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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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Gross Appearance
Rare only a singleusually many exist
Well-circumscribednonencapsulated
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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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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Symptoms
menorrhagia and prolonged menstrual period
common
Pelvic pain
occurs in pregnancy if undergoing degeneration
or torsion of a pedunculated myoma
Pelvic pressureurinary frequency
bowel difficultyconstipation
Spontaneous abortion
Infertility




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Signs
A palpable abdominal tumour

Pelvic examination
uterus enlarged and irregular
hard

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Degeneration
Hyaline degeneration
Cystic degeneration
Red degeneration
Sarcomatous change
The othersfat degeneration
calcification
the secondary infection
Result from the diminished
vascularity of the
connective-tissue element
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Red Degeneration
Occasionally seen as a complication of
pregnancyduring 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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Differential Diagnosis
Pregnancy
Ovarian tumour
Adenomyosis
Malignant tumors of uterus
sarcoma of uterus
endometrial carcinoma
cervical cancer

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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
preserve fertility
significant risk of recurrence

Hysterectomy radical therapy

Subtotal hysterectomy





Only true cure
for leiomyomas
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Surgery Treatment3
Approach
trans-abdominal

trans-vaginal

laparoscopic or hysteroscopic