This document discusses fibroids (leiomyomas), which are benign smooth muscle tumors of the uterus. Key points include: - Fibroids are the most common benign tumors of the uterus, occurring in 20-30% of women by age 30. - They are estrogen-dependent tumors that grow during reproductive years and often shrink after menopause. - Symptoms include heavy menstrual bleeding, pelvic pressure, pain, urinary symptoms, and infertility. - Fibroids can be intramural, subserosal, submucosal, or cervical. Complications include degeneration, infection, and torsion of pedunculated fibroids.

1. FIBROID UTERUS
S KAIBAH KONYAK
2011

2. FIBROIDS
 THE COMMONEST
-BENIGN TUMOUR OF THE UTERUS
-BENIGN SOLID TUMOUR IN FEMALE
 HISTOLOGICALLY
-
LEIOMYOMA/MYOMA/FIBROMYOMA

3. FIBROIDS
 Arising from the myometrium or
muscles of its vessel walls
 Composed of smooth muscles
interspersed with varying amounts of
fibrous tissue

4. INCIDENCE
 20% OF WOMEN AT AGE OF 30
 3% SYMPTOMATIC CASES IN O.P
 BLACK WOMEN HAS THE
HIGHEST
 MORE COMMON IN
NULLIPAROUS
 MOST COMMON AGE-35 TO 45
YEARS

5. HISTOGENESIS
 ORIGIN
- AETIOLOGY IS UNKNOWN
- IT IS PRESUMED THAT IT ARISES FROM
THE SINGLE SMOOTH MUSCLE OF
THE MYOMETRIUM

6. GROWTH
 PREDOMINANTLY AN ESTROGEN DEPENDENT TUMOUR
EVIDENCES:
 INCREASED GROWTH DURING PREGNANCY
 RARE BEFORE MENARCHE
 CEASE TO GROW FOLLOWING MENOPAUSE
 MORE ESTROGEN RECEPTORS THAN ADJACENT MYOMETRIUM
 ASSOCIATION OF ANOVULATION

7. CYTOGENIC
 Cytogenitic abnormalities-50%-
 Translocation of chro. 7;12 & 14,
 Structural abnormalities-chr.6
 Progesterone &GnRH-inhibits growth of myomas
 Less common in smokers
 Bcl-2 an inhibitor of apoptosis significantly
increased in leiomyoma.

8. RISK FACTORS FOR FIBROID
 NULLIPARITY
 OBESITY
 EARLY MENARCHE
 HYPERESTROGENISM
 ETHNICITY – AFROCARRIBEAN
 FAMILY HISTORY

9. CLASSIFICATION OF UTERINE FIBROIDS
BODY(CORPOREAL) CERVICAL
INTERSTITIAL(75%) SUBSEROUS (15%) SUBMUCOUS(10%)
SESSILE PEDUNCULATED
ANTERIOR POSTERIOR CENTRAL LATERAL

11. INTRAMURAL
 MOST COMMON(75 %)
 WITHIN THE MYOMETRIAL WALL
 PSEUDOCAPSULE
 BLOOD SUPPLY – THROUGH THE PSEUDOCAPSULE

12. SUBSEROUS(15 %)
-TUMOR GROWS OUTWARDS TO THE PERITONIAL SURFACE
- (further extrusion outwards with development of a
pedicle)
PEDUNCULATED SUBSEROUS FIBROID
-(gets attached to vascular organ & cut off from uterine
origin)
WANDERING PARASITIC FIBROID

13. SUBMUCOUS(10 %)
Grows inwards into the cavity
Make the uterine cavity irregular
& distorted
Pedunculated fibroid can come
out through cervix

14. SUBMUCOUS
 It may become infected
Ulcerated menorrhagia,
metorrhagia
 Infertility, recurrent miscarriage
SUBMUCUS MYOMATOUS POLYP
(Submucus myoma force itself towards vagina by
a pedicle)

15. CERVICAL FIBROID
 Intramural,subserous or submucous
 Anterior/posterior/central/lateral
 Impacted in the pelvis bladder
compression & urinary symptoms

16. PSEUDOCERVICAL FIBROID
A FIBROID POLYP ARISING FROM THE
UTERINE BODY WHEN IT OCCUPIES AND
DISTENDS THE CERVICAL CANAL

17. BROAD LIGAMENT FIBROID
TRUE
 NO ATTACHMENT TO THE
UTERUS
 URETER MEDIAL TO THE
FIBROID
FALSE
 COMMON
 ARISES FROM THE LATERAL UTERINE WALL
 GROWS BETWEEN LAYERS OF BROAD
LIGAMENT
 URETER LATERAL TO THE FIBROID

18. MORPHOLOGY
BODY/CORPOREAL FIBROIDS
GROSS APPEARANCE
CIRCUMSCRIBED
DISCRETE
ROUND
FIRM,GRAY WHITE TUMORS

19. MORPHOLOGY
SIZE
VISIBLE NODULES TO MASSIVE TUMOR
CUT SECTION
 SMOOTH AND WHITISH
 WHORLED APPEARANCE

20. MICROSCOPY
 Consists of whorled pattern of smooth muscles
and fibrous connective tissue
 Subserous and cervical myomas :
more fibrous tissue and less of muscle

