Beruflich Dokumente
Kultur Dokumente
Definition
Benign tumours of the uterus primarily composed of smooth muscle & fibroids connective tissue
leiomyomata (monoclonal).
- Benign monoclonal growth of myometrium
o Contains collagen
o Surrounded by pseudo-capsule
Epidemiology
Occurs in 20 50% of women >30y.o.
o YOUNGER PATIENTS (Polyps = older patients)
Most common solid tumour of the female pelvis
In ~85% of cases, fibroids occur in multiples
Risk factors/Aetiology
BMI
Advanced maternal age
Black ethnicity
Exposure to sex hormones (e.g. contraceptive, HRT)
Nulliparity
Hypertension
High intake of beef/red meat
Smoking
Pathophysiology
Arise from the myometrial layer of the uterine corpus (intramural)
o Protrudes outward = subserosal
o Protrudes inward = submucous
Symptoms associated with distortion of endometrial lining more common in submucous
Growth accelerates during pregnancy (due to elevated hormones)
Involutes at menopause (decrease in size)
Hormone sensitive
o More hormone = grow faster
Increases in size with pregnancy
o Decreases in size after menoapuse
Degeneration
- Fibroids may undergo atrophy, internal haemorrhage, fibrosis and calcification.
o This is bad it will be painful!
Types of degeneration:
1. Red degeneration**
Sudden cut of blood supply
Presents with acute abdo pain + localised tenderness over uterus
Risk factors
o Pregnancy
o PCOS
o Hormone supplement (e.g. OCP, HRT)
Due to haemorrhagic infarction
4. Myxoid degeneration
Filled with gelatinous material
Appear as complex cystic masses
Can mimic malignant leiomyosarcoma
Bloating
Pelvic pressure
Urinary frequency/urgency
Urinary & faecal incontinence
Pedunculated submucous fibroids can dilate cervix prolapse into vagina risk of infection
Pain:
Abnormal PV bleed
Bimanual examination
Cobble-stone uterus irregular, hard, palpable mass on the uterus
Diagnosis
Test Findings
Bimanual examination Round firm irregular vagina
BUZZWORD: Cobblestone uterus
Abdominal U/S 1st line Heterogenous hypoechoic masses +/- cystic areas
- Rule out ovarian mass
Calcification (cystic degeneration)
Hysteroscopy Direct visualisation of space-occupying lesions
Complications