1. Women’s Hospital, School of Medicine Zhejiang University Prof. Lin Jun
Uterine Myoma
Women’s Hospital, School of Medicine Zhejiang University Prof. Lin Jun

2. Introduction Most common benign tumor of female reproductive system
Benign neoplasm composed primarily of smooth muscle and connectives tissue
Common in women 30-50y
Usually asymptomatic

3. Etiology Estrogen and ER ↑ Progestin may promote mitosis of myoma
Not detectable before puberty and after menopause
Probably relates to female hormones
Estrogen and ER ↑
Progestin may promote mitosis of myoma

4. Classification According to the location： Uterine body myoma 90%
Cervical myoma %

5. Classification
According to the relationship between myoma and uterine myometrium ：
intramural myoma %-70% 
subserous myoma %
submucous myoma 10%-15%

6. Classification

7. Classification
multiple myoma

8. Pathology Gross Appearance： round, smooth, and usually firm
false capsular covering ——pseudocapsule
can be clearly demarcated from the surrounding myometrium

9. Pathology Gross Appearance： Transverse section : light gray
a whorl-like arrangement or an intertwining pattern

10. Pathology Microscopic examination：
composed of smooth muscle cells and varying amounts of connectives 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.

11. Degeneration Hyaline degeneration Cystic degeneration Red degeneration
Sarcomatous change
Degeneration with calcification

12. Degeneration Red degeneration
most common during pregnancy and puerperium
venous thrombosis and congestion with interstitial hemorrhage

13. Degeneration
← Red degeneration
← Hyaline degeneration

14. Degeneration Sarcomatous change malignant rare, 0.4-0.8% old women
enlarge rapidly with irregular vaginal bleeding

15. Degeneration
Sarcomatous change

16. Symptoms Usually no symptoms
Associate with location, and degenerations
Not associate with the size and the number

17. Symptoms 1. menorrhagia and prolonged menses large intramural myoma
submucous myoma
2. abdominal mass
3. leukorrhagia

18. Symptoms 4. pressure effects 5.others
pressure bladder or rectum → urinary frequency, constipation
intraligamentous myoma and large cervical myoma → obstruct ureter
5.others
infertility
spontaneous abortion
abdominal pain

19. Sign associated with： size location number degeneration
large myoma→ palpable abdominal mass
Pelvic examination：
uterus —— enlarged，irregular and hard

20. Diagnosis Typical symptoms and signs Ultrasound Hysteroscopy
Laparoscopy

21. Ultrasound

22. Ultrasound

23. Diagnosis
Hysteroscopy

24. Diagnosis
Laparoscopy

25. Differential diagnosis
Pregnancy
Ovarian neoplasms
Adenomyosis
Malignant tumors of uterus
uterine sarcoma
endometrial carcinoma
cervical cancer

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

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

28. Medical measure Indications： smaller than 2 months in size
slight symptoms
near menopause

29. Medical measure GnRH-a LH、FSH↓ E2↓ shrinkage of myoma
1.Androgenic agents：
testosterone propionate
2.Gonadotropin-releasing hormone agonist, （GnRH-a）
GnRH-a LH、FSH↓ E2↓
shrinkage of myoma
leuprorilin
goserelin

30. Medical measure 2.GnRH-a 3.Mifepristone Side effects:
Hypoestrogenic side effects
Osteoporosis
3.Mifepristone

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

32. Surgical measures
Approaches：
laparotomy
hystereoscopy
laparoscopy

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

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

35. Myomas during pregnancy
Red degeneration
Clinical finding:
rapid growth of myoma
pain, fever, WBC↑
Conservative treatment

36. Thank You !