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Leiomyomas
 

Leiomyomas

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    Leiomyomas Leiomyomas Presentation Transcript

    • Uterine Leiomyoma www.freelivedoctor.com
    • Uterine Leiomyoma www.freelivedoctor.com leiomyomata Uterine fibroids myoma fibromyoma
    • Uterine Leiomyoma
      • Benign neoplasm of smooth muscle
      • Estrogen sensitive
      • Surrounded by pseudocapsule
      • Rare malignant potential (Leiomyosarcoma)
      www.freelivedoctor.com
    • Location www.freelivedoctor.com
    • Leiomyoma www.freelivedoctor.com
    • Leiomyosarcoma www.freelivedoctor.com
    • Prevalence
      • 20-30% of reproductive-age women
      • Most common indication for surgery in U.S. women
      • 1/3 of all hysterectomies
      • 3-fold higher incidence rate in Black women [1,2]
      www.freelivedoctor.com
    • Risk factors
      • African American
      • Nonsmoking
      • Obese
      • Perimenopausal
      • Gene mutations
      www.freelivedoctor.com
    • Genetic basis?
      • Twin studies [3]
      • First-degree affected relatives [4,5]
      • Race as risk factor
      • Hereditary Leiomyomatosis and Renal Cell Carcinoma (HLRCC) [6]
        • Cutaneous and uterine leiomyomata
        • At risk for papillary renal cell carcinoma (women > men) [7,8]
        • Women: increased risk of leiomyosarcoma [7,8]
        • Mutation in fumarate hydratase gene
      www.freelivedoctor.com
    • Signs and Symptoms
      • Bleeding
      • Pressure
      • Pain
      • Infertility
      • Pregnancy complications: cesarean delivery, breech presentation, malposition, preterm delivery, placenta previa, severe postpartum hemorrhage [9]
      • 50-60% Asymptomatic
      www.freelivedoctor.com
    • Diagnosis
      • History
      • Bimanual pelvic or abdominal exam
      • Pelvic ultrasound - most common
      • MRI, HSG, sonohystogram, hysteroscopy
      www.freelivedoctor.com
    • Treatment
      • Expectant management - most cases
      • Indications for treatment
        • Abnormal uterine bleeding, causing anemia
        • Severe pelvic pain
        • Large or multiple
        • Obscuring evaluation of adnexae
        • Urinary tract symptoms
        • Postmenopausal or rapid growth
      www.freelivedoctor.com
    • Treatment Choices
      • Medical therapies
        • Medroxyprogesterone (Provera)
        • Danazol
        • GnRH agonists (nafarelin acetate, Depot Lupron)
      www.freelivedoctor.com
    • Treatment Choices
      • Myomectomy
        • Hysteroscopically
        • Laparoscopically
        • Abdominally
      www.freelivedoctor.com
    • Treatment Choices
      • Uterine Artery Embolization (UAE)
      www.freelivedoctor.com
    • Treatment Choices: MR guided Focused Ultrasound www.freelivedoctor.com
    • Treatment Choices
      • Hysterectomy
        • Vaginal
        • Abdominal
      www.freelivedoctor.com
    • Gene Therapy
      • Gene-based vectors [13]
        • Dominant-negative form of estrogen receptor to inactivate estrogen signaling and induce apoptosis [13]
      www.freelivedoctor.com
    • Follow-up (Treatment)
      • Monitor size and location of fibroids
      • Indications for treatment
        • Abnormal uterine bleeding, causing anemia
        • Severe pelvic pain
        • Large or multiple
        • Obscurrng evaluation of adnexae
        • Urinary tract symptoms
        • Postmenopausal or rapid growth
      www.freelivedoctor.com