BENIGN

CONDITIONS OF

THE UTERUS

Prof. Leon SnymanM.B.Ch.B, M.Prax.Med, M.Med (O&G), FCOG(SA)

Gynaecologic Oncology Unit

Department Obstetrics & Gynaecology

Introduction

• Uterus consists of:

• Cervix

• Corpus

• Fallopian tubes

• Ligaments

Cervix

• Benign tumours

– Endocervical polyp

– Cervical myoma

– Cervical papilloma

– Others

Cervix

• Other

– Nabothian cysts

– Columnar epithelium eversion

Cervix

• Infections

– Condyloma

– Herpes simplex

– Cervicitis (Chlamydia)

– Bilharzia

– TB

Uterus

• Benign tumors

– Leiomyomas are by far the most common

uterine benign tumors

– Endometrial polyps

• Other benign conditions

– Developmental abnormalities

– Adenomyosis

– Dysfunctional uterine bleeding

Prevalence of leiomyomas

• Present in at least 20% of all women of

reproductive age

• More prevalent in black women

• Familial incidence

Definition

• Benign neoplasm consisting of smooth

muscle and connective tissue.

Etiology

• Unknown

• Genetic tendency

• Risk

– Race

– Obesity

• Risk

– Oral contraceptive

Different types

• Pedunculated

• Subserosal

• Intramural

• Submucosal

• Cervical

• Parasitic

Clinical presentation

• Asymptomatic

• Presence of a pelvic mass

• Abnormal uterine bleeding

• Pain:

– Backache, dysmenorrhoea, dyspareunia

• Pressure symptoms

• Urinary symptoms (retention, frequency)

Clinical presentation

• Controversial:

• Infertility

– Less than 3% of infertile patients

– Submucosal leiomyomas

• Pregnancy complications

– Most have uncomplicated pregnancies and

deliveries

Complications

• Torsion of pedunculated myoma

• Bleeding and anaemia

• Degeneration:

– Red, hyaline, mucoid, cystic, fat

• Calcification

• Malignant changes (0.1 to 0.5%)

On examination

• Abdomen:

– Palpable mass from pelvis

• Bimanual examination

– Palpable mass

– Enlarged uterus

Differential diagnosis

• All causes of abnormal uterine bleeding

– Ca cervix and Ca endometrium

– Polyps

– Pregnancy

Differential diagnosis

• All causes of pelvic masses

– Ovarian

– Inflammatory

– Pregnancy

– Bladder

– GIT

– etc

Special Investigations

• Cervical smear

• Endometrial biopsy

• Hematocrit and platelets

• Other investigations

as indicated

• Ultrasound

Treatment

• Different options available according to

individual patient’s needs

• Surgical

• Non-surgical

Non-surgical

• Expectant with follow-up

• Medical treatment

– GnRH analogues

• Short term: pre-op, anaemia recovery, peri-

menopausal

• Regrowth after cessation of therapy

• Bone loss

More non-surgical

– Danazol

– Mifepristone

• Invasive management

– Uterine artery embolisation

• Effective modality over short term

• 3% failure rate

• Especially small myomas

Surgical

• Myomectomy

– Where fertility is wanted

– Submucosal myomas with operative

hysteroscope

– Laparoscopy for small pedunculated and

subserosal myomas

– Laparotomy for bigger and intramural

myomas

More surgical options

• Hysterectomy

• Vaginal myomectomy for prolapsing

pedunculated submucosal myomas

Adenomyosis

• Ingrowth of the endometrium into the

uterine musculature

• Causes secondary dysmenorrhea,

dyspareunia and menorrhagia

• Often asymptomatic

• Uterus diffusely enlarged, soft and tender

Adenomyosis

• No special investigations

• Management

– Symptomatically (NSAIDS, OC, Progestins)

– Hysterectomy

Benign tumours Fallopian

tubes

• Adenomatoid tumor

• Other (rare)

– Leyomyoma, adenomyomas, lypomas etc.

– Cysts

• Hydatid cyst of Morgagni (remanat of accessory

Muller duct system)

• Salpingitis istmica nordosa (epithelium in

myosalpinx

• Polyps

• Endosalpingiosis

Ligaments

• Lyomyomas and endometriosis can

involve these structures