Myoma of Uterus

Bi jianlei

19/7/10 1
Synonyms
leiomyoma of uterus
leiomyomas
fibromyomas
myofibromas
fibroids
fibromas
myomas
19/7/10 2
Incidence

Most common solid pelvic tumors

Develop in 20 ～ 25% of women during
reproductive years
30 ～ 50 years old

19/7/10 3
Correlative Factors
puberty
青春期
An estrogenic milieu may be necessary
menopause
Progesterone function 绝经期

estrogen progesterone
雌激素 孕激素

Growth factor and their receptor ：

epithelial growth factor （ EGF ）
Insulin-like growth factor （ IGF ）
platelet-derived growth factor
19/7/10 4
 Pathology

19/7/10 5
Gross Appearance
Rare only a single ， usually many exist
Well-circumscribed ， nonencapsulated
pseudocapsule
A pseudocapsule is present. 假包膜

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

19/7/10 6
Microscopic
Appearance
Composition ： smooth muscle
connective tissue

The nonstriated muscle fibers are arranged

in bundles of various sizes that run in
multiple directions.

19/7/10 7
Classification （ 1 ）

According to growth location ：

• Myomas on the body of uterus （ 90% ）
• Myomas on the cervix of uterus （ 10% ）

19/7/10 8
Classification （ 2 ）
According to the relation to uterine muscle ：
• Submucosal （ 10 ～ 15% ）
• Intramural （ 60 ～ 70% ）
• Subserosal （ 20% ）

Few leiomyomas are actually of a single “pure” type.

— hybrids
19/7/10 9
 Smooth muscle tumors of the uterus are often
multiple. Seen here are submucosal, intramural,
and subserosal leiomyomata of the uterus.
19/7/10 10
19/7/10 11
 Clinical
Manifestation

19/7/10 12
Symptoms
menorrhagia and prolonged menstrual period ：
common menorrhagia
月经过多
Pelvic pain ：
occurs in pregnancy if undergoing degeneration or
torsion of a pedunculated myoma pedunculated
有蒂的
Pelvic pressure ： urinary frequency
bowel difficulty （ constipation ）
Spontaneous abortion spontaneous abortion
自然流产
Infertility
infertility
不育症
19/7/10 13
Signs

A palpable abdominal tumour

Pelvic examination ：
uterus — enlarged and irregular ；
hard

19/7/10 14
Degeneration
Hyaline degeneration Result from the diminished
vascularity of the
Cystic degeneration connective-tissue element
Red degeneration
Sarcomatous change
The others ： fat degeneration
calcification
the secondary infection
19/7/10 15
Red Degeneration
产褥期
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

19/7/10 16
 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.
19/7/10 17
Sarcomatous Change
Rare ： 0.4% ～ 0.8%
More common at 40 ～ 50 years old
Usually occur in intramural fiboids
grow quickly
vaginal bleeding

19/7/10 18
Diagnosis
History
Bimanual examination
Ultrasonography
（ B–ultrasound examination ）
hysteroscopy
Hysteroscopy 子宫镜检查

laparoscopy
Laparoscopy 腹腔镜检查

Hysterography

19/7/10 19
Differential Diagnosis
Pregnancy
Ovarian tumour
Adenomyosis
Malignant tumors of uterus
• sarcoma of uterus
• endometrial carcinoma
• cervical cancer
19/7/10 20
 Treatment

19/7/10 21
Observation and Follow
Up
Small ， asymptomatic fibroids need not be
treated ， especially near menopause.
Interval ： 3 ～ 6 months

19/7/10 22
Medical Treatment
Androgenic agents ： testosterone propionate 丙睾

GnRH-a ：
• induce a hypoestrogenic pseudomenopausal
state
• not recommended for longer than 6 months
• “add-back” regimens 反向添加疗法，垫背疗法

19/7/10 23
Surgery Treatment
（1 ）
Indications ：
greater than 10 weeks’ gestational size
menorrhagia ， lead to anemia
have pressure symptoms
grows rapidly
failure of medical treatment

19/7/10 24
Surgery Treatment
（2 ）
Method ：
Myomectomy—conservative therapy
preserve fertility
myomectomy
significant risk of recurrence
肌瘤剔除术

Hysterectomy— radical therapy

Subtotal hysterectomy Only true “cure”

hysterectomy for leiomyomas
子宫切除术

次全子宫切除术
19/7/10 25
Surgery Treatment
（3 ）
Approach ：
• trans-abdominal
• trans-vaginal
• laparoscopic or hysteroscopic

19/7/10 26
19/7/10 27
19/7/10 28
19/7/10 29
19/7/10 30
19/7/10 31
 It is important to
individualize
the choice of
therapy.

19/7/10 32
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

19/7/10 33
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.

19/7/10 34