Uterine leiomyoma (fibroid)
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Uterine leiomyomas, or fibroids, are benign smooth muscle tumors that are the most common pelvic tumor in women. Fibroids can be described by their location in the uterus and may cause abnormal uterine bleeding, pelvic pressure and pain, or reproductive dysfunction. Symptoms are often relieved at menopause.
Uterine leiomyoma (fibroid)
- 4. Definition of Uterine leiomyomas (fibroids or myomas) are the most common pelvic tumor in women. They are benign monoclonal tumors arising from the smooth muscle cells of the myometrium.
- 5. Groosly ,Leiomyomas are pseudoencapsulated solid tumors, well demarcated from the surrounding myometrium. Microscopically, these appear as smooth muscle cells in longitudinal or cross-section intermixed with fibrous connective tissue. Vascular structures are few, and mitoses are rare.
- 6. Risk of Malignancy Leiomyosarcomas are found rarely in hysterectomy or myomectomy specimens (incidence 0.2%).
- 8.  Uterine leiomyomas are the most common pelvic tumor in women.  Leiomyomas have not been described in prepubertal girls, but they are occasionally noted in adolescents.  Myomas are clinically apparent in approximately 12 to 25 percent of reproductive age women and noted on pathological examination in approximately 80 percent of surgically excised.  Most, but not all, women have shrinkage of leiomyomas at menopause
- 10. Race Menstrual history & parity Hormonal contraception Ovulation induction agents others Early menarche (<10 years old) is associated with an increased risk of developing fibroids.  Parity (having one or more pregnancies extending beyond 20 weeks) decreases the chance of fibroid formation.  It has been hypothesized that the postpartum remodeling of the uterus may have the effect of clearing smaller fibroids.  Recent studies supported this hypothesis with the finding that over a third of women with a single fibroid identified during pregnancy had none on postpartum ultrasound, and almost 80 percent of fibroids were smaller following pregnancy.  In some cohorts, early age at first birth decreases risk and a longer interval since last birth increases risk the association of fibroid growth with agents for ovulation induction is unlikely Most studies show a relationship between fibroids and increasing body mass. The relationship is complex and is likely modified by other factors
- 12. Fibroids are often described according to their location in the uterus
- 15. the majority of myomas are small and asymptomatic. The symptoms are related to the number, size, and location of the neoplasms. Myomas can occur as single or multiple tumors and range in size from microscopic to tens of centimeters. The size of the myomatous uterus is described in menstrual weeks, as with the gravid uterus. As an example, a 20-week size myomatous uterus is not unusual, and is often associated with heavy menses, increasing abdominal fullness similar to pregnancy
- 17.  It is the most common symptom.  Heavy and/or prolonged menses is the typical bleeding pattern with myomas .  Intermenstrual bleeding and postmenopausal bleeding are NOT characteristic of myomas and should be investigated to exclude endometrial pathology.  The presence and degree of uterine bleeding are determined, in large part, by the location of the fibroid; size is of secondary importance.
- 18. Bulk-related symptoms — As examples, urinary frequency, difficulty emptying the bladder, and, rarely, urinary obstruction can all occur with fibroids Dysmenorrhea — Dysmenorrhea is also reported by many women with fibroids. Leiomyoma degeneration or torsion — Infrequently, fibroids cause acute pain from degeneration (eg, carneous or red degeneration) or torsion of a pedunculated tumor.
- 19. Leiomyomas that distort the uterine cavity (submucosal or intramural with an intracavitary component) result in:  difficulty conceiving a pregnancy  and an increased risk of miscarriage leiomyomas have been associated with adverse pregnancy outcomes eg,  placental abruption,  fetal growth restriction,  and preterm labor and birth
- 24. Condoleezza Rice's uterine fibroid embolization was performed at Georgetown University Hospital by interventional radiologist James Spies, MD. The procedure took about 90 minutes and was reported as successful.
- 25. Management Clinical effect Method of Treatment Observation Most Serial Pelvic Exams Presurgical Shrinkage Size by 70% GnRH analog 3-6months; regrowth after stopping Myomectomy Preserves fertility Laparotomy, laparoscopy Embolization Preserves the uterus Invasive radiotherapy Hysterectomy Fertility completed TAH,TVH Definitive tx
- 27.  Uterine leiomyomas (fibroids or myomas) are the most common pelvic tumor in women .  Fibroids are often described according to their location in the uterus (submucosal, intramural, subserosal, cervical).  Symptoms attributable to uterine myomas can generally be classified into three distinct categories: abnormal uterine bleeding, pelvic pressure and pain, reproductive dysfunction.  Relief of symptoms related to fibroids usually occurs at the time of menopause