This document discusses fibroids (leiomyomas), which are benign smooth muscle tumors of the uterus. Key points include:
- Fibroids are the most common benign tumors of the uterus, occurring in 20-30% of women by age 30.
- They are estrogen-dependent tumors that grow during reproductive years and often shrink after menopause.
- Symptoms include heavy menstrual bleeding, pelvic pressure, pain, urinary symptoms, and infertility.
- Fibroids can be intramural, subserosal, submucosal, or cervical. Complications include degeneration, infection, and torsion of pedunculated fibroids.
2. FIBROIDS
THE COMMONEST
-BENIGN TUMOUR OF THE UTERUS
-BENIGN SOLID TUMOUR IN FEMALE
HISTOLOGICALLY
-
LEIOMYOMA/MYOMA/FIBROMYOMA
3. FIBROIDS
Arising from the myometrium or
muscles of its vessel walls
Composed of smooth muscles
interspersed with varying amounts of
fibrous tissue
4. INCIDENCE
20% OF WOMEN AT AGE OF 30
3% SYMPTOMATIC CASES IN O.P
BLACK WOMEN HAS THE
HIGHEST
MORE COMMON IN
NULLIPAROUS
MOST COMMON AGE-35 TO 45
YEARS
6. GROWTH
PREDOMINANTLY AN ESTROGEN DEPENDENT TUMOUR
EVIDENCES:
INCREASED GROWTH DURING PREGNANCY
RARE BEFORE MENARCHE
CEASE TO GROW FOLLOWING MENOPAUSE
MORE ESTROGEN RECEPTORS THAN ADJACENT MYOMETRIUM
ASSOCIATION OF ANOVULATION
7. CYTOGENIC
Cytogenitic abnormalities-50%-
Translocation of chro. 7;12 & 14,
Structural abnormalities-chr.6
Progesterone &GnRH-inhibits growth of myomas
Less common in smokers
Bcl-2 an inhibitor of apoptosis significantly
increased in leiomyoma.
8. RISK FACTORS FOR FIBROID
NULLIPARITY
OBESITY
EARLY MENARCHE
HYPERESTROGENISM
ETHNICITY – AFROCARRIBEAN
FAMILY HISTORY
9. CLASSIFICATION OF UTERINE FIBROIDS
BODY(CORPOREAL) CERVICAL
INTERSTITIAL(75%) SUBSEROUS (15%) SUBMUCOUS(10%)
SESSILE PEDUNCULATED
ANTERIOR POSTERIOR CENTRAL LATERAL
10.
11. INTRAMURAL
MOST COMMON(75 %)
WITHIN THE MYOMETRIAL WALL
PSEUDOCAPSULE
BLOOD SUPPLY – THROUGH THE PSEUDOCAPSULE
12. SUBSEROUS(15 %)
-TUMOR GROWS OUTWARDS TO THE PERITONIAL SURFACE
- (further extrusion outwards with development of a
pedicle)
PEDUNCULATED SUBSEROUS FIBROID
-(gets attached to vascular organ & cut off from uterine
origin)
WANDERING PARASITIC FIBROID
13. SUBMUCOUS(10 %)
Grows inwards into the cavity
Make the uterine cavity irregular
& distorted
Pedunculated fibroid can come
out through cervix
14. SUBMUCOUS
It may become infected
Ulcerated menorrhagia,
metorrhagia
Infertility, recurrent miscarriage
SUBMUCUS MYOMATOUS POLYP
(Submucus myoma force itself towards vagina by
a pedicle)
17. BROAD LIGAMENT FIBROID
TRUE
NO ATTACHMENT TO THE
UTERUS
URETER MEDIAL TO THE
FIBROID
FALSE
COMMON
ARISES FROM THE LATERAL UTERINE WALL
GROWS BETWEEN LAYERS OF BROAD
LIGAMENT
URETER LATERAL TO THE FIBROID
20. MICROSCOPY
Consists of whorled pattern of smooth muscles
and fibrous connective tissue
Subserous and cervical myomas :
more fibrous tissue and less of muscle
25. CACIFIC DEGENERATION
Due to circulatory impairment
Common after menopause
Occur in sub-serous fibroid with narrow pedicle
Calcium carbonate or phosphate is deposited in the
centre of the tumor which is least vascular
WOMB STONE (CALCIFIED FIBROID)
26. RED DEGENERATION
Occurs in large fibroid
During
Pregnancy
Puerperium
Cause
Vascular
Thrombosis of blood vessels →
coagulative necrosis
27. RED DEGENERATION
TUMOR APPEARS DARK
CUT SURFACE SHOWS
-HEMORRHAGICC MEATY
APPEARANCE
MICROSCOPY
-EVIDENCE OF THROMBOSIS
NECROSIS OF VESSELS
28. COMPLICATIONS OF FIBROID
DEGENERATION
