Uterine Leiomyomas Flashcards
MC pelvic tumor in women
leiomyoma aka fibroids
leiomyoma
smooth muscle pelvic tumor
benign in myometrium
epidemiology of leiomyoma
30-40 y.o
AA younger
2-3x more common in AA women
risk factors of leiomyoma
early menarche** (<10)
DES tx, obesity, fHTN
protective factors of leiomyoma
parity (20+ weeks)
long acting progestin only contraception
smoking
fibroids and reproductive hormones
nonexistent in pre puberty, found in reproductive age , and regress after menopause
intramural myxomas
developing within uterine wall
submucosal myomas
derive from myometrial cells
below endometrium
protrurde into uterine cavity
subserosal myomas
OG at myometrium at SEROSAL surface of uterus
extend OUTWARD
cervical myoma
located in cervix
rare
clinical presentation
- heavy/prolonged menstrual bleeding
- pelvic pressure and pain
- reproductive dysfunction
heavy bleeding in CP
can cause IDA, increased PMS symptoms
this is NOT intermenstrual and post menopausal
heavy, PROLONGED, menarche (nml)
menorrhagia is most associated with
submucosal fibroids that protrude into uterine wall (O and I)
type 0 submucosal
not located within uterine wall
type I submucosal
<50% invasion of uterine wall
type II submucosal
> 50% invasion of uterine wall
degeneration of fibroid
fibroid gets so large that blood supply is inefficient so it undergoes necrosis
should be on DDX
low fever, leukocytosis, peritoneal signs
bimanual exam findings fibroid
enlarged, mobile uterus w/irregular contour and firmness
evaluation fibroid
- hCG + TVUS
- hystroscopy
- MRI
necrosed fibroid US looks like?
calcifications with posterior shadowing
TVUS of fibroid
initial tool for eval
whorled appearance + hypoechoic
reproductive dysfunction fibroid
difficulty conceiving, increased miscarriage
placental abruption, IUGR, malpresentation, pre term labor risk
tx of fibroid
relief of symptoms and prevention of complications
typically not removed
medication management leiomyoma
NSAIDs (decrease cramping)
combo OC (decreased bleeding, not size)
progestin only pills (increase size, decrease bleeding)
GnRH agonist (debulking, bridge to sx)
iron replacement
asymptomatic fibroids tx
watchful waiting
postmenopausal fibroid tx
typically shrink and stop symptoms
no tx
when to consider sx of leiomomya
desires fertility
complications arise
declines to take medicine
symptoms progress.fail to improve
surgical options if pt does NOT desire fertility
hysterectomy
MRgFUS
surgical tx if pt DOES desire fertility
hystroscopy (submucosal)
intramural or subserosal - abdominal myomectomy (increased risk fo uterine rupture)
myolysis
UAE
uterine artery embolisation
IR, not optimal for preserving fertility
endometritis and PES risl
PES
acute pain, fever, malaise, n/v, night sweats following UAE sx
resolves by 48 hrs
leiomyosarcoma
smooth muscle malignant neoplasm
ss as myxomas but post menopausal bleeding MC
60 y.o., AA women
BBW due to risk of leiomyosarcoma
tamoxifen
adenomyosis
glands in muscle
endometrial glands and storm present in uterine musculature
adenomyosis
hypertrophy and hyperplasia in myometrium
uterus becomes enlarged (same as prego 12 weeks)
MC in porous
symptoms of adenomyosis
heavy menstrual bleeding (AUB)
painful menstruation
pelvic fullness, chronic pelvic pain
NO indication increased risk of miscarriage/OB outcome
PE adenomyosis
uterus TTP
enlarged and boggy uterus (diffuse)
adenomyosis w.u.
TVUS = TOC
diagnostic criteria on MRI of adenomyosis
asymmetric thickening (> 12 mm)
if <8mm = excluded
definitive dx of adenomyosis
histology of hysterectomy
presence of endometrial tissue within myometrium
definitive tx of adenomyosis
hysterectomy
if completed childbearing
