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Incidence: Most common Neoplasm found in female pelvis and the most common
uterine mass.
Present in 20-25% of females in Reproductive age 3-9 x in black α in 5th decade →
50% of black women will have M.
Etilogy: is unknown.
M are monocolonal T° which arise from a single sm mm cell.
Possible theories:
(1) genetic role – due to somatic mutations and chromosomal obnormalities of chr.
12.
* Estrogen is needed for the expression of this mutation.
Factors affecting growth of myoma:
(1) Estrogen: * M are rarely found b/f puberty
* Stops growing a/f menopause
* New myomas rarely appear a/f menopause
* Rapid growth of M. during pregnancy
(2) Peptide growth factors
(3) Human Placental Lactogen
(4) Local factors – blood supply
adjacency to other T° accounts for variations in T°
degenerative changes volume and rate of growth
Pathology:
M are pseudo encapsulated (is not a true capsule, formed from compression of fibrous
and muscular tissue on the surface of the T°)
M is solid and well demarcated from the surrounding myometrium. pale and more
fibrous than the myometrium.
Most active growth is at the periphery. Very few bl. Vess and lymphatics transverse the
pseudo capsule. ∴ the central part of the T° is more susceptible to degenerative
changes.
Degeneration of M→
Reasons for degeneration: (1) II° to alterations in circulation
(2) Post menopausal atrophy
(3) Infection (in pedunculated M which 1st becomes
necrotic and II° infected)
(4) Malignant transformation
Types:
Treatment: depends on Pt’s age, parity, pregnancy status desire for future
pregnancies, health status, symptoms, size, location.
Consists of→
(1) Bimanual vaginal examination - • every 3-6 months to determine
uterine size and rate of growth
• if slow growth/stable uterine size
→ annual follow up is carried out
onwards
(2) On location →
subserous / submucous → most often myomectomy is done
Hysterectomy -
total hysterectomy → put the clamp paralleled to the Uterus and clamp uterine aa
subtal hysterectomy → put the clamp perpendicular to the Uterus and clamp the
rumus ascendence of Uterine aa
Report prepared by
1. Dr. Sajid Mahmood, MD (EU), Accident & Emergency Department, NHS Royal infirmary Liverpool United Kingdom.
2. Dr. Adnan Akram, MD (EU), Department of Infectious Diseases. University Hospital Riga Latvia.
3. Dr. Aftab Ahmed, MD (EU), Infection Control Department, Kaunas Medical University Clinic. Lithuania.