Leiomyoma is commonest benign tumor of uterus and it takes origin from smooth muscle cells of myometrium

1. Dr. Chaduvula Suresh Babu
Professor
Dept. of OBGYN
GIMSR
Visakhapatnam, AP, India

2.  It is a benign tumour arising from smooth
muscle cells of the Uterus and smooth
muscle cells of vasculature.
 Histologically it has both smooth muscle
fibrils along with fibrous tissue

3.  Fibroid
 Myoma
 Fibromyoma
 Leiomyoma

4.  Mot common benign tumour of the uterus
 Mot common benign neoplasm in female
body

5.  20-40 % in reproductive age group women

6.  Unknown
 Monoclonal origin – arises from single cell
 Genetic Basis definite - Chromosomal
abnormalities at 6 & 7 like deletion and
rearrangement.
 Runs in families – Genetic predisposition
 Growth factors – IGF- I, IGF- II, EGF, TGF

7.  Age – between 35 to 45 years
 Early menarche
 Nulliparous
 Diabetic and Hypertensive
 Obesity
 Family History

8.  Multi-parity
 Cigarette smoking
 Progesterone contraceptive pills
 COC pills

9.  Oestrogen dependent ?
 1. uncommon before puberty and regress in
menopause
 2. grows in pregnancy
 3. contains more oestrogen receptors
 4. frequent association with anovulation

10.  Genetic Factors:
 Translocation between chrom. 12 & 14
 Trisomy 12
 Deletion – chromosome 3 or 7
 Rearrangement of short arm of chromosome
6

11.  Uterine and Extra-uterine
 Uterine – Body and Cervix
 Uterine Body – Intramural, sub-serous,
sub-mucus
 Cervix – central, lateral, posterior
 Extra-uterine – Broad ligament, Round
ligament and utero-sacral ligament,
Parasitic, Wandering fibroid

15.  1. Leiomyomatosis peritonealis disseminata
 2. Leiomyomatosis vascularis.

16.  Well circumscribed, multiple, discrete,
whitish
 False capsule
 Whorled appearance
 Trabeculated
 More vascular in periphery
than central

17.  Smooth muscles with connective tissue like
fibrous tissue

18. Degenerations of Fibroid
 Hyaline degeneration – most common
 Cystic
 Fatty
 Calcific degeneration
 Atrophic
 Red or Carneous degeneration in Pregnancy
 Sarcomatous - rarest

19.  Necrosis – sub-mucus fibroid
 Infection – sub-mucus fibroid
 Vascular changes – Telangiectasis and
Lymphangiectasis

20.  Uterus – enlarged , distorted shape,
myohyperplasia
 Ovaries – congested
 Fallopian tube – inflamed in 15 %
 Ureter – Kinking, hydroureter and
hydronephrosis
 Endometriosis – 30%
 Pelvic congestion
 PID – 15%
 Endometrial cancer – 3%

21.  Degeneration
 Pressure and Pain
 Hydroureter and Hydronephrosis
 Anovulation
 AUB
 Infertility
 Infection – sub-mucus
 Incarceration – in pouch of Douglas
 Torsion
 Sarcoma

22.  Menorrhagia
 Metrorrhagia
 Dysmenorrhea – congestive and spasmodic
 Infertility – 2-10%
 PID
 Pressure and Pain
 Abdominal Lump
 Ascites and Polycythemia

23.  Abortion
 Preterm Labour
 IUGR
 Malpresentation and Malposition
 Obstructed Labour
 PPH
 Inversion
 Delayed Involution
 Red degeneration and increase in size of
tumor

24.  Pallor
 Obese
 Lump - if it I2 week size and more, firm,
non-tender, mobile, lower border not felt
 PSE – cervix pulled up
 PVE – irregularly enlarged, nodular,
transmission of movement felt and no groove
felt

25.  Ultrasound
 Hypoechoeic, well circumscribed lesion,
mixed echogenic
 Gold standard test
 Trans-abdominal
 Trans-vaginal

31.  IVP – course of ureter
 HSG – Infertility
 MRI – Accurate diagnosis
 Endometrial Biopsy – to exclude malignancy
 Others:
 Hemoglobin, Blood group, KFT, BT,CT, PT, INR
 Urine RME

32.  Pregnancy
 Adenomyosis
 Endometriosis
 Hematometra
 Pyometra
 Leiomyosarcoma
 Cancer Endometrium
 Ovarian tumour

33.  50 % are asymptomatic
 12 week fibroid
 Near menopause
 Follow-up – every 6 months

34.  1. Antiprogeterones – Mifepristone
 2. GnRH analogues – Agonists and Antagonists
Goserlin,Luporelin,Naferlin,Buserelin –
agonists
Cetrorelix, Ganirelix
 3. LNG – IUS - Mirena
 4. COCs – combined oral contraceptive pills

35.  5. SPRMs – selective progesterone receptor
modulators - ASOPRISINIL
 6. PG synthetase inhibitors – Ibuprofen
 7. Androgens – Danazol, Gestrinone
 8. Somatostatin analogue – Lanreotide
 9. Anti-fibrinolytics – Tranaxamic acid
 10.SERM – Raloxifene
 11.Progestogens – Medroxy progesterone
acetate

36. Aromatase inhibitors
 Directly inhibit estrogen synthesis & rapidly
produce hypoestrogenic state.
Fadrozole is tried in couple of studies
 71 % reduction occurred in 8 weeks
 Appears to be promising therapy.

37.  Myomectomy – Infertility patients
By laparo or Hysterocopy guided or
conventional
Before Myomectomy –
1. adequate blood to be arranged,
2. consent for hysterectomy
3. GnRH therapy for 3 months

38.  For submucous myoma causing infertility,
RPL, AUB or pain
 Criteria :- < 5 cm in size
< 50 % intramural component
< 12 cm2 uterine size
 Gn RH analogue may be given preoperatively
 Advantages are short procedure , rapid recovery
& all disadvantages of laprotomy avoided.

39.  1. Transabominal
 2. Non-decent vaginal
 3. Laparsocopic

40.  Uterine Artery Embolisation (UAE)
 Polyvinyl alcohol particles, Gel foam through
femoral artery.
 Magnetic resonance guided focussed
ultrasound surgery [MRgFUS]
 Laparocopic Myolysis - LASER
 Cryomyolysis. – LIQUID Nitrous oxide

41. Thank You All