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R
Riski Syahna

Uterine myomas, or fibroids, are the most common solid pelvic tumors in women during their reproductive years. They develop in 20-25% of women and are related to estrogen levels. Myomas can be classified based on their location and relation to the uterine muscle. Common symptoms include menorrhagia and pelvic pressure. Treatment options include observation for small asymptomatic fibroids, medical treatment to induce a pseudo-menopausal state, and surgical options like myomectomy or hysterectomy depending on factors like symptoms and desire to preserve fertility.

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2003-11-3 1 Myoma of Uterus Xu Hong
2003-11-3 2 Synonyms leiomyoma of uterus leiomyomas fibromyomas myofibromas fibroids fibromas myomas
2003-11-3 3 Incidence Most common solid pelvic tumors Develop in 20 ¡« 25% of women during reproductive years 30 ¡« 50 years old
2003-11-3 4 Correlative Factors An estrogenic milieu may be necessary Progesterone function Growth factor and their receptor £º epithelial growth factor £¨ EGF £© Insulin-like growth factor £¨ IGF £© platelet-derived growth factor puberty Çà´ºÆÚ menopause ¾ø¾­ÆÚ estrogen ´Æ¼¤ËØ progesterone Ôм¤ËØ
2003-11-3 5 Pathology
2003-11-3 6 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 £º light gray or pinkish white cut section £º an intertwining pattern or a whorl-like arrangement £» bulgy pseudocapsule ¼Ù°üĤ
2003-11-3 7 Smooth muscle tumors of the uterus are often multiple. Seen here are submucosal, intramural, and subserosal leiomyomata of the uterus.
2003-11-3 8 Microscopic Appearance Composition £º smooth muscle connective tissue The nonstriated muscle fibers are arranged in bundles of various sizes that run in multiple directions.
2003-11-3 9 Classification £¨ 1 £© According to growth location £º ? Myomas on the body of uterus £¨ 90% £© ? Myomas on the cervix of uterus £¨ 10% £©
2003-11-3 10 Classification £¨ 2 £© According to the relation to uterine muscle £º ? Submucous £¨ 10 ¡« 15% £© ? Intramural £¨ 60 ¡« 70% £© ? Subserosal £¨ 20% £© Few leiomyomas are actually of a single ¡°pure¡± type. ¡ª hybrids
2003-11-3 11 Clinical Manifestation
2003-11-3 12 Symptoms menorrhagia and prolonged menstrual period £º common Pelvic pain £º occurs in pregnancy if undergoing degeneration or torsion of a pedunculated myoma Pelvic pressure £º urinary frequency bowel difficulty £¨ constipation £© Spontaneous abortion Infertility menorrhagia Ô¾­¹ý¶à pedunculated ÓÐµÙµÄ spontaneous abortion ×ÔÈ»Á÷²ú infertility ²»ÓýÖ¢
2003-11-3 13 Signs A palpable abdominal tumour Pelvic examination £º uterus ¡ª enlarged and irregular £» hard
2003-11-3 14 Degeneration Hyaline degeneration Cystic degeneration Red degeneration Sarcomatous change The others £º fat degeneration calcification the secondary infection Result from the diminished vascularity of the connective-tissue element
2003-11-3 15 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 £º a cause of pain £¨ acute £© fever rapid growth £¬ tender ²úÈìÆÚ
2003-11-3 16 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.
2003-11-3 17 Sarcomatous Change Rare £º 0.4% ¡« 0.8% More common at 40 ¡« 50 years old Usually occur in intramural fiboids grow quickly vaginal bleeding
2003-11-3 18 Diagnosis History Bimanual examination Ultrasonography £¨ B¨Cultrasound examination £© Hysteroscopy Laparoscopy Hysterography hysteroscopy ×Ó¹¬¾µ¼ì²é laparoscopy ¸¹Ç»¾µ¼ì²é
2003-11-3 19 Differential Diagnosis Pregnancy Ovarian tumour Adenomyosis Malignant tumors of uterus ? sarcoma of uterus ? endometrial carcinoma ? cervical cancer
2003-11-3 20 Treatment
2003-11-3 21 Observation and Follow Up Small £¬ asymptomatic fibroids need not be treated £¬ especially near menopause. Interval £º 3 ¡« 6 months
2003-11-3 22 Medical Treatment Androgenic agents £º testosterone propionate GnRH-a £º ? induce a hypoestrogenic pseudomenopausal state ? not recommended for longer than 6 months ? ¡°add-back¡± regimens ±ûغ ·´ÏòÌí¼ÓÁÆ·¨£¬µæ±³ÁÆ·¨
2003-11-3 23 Surgery Treatment £¨ 1 £© Indications £º greater than 10 weeks¡¯ gestational size menorrhagia £¬ lead to anemia have pressure symptoms grows rapidly failure of medical treatment
2003-11-3 24 Surgery Treatment £¨ 2 £© Method £º Myomectomy¡ªconservative therapy preserve fertility significant risk of recurrence Hysterectomy¡ª radical therapy Subtotal hysterectomy hysterectomy ×Ó¹¬ÇгýÊõ myomectomy ¼¡ÁöÌÞ³ýÊõ Only true ¡°cure¡± for leiomyomas ´ÎÈ«×Ó¹¬ÇгýÊõ
2003-11-3 25 Surgery Treatment £¨ 3 £© Approach £º ? trans-abdominal ? trans-vaginal ? laparoscopic or hysteroscopic
2003-11-3 26 It is important to individualize the choice of therapy.
