Leiomyomata

Question 1

Which type is the most symptomatic type of fibroids?

Answer 1

Submucosal leiomyomata

Symptoms
Bleeding
Infertility

Question 2

Common features of leiomyomata

Answer 2

More common in African
Most often multiple
Monoclonal

Question 3

Classification of fibroids

Answer 3

Intramural leiomyoma: most common

Submucosal: ass with bleeding –> anaemia

Subserosal leiomyoma:
Intraligamentary
Parasitic leiomyoma

Question 4

Microscopic pathology of leiomyoma

Answer 4

Cellular leiomyoma:
5-10 mitotic figures per 10 high power field, no atypia, not cancerous

Leiomyosarcoma:

10 per 10 high power field
Cellular atypia, coagulative necrosis

Question 5

What types of degenerative changes occur in leiomyomas

Answer 5

1) Hyaline degeneration –> calcification: most common
2) Cystic degeneration: due to change and liquefaction after hyaline degeneration
3) red/carneous necrosis: 3rd tri pregnancy
4) mucoid degeneration
5) infection: with pedunclated submucosal leiomyoma
6) calcification: postmenopausal women
7) sacromatous degeneration

Question 6

Symptoms of leiomyoma

Answer 6

AUB: MC
- menorrhagia

Pain: acute –> torsion of pedunculated leiomyoma or infarction

Pressure: increased urinary frequency, compression of pelvic vasculature, constipation, hydroureter and hydronephrosis due to urethral obstruction

Question 7

Pregnancy related disorders in leiomyoma

Answer 7

Tumor may increase in size
Increased incidence of SA and preterm labor
Red degeneration: pain, N/V, rebound tenderness, mild fever, leukocytosis
Malpresentation, uterine dystochia
Postpartum haemorrhage

Question 8

What is the indications for conservative treatment in leiomyoma

Answer 8

Symptoms: absent or minimal
Fibroids:

Question 9

Medical approach: treatment of leiomyoma

Answer 9

NSAIDs
GnRH agonist; hypoestrogenic state, decreases blood flow and cell size (not death or cell number), short term (6 months), before surgery and to reduce bleeding
Progesterone agonist

Question 10

Histology of fibroids

Answer 10

Proliferative 
Well-circumscribed
Psedoencapsulated
Smooth muscle and fibrous C.T
Vasculature located on the periphery