Leiomyoma of the

uterus ( fibromyoma,
fibroid myoma )
General considerations
 20-25% reproductive-age
 Pathology– multiple, discrete,
spherical, irregularly lobulated. False
capsular covering, clearly
demarcated from the surrounding
myometrium. Buff colored, rounded,
smooth, firm.
Classification
 Classified by anatomic location.
 Submucous – pedicles, protude…
 Intramural -- figure 17-4
 Subserous – figure 17-4
Secondary changes—
benign degeneration
 Atrophic – menopause
 Hyaline – white but contain yellow,
soft, and often gelatinous areas of
hyaline change.
 Cystic – fluid…
 Calcific ( calcareous ) – most in
subserous
 Carneous ( red ) – in pregnancy. Pain;
selflimited; preterm labor; initiation
of disseminated intravascular
Secondary changes—
malignant degeneration
 0.1-0.5%
Symptoms
 Abnormal uterine bleeding: -- 30%
 Pain
 Pressure effects: -- bleeding;
discharge; infertility; dyspareunia;
compress ureter, bladder; rectum
 Infertility
 Spontaneous abortion
Diagnosis
 Symptoms: Most discovered by
bimanual examination or palpation of
the lower abdomen.
 Examination: Uterine retroflexion
may obscure examination.
 Pelvic ultrasound:
 MRI ( magnetic resonance imaging ):
 Hysteroscopy – submucous
 Laparoscopy -- myomectomy
Differential diagnosis
 Ovarian cyst or neoplasia
 Adnexal consideration: tubo-ovarian
inflammatory of neoplastic masses.
 Pregnancy ( including subinvolution )
 Endometrial cancer, hypertrophy,
congenital anomalies
 Adenocarcinoma of the endometrium
or uterine tube, uterine sarcomas,
ovarian carcinomas
Differential diagnosis
 Abnormal bleeding: hyperplasia,
polyps, irregular shedding,
dysfunctional bleeding, ovarian
neoplasms, endometriosis,
adenomyosis, exogenous estrogens,
steroid hormones.
 Definitive diagnosis: endometrial
biopsy; fractional dilatation and
curettage ( D and C )
Treatment
 Depends on the age, parity,
pregnancy status, desire for future
pregnancies, general heath,
symptoms, as well as the size,
location and state of preservation of
the leiomyomas.
Treatment
 Emergency measures: blood
transfusion; infected leiomyomata;
acute torsion; intestinal obstruction
caused by a pedunculated or
parasitic myoma; myomectomy is
contraindicated during pregnancy.
Treatment
 Medical measures: most no symptoms and
post manopausal – no treatment. The
gonadotropin-releasing hormone (GnRH);
induce hypogonadism through pituitary
desensitization, downregulation of
receptors, and inhibition of gonadotropins.
 GnRH treatment result: 1. maximal
shrinkage of the myomatous uterus 50%;
2. in 3 months; 3. amenorrhea and
hypoestrogenic side effect; 4.
osteoporosis
Treatment
 Supportive measures: pap smear and
evaluation of the endometrium.
Blood volume; prophylactic
antibiotics; bowel preparation.
Treatment
 Surgical measures:
 1. Evaluation for other neoplasia:
endometrial biopsy.
 2. Myomectomy: symptomatic
patient who wishes to preserve
fertility or conserve the uterus.
Hysteroscope or laparoscope and so
on.
 3. Hysterectomy: TVH ( cystocele,
rectocele, enterocele ); TAH;
oophorectomy.
Thanks!