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

puberty

menopause

progesterone

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 or
pedunculated
torsion of a pedunculated myoma

Pelvic pressure urinary frequency

bowel difficulty constipation
Spontaneous abortion
spontaneous abortion

Infertility
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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
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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

hysteroscopy

Laparoscopy

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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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
preserve fertility
myomectomy
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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