Myoma of Uterus

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Myoma of Uterus

• Xu Hong

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Synonyms

• leiomyoma of uterus
• leiomyomas
• fibromyomas
• myofibromas
• fibroids
• fibromas
• myomas

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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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Correlative Factors
puberty ???

• An estrogenic milieu may be necessary
• Progesterone function
• Growth factor and their receptor
• epithelial growth factor(EGF)
• Insulin-like growth factor(IGF)
• platelet-derived growth factor

menopause ???
estrogen ???
progesterone ???
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Pathology
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Gross Appearance

• Rare only a single,usually many exist
• Well-circumscribed,nonencapsulated
• 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

pseudocapsule ???
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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

• Compositionsmooth 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
  common
• Pelvic pain
• occurs in pregnancy if undergoing
  degeneration or torsion of a pedunculated myoma
• Pelvic pressureurinary frequency
• bowel
  difficulty(constipation)
• Spontaneous abortion
• Infertility

menorrhagia ????
pedunculated ???
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
  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 featuresa 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

• 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

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.
• 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 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
• significant risk of
  recurrence
• Hysterectomy radical therapy
• Subtotal hysterectomy

myomectomy ?????
Only true cure for leiomyomas
hysterectomy ?????
???????
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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 pregnancyabortion
• impact on deliverypremature 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.