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  • 1. Leiomyoma
    • Epidemiology
    • Incidence: somewhere b/w 20-75% of reproductive age women
      • Each uterus harbors ~6.5 tumors
    • Prevalence of fibroids in infertile women can be as high as 13%
      • but no direct link has been established
    • Risk factors
    • 3x higher incidence among Black population
    • Nulliparity
    • Obesity (risk increases by 21% for each 10kg of weight gain)
    • Nonsmokers
    • Signs and Symptoms
    • Asymptomatic!
    • Menstrual disturbances
      • Menorrhea (30%)
      • Metrorrhagia
      • Dysmenorrhea
    • Pelvic pain + dysmenorrhea/pressure (30%)
    • Dyspareunia
    • Infertility (27%)
    • Persistent spontaneous abortions (3%)
    • Irregular hard fundal mass upon PE
    • Pathogenesis/Etiology
    • Benign smooth muscle tumors
      • Arise independently
      • Estrogen/Progesterone sensitive
    • Found almost exclusively in the myometrium, only infrequently involving other uterine structures
    • Most have a normal karyotype
      • ~40% have a chromosomal abnormality, with 6 known cytogenetic subgroups
    • Location determines symptoms:
      • Submucosal  friable hemorrhage  AUB
      • Lower anterior  compression of bladder  urinary frequency sx
      • Near uterine arteries  compression of blood supply  sudden pain and potential for infarct
      • Intracavity  prevents implantation  infertility
    Magnetic resonance scan showing a bright endometrioma (A) with a dependent clot. The arrows show small intramural fibroids Intracavity fibroid seen by hysteroscopy Lei Moma is a 33 y/o G1P0 obese African-American woman who presents to the clinic today with a chief complaint of heavy menses. Further history reveals fertility problems and pelvic pain x 3 years. Her PE was notable for a hard irregular 15wk size uterus that was tender to palpation. Multiple fibroids were seen on ultrasound.
  • 2. References Robbins and Cotran: Pathophysiologic Basis of Disease. 7 th ed. 2005. Lethaby A, Fibroids (uterine myomatosis, leiomyomas). Am Fam Physician. 2005 May 1;71(9):1753-6. PMID: 15887454 Hart R. Unexplained infertility, endometriosis, and fibroids. BMJ. 2003 Sep 27;327(7417):721-4. PMID: 14512481 Aggarwal BK, Panwar S, Rajan S, Aggarwal A, Ahlawat K. Varied appearances & signal characteristics of leiomyomas on MR imaging. Indian J Radiol Imaging [serial online] 2005 [cited 2008 Jul 2];15:271-6. Degenerative Leiomyomas 65% of leiomyomas are degenerative Hyaline (>60% of cases) Cystic (~4%) Red Mucinous Fibrotic (typical change with age) Hence the term “fibroids” Also may see hemorrhage, necrosis, and calcification (~4% of cases) Edema is a common histopathologic finding (~50% of cases) Sarcomatous is controversial Unusual Leiomyomas Lipoleiomyoma Myxoid leiomyoma The “Dr. Chun Special” 2Cs, 2Hs, 2omatous, fatty C ystic C alcific H emorrhagic H yaline myx O matous sarc O matous F atty Uterine Leiomyoma with Degeneration • This is a solitary, ovoid leiomyoma which has been bisected. • The center is soft, brown and degenerated. • Arrow shows the rim of firm, white tissue typical of a leiomyoma. Robbins: A , Leiomyomas of the myometrium. The uterus is opened to reveal the tumors bulging into the endometrial cavity and displaying a firm white appearance on sectioning. B , Leiomyoma showing well-differentiated, regular, spindle-shaped smooth muscle cells. Sharply circumscribed, discrete, round, firm, gray-white tumors varying in size Characteristic whorled pattern of smooth muscle tissue large leiomyoma with "red degeneration