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ASSOCIATE PROFESSOR IOLANDA BLIDARU MD, PhD

Leiomyoma of the uterus. ASSOCIATE PROFESSOR IOLANDA BLIDARU MD, PhD. Epidemiology. The commonest of all pelvic T. (1/3). 20% of female > 3 5 y ears have fibroid. Childbearing life. O ften enlarge during pregnancy or during oral contraceptive use, and regress after menopause

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ASSOCIATE PROFESSOR IOLANDA BLIDARU MD, PhD

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  1. Leiomyoma of the uterus ASSOCIATE PROFESSOR IOLANDA BLIDARU MD, PhD

  2. Epidemiology • The commonest of all pelvic T. (1/3). • 20% of female > 35 years have fibroid. • Childbearing life. • Often enlarge during pregnancyor during oral contraceptive use, and regress after menopause • occurin women of reproductive age, often

  3. Uterus deprived from a baby consoles itself with a fibroid.

  4. Causes • Unknown • Hyperestrogenemia – E2 / ER, P / PR, GnRH, growth factors (IGF-1, EGF< PDGF< FGF) • Race • Obesity • Chromosomal abnormalities (7, 12, 14)

  5. Pathology • MACROSCOPY • site • shape • size • consistency • cut section • capsule • number • varieties

  6. Uterine leiomyoma • Cervical • 1-2% • solitary • Corporeal • 98% • multiple

  7. Corporeal leiomyoma • submucus • 24% • not capsulated • Subserous • 18% • Interstitial • 58%

  8. Cervical leiomyoma • Exocervix • small • sessile • polypoid • Supravaginal cervix • sessile • pedunculated

  9. CONSISTENCY Firm Harder (hyaline degeneration). Soft (pregnancy-cystic degeneration). Stony hard (Calcification)

  10. Leiomyomata Uterus

  11. CUT SECTION • well demarcated surrounding muscle. • whorly (intermingling muscle fibers and fibrous tissue). • paler than surrounding (ischaemia).

  12. Microscopic Examination • Few formed blood vessels (blood lakes). • Smooth muscle cells and fibrous tissue cells.

  13. Leiomyoma:

  14. Changes occuring with fibroid General Genital tract Tumor itself

  15. Genital tract • Endometrium - hyperplasia • Tubes - inflammation (salpingitis) • Endometriosis (30-40%)

  16. Tumour itself • Benign degeneration • atrophic • hyaline • red • cystic • fatty • calcification • necrosis with or without infection • vascular (edema, lymphangiectasia) • Malignant degeneration (0.1-0.5 % - growth after menopause, rapid enlargement, recurrent fibroid polyp).

  17. DIAGNOSIS • History • Examination. • Investigation. • D.D.

  18. SYMPTOMS • No symptom • Bleeding (menorrhagia - metrorrhagia). • Pain - uncomplicated → congestion → dysmenorrhea; complicated → degeneration (malignant, infection, torsion) • Infertility • Mass • Discharge • Pressure symptoms (urinary, lower limb edema, constipation)

  19. Signs • Symmetrically enlarged uterus • (submucosal fibroid) • Asymmetrically enlarged uterus(subserous fibroid)

  20. Investigations • Clinical(examination) • Laboratory(Hb, Ht, urinary tests, pregnacy test, Pap test etc) • Imaging & instrumental techniques(US, hysteroscopy, hysterography, colposcopy, fractional curettage, Ct scan) • Miscellaneous(intravenous urography, etc)

  21. DIFFERENTIAL DIAGNOSIS • Pregnancy (normal / abnormal) • Ademomyosis. Leiomyomas - myomectomy, adenomyosis - hysterectomy • Solid Adnexal Mass (fibromas, Brenner tumors, inflammatory mass) • Uterine Leiomyosarcoma ( histologically - the presence of infiltrativemargins, nuclear atypia, and increased mitotic figures )

  22. Uterus Adenomyosis:

  23. DIFFERENTIAL DIAGNOSIS

  24. Uterine Leiomyosarcoma

  25. No treatment Conservative Radiological Surgical GnRH agonists Uterine artery embolization. Patient (age, parity, symptoms). Tumor (number, size, type) Complications. Treatment of Leiomyoma

  26. Treatment of Leiomyoma MEDICAL • Progesterone / Progestins • Selective PR modulator / antagonist(Mifepristone, Ulipristal) • GnRH agonists (Buserelin, Triptorelin, Leuprolid, Histerelin, Goserelin)

  27. SURGICAL Myomectomy (Hysteroscopy, laparoscopy, laparotomy) Hysterectomy

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