21. SECONDARY CHANGES IN FIBROID
 DEGENERATIONS
 ATROPHY
 NECROSIS
 INFECTION
 VASCULAR CHANGES
 SACROMATOUS CHANGES

22. DEGENERATION
 HYALINE DEGENERATION-65%
 CYSTIC DEGENERATION
 FATTY DEGENERATION
 CALCIFIC DEGENERATION-10%
 RED DEGENERATION

23. HYALINE DEGENERATION
Commonest degeneration affecting
all fibroids
CENTRAL PORTION
Least vascular
Most prone to degeneration
Becomes soft & elastic

24. HYALINE DEGENERATION
CUT SURFACE
Loss of characteristic whorled
appearance
MICROSCOPY
Hyaline changes of muscles and
fibrous tissue

25. CACIFIC DEGENERATION
Due to circulatory impairment
 Common after menopause
 Occur in sub-serous fibroid with narrow pedicle
 Calcium carbonate or phosphate is deposited in the
centre of the tumor which is least vascular
 WOMB STONE (CALCIFIED FIBROID)

26. RED DEGENERATION
Occurs in large fibroid
During
 Pregnancy
 Puerperium
Cause
 Vascular
 Thrombosis of blood vessels →
coagulative necrosis

27. RED DEGENERATION
TUMOR APPEARS DARK
CUT SURFACE SHOWS
-HEMORRHAGICC MEATY
APPEARANCE
MICROSCOPY
-EVIDENCE OF THROMBOSIS
NECROSIS OF VESSELS

28. COMPLICATIONS OF FIBROID
 DEGENERATION
 TORSION OF SUBSEROUS PEDUNCULATED
FIBROIDS
 INFECTION
 HAEMORRHAGE

29. COMPLICATIONS OF FIBROID
 SACROMATOUS CHANGE
 LEOMYOMATOSIS
 PSEUDO MEIGS SYNDROME
 POLCYTHEMIA – increased erythropoietin production
by fibroid

30. TORSION
- Sub-serous pedunculated fibroid may
undergo rotation at its site of
attachment to the uterus
-Veins occluded & tumor engorged
with blood
-Very severe a/c abdominal pain

31. INFECTION
 Common in SUBMUCOUS fibroids & especially MYOMATOUS
POLYPI projecting into vagina
 Covered by only a layer of endometrium that becomes
thinned out and sloughs
 Blood stained purulent discharge
 Often following delivery or abortion
 puerperal sepsis

32. SACROMATOUS CHANGES
Not>0.5% cases
More in intramural & submucous
Rare<40yrs
Most common - leiomyosarcoma

33. Fibroids complicating
pregnancy
 Pregnancy causes increase in size of fibroids.
 High tendency to undergo degenerative
changes.
 Severe pain abdomen.
 Respiratory embarrassment ,urinary retention,
obstructed labour.
 Increased risk of miscarriage, preterm labour ,
abnormal presentations,accidental
hemorrhage,dystocia,PPH,peurperal sepsis,uterine
inversion.

34.  SYMPTOMS
 Many are asymptomatic and discovered
only on routine gynecological
examinations
 Peak incidence between age of 35 and
45
 Nulliparity and infertility are usual
associations.
CLINICAL FEATURES

35.  Usual type of bleeding associated with fibroid is
menorrhagia
o This is more with sub-mucous fibroids, also seen
with intramural fibroids.
 Another less common pattern is metrorrhagia
 Some women have menometrorrhagia
ABNORMAL UTERINE
BLEEDING

36.  Increase in endometrial surface area
 Increased vascularity
 Interference with normal uterine contractions
 Ulceration and haemorrhage over fibroid
 Compression of venous plexus
 Associated endometrial hyperplasia and
anovulation
Mechanism of
menorrhagia

37.  Pelvic discomfort or pressure
 occur with large fibroids,
broad ligament fibroids compress sciatic
nerve
-posterior fibroids cause low back ache
pressure symptoms

38.  Fibroid arising from cervix produce
bladder discomfort and compression
 Initially increased urinary frequency then voiding
difficulties
 Sometimes acute retention can occur due to fibroid
impacted in pouch of Douglas
 Large fibroids and broad ligament fibroids cause
ureteric compression and hydronephrosis
Urinary symptoms

39. CAUSES:
 Red degeneration
 Expulsion of sub
mucous fibroid
Hemorrhage into the
fibroid
Torsion of fibroid
Acute retention of
PELVIC PAIN

40.  OTHER SYMPTOMS ARE:
 Edema of lower limbs
 Large fibroids cause venous stasis,
difficulty in defecation even
dyspareunia

41.  Infertility
a)cornual myomas cause tubal occlusion
b)impaired gamete and embryo transport
c)altered relation between semen and
vaginal pool of secretion
d)distortion of cavity

42.  Recurrent miscarriage
 early miscarriage due to defective
implantation
 second trimester miscarriage due
to distortion of cavity

43.  A/E reveal a pelvic mass with smooth or
irregular surface and firm consistency
 Except in case of pedunculated fibroids lower
border may not be palpable
Signs

44.  Bimanual palpation is done to
differentiate between an ovarian tumour
and fibroid
 In case of fibroid uterus is not felt
separated also there will be transmitted
mobility