leiomyoma fibroid uterus gynaecology

1. FIBROID UTERUS
TONY K S
2010 MBBS

2. FIBROID UTERUS
COMMONEST SOLID BENIGN TUMOUR OF UTERUS
COMMONEST BENIGN TUMOUR OF PELVIS

3. FIBROIDS HAVE A PSEUDOCAPSULE &
WHORLED APPEARNACE

4. ESTROGEN DEPENDANT TUMOURS
GROWS DURING PERGNANCY
REGRESSES FOLLOWING MWNOPAUSE
A/W EALRY MENARCHE & LATE MENOPAUSE

5. HISTOLOGY
COMPOSED OF SMOOTH MUSCLES
INTERSPERSED WITH VARYING
AMOUNTS OF FIBROUS TISSUE
LEIOMYOMA / MYOMA/ FIBROMYOMA

6. ETIOLOGY
ESTROGEN ,GH, HPL
PROLIFERATION OF THE MYOMETRIUM OR MUSCLES OF BLOOD VESSEL WALLS

7. RISK FACTORS FOR FIBROID
NULLIPARITY
 OBESITY
 EARLY MENARCHE
 EXOGENOUS HORMONES – OCPs
 ETHNICITY – AFROCARRIBEAN
 INFERTILITY
FAMILY HISTORY

8. CHROMOSOMAL ANOMALIES INVOLVED
IN FIBROID

9. TYPES OF FIBROIDS
FIBROIDS
UTERINE
EXTRA -
UTERINE

10. UTERINE FIBROIDS
UTERINE
FIBROIDS
BODY OF
UTERUS
SUBSEROSAL
INTRAMURAL
SUBMUCOSAL
CERVIX

11. EXTRA UTERINE FIBROIDS
EXRA UTERINE
INTRA
LIGAMENTARY
ROUND
LIGAMENT
UTERO OVARIAN
LIGAMENT
UTERO SACRAL
LIGAMENT
VAGINAL
VULVA

12. TYPES OF FIBROIDS

13.  MOST COMMON
 WITHIN THE MYOMETRIUM
 THIN CONNECTIVE TISSUE SEPARATING FROM MYOMETRIUM } PSEUDOCAPSULE
 BLOOD SUPPLY – THROUGH THE PSEUDOCAPSULE
 ENLARGE TO FORM SUBMUCOUS/SUBSEROUS
INTRA MURAL

14. SUBSEROUS FIBROIDS
INITIALLY INTRAMURAL
SESSILE
(further extrusion outwards with development of a pedicle)
PEDUNCULATED SUBSEROUS FIBROID
(gets attached to vascular organ & cut off from uterine origin)
WANDERING PARASITIC FIBROID

15. SUBSEROUS FIBROIDS
NO MENUSTRAL SYMPTOMS
ONLY PRESSURE SYMPTOMS  PRESSURE ON BLADDER

16. SUBMUCOUD FIBROID
SESSILE (covered with endometrium)
PEDUNCULATED FIBROID
SUBMUCOUS FIBROID  MENUSTRAL DISTURBANCES (menorrhagia, metorrhagia )
INFERTILITY
RECURRENT MISCARRIAGE ,

17. BROAD LIGAMENT FIBROID
TRUE
RARE
NO ATTACHMENT TO THE UTERUS
URETER MEDIAL TO THE FIBROID
FALSE
COMMON
ARISES FROM THE LATERAL UTERINE WALL
GROWS BETWEEN LAYERS OF BROAD
LIGAMENT
URETER LATERAL TO THE FIBROID

18. Cervical fibroid
INTRAMURAL,SUBSEROUS OR SUBMUCOUS
ANTERIOR/POSTERIOR/CENTRAL/LATERAL
IMPACTED IN THE PELVIS BLADDER COMPRESSION URINARYRETENTION
LANTERN ON DOME OF ST PAUL  CERIVICAL FIBROID

19. SECONDARY CHANGES IN FIBROID
 DEGENERATIONS
USUALLY FIRM IN CONSISTENCY LOSES FIRMNESS
 ATROPHY
 NECROSIS
 INFECTION
 VASCULAR CHANGES
 SARCOMATOUS CHANGES

20. DEGENERATION
HYALINE DEGENERATION-65%
MC DEGENERATION
CYSTIC DEGENERATION
 CALCIFIC DEGENERATION-10%
RED DEGENERATION
FATTY DEGENERATION (RARE)
SARCOMATOUS DEGENERATION  LEAST COMMON

21. HYALINE DEGENERATION
Commonest degeneration affecting all fibroids
CENTRAL PORTION (Least vascular)  Most prone to degeneration
CONSISTENCY } soft & elastic
CUT SURFACE } Loss of characteristic whorled appearance
MICROSCOPY } Hyaline changes of muscles and fibrous tissue

