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Xu Hong
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leiomyoma of uterus
leiomyomas
fibromyomas
myofibromas
fibroids
fibromas
myomas


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Most common solid pelvic tumors

Develop in 2025% of women during
reproductive years

3050 years old


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An estrogenic milieu may be necessary
Progesterone function


Growth factor and their receptor
epithelial growth factorEGF
Insulin-like growth factorIGF
platelet-derived growth factor



puberty

menopause

estrogen

progesterone

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Rare only a singleusually many exist
Well-circumscribednonencapsulated
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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Compositionsmooth muscle
connective tissue


The nonstriated muscle fibers are arranged
in bundles of various sizes that run in
multiple directions.
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According to growth location

Myomas on the body of uterus90%
Myomas on the cervix of uterus10%
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According to the relation to uterine muscle
Submucous10 15%
Intramural60 70%
Subserosal20%

Few leiomyomas are actually of a single pure type.
hybrids
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menorrhagia and prolonged menstrual period
common
Pelvic pain
occurs in pregnancy if undergoing degeneration
or torsion of a pedunculated myoma
Pelvic pressureurinary frequency
bowel difficultyconstipation
Spontaneous abortion
Infertility




menorrhagia

pedunculated

spontaneous abortion

infertility

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A palpable abdominal tumour

Pelvic examination
uterus enlarged and irregular
hard

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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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Occasionally seen as a complication of pregnancy
during pregnancy or immediate postpartum period

The pathogenesis is unknownmay 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 painacute
fever
rapid growthtender

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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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Rare0.4% 0.8%
More common at 40 50 years old
Usually occur in intramural fiboids
grow quickly
vaginal bleeding

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History
Bimanual examination
Ultrasonography
Bultrasound examination

Hysteroscopy
Laparoscopy

Hysterography



hysteroscopy

laparoscopy

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Pregnancy
Ovarian tumour
Adenomyosis
Malignant tumors of uterus
sarcoma of uterus
endometrial carcinoma
cervical cancer

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Smallasymptomatic fibroids need not be
treatedespecially near menopause.

Interval36 months


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Androgenic agentstestosterone propionate

GnRH-a
induce a hypoestrogenic pseudomenopausal
state
not recommended for longer than 6 months
add-back regimens



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Indications
greater than 10 weeks gestational size
menorrhagialead to anemia
have pressure symptoms
grows rapidly
failure of medical treatment




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Method
Myomectomyconservative therapy
preserve fertility
significant risk of recurrence

Hysterectomy radical therapy

Subtotal hysterectomy





hysterectomy

myomectomy

Only true cure
for leiomyomas

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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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May be related to superabundant estrogen.
Well-circumscribednonencapsulated.
Have a pseudocapsule.
Can be classified into submucosalintramural
and subserosal types.
Different types have different features.
Menorrhagia is common.
Four degeneration types
Individualized treatmentinclude observation
medical treatment and surgical treatment.