FIBROMYOMAS.

Slides:



Advertisements
Similar presentations
1 Female Reproductive Disorders. 2 Problems Related to Menstruation Premenstrual Syndrome Dysmenorrhea Oligomenorrhea Amenorrhea Menorrhagia Metrorrhagia.
Advertisements

Max Brinsmead PhD FRANZCOG January 2010
Pelvic Pain Mr James Campbell.
Pelvic Ultrasound By. Alaa Malki.
ENDOMETRIOSIS By: Tanel Baehr. WHAT IS IT? o An often painful disorder in which the tissue that normally lines the inside of the uterus (the endometrium)
Nursing Management: Female Reproductive Problems Chapter 54 Overview Chapter 54 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier.
Abnormal uterine bleeding
Endometrium Dr. Raid Jastania.
,, Presence of functioning endometrial glands and stroma outside their usual location ( the uterine cavity) ”.
Leiomyoma, Uterus (Fibroid)
UTERINE FIBROIDS Hazem Al-Mandeel, M.D Course 481 Obstetrics and Gynecology Rotation.
Women’s Hospital, School of Medicine Zhejiang University Prof. Lin Jun
 It is benign uterine tumour consist of smooth muscles,it can present anywhere in the uterine wall.it could be intrmural,subserosal,  Submucosal,cervical.
Myoma of Uterus Xu Hong Synonyms leiomyoma of uterus leiomyomas fibromyomas myofibromas fibroids fibromas myomas.
Reproductive health. Cancer Definition Cancer Definition The abnormal growth of cells without normal control of body. Types of Cancer  Malignant Cancer.
Endometrial Cancer ASSOCIATE PROFESSOR Iolanda Blidaru MD, PhD.
ASSOCIATE PROFESSOR IOLANDA BLIDARU
Hysterectomy.
 Not being able to get pregnant  Common causes for females:  Fallopian tube blockage  Ovulation disorders  Polycystic ovary syndrome  endometriosis.
Gynaecological Causes of Acute Pelvic Pain Max Brinsmead MB BS PhD May 2015.
Academic Year MSIII Ob/Gyn Clerkship Self-Directed Study
( also called uterine Leiomyoma, Myoma, Myomata uteri, fibromyoma).
Department Of Obstetric & Gynecology PELVIC MASS
Uterine myoma and sarcoma Fudan University Weiwei Feng, MD,Ph
FEMALE GENITAL SYSTEM PREMED H&P.
Post-menopausal bleeding PV Dr Nasira Sabiha Dawood.
Ovarian Tumours Max Brinsmead MBBS PhD November 2014.
Computed tomography scan of the abdomen shows a large cystic mass in the abdomen and pelvis without solid tissue or septations (measurement: 43×20×31-cm.
Sex Part 2.
In the name of God Isfahan medical school Shahnaz Aram MD.
Endometrial Carcinoma
Component 3-Terminology in Healthcare and Public Health Settings
Tumors of Cervix.
Ovarian Cyst And Its Complication
Endometrial Cancer By Jessica Hall. Symptoms Unusual vaginal bleeding or discharge Difficult or painful urination Pain during intercourse Pain in the.
By: Maureen Jaminal BIOL 316
ENDOMETRIOSIS Akmal Abbasi. DEFINITION The presence of functional endometrial tissue outside the uterine cavity.
Postmenopausal bleeding
Early Pregnancy Loss and Ectopic Pregnancy
Uterine Fibroids for Undergraduates
ENDOMETRIOSIS. Definition Is a condition in which tissues similar to normal endometrium in structure and function are found in sites other than the lining.
UTERINE CORPUS. ACUTE ENDOMETRITIS Is most often related to intrauterine trauma from instrumentation, intrauterine contraceptive device or complications.
DYSFUNCTIONAL UTERINE BLEEDING Gem Ashby MD OB/GYN.
Dr. Ahmed jasim Ass.Prof.MBChB-DOG-FICMS COSULTANT OF GYN. & OBST. COSULTANT OF GYN. & OBST.
Endometriosis د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد.
Endometriosis and Adenomyosis
Endometriosis. Objectives of this lecture: 1.To know the definition of endometriosis. 2.To know the theories of pathophysiology. 3.To know the demographic.
Endometriosis, Fibroids, PCOD Dr: Salah Ahmed. Endometriosis - presence of endometrium (glands and stroma) outside the uterine cavity - occurs in as many.
Leiomyoma of uterus Liuna
1 UTERINE LEIOMYOMAS OUYANG,W.X. DEP GYNECOL & OBSTET UNION HOSPITAL TONGJI MEDICAL COLLEGE HUAZHONG UNIV SCIE TECH.
Lecture TWO Ultrasound Evaluation of the Uterus Holdorf.
Reproductive Blueprint
Alternatives to Hysterectomy
Endometriosis *Is the presence of endometrial glands and stroma outside the endometrial cavity and walls *Deposits proliferate during the menstrual cycle,
UTERINE LEIOMYOMA AND NEOPLASIA
Intravascular leiomyomatosis (A rare case report)
Gynecological disorders in pregnancy
Male and Female Reproductive Health Concerns
Body Systems and Disorders
Female Genital Tract د- نجلاء حنون Lec.1
UTERINE FIBROIDS Dr. SALWA NEYAZI CONSULTANT OBSTETRICIAN GYNECOLOGIST
Dr Fulufhelo Tshivhula Specialist Gynaecologist Polokwane
Uterine Leiomyomas. Uterine Leiomyomas Most common benign uterine tumors Location :uterus ,cervix ,broad ligament Subserosal Intramural Submucosal.
Fibromyomas of the uterus
ENDOMETRIAL CARCINOMA
Practical histopathology
Pearl Woman’s Hospital
Presentation transcript:

