Transcript Slide 1

Leiomyoma, Uterus (Fibroid)
By:
Ali azizi
Alborz hedayati
Leiomyoma, Uterus (Fibroid)
Leiomyomas are benign
tumors of the uterus
Arise from the overgrowth of smooth muscle and connective tissue in the uterus
A genetic predisposition exists
Female>30(25-50%)
Leiomyoma, Uterus (Fibroid)
Evidence of an apparent hormonal dependency includes the following:
1-Estrogen and progestin receptors are present in fibroids
2-Elevated estrogen levels may cause fibroid enlargement. During the first trimester
of pregnancy, 15-30% of fibroids may enlarge and then shrink in
puerperium. Some fibroids may decrease in size during pregnancy
3-Fibroids shrink after menopause
4-Some regrowth may occur with hormonal therap y.
Leiomyoma, Uterus (Fibroid)
Complications during pregnancy include
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Spontaneous abortion
Intrauterine growth retardation
Preterm labor
Uterine dyskinesia
Inertia during labor
Obstruction of the birth canal
Postpartum hemorrhage
Hydronephrosis
Leiomyoma, Uterus (Fibroid)
Anatomy
Most leiomyomas occur in the fundus and body of the uterus; only 3% occur in the
cervix. The fibroids may be solitary, multiple, or diffuse
Leiomyoma, Uterus (Fibroid)
There are three primary types of uterine fibroids, classified primarily
according to location in the uterus:
Subserosal uterine
fibroids
These fibroids develop in the outer
portion of the uterus and continue to
grow outward
Intramural uterine
fibroids
The most common type of
fibroid. These develop within the
uterine wall and expand making the
uterus feel larger than normal (which
may cause "bulk symptoms)
Submucosal uterine
fibroids
These fibroids develop just under the
lining of the uterine cavity. These are
the fibroids that have the most effect
on heavy menstrual bleeding and the
ones that can cause problems with
infertility and miscarriage
Leiomyoma, Uterus (Fibroid)
Clinical Details
Most women with fibroids are asymptomatic. Only 10-20%
of patients require treatment
Fibroid symptoms are related to the number of tumors, as
well as to their size and location
1 Bleeding: (Menorrhagia)(Most common)
2 Pain
3 Pressure
Leiomyoma, Uterus (Fibroid)
Bleeding: (Menorrhagia)(Most common)
Menorrhagia may result in severe anemia and can be life
threatening, although this is rare. Menorrhagia usually results
from the erosion of a submucosal fibroid into the endometrial
cavity. Rarely, dilated veins on the surface of a subserosal,
pedunculated fibroid can cause sudden, massive
intraperitoneal bleeding
Leiomyoma, Uterus (Fibroid)
Pain
Women may experience abdominal cramping. Pain usually
is felt during menstruation. Less often, pain occurs
intermenstrually
Pressure
Urinary frequency, urgency, and/or incontinence result from
pressure on the bladder
Constipation, difficult defecation, or rectal pain results
from pressure on the colon
Leiomyoma, Uterus (Fibroid)
Differential diagnosis
Normal ovary - May be confused with fibroids at US
Ovarian mass - Hemorrhagic cyst, endometrioma, dermoid, cystadenoma, malignant tumor
Uterine leiomyosarcoma - Rare, arise de novo or as a result of the malignant
degeneration of a uterine fibroid
Adenomyosis - May be difficult to distinguish from multiple small fibroids
Myometrial contraction - Especially during pregnancy
Necrotic fibroids - May mimic intrauterine gestational sac, intrauterine fluid collection,
hydatiform mole
Leiomyoma, Uterus (Fibroid)
Radiogrph findings:
Conventional radiographs have a
limited role in the diagnosis of uterine fibroids
Unless heavily calcified, fibroids are not depicted on radiographs
CT findings
CT scanning has a limited role in the diagnosis of uterine fibroids
On CT scans, fibroids are usually indistinguishable from healthy myometrium unless they are
calcified or necrotic
Calcifications may be more visible on CT scans than on conventional
radiographs because of the superior contrast differentiation with CT scanning
Leiomyoma, Uterus (Fibroid)
Sonography
US is the imaging modality of choice in the detection and evaluation of uterine fibroids
The most frequent US appearance is that of a concentric,
solid, hypoechoic mass
These solid masses absorb sound waves and therefore cause a variable amount of acoustic
shadowing
Leiomyoma, Uterus (Fibroid)
Sonogram shows the subserosal, 2.3- to 2.5-cm, right anterior fundal uterine
fibroid
Leiomyoma, Uterus (Fibroid)
They can be heterogeneous or hyperechoic, depending on the amount of fibrous tissue
and/or calcification
Sagittal sonogram shows a posterior, fundal, 4.2 X 3.5-cm intramural uterine fibroid
Leiomyoma, Uterus (Fibroid)
CT scan shows a subserosal, 2.3- to 2.5-cm, right anterior fundal uterine fibroid
Leiomyoma, Uterus (Fibroid)
MRI findings:
MRI has an important role in defining the anatomy of the uterus and ovaries
Fibroids are sharply marginated areas of low-to-intermediate signal intensity
on T1- and T2-weighted MRI scans
Leiomyoma, Uterus (Fibroid)
Leiomyoma, Uterus (Fibroid)
One third of fibroids have a hyperintense
rim on T2-weighted images as
a result of dilated veins, lymphatics, or edema.
Sagittal T2-weighted MRI shows that the largest fibroid is located in the lower uterus and
has a partially hyperintense rim. A smaller discrete fibroid is depicted in the fundus
Leiomyoma, Uterus (Fibroid)
Axial MRI shows the cross section of the larger fibroid in the lower uterus.
Note the mass effect on the bladder, which is located anteriorly
Leiomyoma, Uterus (Fibroid)
An inhomogeneous area of high signal intensity may be depicted on T2-weighted images;
this results from hemorrhage,
hyaline degeneration, edema, or
highly cellular fibroids
Leiomyoma, Uterus (Fibroid)
The intravenous administration of gadolinium-based contrast material usually is not required
if it is administered, fibroids usually enhance later than does the healthy myometrium.
Fibroid enhancement can be hypointense (65%), isointense (23%), or
hyperintense (12%) in relation to that of the myometrium
MRI has a sensitivity of 86-92%, a specificity of 100%, and an
accuracy of 97% in the evaluation of probable fibroids
Thank you