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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 20 25% of women during reproductive years 30 50 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 factor EGF Insulin-like growth factor IGF platelet-derived growth factor
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Pathology

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Gross Appearance
Rare only a single usually many exist Well-circumscribed nonencapsulated pseudocapsule A pseudocapsule is present. The consistency is usually firm or even hard except when degeneration or hemorrhage has occurred. color light gray or pinkish white cut section an 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
Composition smooth muscle connective tissue The nonstriated muscle fibers are arranged in bundles of various sizes that run in multiple directions.

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Classification 1
According to growth location Myomas on the body of uterus 90% Myomas on the cervix of uterus 10%

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Classification 2
According to the relation to uterine muscle Submucous 10 15% Intramural 60 70% Subserosal 20%
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 pressure urinary frequency bowel difficulty constipation 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 others fat degeneration calcification the secondary infection 2003-11-3 14

Red Degeneration
Occasionally seen as a complication of pregnancy during pregnancy or immediate postpartum
period

The pathogenesis is unknown may be the result of the accumulation of blood in the tumour because of venous obstruction. The cut surface resembles raw meat. Clinical features a cause of pain acute fever rapid growth tender
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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
Rare 0.4% 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


Small asymptomatic fibroids need not be treated especially near menopause. Interval 3 6 months

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Medical Treatment
Androgenic agents testosterone propionate GnRH-a induce a hypoestrogenic pseudomenopausal state not recommended for longer than 6 months add-back regimens
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Surgery Treatment 1
Indications greater than 10 weeks gestational size menorrhagia lead to anemia have pressure symptoms grows rapidly failure of medical treatment
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Surgery Treatment 2
Method Myomectomyconservative therapy myomectomy preserve fertility significant risk of recurrence Hysterectomy radical therapy Subtotal hysterectomy
hysterectomy

Only true cure for leiomyomas

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Surgery Treatment 3
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 pregnancy abortion impact on delivery premature 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-circumscribed nonencapsulated. Have a pseudocapsule. Can be classified into submucosal intramural and subserosal types. Different types have different features. Menorrhagia is common. Four degeneration types Individualized treatment include observation medical treatment and surgical treatment.
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