benign uterine masses part 1 Flashcards
what are the most common benign lesions of the uterus ?
leiomyomata/fibroids
what are other terms that mean leiomyomata ?
fibriods
fibromyomata
myomata
what is the etiology of fibroids ?
hyperestrinism
growth factors
genetic factors
what hormone is responsible for the growth of fibroids ?
oestrogen
what are fibrioids commonly associated with ?
endometrial hyperplasia
when do we most commonly see fibroids in women ?
in their child bearing period ( reproductive age zay el endometriosis ) , they cannot exist before puberty or after menopause
what are the risk factors for leiomyomata ?
nulliparity ( never given birth)
obesity
positive family history
racial factor ( more common in black african women)
why are women who have not given birth more liable to get fibroids ?
due to increased levels of oestradiol
what are the different sites of fibroids ?
corporeal fibroid
cervical fibroid
broad ligament fibroid
what are the types fibroids ?
interstitial myomata subserosa myomata submucosa myomata ( diagnosed by saline infusion sonography) pedunculated SSM submucous fibroid polyp
what is the pattern with
corporeal fibroids
submucosa fibroid polyp
cervical and broad ligament fibroids
corporeal fibroids - multiple
submucosa fibroid polyp - single
cervical and broad ligament fibroids- single
why is the cut section of the fibroid paler than the myometrium ?
due to poor vascularity
what is the nature of the fibroid capsule ?
a pseudo capsule of compressed normal myometrium
what are the pathological changes in fibroids ?
atrophy hyaline degeneration cystic degeneration fatty degeneration calcification red degeneration necrosis infection vascular changes malignant changes
why does atrophy happen in fibroids ?
due to diminished vascularity
when do atrophic changes in fibroids happen ?
after menopause and during the post partum period
what is the most common change in fibroids ?
hyaline degeneration
how does cystic degeneration happen ?
due to absorption of liquified hyaline material
what are the different forms that calcifications can take in fibroids?
peripheral calcification - egg shell
diffuse calcification - womb stone
how can calcifications in fibroids be detected ?
Ultrasound
what is red degeneration ?
hemorrhagic infarction of the uterine leiomyoma (incomplete necrosis)
what is another term for red degeneration ?
necrobiosis
when does red degeneration more commonly happen ?
during pregnancy
what is a common present is the most common presentation with red degeneration ?
fishy odours
sudden severe abdominal pain
fever
vomiting
what are the changes that may happen after torsion of a fibroid ?
vascular changes ( oedema and congestion) necrosis
what are the malignant changes in fibroids ?
leiomyosarcoma
when do we clinically suspect a leiomyosarcoma ?
fibroids presenting with postmenopausal bleeding
rapid increase in size of myoma
rapid recurrence after myomectomy
post-menopausal growth of a pre-existing fibroid
what is the effect of fibroids on the uterus ?
myometrium shows increased vascularity
uterine cavity is enlarged
uterus may be displaced in position
what are the associated conditions with fibroids ?
endometrial and myometrial hyperplasia
endometriosis
adenomyosis
endometrial carcinoma
what is the effect of fibroids on the urethra ?
ureteric compression
lateral displacement of the ureter
what are the features of a typical patient who may be suffering from a fibroid ?
a nulliparous 25-45 year old woman usually asymptomatic
what are the symptoms associated with symptomizing fibroids ?
menstrual symptoms pressure symptoms pain infertility leucorrhea abdominal mass pregnancy complications general symptom od anemia
what are the menstrual symptoms associated with symptomizing fibroids ?
menorrhagia
metrorrhagia
polymenorrhea
what are the pressure symptoms associated with symptomizing fibroids ?
urinary frequency and incontinence
loin pain due to ureteric compression
pressure on pelvic veins causing LL oedema
pressure on pelvic nerves
when is pain associated with fibroids ?
painless until complicated
what are the causes of infertility in fibroids ?
uncommon but interference with implantation tubal obstruction interference with ascent of sperm associated conditions ( salpingoophoritis )
what does a fibroid look like on clinical examination ?
central suprapubic mass
firm in consistency
moveable from one side to the other
what are the indications to operate on a symptomless fibroid ?
no symptoms no treatment unless the patient is :
pregnant more than 14 weeks
pedunculated subserous fibroid
or under any suspicion of malignancy
when is medical treatment indicated ?
menorrhagia with a pregnant uterus less than 12 weeks
with the aim to control the menorrhagia
what medications are used for the management of fibroids ?
progestins, danazol and anti-progesterone LHRH agonists ( leuprolide acetate)
what is the definitive surgical management of fibroids ?
hysterectomy
what is the non definitive surgical management of fibroids that can be used to maintain fertility ?
myomectomy
what are the contraindications to a myomectomy ?
after menopause or in premenopausal women
during pregnancy
at CS
suspicion of sarcomatous change
when do we perform a vaginal myomectomy ?
in fibroid polyp
what are the symptoms of cervical fibroids ?
they have no effect of menstrual function but may present with pressure symptoms
what type of surgery can be used for a small myomata within the cavity ?
Hysteroscopic Myomectomy
