Fibroid Flashcards
Def
Incidence
Et
1-Benign tumor in myometrium consisting of smooth muscle fibers and fibrous tissue,
2-25% in child-bearing period.
3-The commonest benign tumor in female genital tract.
4-
•Genetic maternal.
•Racial black.
•E2 dependent
-Nulligravida or low parity
-Anovulation.
-High BMI.
-Early puberty ,Late menopause ( + period of + e2)
Macro patho
- Site
•corporeal
-the most common95%
-multiple and varies in size
-anatomical type :-
1-interstitial : center of the myometry,
2-submucosal: towards endometrium,+_pedicle, 3-subserosal: towards peritoneum,+_pedicle,
•cervical
-less than 5% solitary
-towards peritoneum
- maybe from :-
1-portio vaginalis :compressing the vagina
2-supravaginalis!cervicis: compressing pelvis, ureter,rectum,
•brood ligament
-rare
1-true, the fibroid originates from muscles in brood ligament, not connected to uterus,
2-false, subserosal fibroids attached to brood ligament connected to uterus with pedicle or directly.
FIGO Classification
Type 0: Pedunculated submucous (completely intracavity)
2-5
Type 1: Submucous <50% intramural
Type 2: Submucous ≥50% intramural
Type 3: 100% intramural but contacts the endometrium
Type 4: Intramural
Type 5: Subserous >_50% intramural
Type 6: subserous <50% intramural
Tipe 7: Subserous pedunculated
Type 8: Other
•Number :Multiple in corporeal, solitary in cervical
•Size varies
•Shape round
•5C
1-Cut section:Word appearance. Interlacing fibers of smooth muscle and fibrous tissue.
2- Color :Paler Due to low vascularity and fibrous tissue.
3-Consistency. Firm. Ex. Degeneration
4- Capsule. Pseudocapsule from compressed normal myometerium
5-Circulation. Blood supply from capsule through radial branches. Thus. calcification. ~> periphral , degeneration ~>Central.
Micro patho
-Mitotic numbers 5-10-10-Hpf
-Associated with adenomyosis,
-pathological changes in myomas,
( ٣ ظواهر + ٥ مكونات)
1- atrophy
-most common change in menopause due to low E2
2- necrosis at the tip of SMF polyp, as it takes blood supply from the pedicle
3-infection in the same site of necrosis
4-Hyaline dege. (4)
-the commonest change in childbearing period -due to diminished vascularity
- in center
-soft consistency
5-cystic degeneration
- absorbed of hyaline
- in center
6- calcification (4)
-in long-standing myomas and menopause,
-at the peripher
- hard consistency
-egg shell appearance in X-ray
7-fat change :the precursor of calcification
8-red degeneration (necrobiosis )
-the commonest change during pregnancy
-as there will be high E2, thus enlargement and +in vascularity, when PRG takes the upper hand, as if incomplete necrosis will happen
restricting the enlargement
- signs : enlarged, red, pelvic pain, pyrexia, -management risks and saves, never treat during pregnancy, due to high E2, high vascularity, except in certain conditions,
Malignant trans
Rare
-postmenopausal bleeding
-increase in size after menopause
-rapid growth without any signs of degeneration
-recurrence.
Cp
- type of patient
Black race
nonigravida or low parity
high BMi
anovulation
35:45
-symptoms
1-The most clinical presentation is asymptomatic, except if it’s submucosal or SMF-polyp, even if it’s small, causing menorrhagia and metorrhagia,
2- menorrhagia due to increased surface of endometrium, mechanical interference,
3-metorrhagia,
due to anovulation(hormonal imbalance)
SMF-polyp,
Carcinoma
4-Pelvic pain
fibroids are painless, unless complicated
-Dull aching, hyaline, infection,
-acute abdominal pain, red degeneration, torsion of the subserosal myoma.
-colikcy pain when fibroids extrude to cervix. -2ry dysmenorrhea with the polyp
5-Pelvic pressure, (especially with subserosal and cervical)
- ub~> frequency and dysuria.
- rectum ~>constipation.
- pelvic nerves ~>Back pain
-Cervical type to the urethra ~> retention
6-RPL and infertility, due to implantation on submucosal type.
7-Pregnancy complication,
preterm ,pph, malpresentation.
8-Vaginal discharge.
Leucorrhea in case of pelvic congestion.
Foul smelling if infection.
9-Progressive abdominal enlargement.
Signs of fibroid
General ~> anemia
Abd ~> asymmetrical ~> multiple
Symterical ~> submucus solitary
Pv and bimanual ~> by weeks as lower border cant be felt as it is pelvi abdominal unlike ovaries
Inv
-U.S.
•is the gold standard, showing all types.
• sis : saline infusion sonography
-HSG ,Hysteroscope showing submucous only. -Labroscope showing subserous only.
D.d
Pregnancy
Management
1-Conservative Approach
-Following of 6 to 12 months
-Waiting until Pregnancy
Except in
1->_ 14 weeks
2- BLM that causes uretric compression and renal function impairment
3- Submucosal myoma causing RPL and infertility
4- Severe bleeding and severe symptoms 5-Increase in size after menopause
5- Recurrence
2-Medical Ttt
- Bleeding
antifibrolytic :transexamic acid
Venotonic :Daflon
-Pain
Nsaids and Analgesics
3- Hormonal TTT
-OCPs and Gestogen :to treat menorrhagia
-GnRH agonists :
•Temporary, as it’s expensive and can cause menopausal symptoms,
•Preoperatively to decrease vascularity and size.
4- micro invasive ttt
1-Uterine artery embolization ( uae)
-Catheter to femoral artery ~>Getting rid of the feeding vessel ~>thus shrunkage ,atrophy
-Advantage :safe , effective.
-Disadvantage. May cause infertility, pain.
2-Laproscopic myolysis.
-Myolysis by current or laser or cryo-myolysis.
-Advantage :Decreasing the size.
-Disadvantage : It acts only on small subserosal myoma, which is not symptomizing.
3-MRI-guided high-frequency ultrasound ( hifu ) -Using MRI to guide for myoma
-Using the generated heat from the ultrasound to cause cell death.
-Advantage :Improvement ,Decreasing the size.
- disadvantage:Causes pain and abnormal vaginal discharge.
5-Definitive surgeries
-Myomectomy
•Laproscope, Laprotomy, Hysteroscope, •enucleation of the Fibroma, and Closing the Dead Space.
•GnRH agonists are taken before the surgery.
-Hysterectomy,
•Laproscope, Laprotomy, Vaginal.
•If menopause and there is tendency towards carcinoma.
•If she is multiparous, completed her family, no desire for infertility, and it has large fibroids.