TORSION OF SUBSEROUS PEDUNCULATED
FIBROIDS
INFECTION
HAEMORRHAGE
29. COMPLICATIONS OF FIBROID
SACROMATOUS CHANGE
LEOMYOMATOSIS
PSEUDO MEIGS SYNDROME
POLCYTHEMIA – increased erythropoietin production
by fibroid
30. TORSION
- Sub-serous pedunculated fibroid may
undergo rotation at its site of
attachment to the uterus
-Veins occluded & tumor engorged
with blood
-Very severe a/c abdominal pain
31. INFECTION
Common in SUBMUCOUS fibroids & especially MYOMATOUS
POLYPI projecting into vagina
Covered by only a layer of endometrium that becomes
thinned out and sloughs
Blood stained purulent discharge
Often following delivery or abortion
puerperal sepsis
33. Fibroids complicating
pregnancy
Pregnancy causes increase in size of fibroids.
High tendency to undergo degenerative
changes.
Severe pain abdomen.
Respiratory embarrassment ,urinary retention,
obstructed labour.
Increased risk of miscarriage, preterm labour ,
abnormal presentations,accidental
hemorrhage,dystocia,PPH,peurperal sepsis,uterine
inversion.
34. SYMPTOMS
Many are asymptomatic and discovered
only on routine gynecological
examinations
Peak incidence between age of 35 and
45
Nulliparity and infertility are usual
associations.
CLINICAL FEATURES
35. Usual type of bleeding associated with fibroid is
menorrhagia
o This is more with sub-mucous fibroids, also seen
with intramural fibroids.
Another less common pattern is metrorrhagia
Some women have menometrorrhagia
ABNORMAL UTERINE
BLEEDING
36. Increase in endometrial surface area
Increased vascularity
Interference with normal uterine contractions
Ulceration and haemorrhage over fibroid
Compression of venous plexus
Associated endometrial hyperplasia and
anovulation
Mechanism of
menorrhagia
37. Pelvic discomfort or pressure
occur with large fibroids,
broad ligament fibroids compress sciatic
nerve
-posterior fibroids cause low back ache
pressure symptoms
38. Fibroid arising from cervix produce
bladder discomfort and compression
Initially increased urinary frequency then voiding
difficulties
Sometimes acute retention can occur due to fibroid
impacted in pouch of Douglas
Large fibroids and broad ligament fibroids cause
ureteric compression and hydronephrosis
Urinary symptoms
39. CAUSES:
Red degeneration
Expulsion of sub
mucous fibroid
Hemorrhage into the
fibroid
Torsion of fibroid
Acute retention of
PELVIC PAIN
40. OTHER SYMPTOMS ARE:
Edema of lower limbs
Large fibroids cause venous stasis,
difficulty in defecation even
dyspareunia
41. Infertility
a)cornual myomas cause tubal occlusion
b)impaired gamete and embryo transport
c)altered relation between semen and
vaginal pool of secretion
d)distortion of cavity
42. Recurrent miscarriage
early miscarriage due to defective
implantation
second trimester miscarriage due
to distortion of cavity
43. A/E reveal a pelvic mass with smooth or
irregular surface and firm consistency
Except in case of pedunculated fibroids lower
border may not be palpable
Signs
44. Bimanual palpation is done to
differentiate between an ovarian tumour
and fibroid
In case of fibroid uterus is not felt
separated also there will be transmitted
mobility
Hinweis der Redaktion
EXTRAUTERINE FIBROIDS
Submucus myoma force itself towards vagina by a pedicle and become a SUBMUCUSMYOMATOUS POLYP
Submucus myoma force itself towards vagina by a pedicle and become a SUBMUCUSMYOMATOUS POLYP
2 TYPES OF BROAD LIGAMENT FIBROIDS
Rarely
AFTER gnrh AGONIST rx OR
Uterine artery embolization