UTERINE LEIOMYOMA (fibroid)Done By: Sara Al-Ghanem | Medical intern from KFU

OBJECTIVES

definition

Prevalence

Risk Factors

classification

Clinical Manifestations

Diagnosis

Management

DEFINITION

Definition of UTERINE LEIOMYOMA (fibroid)

Uterine leiomyomas (fibroids or myomas) are the most common pelvic tumor in women. They are benign monoclonal tumors arising from the smooth muscle cells of the myometrium.

PATHOLOGY

Groosly ,Leiomyomas are pseudoencapsulated solid tumors, well demarcated from the surrounding myometrium.

Microscopically, these appear as smooth muscle cells in longitudinal or cross-section intermixed with fibrous connective tissue. Vascular structures are few, and mitoses are rare.

Risk of Malignancy

Leiomyosarcomas are found rarely in hysterectomy or myomectomy specimens (incidence 0.2%).

PREVALENCE

PREVALENCE

Uterine leiomyomas are the most common pelvic tumor in women.

Leiomyomas have not been described in prepubertal girls, but they are occasionally noted in adolescents.

Myomas are clinically apparent in approximately 12 to 25 percent of reproductive age women and noted on pathological examination in approximately 80 percent of surgically excised.

Most, but not all, women have shrinkage of leiomyomas at menopause

RISK FACTORS

RISK FACTORS

RaceMenstrual history &

parity

Hormonal contraception

Ovulation induction

agentsothers

Early menarche (<10 years old) is associated with an increased risk of developing fibroids.

Parity (having one or more pregnancies extending beyond 20 weeks) decreases the chance of fibroid formation.

It has been hypothesized that the postpartum remodeling of the uterus may have the effect of clearing smaller fibroids.

Recent studies supported this hypothesis with the finding that over a third of women with a single fibroid identified during pregnancy had none on postpartum ultrasound, and almost 80 percent of fibroids were smaller following pregnancy.

In some cohorts, early age at first birth decreases risk and a longer interval since last birth increases risk

the association of fibroid growth with agents for ovulation induction is unlikelyMost studies show a relationship between fibroids and increasing body mass. The relationship is complex and is likely modified by

other factors

CLASSIFICATION

CLASSIFICATIONS

Fibroids are often described according to their location in the uterus

Submucosal leiomyma position: European Society of Hysteroscopy classification

CLINICAL MANIFESTATIONS

the majority of myomas are small and asymptomatic. The symptoms are related to the number, size, and location of the neoplasms. Myomas can occur as single or multiple tumors and range in size from microscopic to tens of centimeters. The size of the myomatous uterus is described in menstrual weeks, as with the gravid uterus. As an example, a 20-week size myomatous uterus is not unusual, and is often associated with heavy menses, increasing abdominal fullness similar to pregnancy

CLINICAL MANIFESTATIONS

Abnormal uterine Bleeding

Pelvic pressure & pain

Reproductive Dysfunction

ABNORMAL UTERINE BLEEDING

It is the most common symptom. Heavy and/or prolonged menses is the typical bleeding

pattern with myomas . Intermenstrual bleeding and postmenopausal bleeding

are NOT characteristic of myomas and should be investigated to exclude endometrial pathology.

The presence and degree of uterine bleeding are determined, in large part, by the location of the fibroid; size is of secondary importance.

Bulk-related symptoms —As examples, urinary frequency, difficulty emptying the bladder, and, rarely, urinary obstruction can all occur with fibroids

Dysmenorrhea — Dysmenorrhea is also reported by many women with fibroids.

Leiomyoma degeneration or torsion — Infrequently, fibroids cause acute pain from degeneration (eg, carneous or red degeneration) or torsion of a pedunculated tumor.

PELVIC PRESSURE AND PAIN

EFFECTS ON REPRODUCTION

Leiomyomas that distort the uterine cavity (submucosal or intramural with an intracavitary component) result in: difficulty conceiving a pregnancy and an increased risk of miscarriage leiomyomas have been associated with adverse pregnancy outcomes eg, placental abruption, fetal growth restriction, and preterm labor and birth

DIAGNOSIS

Diagnosis Pelvic Exam

Imaging

Ultrasound

Diagnostic hysteroscopy

MRI

HSG

MANAGEMENT

Condoleezza Rice's uterine fibroid embolization was performed at Georgetown University Hospital by interventional radiologist James Spies, MD. The procedure took about 90 minutes and was reported as successful.

MANAGEMENT OF LEIOMYOMAManagement Clinical effect\ Method of

TreatmentObservation Most

Serial Pelvic ExamsPresurgical Shrinkage Size by 70%

GnRH analog 3-6months; regrowth after stopping

Myomectomy Preserves fertilityLaparotomy, laparoscopy

Embolization Preserves the uterusInvasive radiotherapy

Hysterectomy Fertility completedTAH,TVHDefinitive tx

SUMMARY

POINTS TO REMEMBER : Uterine leiomyomas (fibroids or myomas) are

the most common pelvic tumor in women . Fibroids are often described according to their

location in the uterus (submucosal, intramural, subserosal, cervical).

Symptoms attributable to uterine myomas can generally be classified into three distinct categories: abnormal uterine bleeding, pelvic pressure and pain, reproductive dysfunction.

Relief of symptoms related to fibroids usually occurs at the time of menopause

REFERENCES

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