1. ASSOCIATE PROFESSOR IOLANDA BLIDARU
Leiomyoma of the uterus
ASSOCIATE PROFESSOR IOLANDA BLIDARU
MD, PhD

2. Epidemiology The commonest of all pelvic T. (1/3).
20% of female > 35 years have fibroid.
Childbearing life.
Often enlarge during pregnancy or
during oral contraceptive use, and regress after menopause
occur in women of reproductive age, often

3. Uterus deprived from a baby consoles itself with a fibroid.

4. Causes
Unknown
Hyperestrogenemia – E2 / ER, P / PR, GnRH, growth factors (IGF-1, EGF< PDGF< FGF)
Race
Obesity
Chromosomal abnormalities (7, 12, 14)

5. Pathology MACROSCOPY site shape size consistency cut section capsule
number
varieties

6. Uterine leiomyoma
Cervical
1-2%
solitary
Corporeal
98%
multiple

7. Corporeal leiomyoma Subserous 18% submucus 24% not capsulated
Interstitial
58%

12. Cervical leiomyoma Exocervix Supravaginal cervix sessile pedunculated
small
sessile
polypoid
Supravaginal cervix
sessile
pedunculated

13. CONSISTENCY Firm Harder (hyaline degeneration).
Soft (pregnancy-cystic degeneration).
Stony hard (Calcification)

14. Leiomyomata Uterus

15. CUT SECTION well demarcated surrounding muscle.
whorly (intermingling muscle fibers and fibrous tissue).
paler than surrounding (ischaemia).

16. Microscopic Examination
Few formed blood vessels (blood lakes).
Smooth muscle cells and fibrous tissue cells.

17. Leiomyoma:

19. Changes occuring with fibroid
General
Genital tract
Tumor itself

20. Genital tract Endometrium - hyperplasia
Tubes - inflammation (salpingitis)
Endometriosis (30-40%)

21. Tumour itself Benign degeneration Malignant degeneration atrophic
hyaline
red
cystic
fatty
calcification
necrosis with or without infection
vascular (edema, lymphangiectasia)
Malignant degeneration
( % - growth after menopause, rapid enlargement, recurrent fibroid polyp).

22. DIAGNOSIS
History
Examination.
Investigation.
D.D.

23. SYMPTOMS No symptom Bleeding (menorrhagia - metrorrhagia).
Pain - uncomplicated → congestion → dysmenorrhea; complicated → degeneration (malignant, infection, torsion)
Infertility
Mass
Discharge
Pressure symptoms (urinary, lower limb edema, constipation)

24. Signs Symmetrically enlarged uterus (submucosal fibroid)
Asymmetrically enlarged uterus (subserous fibroid)

25. Investigations Clinical (examination)
Laboratory (Hb, Ht, urinary tests, pregnacy test, Pap test etc)
Imaging & instrumental techniques (US, hysteroscopy, hysterography, colposcopy, fractional curettage, Ct scan)
Miscellaneous (intravenous urography, etc)

26. DIFFERENTIAL DIAGNOSIS
Pregnancy (normal / abnormal)
Ademomyosis. Leiomyomas - myomectomy, adenomyosis - hysterectomy
Solid Adnexal Mass (fibromas, Brenner tumors, inflammatory mass)
Uterine Leiomyosarcoma ( histologically - the presence of infiltrative margins, nuclear atypia, and increased mitotic figures )

27. Uterus Adenomyosis:

28. DIFFERENTIAL DIAGNOSIS

29. Uterine Leiomyosarcoma

30. Treatment of Leiomyoma
No treatment
Conservative
Radiological
Surgical
GnRH agonists
Uterine artery embolization.
Patient (age, parity, symptoms).
Tumor (number, size, type)
Complications.

31. Treatment of Leiomyoma
MEDICAL
Progesterone / Progestins
Selective PR modulator / antagonist (Mifepristone, Ulipristal)
GnRH agonists (Buserelin, Triptorelin, Leuprolid, Histerelin, Goserelin)

32. Myomectomy (Hysteroscopy, laparoscopy, laparotomy) Hysterectomy
SURGICAL
Myomectomy (Hysteroscopy, laparoscopy, laparotomy)
Hysterectomy