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  1. 1. Leiomyoma <ul><li>Epidemiology </li></ul><ul><li>Incidence: somewhere b/w 20-75% of reproductive age women </li></ul><ul><ul><li>Each uterus harbors ~6.5 tumors </li></ul></ul><ul><li>Prevalence of fibroids in infertile women can be as high as 13% </li></ul><ul><ul><li>but no direct link has been established </li></ul></ul><ul><li>Risk factors </li></ul><ul><li>3x higher incidence among Black population </li></ul><ul><li>Nulliparity </li></ul><ul><li>Obesity (risk increases by 21% for each 10kg of weight gain) </li></ul><ul><li>Nonsmokers </li></ul><ul><li>Signs and Symptoms </li></ul><ul><li>Asymptomatic! </li></ul><ul><li>Menstrual disturbances </li></ul><ul><ul><li>Menorrhea (30%) </li></ul></ul><ul><ul><li>Metrorrhagia </li></ul></ul><ul><ul><li>Dysmenorrhea </li></ul></ul><ul><li>Pelvic pain + dysmenorrhea/pressure (30%) </li></ul><ul><li>Dyspareunia </li></ul><ul><li>Infertility (27%) </li></ul><ul><li>Persistent spontaneous abortions (3%) </li></ul><ul><li>Irregular hard fundal mass upon PE </li></ul><ul><li>Pathogenesis/Etiology </li></ul><ul><li>Benign smooth muscle tumors </li></ul><ul><ul><li>Arise independently </li></ul></ul><ul><ul><li>Estrogen/Progesterone sensitive </li></ul></ul><ul><li>Found almost exclusively in the myometrium, only infrequently involving other uterine structures </li></ul><ul><li>Most have a normal karyotype </li></ul><ul><ul><li>~40% have a chromosomal abnormality, with 6 known cytogenetic subgroups </li></ul></ul><ul><li>Location determines symptoms: </li></ul><ul><ul><li>Submucosal  friable hemorrhage  AUB </li></ul></ul><ul><ul><li>Lower anterior  compression of bladder  urinary frequency sx </li></ul></ul><ul><ul><li>Near uterine arteries  compression of blood supply  sudden pain and potential for infarct </li></ul></ul><ul><ul><li>Intracavity  prevents implantation  infertility </li></ul></ul>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. 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. http://radiology.uchc.edu/eAtlas/GYN/153.htm 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 &quot;red degeneration http://library.med.utah.edu/WebPath/FEMHTML/FEM029.html