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Uterine fibroids, Benign tumor of the Uterus (Leimyoma)

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A brief description of uterine fibroids, classifications, degenerative changes, pathophysiology, risk factors clinical presentations and management

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Uterine fibroids, Benign tumor of the Uterus (Leimyoma)

  1. 1. Uterine Fibroids By: Oriba Dan Langoya, MBchB Obs / Gyn Seminar 04/09/2014
  2. 2. Myometrium: Uterine Fibroids • Pathology A fibroid is a benign tumour of uterine smooth muscle, a leiomyoma. • Gross appearance: Firm, whorled tumour located adjacent to & bulging into the endometrial cavity (submucous fibroid) Centrally within the myometrium ( Intramural fibroids) Attached to uterus by narrow pedicle (Pedunculated fibroid)
  3. 3. Pathology • Fibroids can arise separately from the uterus esp. from broad lig presumably embryonal remnants • Appearance may be altered and 3 form are; 1. Red 2. Hyaline 3. Cystic
  4. 4. Pathology 1. Red degeneration is due to acute disruption of blood supply. May present with acute onset of pain and tenderness over the uterus, assoc with mild pyrexia & leukocytosis. 2. Hyaline degeneration; When fibroids outgrow its blood supply
  5. 5. Location of uterine Polyps
  6. 6. Pathophysiology • Aetiology • Key feature is occurrence in reproductive yrs. • Racial or familial predisposition. • Possibility of abnormal ER has been explored • Both main Progesterone Receptor subtypes are expressed in myoma & normal myometrium
  7. 7. Pathophysiology • Exp’t Progesterone has been shown to stimulate production of apoptosis-inhibiting protein and EGF. • Oestradiol has the effect of stimulating expression of EGF • Reduced expression of Inhibitory factors eg MCP-1 may contribute to loss of inhibitory required for fibroid growth • Tx by Ovarian suppression is assoc with increase in MMP and decease in TIMP activity
  8. 8. Pathophysiology • Cytogenic studies: Indiv Myoma are monoclonal in origin but ell from diff myomas within the uterus are independent in origin • Clonal expansion of tumour cell precede dev’t of cytogenic aberration • Common cytogenic aberations are detected in chromosomes 12, 6, 7 , aring chrom 1 & translocation involving 12 & 14. • Relevant areas on chrom 12, 6 & 7 contain putative GR & TSG.
  9. 9. Pathophysiology • Risk of malignant transformation 0.5% • In leimyosarcoma, tissue are of more extensive genetic Instability • With frequent deletions especially involving chromosomes 1 & 10
  10. 10. Clinical Features • Common & detectable in 20% of women over 30yrs • Autopsy shows prevalence of up to 50%. • Risk factors Nulliparity Obesity A family history African racial origin • Majority don’t cause symptoms & identified coincidentally
  11. 11. Clinical Features Common PC Menstrual disturbances Pressure symptoms esp. urinary frequency. Pain is unusual except in acute degeneration Menorrhagia may occur coincidentally
  12. 12. Clinical Features • Subfertility may result from mechanical distortion or occlusion of Fallopian tube • Prevention of implantation esp by submucous fibroids • Risk of miscarriage is not increased once pregnancy is established • In late pregnancy may be the cause of abnormal lie.
  13. 13. Clinical Features • Postpartum hemorrhage may occur due to inefficient uterine contraction. • Abdominal examination may indicate presence of a firm mass arising from pelvis • Bimanual exams; the mass is felt to be part of the uterus usually with some mobility
  14. 14. Differential diagnosis • Other causes of abdominopelvic mass should be evaluated. • Uterus with fibroids is firm in contrast to that enlarged with pregnancy. • An ovarian tumour • Leimyosarcoma typically resent with rapidly enlarging abdominopelvic mass. Less mobility of uterus than expetedin fibroid and general signs of cachexia
  15. 15. Investigations 1. Clinical features alone is usually sufficient 2. Hb conc to help indicate anaemia if there is clinically significant menorrhagia. 3. Ultrasonography is is useful in distinguishing a uterine from an ovarian mass. 4. Imaging of Urinary tract to exclude hydronephrosis 5. Clinical suspicion of sarcoma: do needle biopsy or urgent laparotomy
  16. 16. Hysteroscopic appearance of fibroid polyp within the endometrial cavity
  17. 17. Tx Conservative management is appropriate Ovarian suppression using GnRH agonist Mifepristone has been shown to be effective in shrinking fibroids. Choice of tx is by patients PC and aspiration for normal menstruation and fertility. Hysteroscopic resection Myomectomy Pretreatment with GnRH for 2 months facilitates the process.
  18. 18. Management a) Pelvic examination often reveals an enlarged & tender uterus. b) If the woman has no symptoms and the uterus is not enlarged, no tx is indicated. c) If the woman is symptomatic, hysterectomy is the preferred tx, since adenomyosis does not respond well to hormonal treatment.
  19. 19. THE END

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