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Leiomyoma of theLeiomyoma of the

uterus (uterus ( fibromyoma,fibromyoma,

fibroid myomafibroid myoma ))

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General considerationsGeneral considerations

20-25% reproductive-age20-25% reproductive-age

Pathology– multiple, discrete,Pathology– multiple, discrete,

spherical, irregularly lobulated. Falsespherical, irregularly lobulated. Falsecapsular covering, clearlycapsular covering, clearly

demarcated from the surroundingdemarcated from the surrounding

myometrium. Buff colored, rounded,myometrium. Buff colored, rounded,

smooth, firm.smooth, firm.

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ClassificationClassification 

Classified by anatomic location.Classified by anatomic location.

Submucous – pedicles, protude…Submucous – pedicles, protude…

Intramural -- figure 17-4Intramural -- figure 17-4 Subserous – figure 17-4Subserous – figure 17-4

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Secondary changes—Secondary changes—

benign degenerationbenign degeneration Atrophic – menopauseAtrophic – menopause

Hyaline – white but contain yellow,Hyaline – white but contain yellow,

soft, and often gelatinous areas of soft, and often gelatinous areas of 

hyaline change.hyaline change.

Cystic – fluid…Cystic – fluid…

Calcific ( calcareous ) – most inCalcific ( calcareous ) – most in

subseroussubserous

Carneous ( red ) – in pregnancy. Pain;Carneous ( red ) – in pregnancy. Pain;

selflimited; preterm labor; initiationselflimited; preterm labor; initiation

of disseminated intravascularof disseminated intravascular

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Secondary changes—Secondary changes—

malignant degenerationmalignant degeneration

0.1-0.5%0.1-0.5%

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DiagnosisDiagnosis

Symptoms: Most discovered bySymptoms: Most discovered by

bimanual examination or palpation of bimanual examination or palpation of 

the lower abdomen.the lower abdomen.

Examination: Uterine retroflexionExamination: Uterine retroflexion

may obscure examination.may obscure examination.

Pelvic ultrasound:Pelvic ultrasound:

MRI ( magnetic resonance imaging ):MRI ( magnetic resonance imaging ):

Hysteroscopy – submucousHysteroscopy – submucous

Laparoscopy -- myomectomyLaparoscopy -- myomectomy

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Differential diagnosisDifferential diagnosis

Ovarian cyst or neoplasiaOvarian cyst or neoplasia

Adnexal consideration: tubo-ovarianAdnexal consideration: tubo-ovarian

inflammatory of neoplastic masses.inflammatory of neoplastic masses.

Pregnancy ( including subinvolution )Pregnancy ( including subinvolution )

Endometrial cancer, hypertrophy,Endometrial cancer, hypertrophy,

congenital anomaliescongenital anomalies Adenocarcinoma of the endometriumAdenocarcinoma of the endometrium

or uterine tube, uterine sarcomas,or uterine tube, uterine sarcomas,

ovarian carcinomasovarian carcinomas

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TreatmentTreatment

Emergency measures: bloodEmergency measures: blood

transfusion; infected leiomyomata;transfusion; infected leiomyomata;

acute torsion; intestinal obstructionacute torsion; intestinal obstruction

caused by a pedunculated orcaused by a pedunculated orparasitic myoma; myomectomy isparasitic myoma; myomectomy is

contraindicated during pregnancy.contraindicated during pregnancy.

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TreatmentTreatment

Medical measures: most no symptoms andMedical measures: most no symptoms and

post manopausal – no treatment. Thepost manopausal – no treatment. The

gonadotropin-releasing hormone (GnRH);gonadotropin-releasing hormone (GnRH);

induce hypogonadism through pituitaryinduce hypogonadism through pituitarydesensitization, downregulation of desensitization, downregulation of 

receptors, and inhibition of gonadotropins.receptors, and inhibition of gonadotropins.

GnRH treatment result: 1. maximalGnRH treatment result: 1. maximal

shrinkage of the myomatous uterus 50%;shrinkage of the myomatous uterus 50%;2. in 3 months; 3. amenorrhea and2. in 3 months; 3. amenorrhea and

hypoestrogenic side effect; 4.hypoestrogenic side effect; 4.

osteoporosisosteoporosis

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TreatmentTreatment

Supportive measures: pap smear andSupportive measures: pap smear and

evaluation of the endometrium.evaluation of the endometrium.

Blood volume; prophylacticBlood volume; prophylactic

antibiotics; bowel preparation.antibiotics; bowel preparation.

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TreatmentTreatment

Surgical measures:Surgical measures: 1. Evaluation for other neoplasia:1. Evaluation for other neoplasia:

endometrial biopsy.endometrial biopsy. 2. Myomectomy: symptomatic2. Myomectomy: symptomatic

patient who wishes to preservepatient who wishes to preservefertility or conserve the uterus.fertility or conserve the uterus.

Hysteroscope or laparoscope and soHysteroscope or laparoscope and soon.on. 3. Hysterectomy: TVH ( cystocele,3. Hysterectomy: TVH ( cystocele,

rectocele, enterocele ); TAH;rectocele, enterocele ); TAH;

oophorectomy.oophorectomy.

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Thanks!Thanks!