Leiomyoma, Uterus (Fibroid)

Leiomyoma, Uterus (Fibroid)

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Leiomyomas are benign tumorsbenign tumors of the uterus

Arise from the overgrowth of smooth muscle and connective tissue in the uterus

A genetic predisposition exists

Female>30(25-50%)

Evidence of an apparent hormonal dependency includes the following:


1-Estrogen and progestin receptors are present in fibroids

2-Elevated estrogen levels may cause fibroid enlargement. During the first trimester of pregnancy, 15-30% of fibroids may enlarge and then shrink in puerperium. Some fibroids may decrease in size during pregnancyduring pregnancy

3-Fibroids shrink after menopauseshrink after menopause.y 4-Some regrowth may occur with hormonal therap

1. Spontaneous abortion2. Intrauterine growth retardation3. Preterm labor4. Uterine dyskinesia 5. Inertia during labor6. Obstruction of the birth canal7. Postpartum hemorrhage 8. Hydronephrosis

Complications during pregnancy include


AnatomyMost leiomyomas occur in the fundus and body of the uterusfundus and body of the uterus; only 3% occur in the cervix.

The fibroids may be solitarysolitary, multiplemultiple, or diffusediffuse


Subserosal uterine fibroids

These fibroids develop in the outer portion of the uterus and continue to grow outward

Intramural uterine fibroids

The most common type of fibroid. These develop within the uterine wall and expand making the uterus feel larger than normal (which may cause "bulk symptoms)

Submucosal uterine fibroids

These fibroids develop just under the lining of the uterine cavity. These are the fibroids that have the most effect on heavy menstrual bleeding and the ones that can cause problems with infertility and miscarriage


There are three primary types of uterine fibroids, classified primarily according to location in the uterus:

Clinical Details


Most women with fibroids are asymptomatic. Only 10-20% of patients require treatment

Fibroid symptoms are related to the number of tumors, as well as to their size and location

Bleeding: (Menorrhagia)(Most common)

Pain

Pressure

123

Menorrhagia may result in severe anemia and can be life threatening, although this is rare. Menorrhagia usually results

from the erosion of a submucosal fibroid into the endometrial cavity. Rarely, dilated veins on the surface of a subserosal,

pedunculated fibroid can cause sudden, massive intraperitoneal bleeding

Bleeding: (Menorrhagia)(Most common)



Pain

Women may experience abdominal cramping. Pain usually is felt during menstruation. Less often, pain occurs

intermenstrually

PressureUrinary frequency, urgency, and/or incontinence result from

pressure on the bladder

Constipation, difficult defecation, or rectal pain results from pressure on the colon

Normal ovary - May be confused with fibroids at US Ovarian mass - Hemorrhagic cyst, endometrioma, dermoid, cystadenoma, malignant tumor

Uterine leiomyosarcoma - Rare, arise de novo or as a result of the malignant degeneration of a uterine fibroid Adenomyosis - May be difficult to distinguish from multiple small fibroids Myometrial contraction - Especially during pregnancy Necrotic fibroids - May mimic intrauterine gestational sac, intrauterine fluid collection, hydatiform mole


Differential diagnosis


Radiogrph findings:

Conventional radiographs have a limited role in the diagnosis of uterine fibroids

Unless heavily calcified, fibroids are not depicted on radiographs

CT findings

CT scanning has a limited role in the diagnosis of uterine fibroids

On CT scans, fibroids are usually indistinguishable from healthy myometrium unless they are calcified or necrotic

Calcifications may be more visible on CT scans than on conventional radiographs because of the superior contrast differentiation with CT scanning

US is the imaging modality of choicemodality of choice in the detection and evaluation of uterine fibroids

The most frequent US appearance is that of a concentric, solid, hypoechoic massconcentric, solid, hypoechoic mass


These solid masses absorb sound waves and therefore cause a variable amount of acoustic shadowing

Sonography


Sonogram shows the subserosal, 2.3- to 2.5-cm, right anterior fundal uterine fibroid


They can be heterogeneous or hyperechoic, depending on the amount of fibrousamount of fibrous tissue and/or calcificationcalcification

Sagittal sonogram shows a posterior, fundal, 4.2 X 3.5-cm intramural uterine fibroid

http://www.emedicine.com/radio/images/336139-405676-1120.jpg



CT scan shows a subserosal, 2.3- to 2.5-cm, right anterior fundal uterine fibroid



MRI findings:MRI has an important rolean important role in defining the anatomy of the uterus and ovaries

Fibroids are sharply marginatedsharply marginated areas of lowlow--toto--intermediate signal intensityintermediate signal intensity on T1- and T2-weighted MRI scans


One third of fibroids have a hyperintense rim on T2-weighted images as a result of dilated veins, lymphatics, or edema.

Sagittal T2-weighted MRI shows that the largest fibroid is located in the lower uterus and has a partially hyperintense rim. A smaller discrete fibroid is depicted in the fundus


Axial MRI shows the cross section of the larger fibroid in the lower uterus .Note the mass effect on the bladder, which is located anteriorly


An inhomogeneous area of high signal intensity may be depicted on T2-weighted

images; this results from hemorrhage, hyaline degeneration, edema, or highly cellular fibroids

The intravenous administration of gadolinium-based contrast material usually is not required


if it is administered, fibroids usually enhance later than does the healthy myometrium. Fibroid enhancement can be hypointense hypointense ((65%65%)), isointense , isointense ((23%23%)), or , or

hyperintense hyperintense ((12%12%)) in relation to that of the myometrium

MRI has a sensitivity of 86-92%, a specificity of 100%,specificity of 100%, and an

accuracy of 97% in the evaluation of probable fibroids

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Leiomyoma, Uterus (Fibroid)

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