Leiomyomas

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Leiomyomas

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

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