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Uterine Myoma

Uterine Myoma. Women’s Hospital, School of Medicine Zhejiang University Prof. Lin Jun. Introduction. Most common benign tumor of female reproductive system Benign neoplasm composed primarily of smooth muscle and connectives tissue Common in women 30-50y Usually asymptomatic.

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Uterine Myoma

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  1. Uterine Myoma Women’s Hospital, School of Medicine Zhejiang University Prof. Lin Jun

  2. Introduction • Most common benign tumor of female reproductive system • Benign neoplasm composed primarily of smooth muscle and connectives tissue • Common in women 30-50y • Usually asymptomatic

  3. Etiology Not detectable before puberty and after menopause Probably relates to female hormones • Estrogen and ER ↑ • Progestin may promote mitosisof myoma

  4. Classification According to the location： • Uterine body myoma 90% • Cervical myoma 10%

  5. Classification According to the relationship between myoma and uterine myometrium ： • intramural myoma60%-70% • subserous myoma20% • submucous myoma 10%-15%

  6. Classification

  7. Classification multiple myoma

  8. Pathology Gross Appearance： • round, smooth, and usually firm • false capsular covering ——pseudocapsule can be clearly demarcated from the surrounding myometrium

  9. Pathology Gross Appearance： Transverse section : • light gray • a whorl-like arrangement or an intertwining pattern

  10. Pathology Microscopic examination： • composed of smooth muscle cells and varying amounts of connectives tissue • Individual cells are quite uniform in size, spindle shaped, have elongated nuclei. • Nonstriated muscle fibersare arranged in interlacing bundles of varying size running in different directions.

  11. Degeneration • Hyaline degeneration • Cystic degeneration • Red degeneration • Sarcomatous change • Degeneration with calcification

  12. Degeneration Red degeneration • most common during pregnancy and puerperium • venous thrombosis and congestion with interstitial hemorrhage

  13. Degeneration ← Red degeneration ← Hyaline degeneration

  14. Degeneration Sarcomatous change • malignant • rare, 0.4-0.8% • old women • enlarge rapidly with irregular vaginal bleeding

  15. Degeneration Sarcomatous change

  16. Symptoms • Usually no symptoms • Associate with location, and degenerations • Not associate with the size and the number

  17. Symptoms 1. menorrhagia and prolonged menses • large intramural myoma • submucous myoma 2. abdominal mass 3. leukorrhagia

  18. Symptoms 4. pressure effects • pressure bladder or rectum → urinary frequency, constipation • intraligamentous myomaand large cervical myoma → obstruct ureter 5.others • infertility • spontaneous abortion • abdominal pain

  19. Sign associated with： • size • location • number • degeneration large myoma→ palpable abdominal mass Pelvic examination： uterus —— enlarged，irregular and hard

  20. Diagnosis • Typical symptoms and signs • Ultrasound • Hysteroscopy • Laparoscopy

  21. Ultrasound

  22. Ultrasound

  23. Diagnosis Hysteroscopy

  24. Diagnosis Laparoscopy

  25. Differentialdiagnosis • Pregnancy • Ovarian neoplasms • Adenomyosis • Malignant tumors of uterus • uterine sarcoma • endometrial carcinoma • cervical cancer

  26. Treatment According to : • age • desire for childbearing • symptoms • location , size and amount of myoma

  27. Treatment Observation and Follow Up • Small，asymptomatic，especially near menopause • Interval：3～6 months

  28. Medical measure Indications： • smaller than 2 months in size • slight symptoms • near menopause

  29. Medical measure 1.Androgenic agents： testosterone propionate 2.Gonadotropin-releasing hormone agonist, （GnRH-a） GnRH-a LH、FSH↓ E2↓ shrinkage of myoma • leuprorilin • goserelin

  30. Medical measure • 2.GnRH-a • Side effects: • Hypoestrogenic side effects • Osteoporosis 3.Mifepristone

  31. Surgical measures Indications： • greater than 10 weeks in size • menorrhagia→ anemia • pressure effects • grows rapidly • failure in medical treatment • infertility or recurrent abortion

  32. Surgical measures Approaches： • laparotomy • hystereoscopy • laparoscopy

  33. Surgical measures • Myomectomy • preserve fertility, <35 years old 2. Hysterectomy • Large myoma • Numerous tumors • Obviously symptomatic patient • No wish of preserving fertility • Suspected to malignant transformation

  34. Myomas during pregnancy Impact on pregnancy and delivery ： • abortion • preterm labor • fetal malpresentation • placenta previa • birth canal obstruction • postpartum hemorrhage

  35. Myomas during pregnancy Red degeneration • Clinical finding: • rapid growth of myoma • pain, fever, WBC↑ • Conservative treatment

  36. Thank You !

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