2003-11-3 27 Uterine Leiomyomas Complicating Pregnancy impact on pregnancy £º abortion impact on delivery £º premature labour fetal malpresentation retained placenta placenta previa need for operative delivery £¨ birth canal obstruction £© postpartum hemorrhage Conservative treatment
2003-11-3 28 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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  • 1. 2003-11-3 1 Myoma of Uterus Xu Hong
  • 2. 2003-11-3 2 Synonyms leiomyoma of uterus leiomyomas fibromyomas myofibromas fibroids fibromas myomas
  • 3. 2003-11-3 3 Incidence Most common solid pelvic tumors Develop in 20 ¡« 25% of women during reproductive years 30 ¡« 50 years old
  • 4. 2003-11-3 4 Correlative Factors An estrogenic milieu may be necessary Progesterone function Growth factor and their receptor £º epithelial growth factor £¨ EGF £© Insulin-like growth factor £¨ IGF £© platelet-derived growth factor puberty Çà´ºÆÚ menopause ¾ø¾­ÆÚ estrogen ´Æ¼¤ËØ progesterone Ôм¤ËØ
  • 6. 2003-11-3 6 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 £º light gray or pinkish white cut section £º an intertwining pattern or a whorl-like arrangement £» bulgy pseudocapsule ¼Ù°üĤ
  • 7. 2003-11-3 7 Smooth muscle tumors of the uterus are often multiple. Seen here are submucosal, intramural, and subserosal leiomyomata of the uterus.
  • 8. 2003-11-3 8 Microscopic Appearance Composition £º smooth muscle connective tissue The nonstriated muscle fibers are arranged in bundles of various sizes that run in multiple directions.
  • 9. 2003-11-3 9 Classification £¨ 1 £© According to growth location £º ? Myomas on the body of uterus £¨ 90% £© ? Myomas on the cervix of uterus £¨ 10% £©
  • 10. 2003-11-3 10 Classification £¨ 2 £© According to the relation to uterine muscle £º ? Submucous £¨ 10 ¡« 15% £© ? Intramural £¨ 60 ¡« 70% £© ? Subserosal £¨ 20% £© Few leiomyomas are actually of a single ¡°pure¡± type. ¡ª hybrids
  • 12. 2003-11-3 12 Symptoms menorrhagia and prolonged menstrual period £º common Pelvic pain £º occurs in pregnancy if undergoing degeneration or torsion of a pedunculated myoma Pelvic pressure £º urinary frequency bowel difficulty £¨ constipation £© Spontaneous abortion Infertility menorrhagia Ô¾­¹ý¶à pedunculated ÓÐµÙµÄ spontaneous abortion ×ÔÈ»Á÷²ú infertility ²»ÓýÖ¢
  • 13. 2003-11-3 13 Signs A palpable abdominal tumour Pelvic examination £º uterus ¡ª enlarged and irregular £» hard
  • 14. 2003-11-3 14 Degeneration Hyaline degeneration Cystic degeneration Red degeneration Sarcomatous change The others £º fat degeneration calcification the secondary infection Result from the diminished vascularity of the connective-tissue element
  • 15. 2003-11-3 15 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 £º a cause of pain £¨ acute £© fever rapid growth £¬ tender ²úÈìÆÚ
  • 16. 2003-11-3 16 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.
  • 17. 2003-11-3 17 Sarcomatous Change Rare £º 0.4% ¡« 0.8% More common at 40 ¡« 50 years old Usually occur in intramural fiboids grow quickly vaginal bleeding
  • 18. 2003-11-3 18 Diagnosis History Bimanual examination Ultrasonography £¨ B¨Cultrasound examination £© Hysteroscopy Laparoscopy Hysterography hysteroscopy ×Ó¹¬¾µ¼ì²é laparoscopy ¸¹Ç»¾µ¼ì²é
  • 19. 2003-11-3 19 Differential Diagnosis Pregnancy Ovarian tumour Adenomyosis Malignant tumors of uterus ? sarcoma of uterus ? endometrial carcinoma ? cervical cancer
  • 21. 2003-11-3 21 Observation and Follow Up Small £¬ asymptomatic fibroids need not be treated £¬ especially near menopause. Interval £º 3 ¡« 6 months
  • 22. 2003-11-3 22 Medical Treatment Androgenic agents £º testosterone propionate GnRH-a £º ? induce a hypoestrogenic pseudomenopausal state ? not recommended for longer than 6 months ? ¡°add-back¡± regimens ±ûغ ·´ÏòÌí¼ÓÁÆ·¨£¬µæ±³ÁÆ·¨
  • 23. 2003-11-3 23 Surgery Treatment £¨ 1 £© Indications £º greater than 10 weeks¡¯ gestational size menorrhagia £¬ lead to anemia have pressure symptoms grows rapidly failure of medical treatment
  • 24. 2003-11-3 24 Surgery Treatment £¨ 2 £© Method £º Myomectomy¡ªconservative therapy preserve fertility significant risk of recurrence Hysterectomy¡ª radical therapy Subtotal hysterectomy hysterectomy ×Ó¹¬ÇгýÊõ myomectomy ¼¡ÁöÌÞ³ýÊõ Only true ¡°cure¡± for leiomyomas ´ÎÈ«×Ó¹¬ÇгýÊõ
  • 25. 2003-11-3 25 Surgery Treatment £¨ 3 £© Approach £º ? trans-abdominal ? trans-vaginal ? laparoscopic or hysteroscopic
  • 26. 2003-11-3 26 It is important to individualize the choice of therapy.
  • 27. 2003-11-3 27 Uterine Leiomyomas Complicating Pregnancy impact on pregnancy £º abortion impact on delivery £º premature labour fetal malpresentation retained placenta placenta previa need for operative delivery £¨ birth canal obstruction £© postpartum hemorrhage Conservative treatment
  • 28. 2003-11-3 28 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.