several studies identified specific gene mutations associated with fibroids
o Defects involving the RNA polymerase II transcriptional mediator subunit
▪ RNA Polymerase II Mediator is a large protein complex that binds RNA polymerase II and
controls transcription from class II genes.
• RNA polymerase II is an enzyme that transcribes all the precursors of mRNA, miRNA,
and snRNA.
• mRNA is the translated form of DNA that the machinery can recognize and use to
assemble amino acids into proteins. There is a fundamental link between the code of
life and the actual cell being able to construct a living organism. mRNA is a crucial piece
of the fundamental way in which the living organism is created (cells for example)
Pathophysiology

• highly sensitive to the effects of steroid hormones

o Leiomyomas have increased expression of both estrogen and progesterone receptors
• Studies indicate that ovarian steroids, estradiol, and progesterone promote the growth of leiomyomas
o Size of fibroids often decline after menopause when levels of those hormones fall
Assessments

• Clinical presentation of fibroids vary ranging from asymptomatic patients to recurrent and progressive
symptoms
o Most common presenting symptoms:
▪ Pain
▪ Pressure
▪ Abnormal Vaginal Bleeding
• Physical examination confirms an enlarged, irregularly-shaped uterus.
• Confirmation of clinical diagnosis is most easily accomplished with ultrasonography
Treatment/Management

• Effective treatment is necessary to reduce the detrimental effects it poses on a woman’s daily function.
o Initial interventions
▪ hormonal therapy (GnRH Agonists – obstructing creation of estrogen and progesterone, oral
contraceptives, single agent progesterone suppression)
 • only used for short duration; increased complications are associated with long-term
treatment using exogenous hormones
▪ NSAIDS (relieve pain; Acetaminophen ex.)
• Useful for reducing menstrual blood loss
• Decrease the endometrial prostaglandins, which subsequently inhibit vascularization
and new vascularization
o that’s why NSAIDS are avoided or limited to the lowest effective dose and
shortest duration possible between 20 – 30 weeks of pregnancy, and not used at
all after 30 weeks of pregnancy
▪ Antifibrinolytics (ease symptom during menstrual periods)
▪ modulation of the hypothalamic-pituitary axis
• Surgical intervention remains the most successful treatment
o Endometrial ablation = hysteroscopic destruction of the full-thickness endometrium
o Uterine Artery embolization -= reduced blood flow to individual fibroids to reduce growth
o Myomectomy = surgical removal of FIBROIDS only
▪ Enables future fertility while reducing size and symptoms from fibroids
o Hysterectomy = only treatment that provides DEFINITIVE THERAPY

• Nabothian Cysts – small mucus -filled bumps on cervix

• A heterogenous texture of the uterus refers to a mixture of

different densities or textures within the tissue of the uterus
(normal layer of uterus = homogenous layer)

On March 10, 2024, at 11:14 pm, patient PTA reports onset of heavy menses with an admission diagnosis of multiple myoma.
OB Score is G1P1(0001). Upon ultrasound results, findings include Nabothian cysts present on the cervix, uterus retroverted,
texture of uterus is heterogenous, and findings with more than 3 well defined heterogenous masses. Sonographic Impressions
and findings include enlarged retroverted uterus with multiple myoma as described thickened endometrium.