Leiomyoma, Uterus (Fibroid)
Leiomyomas are benign tumorsbenign 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%)
Evidence of an apparent hormonal dependency includes the following:
Leiomyoma, Uterus (Fibroid)
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 pregnancyduring pregnancy
3-Fibroids shrink after menopauseshrink after menopause.y 4-Some regrowth may occur with hormonal therap
1. Spontaneous abortion2. Intrauterine growth retardation3. Preterm labor4. Uterine dyskinesia 5. Inertia during labor6. Obstruction of the birth canal7. Postpartum hemorrhage 8. Hydronephrosis
Complications during pregnancy include
Leiomyoma, Uterus (Fibroid)
AnatomyMost leiomyomas occur in the fundus and body of the uterusfundus and body of the uterus; only 3% occur in the cervix.
The fibroids may be solitarysolitary, multiplemultiple, or diffusediffuse
Leiomyoma, Uterus (Fibroid)
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)
There are three primary types of uterine fibroids, classified primarily according to location in the uterus:
Clinical Details
Leiomyoma, Uterus (Fibroid)
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
Bleeding: (Menorrhagia)(Most common)
Pain
Pressure
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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
Bleeding: (Menorrhagia)(Most common)
Leiomyoma, Uterus (Fibroid)
Leiomyoma, Uterus (Fibroid)
Pain
Women may experience abdominal cramping. Pain usually is felt during menstruation. Less often, pain occurs
intermenstrually
PressureUrinary frequency, urgency, and/or incontinence result from
pressure on the bladder
Constipation, difficult defecation, or rectal pain results from pressure on the colon
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)
Differential diagnosis
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
US is the imaging modality of choicemodality of choice in the detection and evaluation of uterine fibroids
The most frequent US appearance is that of a concentric, solid, hypoechoic massconcentric, solid, hypoechoic mass
Leiomyoma, Uterus (Fibroid)
These solid masses absorb sound waves and therefore cause a variable amount of acoustic shadowing
Sonography
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 fibrousamount of fibrous tissue and/or calcificationcalcification
Sagittal sonogram shows a posterior, fundal, 4.2 X 3.5-cm intramural uterine fibroid
CT scan shows a subserosal, 2.3- to 2.5-cm, right anterior fundal uterine fibroid
Leiomyoma, Uterus (Fibroid)
Leiomyoma, Uterus (Fibroid)
MRI findings:MRI has an important rolean important role in defining the anatomy of the uterus and ovaries
Fibroids are sharply marginatedsharply marginated areas of lowlow--toto--intermediate signal intensityintermediate signal intensity on T1- and T2-weighted MRI scans
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
The intravenous administration of gadolinium-based contrast material usually is not required
Leiomyoma, Uterus (Fibroid)
if it is administered, fibroids usually enhance later than does the healthy myometrium. Fibroid enhancement can be hypointense hypointense ((65%65%)), isointense , isointense ((23%23%)), or , or
hyperintense hyperintense ((12%12%)) in relation to that of the myometrium
MRI has a sensitivity of 86-92%, a specificity of 100%,specificity of 100%, and an
accuracy of 97% in the evaluation of probable fibroids