fibroids powerpoint
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Fibroids
The Uterus
Layers of the Uterus The uterus has three main layers, starting from inside to
outside: Endometrium Myometrium Perimetrium
Fibroids
Leiomyoma, Fibromyoma, Myoma Most common benign uterine tumor. Leading cause of hysterectomy in the US. Estimated 50% or greater of all women eventually develop
fibroid. A minority, 20 to 30% of these women are symptomatic Most frequently symptomatic ages 30s & 40s. More common in AA than White females. It is an estrogen sensitive tumor: may enlarge during pregnancy. Not a precursor for Leiomyosarcoma (the malignant tumor of the
uterus)
Tumor characteristics Undergoes: Degeneration Dystrophic calcification Hyalinization: the reason for the term “fibroids” Small: symptomatic if located within the uterine cavity Large: Usually go unnoticed and located outside of the
uterus
Risk Factors
African American 2-3 times greater risk than white women.
Obesity 21 % Increased risk for each 10 kg increase in weight. Increased conversion of androgen to estrone in obese women.
Family history 1st degree relative, 3-5 times more risk of developing fibroids.
Diet Meat, ham and beef increase risk.
Hypertension Every 10 mmHg in diastolic pressure there was an 8% increase in
diagnosis of unterine fibroid.
Symptoms Symptoms depend on size and location Menorrhagia: when located in the submucosa, is the most common symptom.
This may also lead to Iron deficieny anemia. Painful menstruation Painful sexual intercourse Pressure on bladder leading to: Frequency, urgency, incontinence Abnormal gynecologic hemorrhage Abdominal discomfort or bloating Pressure on colon: constipation, painful defecation Backache Some cases infertility but only accounts for 3% of cases; in such cases a
fibroid is located in submucosal position and it is thought that this location may interfere with functioning of lining and ability of the embryo to implant.
Classification Submucosal Fibroids Intramural Fibroids (most common) Subserosal Fibroids Pedunculated Fibroids Extrauterine Fibroids
Submucosal Fibroids Leiomyomata that are primarily on the endometrial side of
the uterus and protrude into the uterine cavity In muscle beneath the endometrium of the uterus Distorts uterine cavity Small lesion which may lead to bleeding and infertility Can prolapse through cervix, leading to labor-like uterine
contractions
Intramural Fibroids Leiomyomata that are primarily located in the uterine muscle It is the most common type They begin as small nodules in the muscular wall of the
uterus They may expand inwards and cause distortions and
elongation of the uterine cavity
Subserosal Fibroids Leiomyomata that are primarily on the outside of the uterus,
on the serosal surface. They are located underneath the mucosal surface of the
uterus They can become very large They can grow out into a papillary manner to become
pedunculated growths They can detach from the uterus and become parasitic
leiomyomata
Pedunculated Fibroids They are intra-cavitary fibroids located on the stalk They can be passed through the cervix
Extrauterine Fibroids Parasitic myomas They are located in other parts of the body Related or identical to metastasizing leiomyoma
Carneous Degeneration These are changes of the leiomyomata due to rapid growth The center of the fibroid becomes red, causing pain It is synonymous with red degeneration
Etiology
Exact mechanism is unknown Evidence suggest that uterine fibroid grows from a single mutated uterine smooth
muscle cell, and are thereby monoclonal tumors.
GENETIC
Chromosomal rearrangement. translocations between chromosomes 12 and14. Deletions of chromosome 7 Trisomy of chromosome 12 in large tumors. 60% may have yet undetected mutations More than 100 genes are up and down regulation in fibroid cells
internatinal Journal of Cancer
International Journal of Cancer
Diagnosis Pelvic examination: irregular pelvic mass that is mobile,
midline and moves contiguously with the cervix Transabdominal Ultrasound Transvaginal Ultrasound MRI Sonohysterography (Gynecologic ultrasonography)
Sonography is the most readily available and least costly to differentiate fibroids from other pelvic pathology . It is reasonably reliable for evaluation of uterus with< 375 cc volume and 3-4 or fewer fibroids.
Differential Diagnosis Adenomyosis Endometrial polyp Pregnancy Endometrial carcinoma
Treatment Many uterine fibroids are asymptomatic and only need to be monitored. Very rarely uterine leiomyomata degenerate into leiomyosarcoma Medication to control symptoms (like pain) such as NSAIDs Medications to shrink tumors: GnRH agonists such as Danazol but often
once you stop the treatment the tumors regrow to pretreatment size Thus GnRH agonist therapy is reserved for tumor shrinkage or correction
of anemia prior to operative treatment. Hysterectomy: for symptomatic fibroids when future pregnancy is
undesired. Ultrasound fibroid destruction Myomectomy for women who still desire children Uterine artery embolization
Uterine Artery Embolization Technique performed under anesthesia by cannulizing the
femoral artery and catheterizing both uterine arteries directly Infusing embolization particles that preferentially float to the
fibroid vessels This causes fibroid infarction and subsequent hyalinization and
fibrosis Initial studies with follow-up over 5 years shows symptom relief
for approx. 75% of women However this intervention should not be used in women who
want to get pregnant in the future because there is an increased risk of placentation abnormalities.
You don’t want these eggs that I made you? Fine. That’s fine. You know what?
That’s just GREAT. These perfectly good eggs. That I spent all month slaving over. It’s fine. I’ll just throw
them away. Whatever. No big deal.”
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