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Uterine Leiomyomas

Uterine Leiomyomas. Most common benign uterine tumors Location :uterus ,cervix ,broad ligament Subserosal Intramural Submucosal In reproductive ages 20% Older than 35 years 40-50% Single or multiple. Increased familial tendency During pregnancy enlarged

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Uterine Leiomyomas

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  1. Uterine Leiomyomas

  2. Most common benign uterine tumors • Location :uterus ,cervix ,broad ligament • Subserosal • Intramural • Submucosal • In reproductive ages 20% • Older than 35 years 40-50% • Single or multiple

  3. Increased familial tendency • During pregnancy enlarged • During menaupouse regress

  4. Microscopic or huge • Hard and stony to soft ,usually firm or rubbery • Do not have a true capsule • Margins of the tumor are blant noninfiltrating and pushing (psudocapsul) • Degenerative changes in two third • Malignant degeneration in less than 0.5%

  5. Symptoms in ½ • AUB • Pelvic pain • Pelvic pressure • Uretral obstraction • Constipation • Infertility • Prolapse • Venous StaSis thrombophlebitis • Polycythemia • Ascites

  6. Management of leiomyomas • Observation and periodic examination • Medical therapy GNRH agonist RU486 (progestron antagonist ) • Surgical therapy Myomectomy Hysterectomy

  7. GNRH agonists • 40-60% decrease the volume • Bone loss • Hot plashes • Short term use • Regrowth of leiomyomas within few months

  8. Uterine cancer • Most common malignancy of the female genital tract • ½ of all gynecologic cancers • Endometrial carcinoma is the fourth most common cancers (ranking behind breast , lung, bowel) • Seventh leading cause of death from malignancy in women

  9. Endometrial carcinoma Estrogen dependent • Younger • Perimenopause • History of exposure to estrogen • Benign as hyperplastic endometrium and progress to carcinoma • More favorable prognosis

  10. Endometrial carcinoma Non estrogen dependent • Arise in background of atrophic endometrium • Less differentiated • Poor prognosis • Older postmenopausal • Thin • African American • Asian

  11. Endometrial hyperplasia Simple • Dilated gland with round to slightly irregular shapes • Increased glandular to stromal ratio • No glandular crowding • No cytologic atypia

  12. Complex • Architecturally complex (budding and folding ) • Crowded glands (less intervening stroma) • Without atypia

  13. Atypical hyperplasia Complex hyperplasia with atypia Simple hyperplasia with atypia • Large nuclei of variable size and shape that have lost polarity • Increased nuclear to cytoplasmic ratio • Prominant nuclei and irregularly clupmed chromatin

  14. Complex Atypical hyperplasia 25% isassociated with well differentiated endometrial carcinoma • Progesterone is very effective in reversing endometrial hyperplasia without atypica but less effective for endometrial hyperplasia with atypia • Continuous megestrol acetate 40 mg 2-3 months • Biopsy 3-4 w after completion of therapy

  15. Endometrial cancer screening • Lack of an appropriate , cost-effective and acceptable test that reduces mortality • Pap smear • TVS • Endometrial biopsy • Screening of high risk individuals could detect ½ of all cases

  16. Clinical symptoms of endometrial carcinoma • In sixth and seventh decades • Average age 60 years • 75% are older than 60 years • 90% have vaginal bleeding or discharge • Seek medical consultation in 3 months Pelvic pressure Pelvic discomfort Hematometra Pyometra Less than 5% are asymptomatic

  17. Diagnosis of endometrial cancer • Office endometrial aspiration biopsy (90-98% accuracy compared with D&C or hysterectomy) • Pap smear 30-50 • D&C • Hysteroscopy is more accurate in identifying polyps and sub mucous myomas than biopsy or D&C alone . • TVS Endometrial thickness greater than 4 mm Polypoid endometrial mass Collection of fluid in the uterus

  18. Pre treatment evaluation Complete history and PhE • Diabetus • Hypertension • Bladder or intestinal complains • Stool for occult blood • Complete blood and platelet counts • Serum chemistries (renal and liver function tests) • Blood type • Urinalysis

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