Leiomyoma of the Uterus
Transcript of Leiomyoma of the Uterus
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Leiomyoma of theLeiomyoma of the
uterus (uterus ( fibromyoma,fibromyoma,
fibroid myomafibroid myoma ))
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General considerationsGeneral considerations
20-25% reproductive-age20-25% reproductive-age
Pathology– multiple, discrete,Pathology– multiple, discrete,
spherical, irregularly lobulated. Falsespherical, irregularly lobulated. Falsecapsular covering, clearlycapsular covering, clearly
demarcated from the surroundingdemarcated from the surrounding
myometrium. Buff colored, rounded,myometrium. Buff colored, rounded,
smooth, firm.smooth, firm.
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ClassificationClassification
Classified by anatomic location.Classified by anatomic location.
Submucous – pedicles, protude…Submucous – pedicles, protude…
Intramural -- figure 17-4Intramural -- figure 17-4 Subserous – figure 17-4Subserous – figure 17-4
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Secondary changes—Secondary changes—
benign degenerationbenign degeneration Atrophic – menopauseAtrophic – menopause
Hyaline – white but contain yellow,Hyaline – white but contain yellow,
soft, and often gelatinous areas of soft, and often gelatinous areas of
hyaline change.hyaline change.
Cystic – fluid…Cystic – fluid…
Calcific ( calcareous ) – most inCalcific ( calcareous ) – most in
subseroussubserous
Carneous ( red ) – in pregnancy. Pain;Carneous ( red ) – in pregnancy. Pain;
selflimited; preterm labor; initiationselflimited; preterm labor; initiation
of disseminated intravascularof disseminated intravascular
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Secondary changes—Secondary changes—
malignant degenerationmalignant degeneration
0.1-0.5%0.1-0.5%
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DiagnosisDiagnosis
Symptoms: Most discovered bySymptoms: Most discovered by
bimanual examination or palpation of bimanual examination or palpation of
the lower abdomen.the lower abdomen.
Examination: Uterine retroflexionExamination: Uterine retroflexion
may obscure examination.may obscure examination.
Pelvic ultrasound:Pelvic ultrasound:
MRI ( magnetic resonance imaging ):MRI ( magnetic resonance imaging ):
Hysteroscopy – submucousHysteroscopy – submucous
Laparoscopy -- myomectomyLaparoscopy -- myomectomy
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Differential diagnosisDifferential diagnosis
Ovarian cyst or neoplasiaOvarian cyst or neoplasia
Adnexal consideration: tubo-ovarianAdnexal consideration: tubo-ovarian
inflammatory of neoplastic masses.inflammatory of neoplastic masses.
Pregnancy ( including subinvolution )Pregnancy ( including subinvolution )
Endometrial cancer, hypertrophy,Endometrial cancer, hypertrophy,
congenital anomaliescongenital anomalies Adenocarcinoma of the endometriumAdenocarcinoma of the endometrium
or uterine tube, uterine sarcomas,or uterine tube, uterine sarcomas,
ovarian carcinomasovarian carcinomas
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TreatmentTreatment
Emergency measures: bloodEmergency measures: blood
transfusion; infected leiomyomata;transfusion; infected leiomyomata;
acute torsion; intestinal obstructionacute torsion; intestinal obstruction
caused by a pedunculated orcaused by a pedunculated orparasitic myoma; myomectomy isparasitic myoma; myomectomy is
contraindicated during pregnancy.contraindicated during pregnancy.
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TreatmentTreatment
Medical measures: most no symptoms andMedical measures: most no symptoms and
post manopausal – no treatment. Thepost manopausal – no treatment. The
gonadotropin-releasing hormone (GnRH);gonadotropin-releasing hormone (GnRH);
induce hypogonadism through pituitaryinduce hypogonadism through pituitarydesensitization, downregulation of desensitization, downregulation of
receptors, and inhibition of gonadotropins.receptors, and inhibition of gonadotropins.
GnRH treatment result: 1. maximalGnRH treatment result: 1. maximal
shrinkage of the myomatous uterus 50%;shrinkage of the myomatous uterus 50%;2. in 3 months; 3. amenorrhea and2. in 3 months; 3. amenorrhea and
hypoestrogenic side effect; 4.hypoestrogenic side effect; 4.
osteoporosisosteoporosis
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TreatmentTreatment
Supportive measures: pap smear andSupportive measures: pap smear and
evaluation of the endometrium.evaluation of the endometrium.
Blood volume; prophylacticBlood volume; prophylactic
antibiotics; bowel preparation.antibiotics; bowel preparation.
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TreatmentTreatment
Surgical measures:Surgical measures: 1. Evaluation for other neoplasia:1. Evaluation for other neoplasia:
endometrial biopsy.endometrial biopsy. 2. Myomectomy: symptomatic2. Myomectomy: symptomatic
patient who wishes to preservepatient who wishes to preservefertility or conserve the uterus.fertility or conserve the uterus.
Hysteroscope or laparoscope and soHysteroscope or laparoscope and soon.on. 3. Hysterectomy: TVH ( cystocele,3. Hysterectomy: TVH ( cystocele,
rectocele, enterocele ); TAH;rectocele, enterocele ); TAH;
oophorectomy.oophorectomy.
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Thanks!Thanks!