Understanding uterine fibroids nchanji nkeh keneth

Understanding Uterine
Fibroids
Nchanji Nkeh Keneth
kennchanji@yahoo.com
B.TECH/HPD MDIRT
POLYVALENT RADIOLOGIC
TECHNOLOGIST/SONOGRAPHER
St. Blaise Clinic, Big Mankon- Bamenda
Medical Imaging Dpt.
Thursday August 9, 2018
10/2/2018 5-1
Nchanji Nkeh Keneth,
excellence660@gmail.com, 671459765, DMU
Training Resource

The Female Pelvic Anatomy
10/2/2018
excellence660@gmail.com,
671459765, DMU Training Resource
2

excellence660@gmail.com, 671459765,
DMU Training Resource
3

Introduction/Summary of Key Issues
Fibroids (aka Myomas, leiomyomas); are
the most common benign tumors of female
reproductive system
Benign neoplasms composed primarily of
smooth muscle and connectives tissue
Common in women 30-50y
Usually asymptomatic
4

what causes uterine fibroids???
Not detectable before puberty and after
menopause
Probably relates to female hormones
Estrogen and ER ↑
Progestin may promote mitosis of myoma
5

Classification
According to the location：
Uterine body myoma 90%
Cervical myoma 10%
6

Classification
According to the relationship between
myoma and uterine myometrium ：
 intramural myoma 60%-70%
 subserous myoma 20%
 submucous myoma 10%-15%
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Classification
8

Classification
multiple myoma
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Pathology
Gross Appearance：
round, smooth, and usually firm
false capsular covering ——pseudocapsule
can be clearly demarcated from the surrounding
myometrium
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Pathology
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Pathology
Microscopic examination：
composed of smooth muscle cells and varying
amounts of connective tissue
Individual cells are quite uniform in size, spindle shaped,
have elongated nuclei.
Nonstriated muscle fibers are arranged in interlacing
bundles of varying size running in different directions.
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Secondary degeneration of
Uterine Fibroids
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Degeneration (secondary changes in the
myoma)
Hyaline degeneration
Cystic degeneration
Red degeneration
Sarcomatous change
Degeneration with calcification
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1-BENIGN DEGENERATION
• Atrophic
• Hyaline  yellow, soft gelatinous areas
• Cystic liquefaction follows extreme hyalinization
• Calcific circulatory deprivation precipitation of
Ca carbonate & phosphate
• Septic circulatory deprivation necrosis 
infection
• Myxomatous (fatty) uncommon, follows hyaline
or cystic degenration

1-BENIGN DEGENRATION (cont’d)
Red (corneous) degeneration
• Commonly occurs during pregnancy
• Edema & hypertrophy impede blood supply
aseptic degeneration & infarction with venous
thrombosis & hemorrhage
• Painful but self-limiting
• May result in preterm labor & rarely DIC
2-MALIGNANT TRANSFORMATION
• Transformation to leiomyosarcoma occurs in 0.1-
0.5%

Degeneration
Red degeneration
most common during pregnancy and
puerperium
venous thrombosis and congestion with
interstitial hemorrhage
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Degeneration
← Red degeneration
← Hyaline degeneration
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Degeneration
Sarcomatous change!!!!!!!!!!!!!!!!!!!!
malignant
rare, 0.4-0.8%
old women
enlarge rapidly with irregular vaginal bleeding
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Degeneration
Sarcomatous change
20

Symptoms
Usually no symptoms
Associate with location, and degenerations
Not associate with the size and the number
21

SYMPTOMS
• Symptomatic in only 35-50% of Pt
• Symptoms depend on location, size, changes &
pregnancy status
1-Abnormal uterine bleeding
• The most common 30%
• Heavy / prolonged bleeding (menorrhagia)  iron
deficiency anemia

