1. Leiomyoma, Uterus (Fibroid)
By:
Ali azizi
Alborz hedayati

2. Leiomyoma, Uterus (Fibroid)
Leiomyomas are benign tumors of the uterus
Arise from the overgrowth of smooth muscle and connective tissue in the uterus
A genetic predisposition exists
Female>30(25-50%)

3. Leiomyoma, Uterus (Fibroid)
Evidence of an apparent hormonal dependency includes the following:
1-Estrogen and progestin receptors are present in fibroids
2-Elevated estrogen levels may cause fibroid enlargement. During the first trimester of pregnancy, 15-30% of fibroids may enlarge and then shrink in puerperium. Some fibroids may decrease in size during pregnancy
3-Fibroids shrink after menopause
.y 4-Some regrowth may occur with hormonal therap

4. Leiomyoma, Uterus (Fibroid)
Complications during pregnancy include
Spontaneous abortion
Intrauterine growth retardation
Preterm labor
Uterine dyskinesia
Inertia during labor
Obstruction of the birth canal
Postpartum hemorrhage
Hydronephrosis

5. Leiomyoma, Uterus (Fibroid)
Anatomy
Most leiomyomas occur in the fundus and body of the uterus; only 3% occur in the cervix. The fibroids may be solitary, multiple, or diffuse

6. Leiomyoma, Uterus (Fibroid)
There are three primary types of uterine fibroids, classified primarily according to location in the uterus:
Leiomyoma, Uterus (Fibroid)
There are three primary types of uterine fibroids, classified primarily according to location in the uterus:
These fibroids develop in the outer portion of the uterus and continue to grow outward
Subserosal uterine fibroids
The most common type of fibroid. These develop within the uterine wall and expand making the uterus feel larger than normal (which may cause "bulk symptoms)
Intramural uterine fibroids
These fibroids develop just under the lining of the uterine cavity. These are the fibroids that have the most effect on heavy menstrual bleeding and the ones that can cause problems with infertility and miscarriage
Submucosal uterine fibroids

7. 1 2 3 Leiomyoma, Uterus (Fibroid) Clinical Details
Most women with fibroids are asymptomatic. Only 10-20% of patients require treatment
Fibroid symptoms are related to the number of tumors, as well as to their size and location 1
Bleeding: (Menorrhagia)(Most common) 2
Pain 3
Pressure

8. Bleeding: (Menorrhagia)(Most common)
Leiomyoma, Uterus (Fibroid)
Bleeding: (Menorrhagia)(Most common)
Menorrhagia may result in severe anemia and can be life threatening, although this is rare. Menorrhagia usually results from the erosion of a submucosal fibroid into the endometrial cavity. Rarely, dilated veins on the surface of a subserosal, pedunculated fibroid can cause sudden, massive intraperitoneal bleeding

9. Pain Pressure Leiomyoma, Uterus (Fibroid)
Women may experience abdominal cramping. Pain usually is felt during menstruation. Less often, pain occurs intermenstrually
Pressure
Urinary frequency, urgency, and/or incontinence result from pressure on the bladder
Constipation, difficult defecation, or rectal pain results from pressure on the colon

10. Leiomyoma, Uterus (Fibroid)
Differential diagnosis
Normal ovary - May be confused with fibroids at US
Ovarian mass - Hemorrhagic cyst, endometrioma, dermoid, cystadenoma, malignant tumor Uterine leiomyosarcoma - Rare, arise de novo or as a result of the malignant degeneration of a uterine fibroid Adenomyosis - May be difficult to distinguish from multiple small fibroids Myometrial contraction - Especially during pregnancy Necrotic fibroids - May mimic intrauterine gestational sac, intrauterine fluid collection, hydatiform mole

11. Leiomyoma, Uterus (Fibroid)
Radiogrph findings:
Conventional radiographs have a limited role in the diagnosis of uterine fibroids
Unless heavily calcified, fibroids are not depicted on radiographs
CT findings
CT scanning has a limited role in the diagnosis of uterine fibroids
On CT scans, fibroids are usually indistinguishable from healthy myometrium unless they are calcified or necrotic
Calcifications may be more visible on CT scans than on conventional radiographs because of the superior contrast differentiation with CT scanning

12. Leiomyoma, Uterus (Fibroid)
Sonography
US is the imaging modality of choice in the detection and evaluation of uterine fibroids
The most frequent US appearance is that of a concentric, solid, hypoechoic mass
These solid masses absorb sound waves and therefore cause a variable amount of acoustic shadowing

13. Leiomyoma, Uterus (Fibroid)
Sonogram shows the subserosal, 2.3- to 2.5-cm, right anterior fundal uterine fibroid

14. Leiomyoma, Uterus (Fibroid)
They can be heterogeneous or hyperechoic, depending on the amount of fibrous tissue and/or calcification
Sagittal sonogram shows a posterior, fundal, 4.2 X 3.5-cm intramural uterine fibroid

15. Leiomyoma, Uterus (Fibroid)
CT scan shows a subserosal, 2.3- to 2.5-cm, right anterior fundal uterine fibroid

16. Leiomyoma, Uterus (Fibroid)
MRI findings:
MRI has an important role in defining the anatomy of the uterus and ovaries
Fibroids are sharply marginated areas of low-to-intermediate signal intensity on T1- and T2-weighted MRI scans

17. Leiomyoma, Uterus (Fibroid)

18. Leiomyoma, Uterus (Fibroid)
One third of fibroids have a hyperintense rim on T2-weighted images as a result of dilated veins, lymphatics, or edema.
Sagittal T2-weighted MRI shows that the largest fibroid is located in the lower uterus and has a partially hyperintense rim. A smaller discrete fibroid is depicted in the fundus

19. Note the mass effect on the bladder, which is located anteriorly
Leiomyoma, Uterus (Fibroid)
Axial MRI shows the cross section of the larger fibroid in the lower uterus.
Note the mass effect on the bladder, which is located anteriorly

20. Leiomyoma, Uterus (Fibroid)
An inhomogeneous area of high signal intensity may be depicted on T2-weighted images; this results from hemorrhage, hyaline degeneration, edema, or highly cellular fibroids

21. Leiomyoma, Uterus (Fibroid)
The intravenous administration of gadolinium-based contrast material usually is not required
if it is administered, fibroids usually enhance later than does the healthy myometrium. Fibroid enhancement can be hypointense (65%), isointense (23%), or hyperintense (12%) in relation to that of the myometrium
MRI has a sensitivity of 86-92%, a specificity of 100%, and an accuracy of 97% in the evaluation of probable fibroids

22. Thank you