Myoma of Uterus Xu Hong

Synonyms leiomyoma of uterus leiomyomas fibromyomas myofibromas fibroids fibromas myomas

Incidence Most common solid pelvic tumors Develop in 20 ～ 25% of women during reproductive years 30 ～ 50 years old

Correlative Factors An estrogenic milieu may be necessary Progesterone function Growth factor and their receptor ： epithelial growth factor （ EGF ） Insulin-like growth factor （ IGF ） platelet-derived growth factor puberty 青春期 menopause 绝经期 estrogen 雌激素 progesterone 孕激素

Pathology

Gross Appearance Rare only a single ， usually many exist Well-circumscribed ， nonencapsulated A pseudocapsule is present. The consistency is usually firm or even hard except when degeneration or hemorrhage has occurred. color ： light gray or pinkish white cut section ： an intertwining pattern or a whorl-like arrangement ； bulgy pseudocapsule 假包膜

Smooth muscle tumors of the uterus are often multiple. Seen here are submucosal, intramural, and subserosal leiomyomata of the uterus.

Microscopic Appearance Composition ： smooth muscle connective tissue The nonstriated muscle fibers are arranged in bundles of various sizes that run in multiple directions.

Classification （ 1 ） According to growth location ： Myomas on the body of uterus （ 90% ） Myomas on the cervix of uterus （ 10% ）

Classification （ 2 ） According to the relation to uterine muscle ： Submucous （ 10 ～ 15% ） Intramural （ 60 ～ 70% ） Subserosal （ 20% ） Few leiomyomas are actually of a single “pure” type. — hybrids

Clinical Manifestation

Symptoms menorrhagia and prolonged menstrual period ： common Pelvic pain ： occurs in pregnancy if undergoing degeneration or torsion of a pedunculated myoma Pelvic pressure ： urinary frequency bowel difficulty （ constipation ） Spontaneous abortion Infertility menorrhagia 月经过多 pedunculated 有蒂的 spontaneous abortion 自然流产 infertility 不育症

Signs A palpable abdominal tumour Pelvic examination ： uterus — enlarged and irregular ； hard

Degeneration Hyaline degeneration Cystic degeneration Red degeneration Sarcomatous change The others ： fat degeneration calcification the secondary infection Result from the diminished vascularity of the connective-tissue element

Red Degeneration Occasionally seen as a complication of pregnancy （ during pregnancy or immediate postpartum period ） The pathogenesis is unknown ， may be the result of the accumulation of blood in the tumour because of venous obstruction. The cut surface resembles raw meat. Clinical features ： a cause of pain （ acute ） fever rapid growth ， tender 产褥期

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.

Sarcomatous Change Rare ： 0.4% ～ 0.8% More common at 40 ～ 50 years old Usually occur in intramural fiboids grow quickly vaginal bleeding

Diagnosis History Bimanual examination Ultrasonography （ B–ultrasound examination ） Hysteroscopy Laparoscopy Hysterography hysteroscopy 子宫镜检查 laparoscopy 腹腔镜检查

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

Treatment

Observation and Follow Up Small ， asymptomatic fibroids need not be treated ， especially near menopause. Interval ： 3 ～ 6 months

Medical Treatment Androgenic agents ： testosterone propionate GnRH-a ： induce a hypoestrogenic pseudomenopausal state not recommended for longer than 6 months “add-back” regimens 丙睾 反向添加疗法，垫背疗法

Surgery Treatment （ 1 ） Indications ： greater than 10 weeks’ gestational size menorrhagia ， lead to anemia have pressure symptoms grows rapidly failure of medical treatment

Surgery Treatment （ 2 ） Method ： Myomectomy—conservative therapy preserve fertility significant risk of recurrence Hysterectomy— radical therapy Subtotal hysterectomy hysterectomy 子宫切除术 myomectomy 肌瘤剔除术 Only true “cure” for leiomyomas 次全子宫切除术

Surgery Treatment （ 3 ） Approach ： trans-abdominal trans-vaginal laparoscopic or hysteroscopic

It is important to individualize the choice of therapy.

Uterine Leiomyomas Complicating Pregnancy impact on pregnancy ： abortion impact on delivery ： premature labour fetal malpresentation retained placenta placenta previa need for operative delivery （ birth canal obstruction ） postpartum hemorrhage Conservative treatment

Critical Points May be related to superabundant estrogen. Well-circumscribed ， nonencapsulated. Have a pseudocapsule. Can be classified into submucosal 、 intramural and subserosal types. Different types have different features. Menorrhagia is common. Four degeneration types Individualized treatment ， include observation 、 medical treatment and surgical treatment.