185.Leiomyoma of Uterus
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Transcript of 185.Leiomyoma of Uterus
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Age : 32 yro Gender : female
Marital status : single Occupation :
Admission on 97/10/27
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Lower abdominal mass notedin recent days
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32 year-old woman, no any systemic disease before.
Lower abdominal fullness was noted for more than 1year. Recently, she found a palpable mass , becomingbigger , at the lower abdomin.
97-09-27 :
LMD
transferred to GYN OPD (Dr. )ofTMUH . 97-10-27 GYN echo :
a pelvic mass (right-side.), suspected ovarian
mass. Denied abnormal vaginal bleeding, dysmenorrhea or GI
discomfort.
Frequency was complained.
The impression : pelvic mass suspected ovarian mass
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Obstetrical HistoryG1 P0 SA1AA0 Length of cycles30 days
Duration of flow5-7days; with moderateamount and dysmenorrheal.
Drug allergyNo
Food allergyNo SmokingNo Alcohol useNo
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Medical historydenied Surgical historydenied (+)
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BW/BH 45.7 Kg/162.9 cm Vital Signs T/P/R 36.2 / 60 /minute/ 26 /minute, BP 118 / 72 mmHg
HEENT : grossly normal
Chest : breathing sound- clear
Heart : regular heart beat w/o murmur
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Abdomen distention (+)
Bowel sound:nomactive
tenderness(-), rebounding pain(-)
Palpable mass(-)
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CBC/DC
WBC 7330 HGB 14.5
Platelet 249000
Neutrophil 64.8
U/A
PH 7.0
Sugar
Occult blood
Nitrate
Biochemistry
Glucose 135 BUN 8.3
Creatinine 0.5
GOT 24 GPT 9
Na 134
K 4.4
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971027
Uterus size7.2x3.5x5.6cm
Endometrium thickness
10mm Rt pelvic mass; grossly
240x250 mm
Impression Rt pelvic mass
Difficult to define the rt
ovary.
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Negative finding of theabdomen and wellvisible of bil. psoas
outlines. Soft tissue mass over
the pelvic cavity.
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The liver, spleen, pancreas, bil. kidneys &adrenal glands are normal in size andposition.
Mild ascites & some nodules abutting toperitoneal membrane The urinary system is not obstructed.
Major vessels and para-aortic regionappear normal, with no evidence oflymphadenopathy.
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Ovarian masses Uterus leiomyoma Uterus leiosarcoma
Endometriosis Endometrial polyp, adenoma,
adenocarcinoma
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Ovarian masses
Ultrasound scan showed solid tumor, cysticovarian tumors, i.ecystadenoma/cystadenocarcinoma areexcluded.
Uterus leiomyoma
Ultrasound and CT both show a lobular orenlarged uterine mass
X-ray may show nonspecific soft-tissue mass
in the plevic and displacement of the bowel
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Uterus leiomyosarcoma
Rarely happened, rapid growth of a uterinemyoma after menopause the classic symptom.
Softer, necrosis and hemorrhage however, confirmed by biopsy
Endometriosis
Commonest location is ovary On ultrasound, endometriomas appear as cystic
masses with diffuse uniform low-level echoes
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Endometrial polyp, adenoma,adenocarcinoma
All of above occur in the corpus
the ultrasound showedthe mass was extra-corpus.
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Microscopically
show a picture of leiomyoma composedof interlacing bundles of smooth musclefibers.
Focal hyaline degeneration and focalmyxoid degeneration are noted.
Focal increased cellularity is noted, butneither tumor necrosis nor increasedmitotic figure is seen.
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Leiomyoma of UterusFibroidsUterine myomas
Uterine leiomyomaFibromyomaFibroleiomyoma
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Symptoms
Mostly, Asymptomatic. Otherwise, thesymptoms depend on the siteof the fibroid.
Abnormal uterine bleeding due to submucosal
fibroid, i.e. menorrhagia
Pressure symptoms , i.e. lower abdominal cramps,
discomfort, and heaviness
constipation and urinary frequency,usually due to intramural or subserosalfibroids.
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Pain, due to uterine contractions withpedunculated fibroids. Fibroids can outgrowtheir blood supply, becoming necrotic and painful.This red degeneration is more common in pregnancy .
Lethargy and malaise due to anemia
Infertility, depend on the size and site ofthe fibroid.
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PE and lab findings
Palpable abdominal mass arising from thepelvis
Enlarged, often irregular uterus that ispalpable on bimanual pelvic examination
Signs of anemia due to menorrhagia
Edema and varicosities of the lower limbs
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Plain film
If large enough show multiple irregular but well-definedcalcifications.
Ultrasound In most cases, US can accurately detect
leiomyomas .
The typical ultrasound appearance of leiomyomaa well-marginated, hypoechoic, roundedand/or oval mass within the uterine body.
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Computed tomography
not recommended for the evaluation ofleiomyomas.
Leiomyomas are usually the samedensity as the adjacent myometrium.
most common sign / most specific
findinga contour deformity/ calcification
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1.Hysterectomy 2.Myomectomy
age, future reproductive planShorter Long hospital stays
Less More pelvic adhesion
High rate of urinary tractinjuries
Lower rate
3.Uterine artery embolization(UAE)4.MR-guided high intensity focused ultrasound
ablation
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Only 10-20% patients require treatment.
The condition usually improves withdiminishing levels of circulating
estrogens.(estrogen responsive) Benign tumor. Malignant transformation is
extremely rare.