185.Leiomyoma of Uterus

8/10/2019 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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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.

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185.Leiomyoma of Uterus