Leiomyoma Of The Uterus

Leiomyoma of the uterus ( fibromyoma, fibroid myoma )

General considerations  

20-25% reproductive-age Pathology– multiple, discrete, spherical, irregularly lobulated. False capsular covering, clearly demarcated from the surrounding myometrium. Buff colored, rounded, smooth, firm.

Classification    

Classified by anatomic location. Submucous – pedicles, protude… Intramural -- figure 17-4 Subserous – figure 17-4

Secondary changes— benign degeneration 

Atrophic – menopause

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Hyaline – white but contain yellow, soft, and often gelatinous areas of hyaline change. Cystic – fluid… Calcific ( calcareous ) – most in subserous Carneous ( red ) – in pregnancy. Pain; selflimited; preterm labor; initiation of disseminated intravascular

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Secondary changes— malignant degeneration 

0.1-0.5%

Symptoms   

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Abnormal uterine bleeding: -- 30% Pain Pressure effects: -- bleeding; discharge; infertility; dyspareunia; compress ureter, bladder; rectum Infertility Spontaneous abortion

Diagnosis 

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Symptoms: Most discovered by bimanual examination or palpation of the lower abdomen. Examination: Uterine retroflexion may obscure examination. Pelvic ultrasound: MRI ( magnetic resonance imaging ): Hysteroscopy – submucous Laparoscopy -- myomectomy

Differential diagnosis  

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Ovarian cyst or neoplasia Adnexal consideration: tubo-ovarian inflammatory of neoplastic masses. Pregnancy ( including subinvolution ) Endometrial cancer, hypertrophy, congenital anomalies Adenocarcinoma of the endometrium or uterine tube, uterine sarcomas, ovarian carcinomas

Differential diagnosis 

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Abnormal bleeding: hyperplasia, polyps, irregular shedding, dysfunctional bleeding, ovarian neoplasms, endometriosis, adenomyosis, exogenous estrogens, steroid hormones. Definitive diagnosis: endometrial biopsy; fractional dilatation and curettage ( D and C )

Treatment 

Depends on the age, parity, pregnancy status, desire for future pregnancies, general heath, symptoms, as well as the size, location and state of preservation of the leiomyomas.

Treatment 

Emergency measures: blood transfusion; infected leiomyomata; acute torsion; intestinal obstruction caused by a pedunculated or parasitic myoma; myomectomy is contraindicated during pregnancy.

Treatment 

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Medical measures: most no symptoms and post manopausal – no treatment. The gonadotropin-releasing hormone (GnRH); induce hypogonadism through pituitary desensitization, downregulation of receptors, and inhibition of gonadotropins. GnRH treatment result: 1. maximal shrinkage of the myomatous uterus 50%; 2. in 3 months; 3. amenorrhea and hypoestrogenic side effect; 4. osteoporosis

Treatment 

Supportive measures: pap smear and evaluation of the endometrium. Blood volume; prophylactic antibiotics; bowel preparation.

Treatment   

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Surgical measures: 1. Evaluation for other neoplasia: endometrial biopsy. 2. Myomectomy: symptomatic patient who wishes to preserve fertility or conserve the uterus. Hysteroscope or laparoscope and so on. 3. Hysterectomy: TVH ( cystocele, rectocele, enterocele ); TAH; oophorectomy.

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