FIBROMYOMAS

These are also called leiomyomas , fibroids or myomas. Defn: Benign, uterine neoplasms, arises from the myometrium, primarily composed of smooth muscle These are also called leiomyomas , fibroids or myomas. Generally benign and found in upto 20% of women in the reproductive age group.

etiology 1.25-50% has genetic abnormality, 2.hormone-dependent tumors- estrogen dependent Evidence : Occurs in reproductive age. Fibroids growing faster during pregnancy. After the onset of menopause, uterine fibroids stop growing and even atrophy. the estrogen receptors and progesterone receptors in Uterine fibroid tissue are higher than normal.

3. derived from smooth muscle cells. 4. rarely found before puberty. 5 3. derived from smooth muscle cells. 4.rarely found before puberty. 5.progesterone inhibits the growth .

Anatomy- 1.A typical myoma is a well circumscribed tumour with a pseudocapsule. 2.Firm in consistency . 3.Cut surface – is pinkish white and has a whorled appearance . 4.Blood vessels – lies in the capsule.

(Central portion of the tumour receives least blood supply leading to early degeneration in this part of the tumour). 5.Calcification – begins at the periphery . 6.Microscopically – consists of bundles of plain muscle cells , seperated by fibrous strands .

Types- 1.Intramural or interstitial – 75% , tumour grow symmetrically , within the myometrial wall . 2.Subserous – 10% , tumour grows out wards, towards the peritoneal surface . Subserous Pedunculated subserous (abdominal) parasitic Intraligamentous

3.submucous- 15% , myoma lying towards cavity of uterus , covered by thin endometrium . -either submucosal, pedunculated submucosal or pedunculated vaginal

Unusual form of myomas – Intra-venous myomatosis , with polypoid projections into the veins of the parametrium and broad ligaments . These appear worm-like cords , when pulled out of the veins . Fragments of tumour emboli can cause sudden death ( due to obstruction of blood flow from the atrium).

Majority of myomas arise in the uterus Majority of myomas arise in the uterus . But may also arise from round ligament , uterovarian and uterosacral ligaments , the vagina and the vulva . The intramural and subserous myomas may be single or multiple , varying in size .

The submucous , cervical and broad ligament myomas are usually single The submucous , cervical and broad ligament myomas are usually single. SECONDARY CHANGES – Degenerations – 1.Atrophy –a. shrinkage in size of the tumour after menopause , due to diminished vascularity .

b. Becomes firmer . 2.Calcareous degeneration – Starts in the periphery along the course of vessels . ( phosphates and carbonates of lime are deposited ). Best example of calcareous myomas are – in old patients with long standing myomas (found as womb – stones by radiography).

3. Red degeneration – This complication of uterine myomas develops during pregnancy . Causes severe abdominal pain – myoma becomes tense and tender . Tumour becomes purple red colour

Cystic degeneration

Red degeneration

e. Develops fishy odour f. Patient is febrile e. Develops fishy odour f. Patient is febrile . Needs to be differentiated from – appendicitis , twisted ovarian cyst , pyelitis and accidental haemorrhage . Diagnosed by- ultrasound.

Ovarian tumour

4. Sarcomatous change – a. Extremely rare. ( 0. 5 % of all myomas) b 4.Sarcomatous change – a. Extremely rare . ( 0.5 % of all myomas) b. Intramural and submucous tumours have higher potential for sarcomatous change than subserous tumour. c. Rare under the age of 40 d. Mostly found in post menopausal women suddenly , causing pain and post menopausal bleeding .

sarcoma

e. It is yellowish grey in colour. f e. It is yellowish grey in colour . f. Consistency is soft and friable , not firm like a simple myoma . g. Non-encapsulation of tumour . h. Sarcoma is highly malignant and spreads via blood stream .

