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Gross Appearance
Rare only a single ， usually many exist
Well-circumscribed ， nonencapsulated
A pseudocapsule is present.
The consistency is usually firm or even hard
except when degeneration or hemorrhage has
occurred.
color ： light gray or pinkish white
cut section ： an intertwining pattern or
a whorl-like arrangement ；
bulgy
pseudocapsule
假包膜
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Smooth muscle tumors of the uterus are often
multiple. Seen here are submucosal, intramural,
and subserosal leiomyomata of the uterus.
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Classification （ 1 ）
According to growth location ：
• Myomas on the body of uterus （ 90% ）
• Myomas on the cervix of uterus （ 10% ）
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Classification （ 2 ）
According to the relation to uterine muscle ：
• Submucous （ 10 ～ 15% ）
• Intramural （ 60 ～ 70% ）
• Subserosal （ 20% ）
Few leiomyomas are actually of a single “pure” type.
— hybrids
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Degeneration
Hyaline degeneration
Cystic degeneration
Red degeneration
Sarcomatous change
The others ： fat degeneration
calcification
the secondary infection
Result from the diminished
vascularity of the
connective-tissue element
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Red Degeneration
Occasionally seen as a complication of
pregnancy （ during pregnancy or immediate postpartum
period ）
The pathogenesis is unknown ， may be the result
of the accumulation of blood in the tumour
because of venous obstruction.
The cut surface resembles raw meat.
Clinical features ： a cause of pain （ acute ）
fever
rapid growth ， tender
产褥期
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Here is a very large
leiomyoma of the uterus
that has undergone
degenerative change and is
red (so-called "red
degeneration"). Such an
appearance might make
you think that it could be
malignant. Remember that
malignant tumors do not
generally arise from benign
tumors.
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Sarcomatous Change
Rare ： 0.4% ～ 0.8%
More common at 40 ～ 50 years old
Usually occur in intramural fiboids
grow quickly
vaginal bleeding
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Observation and Follow Up
Small ， asymptomatic fibroids need not be
treated ， especially near menopause.
Interval ： 3 ～ 6 months
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Medical Treatment
Androgenic agents ： testosterone propionate
GnRH-a ：
• induce a hypoestrogenic pseudomenopausal
state
• not recommended for longer than 6 months
• “add-back” regimens
丙睾
反向添加疗法，垫背疗法
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Surgery Treatment （ 1 ）
Indications ：
greater than 10 weeks’ gestational size
menorrhagia ， lead to anemia
have pressure symptoms
grows rapidly
failure of medical treatment
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Surgery Treatment （ 2 ）
Method ：
Myomectomy—conservative therapy
preserve fertility
significant risk of recurrence
Hysterectomy— radical therapy
Subtotal hysterectomy
hysterectomy
子宫切除术
myomectomy
肌瘤剔除术
Only true “cure”
for leiomyomas
次全子宫切除术
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Uterine Leiomyomas
Complicating Pregnancy
impact on pregnancy ： abortion
impact on delivery ： premature labour
fetal malpresentation
retained placenta
placenta previa
need for operative delivery
（ birth canal
obstruction ）
postpartum hemorrhage
Conservative treatment
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Critical Points
May be related to superabundant estrogen.
Well-circumscribed ， nonencapsulated.
Have a pseudocapsule.
Can be classified into submucosal 、 intramural
and subserosal types.
Different types have different features.
Menorrhagia is common.
Four degeneration types
Individualized treatment ， include observation 、
medical treatment and surgical treatment.
