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Puerperium
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Synonyms
leiomyoma of uterus
leiomyomas
fibromyomas
myofibromas
fibroids
fibromas
myomas
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Incidence
Most common solid pelvic tumors
Develop in 20 25% of women during
reproductive years
30 50 years old
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Correlative Factors
Puberty
Progesterone
Menopause
Pathology
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Gross Appearance
Rare only a single usually many exist
Well-circumscribed nonencapsulated
Pseudocapsule
A pseudocapsule is present.
The consistency is usually firm or even hard except
when degeneration or hemorrhage has occurred.
color light gray or pinkish white
cut section an intertwining pattern or
a whorl-like arrangement
bulgy
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Microscopic
Appearance
Composition smooth muscle
connective tissue
The nonstriated muscle fibers are arranged
in bundles of various sizes that run in
multiple directions.
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Classification 1
According to growth location
Myomas on the body of uterus 90%
Myomas on the cervix of uterus 10%
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Classification 2
According to the relation to uterine muscle
Submucous 10 15%
Intramural 60 70%
Subserosal 20%
Few leiomyomas are actually of a single pure type.
hybrids
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Clinical
Manifestation
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Symptoms
menorrhagia and prolonged menstrual period
Menorrhagia
common
Pelvic pain
occurs in pregnancy if undergoing degeneration or
Pedunculated
torsion of a pedunculated myoma
Pelvic pressure urinary frequency
bowel difficulty constipation
Spontaneous abortion
spontaneous abortion
Infertility
Infertility
2003-11-3
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Signs
A palpable abdominal tumour
Pelvic examination
uterus enlarged and irregular
hard
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Degeneration
Result from the diminished
Hyaline degeneration
vascularity of the
Cystic degeneration
connective-tissue element
Red degeneration
Sarcomatous change
The others fat degeneration
calcification
the secondary infection
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Red Degeneration
Occasionally seen as a complication of pregnancy during
pregnancy or immediate postpartum period
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Sarcomatous Change
Rare 0.4% 0.8%
More common at 40 50 years old
Usually occur in intramural fiboids
grow quickly
vaginal bleeding
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Diagnosis
History
Bimanual examination
Ultrasonography
Bultrasound examination
Hysteroscopy
Laparoscopy
Hysteroscopy
Laparoscopy
Hysterography
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Differential Diagnosis
Pregnancy
Ovarian tumour
Adenomyosis
Malignant tumors of uterus
sarcoma of uterus
endometrial carcinoma
cervical cancer
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Treatment
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Medical Treatment
Androgenic agents testosterone propionate
GnRH-a
induce a hypoestrogenic pseudomenopausal
state
not recommended for longer than 6 months
add-back regimens
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Surgery
Treatment 1
Indications
greater than 10 weeks gestational size
menorrhagia lead to anemia
have pressure symptoms
grows rapidly
failure of medical treatment
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Surgery
Treatment 2
Method
Myomectomyconservative therapy
preserve fertility
myomectomysignificant risk of recurrence
Hysterectomy radical therapy
Subtotal hysterectomy
hysterectomy
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Surgery
Treatment 3
Approach
trans-abdominal
trans-vaginal
laparoscopic or hysteroscopic
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It is important to
individualize
the choice of
therapy.
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Uterine Leiomyomas
Complicating Pregnancy
impact on pregnancy abortion
impact on delivery premature labour
fetal malpresentation
retained placenta
placenta previa
need for operative delivery
birth canal obstruction
postpartum hemorrhage
Conservative treatment
2003-11-3
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Critical Points
May be related to superabundant estrogen.
Well-circumscribed nonencapsulated.
Have a pseudocapsule.
Can be classified into submucosal intramural and
subserosal types.
Different types have different features.
Menorrhagia is common.
Four degeneration types
Individualized treatment include
observation medical treatment and surgical treatment.
2003-11-3
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