Symptoms con’t
2.menorrhagia and prolonged menses
large intramural myoma
submucous myoma
3. abdominal mass
4. Leucorrhea (thick whitish vaginal discharge)
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Symptoms con’t
5. pressure effects
pressure bladder or rectum → urinary frequency,
constipation
 intraligamentous myoma and large cervical myoma →
obstruct ureter
6.others
infertility
spontaneous abortion
abdominal pain
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Pressure effects of uterine fibroids
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Sign
associated with：
size
location
number
degeneration
large myoma→ palpable abdominal mass
Pelvic examination：
uterus —— enlarged，irregular and hard
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Diagnosis
 Typical symptoms and signs
 Ultrasound
 Hysteroscopy
 Laparoscopy
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Ultrasound machine with probes. Courtesy of St.
Blaise Clinic
10/2/2018
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Gynecologic Ultrasound scan over the years
has proven useful in the diagnosis of
Uterine fibroids
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Ultrasound
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Diagnosis
Hysteroscopy
35

Diagnosis
Laparoscopy
36

Differential diagnosis
Pregnancy
Ovarian neoplasms
Adenomyosis
Malignant tumors of uterus
uterine sarcoma
endometrial carcinoma
cervical cancerNchanji Nkeh Keneth,
37

DIFFERENTIAL DIAGNOSIS
• Usually easily diagnosed
• Exclude pregnancy
• Exclude other pelvic masses
-Ovarian Ca
-Tubo-ovarian abscess
-Endometriosis
-Adenexa, omentum or bowel adherent to the
uterus
• Exclude other causes of uterine enlargement:
-Adenomyosis

DIFFERENTIAL DIAGNOSIS
Exclude other causes of abnormal bleeding
• Endometrial hyperplasia
• Endometrial or tubal Ca
• Uterine sarcoma
• Ovarian Ca
• Polyps
• Adenomyosis
• DUB
• Endometriosis
• Exogenouse estrogens

Treatment of Uterine Fibroids
40

TREATMENT
DEPENDS ON:
• Age
• Parity
• Pregnancy status
• Desire for future pregnancy
• General health
• Symptoms
• Size
• Location

2009-2010
USUHS MSIII Ob/Gyn
Clerkship Self Directed Studies
Treatment Options

Treatment
According to :
age
desire for childbearing
symptoms
location , size and amount of myoma
43

Treatment
Observation and Follow Up
Small，asymptomatic，especially near
menopause
Interval：3～6 months
44

Medical measure
Indications：
smaller than 2 months in size
slight symptoms
near menopause
45

Surgical measures
Indications：
greater than 10 weeks in size
menorrhagia→ anemia
pressure effects
grows rapidly
failure in medical treatment
infertility or recurrent abortion
46

Surgical measures
Approaches：
laparotomy
hystereoscopy
laparoscopy
47

Surgical measures
1. Myomectomy
 preserve fertility, <35 years old
2. Hysterectomy
 Large myoma
 Numerous tumors
 Obviously symptomatic patient
 No wish of preserving fertility
 Suspected to malignant transformation
48

Myomas during pregnancy
Impact on pregnancy and delivery ：
abortion
preterm labor
fetal malpresentation
placenta previa
birth canal obstruction
postpartum hemorrhage
49

Myomas during pregnancy
Red degeneration
Clinical finding:
 rapid growth of myoma
 pain, fever, WBC↑
Conservative treatment
50

FIBROIDS IN PREGNANCY
51

Complications of fibroids in
Pregnancy
52
1. Spontaneous abortion
2. Intrauterine growth retardation
3. Preterm labor
4. Uterine dyskinesia
5. Inertia during labor
6. Obstruction of the birth canal
7. Postpartum hemorrhage
8. Hydronephrosis

Complications of fibroids in pregnancy
con’t
9. Placenta Previa
10. Fetal Malrotation/ Malpresentation
11. Caesarean Delivery
• Consistent evidence
• Location in lower uterine segment
• Due to higher risk of malpresentation,
dysfunctional labor, abruption
53

FIBROIDS IN PREGNANCY
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10/2/2018
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References
My Sincerest thanks to
1. Prof. Lin Jun
Women’s Hospital, School of Medicine Zhejiang
University
2Dr. SALWA NEYAZI
CONSULTANT OBSTETRICIAN GYNECOLOGIST
PEDIATRIC & ADOLESCENT GYNECOLOGIST
3. Ruth Stefanski, PGY-1: Uterine Leiomyomas in
Pregnancy. January 12, 2010Nchanji Nkeh Keneth,
61

ANY QUESTIONS
10/2/2018
62

Beri wi ba’a ghor
6310/2/2018

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10/2/2018
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Understanding uterine fibroids nchanji nkeh keneth

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