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Synonyms
leiomyoma of uterus
leiomyomas
fibromyomas
myofibromas
fibroids
fibromas
myomas

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

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Correlative Factors

puberty

An estrogenic milieu may be necessary

menopause
Progesterone function

estrogen

progesterone

Growth factor and their receptor

epithelial growth factor EGF
Insulin-like growth factor IGF
platelet-derived growth factor
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Pathology
Gross Appearance
pseudocapsule
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
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Smooth muscle tumors of the uterus are

often multiple. Seen here are submucosal,
intramural, and subserosal leiomyomata of
the uterus.
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Microscopic
Appearance
Composition smooth muscle
connective tissue
The non striated muscle fibers are arranged in
bundles of various sizes that run in multiple
directions.

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

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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
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Symptoms
menorrhagia and prolonged menstrual period
common
menorrhagia

Pelvic pain
occurs in pregnancy if undergoing degeneration
or torsion of a pedunculated myoma pedunculated

Pelvic pressure urinary frequency

bowel
difficulty constipation
spontaneous abortion
Spontaneous abortion

Infertility
infertility

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

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

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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

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

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Diagnosis
History
Bimanual examination
Ultrasonography
Bultrasound examination

Hysteroscopy

hysteroscopy

Laparoscopy

laparoscopy

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

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

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Medical Treatment
Androgenic agents testosterone

propionate
GnRH-a
induce a hypoestrogenic pseudomenopausal
state
not recommended for longer than 6 months
add-back regimens

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

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Surgery
Treatment
2
Method

Myomectomyconservative therapy
preserve fertility
Myomectomy
significant risk of recurrence
Hysterectomy radical therapy
Subtotal hysterectomy
Hysterectomy

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Only true cure

for leiomyomas

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Surgery
Treatment 3
Approach
trans-abdominal
trans-vaginal
laparoscopic or hysteroscopic

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It is important
to
individualize
the choice of
therapy.

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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

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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.

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