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Women’s Hospital, School of Medicine Zhejiang University Prof. Lin Jun

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1 Women’s Hospital, School of Medicine Zhejiang University Prof. Lin Jun
Uterine Myoma Women’s Hospital, School of Medicine Zhejiang University Prof. Lin Jun

2 Introduction Most common benign tumor of female reproductive system
Benign neoplasm composed primarily of smooth muscle and connectives tissue Common in women 30-50y Usually asymptomatic

3 Etiology Estrogen and ER ↑ Progestin may promote mitosis of myoma
Not detectable before puberty and after menopause Probably relates to female hormones Estrogen and ER ↑ Progestin may promote mitosis of myoma

4 Classification According to the location: Uterine body myoma 90%
Cervical myoma %

5 Classification According to the relationship between myoma and uterine myometrium : intramural myoma %-70%  subserous myoma % submucous myoma 10%-15%

6 Classification

7 Classification multiple myoma

8 Pathology Gross Appearance: round, smooth, and usually firm
false capsular covering ——pseudocapsule can be clearly demarcated from the surrounding myometrium

9 Pathology Gross Appearance: Transverse section : light gray
a whorl-like arrangement or an intertwining pattern

10 Pathology Microscopic examination:
composed of smooth muscle cells and varying amounts of connectives tissue Individual cells are quite uniform in size, spindle shaped, have elongated nuclei. Nonstriated muscle fibers are arranged in interlacing bundles of varying size running in different directions.

11 Degeneration Hyaline degeneration Cystic degeneration Red degeneration
Sarcomatous change Degeneration with calcification

12 Degeneration Red degeneration
most common during pregnancy and puerperium venous thrombosis and congestion with interstitial hemorrhage

13 Degeneration ← Red degeneration ← Hyaline degeneration

14 Degeneration Sarcomatous change malignant rare, 0.4-0.8% old women
enlarge rapidly with irregular vaginal bleeding

15 Degeneration Sarcomatous change

16 Symptoms Usually no symptoms
Associate with location, and degenerations Not associate with the size and the number

17 Symptoms 1. menorrhagia and prolonged menses large intramural myoma
submucous myoma 2. abdominal mass 3. leukorrhagia

18 Symptoms 4. pressure effects 5.others
pressure bladder or rectum → urinary frequency, constipation intraligamentous myoma and large cervical myoma → obstruct ureter 5.others infertility spontaneous abortion abdominal pain

19 Sign associated with: size location number degeneration
large myoma→ palpable abdominal mass Pelvic examination: uterus —— enlarged,irregular and hard

20 Diagnosis Typical symptoms and signs Ultrasound Hysteroscopy

21 Ultrasound

22 Ultrasound

23 Diagnosis Hysteroscopy

24 Diagnosis Laparoscopy

25 Differential diagnosis
Pregnancy Ovarian neoplasms Adenomyosis Malignant tumors of uterus uterine sarcoma endometrial carcinoma cervical cancer

26 Treatment According to : age desire for childbearing symptoms
location , size and amount of myoma

27 Treatment Observation and Follow Up
Small,asymptomatic,especially near menopause Interval:3~6 months

28 Medical measure Indications: smaller than 2 months in size
slight symptoms near menopause

29 Medical measure GnRH-a LH、FSH↓ E2↓ shrinkage of myoma
1.Androgenic agents: testosterone propionate 2.Gonadotropin-releasing hormone agonist, (GnRH-a) GnRH-a LH、FSH↓ E2↓ shrinkage of myoma leuprorilin goserelin

30 Medical measure 2.GnRH-a 3.Mifepristone Side effects:
Hypoestrogenic side effects Osteoporosis 3.Mifepristone

31 Surgical measures Indications: greater than 10 weeks in size
menorrhagia→ anemia pressure effects grows rapidly failure in medical treatment infertility or recurrent abortion

32 Surgical measures Approaches: laparotomy hystereoscopy laparoscopy

33 Surgical measures Myomectomy 2. Hysterectomy
preserve fertility, <35 years old 2. Hysterectomy Large myoma Numerous tumors Obviously symptomatic patient No wish of preserving fertility Suspected to malignant transformation

34 Myomas during pregnancy
Impact on pregnancy and delivery : abortion preterm labor fetal malpresentation placenta previa birth canal obstruction postpartum hemorrhage

35 Myomas during pregnancy
Red degeneration Clinical finding: rapid growth of myoma pain, fever, WBC↑ Conservative treatment

36 Thank You !

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