22. CYSTIC DEGENERATION
IN AREAS OF HYALINE DEGENERATION
DUE TO LIQUEFACTION

23. IN LONG STANDING MYOMAS
CALCIUM CARBONATE OR PHOSPHATE IS DEPOSITED IN THE PERIPHERY ALONG THE COURSE OF
BLOOD VESSELS  WOMB STONE (CALCIFIED FIBROID)
CACIFIC DEGENERATION

24. OCCURS IN LARGE FIBROID
DURING
PREGNANCY MOST COMMONLY IN 2ND TRIMESTER
PUERPERIUM
VASCULAR CAUSE
THROMBOSIS OF BLOOD VESSELS → COAGULATIVE NECROSIS
RED DEGENERATION

25. RED DEGENERATION
TUMOUR APPEARS DARK
CUT SURFACE
HEMORRHAGIC MEATY
APPEARANCE
MICROSCOPY
EVIDENCE OF THROMBOSIS
NECROSIS OF VESSELS

27. SARCOMATOUS DEGENRATION
LAEST COMMON
TOWARDS CENTRE IN LARGE FIBROID
RAW PORK APPEARANCE

28. OTHER COMPLICATIONS
TORSION
INFECTION
INVERSION OF UTERUS
SUBCAPSULAR HAEMORRHAGE
PSEUDO MEIGS SYNDROME
WANDERING FIBROIDS

29. TORSION
IN PEDUNCULATED SUB SEROUS FIBROID

30. INFECTION
SUBMUCUS PEDUNCULATED PROJECTING IN TO UTERINE CAVITY / VAGINA
FOLLOWING DELIVERY OR ABORTIONPUERPERAL SEPSIS

31. PSEUDO MEIGS SYNDROME
PSEUDO MEIGS SYNDROME
ANY PELVIC
TUMOUR (LARGE
CYSTIC FIBROID)+
ASCITES +
PLEURAL EFFUSION

32. SARCOMATOUS CHANGES
MORE IN INTRAMURAL & SUBMUCOUS
RARE<40YRS
SUDDEN ENLARGEMENT OF FIBROID IN A POST MENOPAUSAL WOMEN
PAIN,BLEEDING

33. MACROSCOPY
YELLOWISH GREYIN COLOUR &
HEMORRHAGIC
SOFT & FRIABLE IN CONSISTENCY
NONENCAPSULATED

34. MICROSCOPY
High cellularity
Nuclear pleomorphism
Increased mitosis- >10/ 10 HPF

35. CLINICAL FEATURES OF FIBROID
SITE IS MORE IMPORTANT THAN SIZE
ASYMPTOMATIC
MENUSTRAL DISTURBANCES
INFERTILITY & RECURRENT ABORTIONS
PAIN
PRESSURE SYMPTOMS
ABDOMINAL LUMP
VAGINAL DISCHARGE

36. MENUSTRAL DISORDERS
MENORRHAGIA MC SYMPTOM
◦ SUBMUCOUS & INTRAMURAL
◦ INCREASED VASCULARITY , INCREASED SURFACE AREA ,ENDOMETRIAL HYPERPLASIA
METRORRHAGIA
MENOMETRORRHAGIA

37. INFERTILITY
A)CORNUAL MYOMAS TUBAL OCCLUSION
B)IMPAIRED GAMETE AND EMBRYO TRANSPORT
C)ALTERED RELATION BETWEEN SEMEN AND VAGINAL POOL OF SECRETION
D)DISTORTION OF CAVITY

38. RECURRENT MISCARRIAGES
 EARLY MISCARRIAGE DUE TO DEFECTIVE IMPLANTATION
 SECOND TRIMESTER MISCARRIAGE DUE TO DISTORTION OF CAVITY

39. PELVIC PAIN
CAUSES:
 RED DEGENERATION
 EXPULSION OF SUB MUCOUS FIBROID
HAEMORRHAGE INTO THE FIBROID
TORSION OF FIBROID
ACUTE RETENTION OF URINE

40. PRESSURE SYMPTOMS
 ANTERIOR & POSTERIOR FIBROIDSURINARY RETENTION
 BROAD LIGAMENT FIBROIDHYDROURETER & HYDRONEPHROSIS
CONSTIPATION
INTESTINAL OBSTRUCTION
Large fibroids causing venous stasis  Oedema of lower limbs
PEDUNCULATED
FIBROID

41. VAGINAL DISCHARGE
RARE
BLOOD STAINED

42. SIGNS
ANEMIA +
ABDOMINAL EXAMINATION
◦ PELVIC MASS WITH SMOOTH OR IRREGULAR SURFACE FIRM CONSISTENCY
◦ MOBILE FROM SIDE TO SIDE
BIMANUAL PALPATION
DIFFRENTIATE BETWEEN AN OVARIAN TUMOUR AND FIBROID

43. DIFFERENTIAL DIAGNOSIS
PREGNANCY
FULL BLADDER
ADENOMYOSIS
PYOMETRA
ENDOMETRIAL CANCER
SOLID OVARIAN TUMOURS
PELVIC INFECTION AND TUBO OVARIAN MASS