Other complications of myomas – 1 Other complications of myomas – 1.Torsion – subserous pedunculated myoma may undergo torsion . - severe abdominal pain because of torsion . 2. Inversion – uterus is turned inside out . caused by submucous fundal myoma. women complains of lower abdominal pain and irregular bleeding.

Ultrasound confirms inversion. 3 Ultrasound confirms inversion . 3. Capsular haemorrhage – Due to rupture of large veins on the surface of a subserous myoma 4. Infection – Common in submucous and myomatous polypi if they project into cervical canal/vagina , causing purulent ,

blood-stained discharge. 5 blood-stained discharge. 5.Associated endometrial carcinoma – Found with myoma in women over 40 years age in 3% cases . SYMPTOMS- 1.menorrhagia , polymenorrhoea, metrorrhagia – in intra-mural and submucous myoma

2.Infertility , recurrent abortions – due to associated PID , endometriosis , Submucous myoma is responsible for recurrent pregnancy loss . 3.pain- heaviness in lower abdomen , acute pain in torsion , haemorrhage and red degeneration . In elderly women – may be sarcoma .

4. Abdominal lump- Large myoma may be observed as an abdominal tumour growing for a long time. Rapid growth occurs only during pregnancy , on OCP , malignancy .

5.Pressure symptoms – frequency and retention of urine more often premenstrually . Constipation is rare . 6.Vaginal discharge. 50% women are asymptomatic. Myomas are detected during ultrasonography.

tumour is mobile from side to side . Signs- 1.Anaemia 2.Abdominal lump – arising from pelvis , well defined margins , firm in consistency and having smooth surface. tumour is mobile from side to side .

Differential diagnosis- 1.Pregnancy 2.Haematometra 3.Adenomyosis 4.Bicornuate uterus 5.Endometriosis , chocolate cyst 6.Ectopic pregnancy 7.Chronic PID 8.Benign/malignant ovarian tumour

9. Endometrial cancer 10. Myomatous polyp 11 9.Endometrial cancer 10.Myomatous polyp 11.Chronic inversion of uterus 12.Pelvic kidney

INVESTIGATIONS- 1. Hb, blood group 2 INVESTIGATIONS- 1.Hb, blood group 2.USG- a well defined rounded tumour , hypoechoic with cystic space if degeneration has occurred . 3.Hysterosalpingography – confirms submucous myoma and checks the patency of fallopian tubes in infertility.

4.Hysteroscopy – recognizes submucous polyp , excision is made under direct vision . 5.D/C - is required to rule out endometrial cancer . 6.Laparoscopy – in inversion of uterus while excising a myomatous polyp .

TREATMENT- Small and asymptomatic myomas need no treatment , observe every 6 months . Indications for treatment – 1.Infertility 2.Symptomatic myomas 3.Rapid growth of myomas in menopausal women 4.When nature of tumour cannot be ascertained clinically .

Medical treatment- 1. Iron therapy – for anaemia 2 Medical treatment- 1.Iron therapy – for anaemia 2.Drugs to control menorrhagia – Danazol 400-800 mg daily for 3-6 months. Ru 486 (mifepristone ).50mg daily for 3 months . Treatment is costly and only advocated in young women .

Surgery- 1. Myomectomy – in infertile/desirous of child bearing Surgery- 1.Myomectomy – in infertile/desirous of child bearing . Myomectomy should be performed in pre ovulatory menstrual cycle to reduce blood loss during surgery .

Complications of myomectomy- 1 Complications of myomectomy- 1.Haemorrhage – primary / reactionary / secondary . 2.trauma- to the bladder , ureter and bowel during surgery 3.Infection 4.Adhesions/intestinal obstruction 5.Recurrence of myomas .

Hysterectomy – is indicated in women over 40 , multiparous women or associated with malignancy. Complications of hysterectomy- 1.Haemorrhage – primary , reactionary and secondary. 2.Trauma- to bladder and bowel . 3.Sepsis.

4. Anaesthetic complications. 5 4.Anaesthetic complications . 5.Paralytic ileus , intestinal obstruction due to adhesion . 6.Thrombosis- pulmonary embolism

Family planning – Avoid OCP , IUCD Choose barrier method.

Treatment of sarcoma uterus – 1 Treatment of sarcoma uterus – 1.Total hysterectomy with bilateral salpingo-oophorectomy , followed by a full course of radiation therapy . 2.Radical hysterectomy with bilateral lymph node excision , followed by radiation therapy – if the growth is in the region of isthmus or cervix .

5 year cure rate is under 30% Presence of distant metastases is contraindication to surgery . Radiotherapy is ineffective in distant metastases . Chemotherapy is the only choice – combination of cyclophosphamide , vincristine , doxorubicin and actinomycin .